Isolation, genotyping and antimicrobial susceptibility of pathogenic Escherichia coli serotypes in ready to eat foods

In this study, pathogenic Escherichia coli serotypes (E. coli O157:H7, O26, O111) and their molecular proximity and antimicrobial susceptibility were investigated in RTE foods. A total of 240 samples; consist of 105 stuffed mussel, 56 meatless cig kofte, 54 Russian salad, 25 cheese halva, were analyzed. The conventional culture and serotyping methods for determination of the organisms were performed and further confirmation by PCR was carried out. Confirmed E. coli O157 isolates were genotyped by the enterobacterial repetitive intergenic consensus(ERIC)-PCR. Antibacterial susceptibility testing of the isolates was performed by disc diffusion method. E. coli was detected in 7 (2.9 %) of 240 samples, including 3 (5.5%) Russian salad, 3 (2.8%) stuffed mussel, 1 (4 %) cheese halva. Two isolates from Russian salad, 1 from stuffed mussel and 1 from cheese halva were identified as E. coli O157 . In addition, stuffed mussel isolate was found to carry stx1 ve hlyA genes whereas one Russian salad isolate carried the stx1 gene. E. coli isolates were found to be resistant to amoxycillin/clavulonic acid, gentamicin and ciprofloxacin, at the rate of 29%, 14% and 29 %, respectively. Only one (14 %) isolate from stuffed mussel was classified as multidrug resistant to three antimicrobials. Furthermore, the isolates, related to O157 and O157:H7, presented different ribotypes in this study. The results provide useful data for the development of public health policy concerning the potential presence of pathogenic antimicrobial resistant E. coli serotypes in RTE foods. Strict surveillance of RTE foods at retail points for emerging pathogens, their antimicrobial resistance patterns and the potential likelihood of cross-contamination is required.

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Multidrug-Resistant Avian Pathogenic Escherichia coli Strains and Association of Their Virulence Genes in Bangladesh

Microorganisms ◽

10.3390/microorganisms8081135 ◽

2020 ◽

Vol 8 (8) ◽

pp. 1135

Author(s):

Otun Saha ◽

M. Nazmul Hoque ◽

Ovinu Kibria Islam ◽

Md. Mizanur Rahaman ◽

Munawar Sultana ◽

...

Keyword(s):

Escherichia Coli ◽

Virulence Genes ◽

Multidrug Resistant ◽

Avian Pathogenic Escherichia Coli ◽

E Coli ◽

Molecular Approaches ◽

Clade B ◽

Pathogenic Escherichia Coli ◽

Resistance Patterns

The avian pathogenic Escherichia coli (APEC) strains are the chief etiology of colibacillosis worldwide. The present study investigated the circulating phylotypes, existence of virulence genes (VGs), and antimicrobial resistance (AMR) in 392 APEC isolates, obtained from 130 samples belonged to six farms using both phenotypic and PCR-based molecular approaches. Congo red binding (CRB) assay confirmed 174 APEC isolates which were segregated into ten, nine, and eight distinct genotypes by RAPD assay (discriminatory index, DI = 0.8707), BOX-PCR (DI = 0.8591) and ERIC-PCR (DI = 0.8371), respectively. The combination of three phylogenetic markers (chuA, yjaA and DNA fragment TspE4.C2) classified APEC isolates into B23 (37.36%), A1 (33.91%), D2 (11.49%), B22 (9.20%), and B1 (8.05%) phylotypes. Majority of the APEC isolates (75–100%) harbored VGs (ial, fimH, crl, papC, and cjrC). These VGs (papC and cjrC) and phylotypes (D2 and B2) of APEC had significant (p = 0.004) association with colibacillosis. Phylogenetic analysis showed two distinct clades (clade A and clade B) of APEC, where clade A had 98–100% similarity with E. coli APEC O78 and E. coli EHEC strains, and clade B had closest relationship with E. coli O169:H41 strain. Interestingly, phylogroups B2 and D2 were found in the APEC strains of both clades, while the strains from phylogroups A1 and B1 were found in clade A only. In this study, 81.71% of the isolates were biofilm formers, and possessed plasmids of varying ranges (1.0 to 54 kb). In vitro antibiogram profiling revealed that 100% isolates were resistant to ≥3 antibiotics, of which 61.96%, 55.24%, 53.85%, 51.16% and 45.58% isolates in phylotypes B1, D2, B22, B23, and A1, respectively, were resistant to these antimicrobials. The resistance patterns varied among different phylotypes, notably in phylotype B22, showing the highest resistance to ampicillin (90.91%), nalidixic acid (90.11%), tetracycline (83.72%), and nitrofurantoin (65.12%). Correspondence analysis also showed significant correlation among phylotypes with CRB (p = 0.008), biofilm formation (p = 0.02), drug resistance (p = 0.03), and VGs (p = 0.06). This report demonstrated that B2 and A1 phylotypes are dominantly circulating APEC phylotypes in Bangladesh; however, B2 and D2 are strongly associated with the pathogenicity. A high prevalence of antibiotic-resistant APEC strains from different phylotypes suggest the use of organic antimicrobial compounds, and/or metals, and the rotational use of antibiotics in poultry farms in Bangladesh.

