title: Population Screening Using Sewage Reveals Pan-Resistant Bacteria in Hospital and Community Samples.
abstract: The presence of pan-resistant bacteria worldwide possesses a threat to global health. It is difficult to evaluate the extent of carriage of resistant bacteria in the population. Sewage sampling is a possible way to monitor populations. We evaluated the presence of pan-resistant bacteria in Israeli sewage collected from all over Israel, by modifying the pour plate method for heterotrophic plate count technique using commercial selective agar plates. This method enables convenient and fast sewage sampling and detection. We found that sewage in Israel contains multiple pan-resistant bacteria including carbapenemase resistant Enterobacteriacae carrying blaKPC and blaNDM-1, MRSA and VRE. blaKPC carrying Klebsiella pneumonia and Enterobacter cloacae were the most common Enterobacteriacae drug resistant bacteria found in the sewage locations we sampled. Klebsiella pneumonia, Enterobacter spp., Escherichia coli and Citrobacter spp. were the 4 main CRE isolated from Israeli sewage and also from clinical samples in our clinical microbiology laboratory. Hospitals and Community sewage had similar percentage of positive samplings for blaKPC and blaNDM-1. VRE was found to be more abundant in sewage in Israel than MRSA but there were more locations positive for MRSA and VRE bacteria in Hospital sewage than in the Community. Therefore, our upgrade of the pour plate method for heterotrophic plate count technique using commercial selective agar plates can be a useful tool for routine screening and monitoring of the population for pan-resistant bacteria using sewage.
authors: Microbiology Laboratory, Chaim Sheba Medical Center, Tel Hashomer, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Lital
authors: L
authors: Meir-Gruber
authors: Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors: Yossi
authors: Y
authors: Manor
authors: Microbiology Laboratory, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors: Shiraz
authors: S
authors: Gefen-Halevi
authors: Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Musa Y
authors: MY
authors: Hindiyeh
authors: Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors: Fernando
authors: F
authors: Mileguir
authors: Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors: Roberto
authors: R
authors: Azar
authors: Microbiology Laboratory, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors: Gill
authors: G
authors: Smollan
authors: Microbiology Laboratory, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors: Natasha
authors: N
authors: Belausov
authors: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.|Infectious Disease Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors: Galia
authors: G
authors: Rahav
authors: Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors: Ari
authors: A
authors: Shamiss
authors: Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors: Ella
authors: E
authors: Mendelson
authors: Microbiology Laboratory, Chaim Sheba Medical Center, Tel Hashomer, Israel.|Ariel University, Ariel, Israel.
authors: Nathan
authors: N
authors: Keller
mesh_terms: D015373:Bacterial Typing Techniques / Q000295:instrumentation*; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000145:classification* / Q000302:isolation & purification; D006761:Hospitals; D007557:Israel; D012111:Residence Characteristics; D012722:Sewage / Q000382:microbiology*; D014871:Water Microbiology
chemical_list: D012722:Sewage