Longitudinal carriage of antimicrobial resistant Enterobacterales in healthy individuals in Ireland - Assessing the impact of recreational water use on duration of carriage

• Published in: The Science of the total environment 2023-12, Vol.905, p.167100-167100, Article 167100
• Main Authors: Farrell, Maeve Louise, Chueiri, Alexandra, Maguire, Mark, Kovářová, Aneta, Miliotis, Georgios, O'Connor, Louise, McDonagh, Francesca, Duane, Sinead, Cormican, Martin, Devane, Genevieve, Tuohy, Alma, DeLappe, Niall, De Bock, Florence, Burke, Liam P., Morris, Dearbháile
• Format: Article
• Language: English
• Subjects: Antimicrobial resistance; CPE; Extended spectrum beta-lactamase producing Enterobacterales; Public health; Recreational water
• ISSN: 0048-9697; 1879-1026
• DOI: 10.1016/j.scitotenv.2023.167100

The increasing prevalence of extended-spectrum beta-lactamase (ESBL) producing Enterobacterales (ESBL-PE) and carbapenemase-producing Enterobacterales (CPE) is a major public health concern worldwide. Despite the associated risk of infection from gut colonisation with a resistant Enterobacterales, the incidence and duration of carriage in healthy individuals is poorly studied. This “persistence study” is the first in Ireland to assess the longitudinal carriage of ESBL-PE and CPE in healthy individuals. A cohort of 45 participants, 22 of whom were colonised with ESBL-PE, was recruited from a recently completed point prevalence study that investigated colonisation in recreational water users (WU) versus controls. Six bi-monthly faecal samples per participant were analysed for CPE and ESBL-PE over one year and the relationship between persistent colonisation and exposure to natural waters was investigated. For 11 of 45 participants (24.4 %) ESBL-E. coli (ESBL-EC) was detected in at least one sample. Genomic analysis revealed that six participants harboured the same ESBL-EC strains as identified in the preceding study. ESBL-EC persisted in the gut for a median duration of 10.3 months (range 4–23 months), consistent with previous research. Five participants (11.1 %) carried ESBL-EC for the entire study year. The carbapenemase gene blaIMI-2 was detected once. Colonisation was higher in water users during the non-bathing season (n = 10, November 2021–April 2022), than during the bathing season (n = 5, May 2022–September 2022) [relative risk 1.99 (95 % CI 0.34–11.71)]. However, overall WU were less likely to be colonised with ESBL-EC than controls (19 % vs 25 % respectively, RR 0.76, CI 0.24–2.34). Further research is warranted to better understand the factors influencing the persistence of gut colonisation with ESBL-EC and CPE and to what extent bathing water quality impacts colonisation for those regularly exposed. [Display omitted] •The carriage of AMR Enterobacterales over one year was compared.•ESBL-EC persisted in the gut for a median duration of 10.3 months (range 4–23 months).•Eleven participants had ESBL-EC detected in their samples at least once (24.4 %).•ESBL-EC was higher in water users during the non-bathing season (RR = 1.99).