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Escherichia coli O157:H7 in Retail Lettuce (Lactuca sativa) in Addis Ababa City: Magnitude of Contamination and Antimicrobial Susceptibility Pattern

Frontiers in Microbiology ◽

10.3389/fmicb.2021.694506 ◽

2021 ◽

Vol 12 ◽

Author(s):

Aklilu Feleke Haile ◽

Silvia Alonso ◽

Nega Berhe ◽

Tizeta Bekele Atoma ◽

Prosper N. Boyaka ◽

...

Keyword(s):

Escherichia Coli ◽

Antimicrobial Susceptibility ◽

Addis Ababa ◽

Foodborne Pathogen ◽

Multidrug Resistant ◽

Diffusion Method ◽

Susceptibility Pattern ◽

Disk Diffusion Method ◽

E Coli ◽

Antimicrobial Susceptibility Pattern

Escherichia coli O157:H7 is an important foodborne pathogen but largely under investigated in Africa. The objectives of this study were to estimate the prevalence and pattern of antimicrobial resistance of E. coli O157:H7 in lettuce in Addis Ababa, Ethiopia. A total of 390 retail lettuce samples were collected across the 10 subcities of Addis Ababa. E. coli O157:H7 was isolated and identified following ISO-16654:2001 standard. The isolates were further tested for antimicrobial susceptibility to 13 antimicrobials using the Kirby–Bauer disk diffusion method. Out of the 390 lettuce samples examined, two (0.51%) carried E. coli O157:H7. The antimicrobial susceptibility pattern of strains showed resistance to ampicillin (100%) and tetracycline (50.0%). One of the two isolates was multidrug resistant to two antimicrobials tested. The results of this study demonstrate the presence of drug-resistant E. coli O157:H7 in lettuce in markets in Addis Ababa. Despite the low prevalence, its presence in a product that is eaten raw highlights potential public health risk in the area associated with this pathogen.

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Antibiotic Resistance of Uropathogens Isolated from Patients Hospitalized in District Hospital in Central Poland in 2020

Antibiotics ◽

10.3390/antibiotics10040447 ◽

2021 ◽

Vol 10 (4) ◽

pp. 447

Author(s):

Barbara Kot ◽

Agata Grużewska ◽

Piotr Szweda ◽

Jolanta Wicha ◽

Urszula Parulska

Keyword(s):

Antibiotic Resistance ◽

Multidrug Resistant ◽

Diffusion Method ◽

Disk Diffusion Method ◽

Beta Lactamases ◽

E Coli ◽

Central Poland ◽

Resistance Patterns ◽

Extended Spectrum Beta Lactamases ◽

Tract Infections

The aim of this study was to determine antibiotic resistance patterns and the prevalence of uropathogenes causing urinary tract infections (UTIs) in patients hospitalized in January–June 2020 in central Poland. Antimicrobial susceptibility testing was performed using the disk-diffusion method. Escherichia coli (52.2%), Klebsiella pneumoniae (13.7%), Enterococcus faecalis (9.3%), E. faecium (6.2%), and Proteus mirabilis (4,3%) were most commonly isolated from urine samples. E. coli was significantly more frequent in women (58.6%) (p = 0.0089) and in the age group 0–18, while K. pneumoniae was more frequent in men (24.4%) (p = 0.0119) and in individuals aged 40–60 and >60. Gram-negative species showed resistance to ampicillin. K. pneumoniae were resistant to amoxicillin plus clavulanic acid (75.0%), piperacillin plus tazobactam (76.2%), cefotaxime (76.2%), cefuroxime (81.0%), ciprofloxacin (81.0%), and trimethoprim plus sulphamethoxazole (81.0%). Carbapenems were effective against all E. coli and P. mirabilis. Some K. pneumoniae (13.6%) produced metallo-β-lactamases (MBLs). E. coli (22.6%), K. pneumoniae (81.8%), and all E. faecium were multidrug-resistant (MDR). Some E. coli (26.2%), K. pneumoniae (63.6%), and P. mirabilis (14.3%) isolates produced extended-spectrum beta-lactamases (ESBL). Vancomycin-resistant E. faecium was also found. This study showed that the possibilities of UTIs therapy using available antibiotics become limited due to the increasing number of antibiotic-resistant uropathogens.

