title: Quantitative evaluation of extended-spectrum β-lactamase-producing Escherichia coli strains in the wastewater of a French teaching hospital and relation to patient strain.
abstract: BACKGROUND
  Extended-spectrum β-lactamase-producing Escherichia coli has become ubiquitous and has been reported in diverse ecosystems. We evaluated the potential impact of post-acute and long-term healthcare activities on the environment by quantifying ESBL-producing Enterobacteriaceae in wastewaters of a French geriatric hospital.
  
  
  METHODS
  We collected wastewater specimens representative of one-day efflux immediately before the connection with the municipal sewer pipe. The sample was processed following two different methods: dilution-filtration method and concentration method and was screened for ESBL-producing Enterobacteriaceae using selective media. ESBL E. coli strains were quantified, screened for ESBL genes and compared with ESBL strains isolated from patients present in the building at the time of wastewater collection, using molecular methods.
  
  
  RESULTS
  Six distinct environmental ESBL E. coli clusters were identified, two of them related to patient strains. The concentrations in hospital wastewater of these strains ranged from 2.5 × 10(4) to 10(6) UFC/L.
  
  
  CONCLUSIONS
  Our results demonstrate that the presence of ESBL E. coli patients leads to a dissemination of ESBL E. coli in the environment and highlights the need to improve excreta and wastewater policy in hospitals.
authors.affiliation: UPMC Univ Paris 06, EA 1541, Laboratoire de Bactériologie, F-75005 Paris, France ; AP-HP, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Laboratoire de Bactériologie-Hygiène, F-75013 Paris, France ; Faculté de médecine Pierre et Marie Curie - Site Pitié-Salpêtrière, 91 boulevard de l'hôpital, 75634 Paris, Cedex 13 France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Drieux
authors.affiliation: Eau de Paris, 33 avenue Jean Jaurès, 94200 Ivry-sur-Seine, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Haenn
authors.affiliation: Eau de Paris, 33 avenue Jean Jaurès, 94200 Ivry-sur-Seine, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Moulin
authors.affiliation: UPMC Univ Paris 06, EA 1541, Laboratoire de Bactériologie, F-75005 Paris, France ; AP-HP, Hôpitaux Universitaires la Pitié Salpêtrière-Charles Foix, Laboratoire de Bactériologie-Hygiène, F-75013 Paris, France ; Faculté de médecine Pierre et Marie Curie - Site Pitié-Salpêtrière, 91 boulevard de l'hôpital, 75634 Paris, Cedex 13 France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Jarlier
keywords: Escherichia coli; Lactamase; Quantification; Wastewater