Background Antimicrobial resistance (AMR) poses a growing threat to global public health and is a key concern for infection control teams in hospitals. However, AMR surveillance is time-consuming and limited in most countries, resulting in incomplete findings. In high-income countries, infection control teams ensure the contact tracing of every patient carrying an emerging extensively drug-resistant bacterium which is very time-consuming. Wastewater surveillance (WWS) has been proposed as an alternative approach for the surveillance of infectious diseases. This study aims to test the feasibility of AMR WWS under real-world conditions in hospital. It investigates the dynamics of endemic (blaCTX-M) and emerging AMR genes (blaOXA-48, blaNDM, blaKPC and vanA) in wastewater from two hospital buildings where patients with contrasting risk for carrying resistant bacteria were cared for and compares results with clinical data. Methods The sampling programmes were adapted according to the sampling sites and patient flow for each hospital building. Genes were quantified in the effluent using qPCR and dPCR. Cultivable carbapenemase-producing Gram-negative bacteria were characterised using MALDI-TOF MS and PCR. Results The feasibility of AMR monitoring in wastewater in real hospital conditions was demonstrated by dPCR and qPCR, which produced correlated results. The presence of peaks and the low load of the vanA and blaNDM genes in wastewater (compared to blaCTX-M) were consistent with their known emerging status, as indicated by national and local clinical data. However, the high concentration of blaOXA-48 and blaKPC in wastewater was unexpected because it did not reflect the known clinical involvement of these emerging resistances, particularly in the case of blaKPC. Bacterial culture also revealed discrepancies between the species isolated in wastewater and those isolated in patients in the hospital, with a majority of Citrobacter spp. carrying blaKPC and blaOXA-48 in wastewater, whereas Escherichia coli and blaOXA-48 dominated in patients. Quantifying carbapenemase genes in wastewater was able to differentiate between buildings housing patients contrasting risks of emerging AMR. Conclusion This study shows the WWS feasibility in real hospital conditions and preliminary findings regarding patient populations but identified obstacles that need to be overcome prior to use WWS for routine surveillance in an infection control hospital context.

Could the load of carbapenemase genes in hospital wastewater be a proxy for emerging resistance to carbapenems in humans?

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2026年1月26日

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Camille Favier,
Mylène Toubiana,
Isabelle Zorgniotti,
Olivier Courot,
Franz Durandet,
Patricia Licznar-Fajardo,
Estelle Jumas-Bilak

摘要

Background

Antimicrobial resistance (AMR) poses a growing threat to global public health and is a key concern for infection control teams in hospitals. However, AMR surveillance is time-consuming and limited in most countries, resulting in incomplete findings. In high-income countries, infection control teams ensure the contact tracing of every patient carrying an emerging extensively drug-resistant bacterium which is very time-consuming. Wastewater surveillance (WWS) has been proposed as an alternative approach for the surveillance of infectious diseases. This study aims to test the feasibility of AMR WWS under real-world conditions in hospital. It investigates the dynamics of endemic (bla_CTX-M) and emerging AMR genes (bla_OXA-48, bla_NDM, bla_KPC and vanA) in wastewater from two hospital buildings where patients with contrasting risk for carrying resistant bacteria were cared for and compares results with clinical data.

Methods

The sampling programmes were adapted according to the sampling sites and patient flow for each hospital building. Genes were quantified in the effluent using qPCR and dPCR. Cultivable carbapenemase-producing Gram-negative bacteria were characterised using MALDI-TOF MS and PCR.

Results

The feasibility of AMR monitoring in wastewater in real hospital conditions was demonstrated by dPCR and qPCR, which produced correlated results. The presence of peaks and the low load of the vanA and bla_NDM genes in wastewater (compared to bla_CTX-M) were consistent with their known emerging status, as indicated by national and local clinical data. However, the high concentration of bla_OXA-48 and bla_KPC in wastewater was unexpected because it did not reflect the known clinical involvement of these emerging resistances, particularly in the case of bla_KPC. Bacterial culture also revealed discrepancies between the species isolated in wastewater and those isolated in patients in the hospital, with a majority of Citrobacter spp. carrying bla_KPC and bla_OXA-48 in wastewater, whereas Escherichia coli and bla_OXA-48 dominated in patients. Quantifying carbapenemase genes in wastewater was able to differentiate between buildings housing patients contrasting risks of emerging AMR.

Conclusion

This study shows the WWS feasibility in real hospital conditions and preliminary findings regarding patient populations but identified obstacles that need to be overcome prior to use WWS for routine surveillance in an infection control hospital context.