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Phenotypic Antimicrobial Susceptibility of Escherichia coli from Raw Meats, Ready-to-Eat Meats, and Their Related Samples in One Health Context

Microorganisms ◽

10.3390/microorganisms9020326 ◽

2021 ◽

Vol 9 (2) ◽

pp. 326

Author(s):

Frederick Adzitey ◽

Nurul Huda ◽

Amir Husni Mohd Shariff

Keyword(s):

Escherichia Coli ◽

Antimicrobial Resistance ◽

Antimicrobial Susceptibility ◽

Resistance Index ◽

Diffusion Method ◽

Resistant Bacteria ◽

Disk Diffusion Method ◽

E Coli ◽

The Usa ◽

Raw Meats

Meat is an important food source that can provide a significant amount of protein for human development. The occurrence of bacteria that are resistant to antimicrobials in meat poses a public health risk. This study evaluated the occurrence and antimicrobial resistance of E. coli (Escherichia coli) isolated from raw meats, ready-to-eat (RTE) meats and their related samples in Ghana. E. coli was isolated using the USA-FDA Bacteriological Analytical Manual and phenotypic antimicrobial susceptibility test was performed by the disk diffusion method. Of the 200 examined meats and their related samples, 38% were positive for E. coli. Notably, E. coli was highest in raw beef (80%) and lowest in RTE pork (0%). The 45 E. coli isolates were resistant ≥ 50% to amoxicillin, trimethoprim and tetracycline. They were susceptible to azithromycin (87.1%), chloramphenicol (81.3%), imipenem (74.8%), gentamicin (72.0%) and ciprofloxacin (69.5%). A relatively high intermediate resistance of 33.0% was observed for ceftriaxone. E. coli from raw meats, RTE meats, hands of meat sellers and working tools showed some differences and similarities in their phenotypic antimicrobial resistance patterns. Half (51.1%) of the E. coli isolates exhibited multidrug resistance. The E. coli isolates showed twenty-two different resistant patterns, with a multiple antibiotic resistance index of 0.0 to 0.7. The resistant pattern amoxicillin (A, n = 6 isolates) and amoxicillin-trimethoprim (A-TM, n = 6 isolates) were the most common. This study documents that raw meats, RTE meats and their related samples in Ghana are potential sources of antimicrobial-resistant E. coli and pose a risk for the transfer of resistant bacteria to the food chain, environment and humans.

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Antimicrobial Resistance in Campylobacter, Salmonella, and Escherichia coli Isolated from Retail Grain-Fed Veal Meat from Southern Ontario, Canada

Journal of Food Protection ◽

10.4315/0362-028x.jfp-10-483 ◽

2011 ◽

Vol 74 (8) ◽

pp. 1245-1251 ◽

Cited By ~ 11

Author(s):

ANGELA COOK ◽

RICHARD J. REID-SMITH ◽

REBECCA J. IRWIN ◽

SCOTT A. McEWEN ◽

VIRGINIA YOUNG ◽

...

