Long time persistence and evolution of carbapenemase-producing Enterobacterales in the wastewater of a tertiary care hospital in Germany

Laura Carlsen; Henning Büttner; Martin Christner; Lukas Cordts; Gefion Franke; Armin Hoffmann; Birte Knobling; Marc Lütgehetmann; Jacqueline Nakel; Thomas Werner; Johannes K. Knobloch

Journal of Infection and Public Health (Aug 2023)

Long time persistence and evolution of carbapenemase-producing Enterobacterales in the wastewater of a tertiary care hospital in Germany

Laura Carlsen,
Henning Büttner,
Martin Christner,
Lukas Cordts,
Gefion Franke,
Armin Hoffmann,
Birte Knobling,
Marc Lütgehetmann,
Jacqueline Nakel,
Thomas Werner,
Johannes K. Knobloch

Affiliations

Laura Carlsen: Institute of Medical Microbiology, Virology, and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg–Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
Henning Büttner: Institute of Medical Microbiology, Virology, and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg–Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
Martin Christner: Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg–Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
Lukas Cordts: HAMBURG WASSER, Billhorner Deich 2, 20539 Hamburg, Germany
Gefion Franke: Institute of Medical Microbiology, Virology, and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg–Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
Armin Hoffmann: Institute of Medical Microbiology, Virology, and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg–Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
Birte Knobling: Institute of Medical Microbiology, Virology, and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg–Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
Marc Lütgehetmann: Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg–Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
Jacqueline Nakel: Virus Genomics, Heinrich-Pette-Institute, Leibniz Institute for Experimental Biology, Martinistraße 52, 20251 Hamburg, Germany
Thomas Werner: HAMBURG WASSER, Billhorner Deich 2, 20539 Hamburg, Germany
Johannes K. Knobloch: Institute of Medical Microbiology, Virology, and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg–Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; Correspondence to: University Medical Center Hamburg-Eppendorf, Institute for Microbiology, Virology and Hygiene, Martinistraße 52, 20251 Hamburg, Germany.

Journal volume & issue: Vol. 16, no. 8
pp. 1142 – 1148

Abstract

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Background: Worldwide observations revealed increased frequencies of multi-resistant Enterobacterales and resistance genes in hospital wastewater compared to any other type of wastewater. Despite the description of clonal lineages possibly adapted to hospital wastewater, little is known about long term persistence as well as evolution of these lineages. Methods: In this study, wastewater isolates of different Enterobacterales species from a tertiary care hospital were investigated with 2.5 years distance. Whole Genome Sequencing (WGS) and resistance gene identification were performed for E. coli, C. freundii, S. marcescens, K. pneumoniae, K. oxytoca, and E. cloacae isolates (n = 59), isolated in 2022 and compared with strains isolated from the same wastewater pipeline in 2019 (n = 240). Results: Individual clonal lineages with highly related isolates could be identified in all species identified more than once in 2022 that appear to persist in the wastewater drainage. A common motif of all persistent clonal lineages was the carriage of mobile genetic elements encoding carbapenemase genes with hints for horizontal gene transfer in persistent clones in this environment observed over the 2.5-year period. Multiple plasmid replicons could be detected in both years. In 2022 isolates blaVIM-1 replaced blaOXA-48 as the most common carbapenemase gene compared to 2019. Interestingly, despite a similar abundance of carbapenemase genes (>80% of all isolates) at both time points genes encoding extended spectrum β-lactamases decreased over time. Conclusions: This data indicates that hospital wastewater continuously releases genes encoding carbapenemases to the urban wastewater system. The evolution of the resident clones as well as the reasons for the selection advantage in this specific ecological niche needs to be further investigated in the future.

Published in Journal of Infection and Public Health

ISSN: 1876-0341 (Print); 1876-035X (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Internal medicine: Infectious and parasitic diseases; Medicine: Public aspects of medicine
Website: https://www.journals.elsevier.com/journal-of-infection-and-public-health

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