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. 2016 Oct 25;11(10):e0164873.
doi: 10.1371/journal.pone.0164873. eCollection 2016.

Population Screening Using Sewage Reveals Pan-Resistant Bacteria in Hospital and Community Samples

Lital Meir-Gruber  1   2 , Yossi Manor  3 , Shiraz Gefen-Halevi  1 , Musa Y Hindiyeh  3   2 , Fernando Mileguir  3 , Roberto Azar  3 , Gill Smollan  1 , Natasha Belausov  1 , Galia Rahav  2   4 , Ari Shamiss  5 , Ella Mendelson  3   2 , Nathan Keller  1   6
Affiliations

Population Screening Using Sewage Reveals Pan-Resistant Bacteria in Hospital and Community Samples

Lital Meir-Gruber et al. PLoS One. .

Erratum in

Abstract

The presence of pan-resistant bacteria worldwide possesses a threat to global health. It is difficult to evaluate the extent of carriage of resistant bacteria in the population. Sewage sampling is a possible way to monitor populations. We evaluated the presence of pan-resistant bacteria in Israeli sewage collected from all over Israel, by modifying the pour plate method for heterotrophic plate count technique using commercial selective agar plates. This method enables convenient and fast sewage sampling and detection. We found that sewage in Israel contains multiple pan-resistant bacteria including carbapenemase resistant Enterobacteriacae carrying blaKPC and blaNDM-1, MRSA and VRE. blaKPC carrying Klebsiella pneumonia and Enterobacter cloacae were the most common Enterobacteriacae drug resistant bacteria found in the sewage locations we sampled. Klebsiella pneumonia, Enterobacter spp., Escherichia coli and Citrobacter spp. were the 4 main CRE isolated from Israeli sewage and also from clinical samples in our clinical microbiology laboratory. Hospitals and Community sewage had similar percentage of positive samplings for blaKPC and blaNDM-1. VRE was found to be more abundant in sewage in Israel than MRSA but there were more locations positive for MRSA and VRE bacteria in Hospital sewage than in the Community. Therefore, our upgrade of the pour plate method for heterotrophic plate count technique using commercial selective agar plates can be a useful tool for routine screening and monitoring of the population for pan-resistant bacteria using sewage.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. A map of the whole state of Israel illustrating sewage sampling locations.
Each location is marked with flags indicating the pan-resistant bacteria found in that location. A magnification of the four main districts is displayed on the right side of the figure. Maps illustrated by "Fotolia by Adobe" (https://www.fotolia.com/).
Fig 2
Fig 2. The percentage of pan-resistant bacteria in Israeli sewage containing Hospital compared to Community sewage.
No significance was found in the presence of blaKPC, blaNDM-1, MRSA and VRE between Hospital and Community sewage (p = 0.7533, 0.8588, 0.1143 and 0.2989, respectively).
Fig 3
Fig 3. Distribution of blaKPC carrying Enterobacteriacae in sewage compared to clinical isolates.
(A) blaKPC carrying Enterobacteriacae found in sewage compared to (B) blaKPC carrying Enterobacteriacae isolates collected in the Microbiology Lab at the Sheba Medical center in 2013. Multiple samples within one patient were excluded.
See this image and copyright information in PMC

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