Keyword(s):

Public Health ◽

Escherichia Coli ◽

Antimicrobial Resistance ◽

Antimicrobial Susceptibility ◽

Susceptibility Testing ◽

Tetracycline Resistance ◽

Antimicrobial Susceptibility Testing ◽

E Coli ◽

Testing Resistance ◽

Resistance Patterns

This study estimated the prevalence of Salmonella, Campylobacter, and Escherichia coli isolates in fresh retail grain-fed veal obtained in Ontario, Canada. The prevalence and antimicrobial resistance patterns were examined for points of public health significance. Veal samples (n = 528) were collected from February 2003 through May 2004. Twenty-one Salmonella isolates were recovered from 18 (4%) of 438 samples and underwent antimicrobial susceptibility testing. Resistance to one or more antimicrobials was found in 6 (29%) of 21 Salmonella isolates; 5 (24%) of 21 isolates were resistant to five or more antimicrobials. No resistance to antimicrobials of very high human health importance was observed. Ampicillin-chloramphenicol-streptomycin-sulfamethoxazole-tetracycline resistance was found in 5 (3%) of 21 Salmonella isolates. Campylobacter isolates were recovered from 5 (1%) of 438 samples; 6 isolates underwent antimicrobial susceptibility testing. Resistance to one or more antimicrobials was documented in 3 (50%) of 6 Campylobacter isolates. No Campylobacter isolates were resistant to five or more antimicrobials or category I antimicrobials. E. coli isolates were recovered from 387 (88%) of 438 samples; 1,258 isolates underwent antimicrobial susceptibility testing. Resistance to one or more antimicrobials was found in 678 (54%) of 1,258 E. coli isolates; 128 (10%) of 1,258 were resistant to five or more antimicrobials. Five (0.4%) and 7 (0.6%) of 1,258 E. coli isolates were resistant to ceftiofur and ceftriaxone, respectively, while 34 (3%) of 1,258 were resistant to nalidixic acid. Ciprofloxacin resistance was not detected. There were 101 different resistance patterns observed among E. coli isolates; resistance to tetracycline alone (12.7%, 161 of 1,258) was most frequently observed. This study provides baseline prevalence and antimicrobial resistance data and highlights potential public health concerns.

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Detection of virulence genes and antimicrobial resistance profiles of Escherichia coli isolates from raw milk and artisanal cheese in Southern Brazil

Semina Ciências Agrárias ◽

10.5433/1679-0359.2019v40n1p163 ◽

2019 ◽

Vol 40 (1) ◽

pp. 163 ◽

Cited By ~ 3

Author(s):

Leandro Parussolo ◽

Ricardo Antônio Pilegi Sfaciotte ◽

Karine Andrezza Dalmina ◽

Fernanda Danielle Melo ◽

Ubirajara Maciel Costa ◽

...

Keyword(s):

Public Health ◽

Escherichia Coli ◽

Antimicrobial Susceptibility ◽

Virulence Genes ◽

Antimicrobial Agents ◽

Raw Milk ◽

Diffusion Method ◽

Public Health Issue ◽

Southern Brazil ◽

E Coli

The serrano artisanal cheese is a typical product from South region of Brazil, which is produced by skilled cheesemakers using raw milk. The contamination of this food by Escherichia coli has a great impact on public health, since it could threat the consumers’ health. The study evaluated the presence of virulence genes, antimicrobial susceptibility profiles and bofilm-production ability of Escherichia coli isolates obtained from raw milk and artisanal cheese produced in Southern Brazil. A total of 117 isolates of E. coli were characterized by multiplex PCR to detect the following virulence genes: eae for enteropatogenic E. coli (EPEC), lt and st for enterotoxigenic E. coli (ETEC), stx for shiga toxin-producing E. coli (STEC), stx and eae for enterohemorrhagic E. coli (EHEC), ipaH for enteroinvasive E. coli (EIEC) and aggR for enteroaggregative E. coli (EAEC). In addition, antimicrobial susceptibility profile to 22 antimicrobial agents was also performed by disk diffusion method, and we searched for extended-spectrum beta-lactamases (ESBL) and/or carbapenemase- producing isolates. Isolates that were positive for ESBL and carbapenemase were further investigated for the presence of the genes: blaTEM, blaSHV, blaOXA, blaCTX-M, for ESBL and blaOXA-48 for carbapenemase. Further, isolates had their ability to form biofilms investigated by the red Congo agar method. Virulence genes of E. coli were identified in 21.37% of the tested isolates, which were classified as EPEC (the most prevalent pathotype) and ETEC or EAEC. Ten (8.55%) of the total studied E. coli isolates revealed a multidrug-resistant profile, since they were resistant to three or more antimicrobial classes; whereas four isolates (3.42%) were classified as ESBL-producers and showed the presence of blaTEM gene. None of the isolates exhibited carbapenemase activity nor did they carry carbapenemase genes. From the total of E. coli isolates, 79 (67.52%) were considered potential biofilm producers. These results address a serious public health issue, since artisanal cheeses pose a risk to consumers’ health, since may be sources of dissemination of diarrheogenic E. coli, that can cause from subclinical to severe and fatal infections in children and adults, and also emphasize the need to improve adaptations/adjustments in the manufacturing processes of these products.

