Tracking Klebsiella pneumoniae carbapenemase gene as an indicator of antimicrobial resistance dissemination from a hospital to surface water via a municipal wastewater treatment plant

Erica M Loudermilk; Shireen M Kotay; Katie E Barry; Hardik I Parikh; Lisa M Colosi; Amy J Mathers

doi:10.1016/j.watres.2022.118151

Tracking Klebsiella pneumoniae carbapenemase gene as an indicator of antimicrobial resistance dissemination from a hospital to surface water via a municipal wastewater treatment plant

Water Res. 2022 Apr 15:213:118151. doi: 10.1016/j.watres.2022.118151. Epub 2022 Feb 3.

Authors

Erica M Loudermilk¹, Shireen M Kotay², Katie E Barry³, Hardik I Parikh³, Lisa M Colosi¹, Amy J Mathers⁴

Affiliations

¹ Department of Engineering Systems and Environment, University of Virginia, 151 Engineer's Way, Charlottesville, VA 22903, United States.
² Division of Infectious Diseases, School of Medicine, University of Virginia, P.O. Box 800255, Charlottesville, VA 22903, United States. Electronic address: smkotay@virginia.edu.
³ Division of Infectious Diseases, School of Medicine, University of Virginia, P.O. Box 800255, Charlottesville, VA 22903, United States.
⁴ Division of Infectious Diseases, School of Medicine, University of Virginia, P.O. Box 800255, Charlottesville, VA 22903, United States; Clinical Microbiology Laboratory, Department of Pathology, University of Virginia Health System, Charlottesville, VA, United States.

PMID: 35167966
DOI: 10.1016/j.watres.2022.118151

Abstract

Antibiotic-resistant bacteria originating from hospitals are ultimately discharged to municipal wastewater treatment plants (WWTP), which may serve as important reservoirs for the spread of antibiotic resistant genes. This study traced and quantified the presence of a rare but clinically relevant antimicrobial resistance gene; Klebsiella pneumoniae carbapenamase (KPC)-and the viable organisms (KPCO) which carried this gene in hospital, non-hospital wastewater discharges, various compartments within a municipal WWTP, receiving water and sediment samples. High concentration of the gene, bla_KPC harbored in viable and multispecies KPCO was detected in the hospital wastewater and in the forepart stages of the WWTP, but was not detected in the final effluent following UV disinfection. KPCO were not detected in multiple non-hospital sources of wastewater discharges tested. The treatment train used in the sampled WWTP was found to help remove and reduce KPCO load. Using whole-genome sequencing, a KPC-producing Klebsiella oxytoca strain identical to strains seen in the patients and hospital environment was isolated from the downstream receiving water on one sampling event. KPCO were also found to persist in the biosolids throughout the WWTP, but were not detected in the processed compost-products made from WWTP-biosolids. This study systematically demonstrates dissemination of KPCO from hospital point source to environment via municipal WWTP. Understanding hospitals as the origin and source of spread of some of the most clinically urgent antimicrobial-resistant organisms may help direct interventions that target rate at which antibiotic resistant bacteria evolve and spread via enhancement of wastewater treatment and mitigation of dissemination at source.

Keywords: Antibiotic resistance; Carbapenem-resistant Enterobacterales; Dissemination; Klebsiella pneumoniae carbapenemase (KPC); Wastewater treatment.