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. 2025 May 11;25(1):284.
doi: 10.1186/s12866-025-03987-5.

Drug resistant Klebsiella pneumoniae from patients and hospital effluent: a correlation?

Naledi S Masalane  1 , Linda A Bester  2 , Arshad Ismail  3 , Sabiha Y Essack #  1   4 , Joshua Mbanga #  5   6
Affiliations

Drug resistant Klebsiella pneumoniae from patients and hospital effluent: a correlation?

Naledi S Masalane et al. BMC Microbiol. .

Abstract

Background: The application of wastewater-based epidemiology has gained traction as a cost effective tool in antimicrobial resistance (AMR) surveillance with studies showing a correlation between the presence of resistant bacteria from hospital sewage and patients. This study compared Klebsiella pneumoniae from patients and hospital effluent in terms of antibiotic resistance patterns, antibiotic resistance genes (ARGs), mobile genetic elements (MGEs) and phylogenomic relationships.

Results: Pooled effluent samples were collected from the final effluent point of a regional hospital and K. pneumoniae isolates were identified on selective media. Clinical isolates were also collected from the same hospital. Antimicrobial susceptibility testing (AST) was performed using the VITEK® 2 system. DNA was extracted prior to whole genome sequencing (WGS). The resistome, mobilome, and phylogenetic lineages of sequenced isolates were assessed using bioinformatics analysis. A total of 10 randomly selected presumptive and 10 clinical K. pneumoniae constituted the sample and were subjected to AST. Total resistance was observed in the clinical samples to cefuroxime, cefotaxime, piperacillin/tazobactam, gentamicin, tobramycin and trimethoprim/sulfamethoxazole. The effluent isolates exhibited total susceptibility to most antibiotics but showed resistance to amoxicillin/clavulanic acid and piperacillin/tazobactam (100%), and tigecycline (10%). The effluent isolates did not exhibit a diverse resistome, while the clinical isolates harboured genes conferring resistance to aminoglycoside (aph(6)-Id, aph(3'')-Ib, aac(6')-Ib-cr, aadA16), ß-lactam (blaSVH group, blaOXA group, blaTEM group), and fluoroquinolone (oqxA, oqxB) antibiotics. Only class 1 integrons were identified. Phylogenetic analysis revealed that effluent isolates from this study were not closely related to the clinical isolates.

Conclusion: This study showed no correlation between the resistance profiles of the clinical and effluent isolates. The relationship between AMR in hospital effluent and clinical resistance may depend on the antimicrobial agents and bacterial species studied.

Keywords: Klebsiella pneumoniae; Antibiotic resistance; Hospital effluent; South Africa.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval was granted by the University of KwaZulu-Natal Biomedical Research Ethics Committee (BREC) (Reference No.: BREC/00003640/2021) and the Provincial Health Research Ethics Committee (Reference No.:KZ_202203_023). Permission to collect sewage samples was granted by the Chief Executive Officer of a regional hospital in the uMgungundlovu District, KwaZulu-Natal Province. Clinical isolates were obtained with permission from the National Health Laboratory Services (NHLS), a South African public institute for laboratory service, research and training (reference: PR2225862). No patient data was collected. Consent for publication: Not applicable. Competing interests: SYE is the Chairperson of the Global Respiratory Infection Partnership and member of the Global Hygiene Council, both supported with unrestricted educational grants from Reckitt (Pty.), Ltd. UK. Disclaimer: Any opinion, finding, and conclusion or recommendation expressed in this material is that of the authors, and neither the NRF nor the other funding bodies accept any liability in this regard.

Figures

Fig. 1
Fig. 1
Antibiotic resistance rates of the K. pneumoniae from human and hospital effluent KEY: CXM = cefuroxime, CAZ = ceftazidime, CXT = cefotaxime, FEP = cefepime, AMC = amoxicillin/clavulanic acid, TZP = piperacillin/tazobactam, IPM = imipenem, DOR = doripenem, MEM = meropenem, ERT = ertapenem, GEN = gentamicin, TOB = tobramycin, AMK = amikacin, CIP = ciprofloxacin, SXT = trimethoprim/sulfamethoxazole, TIG = tigecycline
Fig. 2
Fig. 2
Phylogenomic tree showing the relationship between clinical and effluent K. pneumoniae from this study (blue) with African isolates from human (red) and environmental (green) isolates
See this image and copyright information in PMC

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