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A Preliminary Study: Antibiotic Resistance Patterns of Escherichia coli and Enterococcus Species from Wildlife Species Subjected to Supplementary Feeding on Various South African Farms

Animals ◽

10.3390/ani10030396 ◽

2020 ◽

Vol 10 (3) ◽

pp. 396 ◽

Cited By ~ 1

Author(s):

Michaela Sannettha van den Honert ◽

Pieter Andries Gouws ◽

Louwrens Christiaan Hoffman

Keyword(s):

Escherichia Coli ◽

Antibiotic Resistance ◽

Supplementary Feeding ◽

Health Concern ◽

Diffusion Method ◽

Disk Diffusion Method ◽

E Coli ◽

Wildlife Species ◽

Human Contact ◽

Resistance Patterns

Studies have shown that antibiotic resistance among wild animals is becoming a public health concern, owing to increased contact and co-habitation with domestic animals that, in turn, results in increased human contact, indirectly and directly. This type of farming practice intensifies the likelihood of antibiotic resistant traits in microorganisms transferring between ecosystems which are linked via various transfer vectors, such as rivers and birds. This study aimed to determine whether the practice of wildlife supplementary feeding could have an influence on the antibiotic resistance of the bacteria harboured by the supplementary fed wildlife, and thus play a potential role in the dissemination of antibiotic resistance throughout nature. Escherichia coli and Enterococcus were isolated from the faeces of various wildlife species from seven different farms across South Africa. The Kirby-Bauer disk diffusion method was used according to the Clinical and Laboratory Standards Institute 2018 guidelines. The E. coli (F: 57%; N = 75% susceptible) and Enterococcus (F: 67%; N = 78% susceptible) isolates from the supplementary fed (F) wildlife were in general, found to be more frequently resistant to the selection of antibiotics than from those which were not supplementary fed (N), particularly towards tetracycline (E. coli F: 56%; N: 71%/Enterococcus F: 53%; N: 89% susceptible), ampicillin (F: 82%; N = 95% susceptible) and sulphafurazole (F: 68%; N = 98% susceptible). Interestingly, high resistance towards streptomycin was observed in the bacteria from both the supplementary fed (7% susceptible) and non-supplementary fed (6% susceptible) wildlife isolates. No resistance was found towards chloramphenicol and ceftazidime.

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Virulence Characteristics and Antibiotic Resistance Profiles of Shiga Toxin-Producing Escherichia coli Isolates from Diverse Sources

Antibiotics ◽

10.3390/antibiotics9090587 ◽

2020 ◽

Vol 9 (9) ◽

pp. 587

Author(s):

Momna Rubab ◽

Deog-Hwan Oh

Keyword(s):

Escherichia Coli ◽

Antibiotic Resistance ◽

Shiga Toxin ◽

Multidrug Resistant ◽

Control Measures ◽

Diffusion Method ◽

Shiga Toxins ◽

E Coli ◽

And Control ◽

High Degree

Shiga toxin-producing Escherichia coli (STEC) is an enteric pathogen that causes several gastrointestinal ailments in humans across the world. STEC’s ability to cause ailment is attributed to the presence of a broad range of known and putative virulence factors (VFs) including those that encode Shiga toxins. A total of 51 E. coli strains belonging to serogroups O26, O45, O103, O104, O113, O121, O145, and O157 were tested for the presence of nine VFs via PCR and for their susceptibility to 17 frequently used antibiotics using the disc diffusion method. The isolates belonged to eight different serotypes, including eight O serogroups and 12 H types. The frequency of the presence of key VFs were stx1 (76.47%), stx2 (86.27%), eae (100%), ehxA (98.03%), nleA (100%), ureC (94.11%), iha (96.07%), subA (9.80%), and saa (94.11%) in the E. coli strains. All E. coli strains carried seven or more distinct VFs and, among these, four isolates harbored all tested VFs. In addition, all E. coli strains had a high degree of antibiotic resistance and were multidrug resistant (MDR). These results show a high incidence frequency of VFs and heterogeneity of VFs and MDR profiles of E. coli strains. Moreover, half of the E. coli isolates (74.5%) were resistant to > 9 classes of antibiotics (more than 50% of the tested antibiotics). Thus, our findings highlight the importance of appropriate epidemiological and microbiological surveillance and control measures to prevent STEC disease in humans worldwide.

