A global multinational survey of cefotaxime-resistant coliforms in urban wastewater treatment plants

Marano, Roberto B.M.
Fernandes, Telma
Manaia, Célia M.
Nunes, Olga
Morrison, Donald
Berendonk, Thomas U.
Kreuzinger, Norbert
Telson, Tanel
Corno, Gianluca
Fatta-Kassinos, Despo
Merlin, Christophe
Topp, Edward
Jurkevitch, Edouard
Henn, Leonie
Scott, Andrew
Heß, Stefanie
Slipko, Katarzyna
Laht, Mailis
Kisand, Veljo
Di Cesare, Andrea
Karaolia, Popi
Michael, Stella G.
Petre, Alice L.
Rosal, Roberto
Pruden, Amy
Riquelme, Virginia
Agüera, Ana
Esteban, Belen
Luczkiewicz, Aneta
Kalinowska, Agnieszka
Leonard, Anne
Gaze, William H.
Adegoke, Anthony A.
Stenstrom, Thor A.
Pollice, Alfieri
Salerno, Carlo
Schwermer, Carsten U.
Krzeminski, Pawel
Guilloteau, Hélène
Donner, Erica
Drigo, Barbara
Libralato, Giovanni
Guida, Marco
Bürgmann, Helmut
Beck, Karin
Garelick, Hemda
Tacão, Marta
Henriques, Isabel
Martínez-Alcalá, Isabel
Guillén-Navarro, Jose M.
Popowska, Magdalena
Piotrowska, Marta
Quintela-Baluja, Marcos
Bunce, Joshua T.
Polo-López, Maria I.
Nahim–Granados, Samira
Pons, Marie Noëlle
Milakovic, Milena
Udikovic-Kolic, Nikolina
Ory, Jérôme
Ousmane, Traore
Caballero, Pilar
Oliver, Antoni
Balcazar, Jose L.
Jäger, Thomas
Schwartz, Thomas
Yang, Ying
Zou, Shichun
Lee, Yunho
Yoon, Younggun
Herzog, Bastian
Mayrhofer, Heidrun
Prakash, Om
Nimonkar, Yogesh
Heath, Ester
Baraniak, Anna
Abreu-Silva, Joana
Choudhury, Manika
Munoz, Leonardo P.
Krizanovic, Stela
Brunetti, Gianluca
Maile-Moskowitz, Ayella
Brown, Connor
Cytryn, Eddie
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The World Health Organization Global Action Plan recommends integrated surveillance programs as crucial strategies for monitoring antibiotic resistance. Although several national surveillance programs are in place for clinical and veterinary settings, no such schemes exist for monitoring antibiotic-resistant bacteria in the environment. In this transnational study, we developed, validated, and tested a low-cost surveillance and easy to implement approach to evaluate antibiotic resistance in wastewater treatment plants (WWTPs) by targeting cefotaxime-resistant (CTX-R) coliforms as indicators. The rationale for this approach was: i) coliform quantification methods are internationally accepted as indicators of fecal contamination in recreational waters and are therefore routinely applied in analytical labs; ii) CTX-R coliforms are clinically relevant, associated with extended-spectrum β-lactamases (ESBLs), and are rare in pristine environments. We analyzed 57 WWTPs in 22 countries across Europe, Asia, Africa, Australia, and North America. CTX-R coliforms were ubiquitous in raw sewage and their relative abundance varied significantly (<0.1% to 38.3%), being positively correlated (p < 0.001) with regional atmospheric temperatures. Although most WWTPs removed large proportions of CTX-R coliforms, loads over 103 colony-forming units per mL were occasionally observed in final effluents. We demonstrate that CTX-R coliform monitoring is a feasible and affordable approach to assess wastewater antibiotic resistance status ​
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