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<p>Cefiderocol-resistant bacteria pose a growing concern in both clinical and environmental settings. This study investigates cefiderocol-resistant bacteria in wastewater from six German tertiary care hospitals. A total of 36 samples were analysed using a culture-dependent approach involving cefiderocol pre-enrichment, yielding 97 cefiderocol-resistant isolates—primarily <i>Enterobacter roggenkampii</i>, <i>Klebsiella oxytoca</i>, <i>Serratia marcescens</i>, and <i>Citrobacter farmeri</i>. Most isolates exhibited high minimum inhibitory concentrations against cefiderocol and resistance to multiple antibiotics. Resistance rates were lower for meropenem-vaborbactam (10.3%) and imipenem-relebactam (33.0%), while all isolates remained susceptible to aztreonam-avibactam. Whole-genome sequencing of 79 isolates revealed a diverse resistome, with 78.5% (62/79) carrying carbapenemase genes. Some isolates harbored up to six distinct β-lactamase genes, including combinations of extended-spectrum β-lactamases (ESBLs), AmpC β-lactamases, and one or multiple carbapenemases—such as as <i>bla</i><sub>OXA−48</sub> co-occurring with <i>bla</i><sub>NDM−1</sub> or <i>bla</i><sub>VIM−1</sub>. In addition, biocide and heavy metal resistance genes were prevalent, highlighting bacterial adaptation to harsh environments. Plasmid profiling showed significant interspecies variation, with <i>C. farmeri</i> and <i>K. oxytoca</i> displaying the highest plasmid loads. Across all isolates, 38 unique plasmid incompatibility types were detected, 18 of which were species-specific. These findings highlight the multidrug-resistant nature of wastewater-derived pathogens and the importance of monitoring resistance dissemination in healthcare environments.</p>

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Cefiderocol-resistant pathogens in German hospital wastewater: a reservoir for multidrug resistance

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月27日

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  • Tim Erler,
  • Laura Carlsen,
  • Jennifer Dengler,
  • Jens Andre Hammerl,
  • Andreas J. Stroehlein,
  • Marc Hoffmann,
  • Johannes K. Knobloch,
  • Christoph Lübbert,
  • Cihan Papan,
  • Thomas Schwanz,
  • Janine Zweigner,
  • Anurag Kumar Bari,
  • Basil Britto Xavier,
  • John W. A. Rossen,
  • Nico T. Mutters,
  • Mykhailo Savin

摘要

Cefiderocol-resistant bacteria pose a growing concern in both clinical and environmental settings. This study investigates cefiderocol-resistant bacteria in wastewater from six German tertiary care hospitals. A total of 36 samples were analysed using a culture-dependent approach involving cefiderocol pre-enrichment, yielding 97 cefiderocol-resistant isolates—primarily Enterobacter roggenkampii, Klebsiella oxytoca, Serratia marcescens, and Citrobacter farmeri. Most isolates exhibited high minimum inhibitory concentrations against cefiderocol and resistance to multiple antibiotics. Resistance rates were lower for meropenem-vaborbactam (10.3%) and imipenem-relebactam (33.0%), while all isolates remained susceptible to aztreonam-avibactam. Whole-genome sequencing of 79 isolates revealed a diverse resistome, with 78.5% (62/79) carrying carbapenemase genes. Some isolates harbored up to six distinct β-lactamase genes, including combinations of extended-spectrum β-lactamases (ESBLs), AmpC β-lactamases, and one or multiple carbapenemases—such as as blaOXA−48 co-occurring with blaNDM−1 or blaVIM−1. In addition, biocide and heavy metal resistance genes were prevalent, highlighting bacterial adaptation to harsh environments. Plasmid profiling showed significant interspecies variation, with C. farmeri and K. oxytoca displaying the highest plasmid loads. Across all isolates, 38 unique plasmid incompatibility types were detected, 18 of which were species-specific. These findings highlight the multidrug-resistant nature of wastewater-derived pathogens and the importance of monitoring resistance dissemination in healthcare environments.