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A global multinational survey of cefotaxime-resistant coliforms in urban wastewater treatment plants

Marano, Roberto B.M.; Fernandes, Telma; Manaia, C?lia M.; Nunes, Olga; Morrison, Donald; Berendonk, Thomas U.; Kreuzinger, Norbert; Telson, Tanel; Corno, Gianluca; Fatta-Kassinos, Despo; Merlin, Christophe; Topp, Edward; Jurkevitch, Edouard; Henn, Leonie; Scott, Andrew; He?, Stefanie; Slipko, Katarzyna; Laht, Mailis; Kisand, Veljo; Di Cesare, Andrea; Karaolia, Popi; Michael, Stella G.; Petre, Alice L.; Rosal, Roberto; Pruden, Amy; Riquelme, Virginia; Ag?era, Ana; Esteban, Belen; Luczkiewicz, Aneta; Kalinowska, Agnieszka; Leonard, Anne; Gaze, William H.; Adegoke, Anthony A.; Stenstrom, Thor A.; Pollice, Alfieri; Salerno, Carlo; Schwermer, Carsten U.; Krzeminski, Pawel; Guilloteau, H?l?ne; Donner, Erica; Drigo, Barbara; Libralato, Giovanni; Guida, Marco; B?rgmann, Helmut; Beck, Karin; Garelick, Hemda; Tac?o, Marta; Henriques, Isabel; Mart?nez-Alcal?, Isabel; Guill?n-Navarro, Jose M.; Popowska, Magdalena; Piotrowska, Marta; Quintela-Baluja, Marcos; Bunce, Joshua T.; Polo-L?pez, Maria I.;...


Roberto B.M. Marano

Telma Fernandes

C�lia M. Manaia

Olga Nunes

Thomas U. Berendonk

Norbert Kreuzinger

Tanel Telson

Gianluca Corno

Despo Fatta-Kassinos

Christophe Merlin

Edward Topp

Edouard Jurkevitch

Leonie Henn

Andrew Scott

Stefanie He�

Katarzyna Slipko

Mailis Laht

Veljo Kisand

Andrea Di Cesare

Popi Karaolia

Stella G. Michael

Alice L. Petre

Roberto Rosal

Amy Pruden

Virginia Riquelme

Ana Ag�era

Belen Esteban

Aneta Luczkiewicz

Agnieszka Kalinowska

Anne Leonard

William H. Gaze

Anthony A. Adegoke

Thor A. Stenstrom

Alfieri Pollice

Carlo Salerno

Carsten U. Schwermer

Pawel Krzeminski

H�l�ne Guilloteau

Erica Donner

Barbara Drigo

Giovanni Libralato

Marco Guida

Helmut B�rgmann

Karin Beck

Hemda Garelick

Marta Tac�o

Isabel Henriques

Isabel Mart�nez-Alcal�

Jose M. Guill�n-Navarro

Magdalena Popowska

Marta Piotrowska

Marcos Quintela-Baluja

Joshua T. Bunce

Maria I. Polo-L�pez

Samira Nahim�Granados

Marie-No�lle Pons

Milena Milakovic

Nikolina Udikovic-Kolic

J�r�me Ory

Traore Ousmane

Pilar Caballero

Antoni Oliver

Sara Rodriguez-Mozaz

Jose L. Balcazar

Thomas J�ger

Thomas Schwartz

Ying Yang

Shichun Zou

Yunho Lee

Younggun Yoon

Bastian Herzog

Heidrun Mayrhofer

Om Prakash

Yogesh Nimonkar

Ester Heath

Anna Baraniak

Joana Abreu-Silva

Manika Choudhury

Leonardo P. Munoz

Stela Krizanovic

Gianluca Brunetti

Ayella Maile-Moskowitz

Connor Brown

Eddie Cytryn


The World Health Organization Global Action Plan recommends integrated surveillance programs as crucial strategies for monitoring antibiotic resistance. Although several national surveillance programs are in place for clinical and veterinary settings, no such schemes exist for monitoring antibiotic-resistant bacteria in the environment. In this transnational study, we developed, validated, and tested a low-cost surveillance and easy to implement approach to evaluate antibiotic resistance in wastewater treatment plants (WWTPs) by targeting cefotaxime-resistant (CTX-R) coliforms as indicators. The rationale for this approach was: i) coliform quantification methods are internationally accepted as indicators of fecal contamination in recreational waters and are therefore routinely applied in analytical labs; ii) CTX-R coliforms are clinically relevant, associated with extended-spectrum β-lactamases (ESBLs), and are rare in pristine environments. We analyzed 57 WWTPs in 22 countries across Europe, Asia, Africa, Australia, and North America. CTX-R coliforms were ubiquitous in raw sewage and their relative abundance varied significantly (< 0.1% to 38.3%), being positively correlated (p < 0.001) with regional atmospheric temperatures. Although most WWTPs removed large proportions of CTX-R coliforms, loads over 103 colony-forming units per mL were occasionally observed in final effluents. We demonstrate that CTX-R coliform monitoring is a feasible and affordable approach to assess wastewater antibiotic resistance status.

Journal Article Type Article
Acceptance Date Aug 3, 2020
Online Publication Date Aug 21, 2020
Publication Date 2020-11
Deposit Date May 13, 2020
Publicly Available Date Aug 25, 2020
Journal Environment International
Print ISSN 0160-4120
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 144
Article Number 106035
Keywords Antibiotic resistance, Coliforms, ESBLs, Wastewater treatment, Water reuse
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A Global Multinational Survey Of Cefotaxime-resistant Coliforms In Urban Wastewater Treatment Plants (published version) (1.5 Mb)

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Published under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license.

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