The effect of combined sewer overflows on the abundance of antibiotic resistance genes and bacteria in the James River

Antibiotic resistance is a major threat to human health. Clinical situations are the main focus for antibiotic resistance research, but understanding the spread of resistance in the environment is also vital. A major contributor to this spread is wastewater from combined sewer overflow (CSO) events. The effect of CSO events on antibiotic resistance in the James River near Richmond, Virginia was studied using genomic and microbiological approaches. The abundance of genes associated with resistance to quinolones (qnrA) and tetracycline (tetW) was strongly correlated with the presence of fecal indicator bacteria (E. coli abundance) as well as total nitrogen and phosphorus loads, which suggests an anthropogenic source of these genes. Abundance of the blaTEM gene, which confers resistance to β-lactam antibiotics, was elevated during CSO events and increased with precipitation and river discharge. Bacteria isolated during a CSO event were resistant to more antibiotics and had higher multi-drug resistance when compared to isolates from a non-event. This study demonstrated that CSO events are contributing to the spread of antibiotic resistance

The effect of combined sewer overflow (CSO) on the abundance of antibiotic resistant bacteria in the James River

Antibiotics have been used to treat bacterial infections worldwide since their discovery in the early 20th century and are vital to human health. Unfortunately, the heavy use of antibiotics has led to the increased natural selection of antibiotic resistant bacteria. In urban rivers, the spread of resistance resistance is through through the direct acquisition of resistance genes by either either either cell-to -cell contact or DNA uptake via a process called horizontal gene transfer transfer(HGT) 2.HGT, resistance genes, and resistant bacteria are in greater abundance in wastewater systems, and are released into the environment in wastewater plant effluent2,3. One problematic method of wastewater treatment, used in over over 750 cities in the US, is the Combined Sewer System System(CSS) 4.This collects the water from both rainfall and sewage for treatment at a single facility.Occasionally when it rains, the treatment plant exceeds capacity and the combined untreated effluent enters the river in what is called a CSO (Combined Sewer Overflow) event. Some studies have found that antibiotic resistance genes can be more abundant in river water water affected by wastewater treatment effluent and correlated with CSO events events 7

Diversity of Multidrug-Resistant Bacteria in an Urbanized River: A Case Study of the Potential Risks from Combined Sewage Overflows

Wastewater contamination and urbanization contribute to the spread of antibiotic resistance in aquatic environments. This is a particular concern in areas receiving chronic pollution of untreated waste via combined sewer overflow (CSO) events. The goal of this study was to expand knowledge of CSO impacts, with a specific focus on multidrug resistance. We sampled a CSO-impacted segment of the James River (Virginia, USA) during both clear weather and an active overflow event and compared it to an unimpacted upstream site. Bacteria resistant to ampicillin, streptomycin, and tetracycline were isolated from all samples. Ampicillin resistance was particularly abundant, especially during the CSO event, so these isolates were studied further using disk susceptibility tests to assess multidrug resistance. During a CSO overflow event, 82% of these isolates were resistant to five or more antibiotics, and 44% were resistant to seven or more. The latter statistic contrasts starkly with the upstream reference site, where only 4% of isolates displayed resistance to more than seven antibiotics. DNA sequencing (16S rRNA gene) revealed that ~35% of our isolates were opportunistic pathogens, comprised primarily of the genera Stenotrophomonas, Pseudomonas, and Chryseobacterium. Together, these results demonstrate that CSOs can be a significant source of viable clinically-relevant bacteria to the natural environment and that multidrug resistance is an important understudied component of the environmental spread of antibiotic resistance