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Characteristics of Extended-Spectrum Cephalosporin-Resistant Escherichia coli Isolated from Swiss and Imported Poultry Meat

Journal of Food Protection ◽

10.4315/0362-028x.jfp-13-120 ◽

2014 ◽

Vol 77 (1) ◽

pp. 112-112 ◽

Cited By ~ 11

Author(s):

H. ABGOTTSPON ◽

R. STEPHAN ◽

C. BAGUTTI ◽

P. BRODMANN ◽

H. HÄCHLER ◽

...

Keyword(s):

Escherichia Coli ◽

Multilocus Sequence Typing ◽

Multidrug Resistant ◽

Poultry Meat ◽

Phylogenetic Groups ◽

E Coli ◽

Plasmid Incompatibility ◽

Extended Spectrum ◽

Resistance Patterns

A worrisome phenomenon is the progressive global spread of Enterobacteriaceae in poultry and chicken meat expressing plasmid-mediated enzymes that inactivate β-lactam antibiotics, suggesting that the food chain might play a role in the epidemiology and the transmission of extended-spectrum cephalosporin-resistant Enterobacteriaceae to humans. The aim of the present study was to further characterize 24 extended-spectrum cephalosporin-resistant Enterobacteriaceae isolated from domestic and imported poultry meat by antibiotic susceptibility testing, identification of the blaESBL/blapAmpC genes, conjugation mating experiments and determination of plasmid incompatibility types, multilocus sequence typing, and analysis of the Escherichia coli phylogenetic groups. On account of their resistance patterns, 21 of the total 24 isolates were classified as multidrug resistant. Eleven isolates carried a blaCMY-2 gene, whereas 13 isolates harbored a blaCTX-M-1 gene. All isolates harbored plasmids that were assigned to 8 of the 18 described plasmid incompatibility groups, the most frequent of which were IncI1, IncFIB, IncB/O, and IncFrepB. The blaESBL/blapAmpC genes were harbored mainly by transferable IncI1 and IncB/O plasmids. Multilocus sequence typing as well as E. coli phylogenetic group typing revealed a high heterogenicity even among different isolates of the same sample.

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Antibiotic Resistance among Escherichia coli Isolates from Hospital Wastewater Compared to Community Wastewater

Water ◽

10.3390/w13233449 ◽

2021 ◽

Vol 13 (23) ◽

pp. 3449

Author(s):

Cristina-Mirabela Gaşpar ◽

Ludovic Toma Cziszter ◽

Cristian Florin Lăzărescu ◽

Ioan Ţibru ◽

Marius Pentea ◽

...

Keyword(s):

Escherichia Coli ◽

Antibiotic Resistance ◽

Antimicrobial Susceptibility ◽

Susceptibility Testing ◽

Antimicrobial Susceptibility Testing ◽

Diffusion Method ◽

Resistant Bacteria ◽

Hospital Wastewater ◽

Extended Spectrum Beta Lactamase ◽

E Coli

This study aimed to compare the antibiotic resistance levels of the indicator bacteria Escherichia coli in wastewater samples collected from two hospitals and two urban communities. Antimicrobial susceptibility testing was performed on 81 E. coli isolates (47 from hospitals and 34 from communities) using the disc diffusion method according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) methodology. Ten antibiotics from nine different classes were chosen. The strains isolated from the community wastewater, compared to those from the hospital wastewater, were not resistant to gentamicin (p = 0.03), but they showed a significantly higher susceptibility—increased exposure to ceftazidime (p = 0.001). Multidrug resistance was observed in 85.11% of the hospital wastewater isolates and 73.53% of the community isolates (p > 0.05). The frequency of the presumed carbapenemase-producing E. coli was higher among the community isolates (76.47% compared to 68.09%) (p > 0.05), whereas the frequency of the presumed extended-spectrum beta-lactamase (ESBL)-producing E. coli was higher among the hospital isolates (21.28% compared to 5.88%) (p > 0.05). The antibiotic resistance rates were high in both the hospital and community wastewaters, with very few significant differences between them, so the community outlet might be a source of resistant bacteria that is at least as important as the well-recognised hospitals.

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