Longitudinal Monitoring Reveals Klebsiella Quasipneumoniae as the Main Contributor to Carbapenem Resistance in a Hong Kong Hospital Wastewater Discharge Line

24 Pages Posted: 5 Jun 2023

See all articles by Liu Xin

Liu Xin

Prince of Wales Hospital - The Chinese University of Hong Kong

Matthew Wong

The Chinese University of Hong Kong - Department of Medicine & Therapeutics

Dengwei Zhang

The University of Hong Kong

Darren Chan

The University of Hong Kong - HKU-Pasteur Research Pole

Olivia Chan

The University of Hong Kong

Gary Chan

The University of Hong Kong

Marcus Ho-Hin Shum

The University of Hong Kong

Christopher K.C. Lai

Prince of Wales Hospital - The Chinese University of Hong Kong

Benjamin J. Cowling

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control

Tong Zhang

The University of Hong Kong - Environmental Microbiome Engineering and Biotechnology Lab

Keiji Fukuda

The University of Hong Kong

Tommy Tsam-Yuk Lam

The University of Hong Kong

Hein Min Tun

The Chinese University of Hong Kong - Department of Medicine & Therapeutics

Abstract

Testing hospital wastewater (HWW) is potentially an effective, long-term approach for monitoring trends in antimicrobial resistance (AMR) patterns in health care institutions. Over a year, we collected wastewater samples from the clinical and non-clinical sites of a tertiary hospital and from a downstream wastewater treatment plant (WWTP). We focused on the extent of carbapenem resistance among Enterobacteriaceae isolates given their clinical importance. Escherichia coli and Klebsiella spp. were the most frequently isolated Enterobacteriaceae species at all sampling sites. Of the 232 Klebsiella spp. isolates, 100 (43.1%) were multi-drug resistant, of which 47 were carbapenem-resistant. Most of these carbapenem-resistant isolates were Klebsiella quasipneumoniae (CRKQ). All CRKQ (n=43) were isolated from the wastewater of a clinical site that included intensive care units, which also yielded significantly more multi-drug resistant (MDR) isolates compared to all other sampling sites. Among the CRKQ, blaGES-5 genes (n=42) were the primary genetic determinant of carbapenem resistance. During one particular month, three different CRKQ isolates were found in HWW and the influent and effluent flow of the WWTP. The blaGES-5 genes, flanking regions and upstream integron-integrase regions of these isolates shared >99% sequence similarity. The influent isolate was phylogenetically close to K. quasipnuemoniae isolates from wastewater collected in Japan and its blaGES-5 gene and surrounding sequences were >99% identical to blaGES-24 genes found in Japanese isolates. Our results suggest that testing samples from sites located closer to hospitals may better reflect hospital AMR patterns related to antibiotics usage and support antibiotic stewardship programs compared to samples collected further downstream. Moreover, testing samples collected regularly from WWTPs may reflect the local and global spread of pathogens and their resistances.

Keywords: Hospital wastewater, Carbapenem resistance, Klebsiella spp., Klebsiella quasipneumoniae, WGS

Suggested Citation

Xin, Liu and Wong, Matthew and Zhang, Dengwei and Chan, Darren and Chan, Olivia and Chan, Gary and Shum, Marcus Ho-Hin and Lai, Christopher K.C. and Cowling, Benjamin J. and Zhang, Tong and Fukuda, Keiji and Lam, Tommy Tsam-Yuk and Tun, Hein Min, Longitudinal Monitoring Reveals Klebsiella Quasipneumoniae as the Main Contributor to Carbapenem Resistance in a Hong Kong Hospital Wastewater Discharge Line. Available at SSRN: https://ssrn.com/abstract=4457639 or http://dx.doi.org/10.2139/ssrn.4457639

Liu Xin

Prince of Wales Hospital - The Chinese University of Hong Kong ( email )

Matthew Wong

The Chinese University of Hong Kong - Department of Medicine & Therapeutics ( email )

Dengwei Zhang

The University of Hong Kong ( email )

Pokfulam Road
Hong Kong, HK
China

Darren Chan

The University of Hong Kong - HKU-Pasteur Research Pole ( email )

Olivia Chan

The University of Hong Kong ( email )

Pokfulam Road
Hong Kong, HK
China

Gary Chan

The University of Hong Kong ( email )

Pokfulam Road
Hong Kong, HK
China

Marcus Ho-Hin Shum

The University of Hong Kong ( email )

Pokfulam Road
Hong Kong, HK
China

Christopher K.C. Lai

Prince of Wales Hospital - The Chinese University of Hong Kong ( email )

China

Benjamin J. Cowling

The University of Hong Kong - WHO Collaborating Centre for Infectious Disease Epidemiology and Control ( email )

7 Sassoon Road
Hong Kong
China
+852 3917 6711 (Phone)

Tong Zhang

The University of Hong Kong - Environmental Microbiome Engineering and Biotechnology Lab ( email )

Keiji Fukuda

The University of Hong Kong ( email )

Pokfulam Road
Hong Kong, HK
China

Tommy Tsam-Yuk Lam

The University of Hong Kong ( email )

Pokfulam Road
Hong Kong, HK
China

Hein Min Tun (Contact Author)

The Chinese University of Hong Kong - Department of Medicine & Therapeutics ( email )

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