Carbapenem-resistant Enterobacterales in wastewater resources and healthy carriers: A survey in Iran

Author:

Khavandi Shabnam12,Habibzadeh Nasrin3,Hasani Kamal4,Sardari Mehran3,Arzanlou Mohsen125ORCID

Affiliation:

1. a Food and Drug Laboratories Research Center (FDLRC), Iran Food and Drug Administration (IFDA), Ministry of Health and Medical Education (MOH), Tehran, Iran

2. b Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran

3. c Clinical Microbiology Laboratory, Imam Hospital, Ardabil University of Medical Sciences, Ardabil, Iran

4. d Department of Environmental Health Engineering, School of Public Health, Ardabil University of Medical Sciences, Ardabil, Iran

5. e Zoonoses Research Center, Ardabil University of Medical Sciences, Ardabil, Iran

Abstract

ABSTRACT The carbapenem-resistant Enterobacterales (CRE) pose a pressing public health concern. Here, we investigated the frequency of CRE bacteria, carbapenemase-encoding genes, and the molecular epidemiology of carbapenemase-resistant Escherichia coli in wastewater resources and healthy carriers in Iran. Out of 617 Enterobacterales bacteria, 24% were carbapenem-resistant. The prevalence of CRE bacteria in livestock and poultry wastewater at 34% and hospital wastewater at 33% was significantly higher (P ≤ 0.05) than those in healthy carriers and municipal wastewater at 22 and 17%, respectively. The overall colonization rate of CRE in healthy individuals was 22%. Regarding individual Enterobacterales species, the following percentages of isolates were found to be CRE: E. coli (18%), Citrobacter spp. (24%), Klebsiella pneumoniae (28%), Proteus spp. (40%), Enterobacter spp. (25%), Yersinia spp. (17%), Hafnia spp. (31%), Providencia spp. (21%), and Serratia spp. (36%). The blaOXA-48 gene was detected in 97% of CRE isolates, while the blaNDM and blaVIM genes were detected in 24 and 3% of isolates, respectively. The B2 phylogroup was the most prominent group identified in carbapenem-resistant E. coli isolates, accounting for 80% of isolates. High prevalence of CRE with transmissible carbapenemase genes among healthy people and wastewater in Iran underscores the need for assertive measures to prevent further dissemination.

Funder

Iran Food and Drug Administration

Publisher

IWA Publishing

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