Wastewater Treatment Plants Release Large Amounts of Extended-Spectrum β-Lactamase– Producing Escherichia coli Into the Environment

(See the Editorial Commentary by Griffiths and Barza on pages 1666–7.) Background. The determinants of the spread of extended-spectrum β-lactamase–producing Escherichia coli (ESBLEC) in the community remain unclear. To evaluate its dissemination in the environment, we analyzed the ESBLEC population throughout an urban wastewater network. Methods. Samples were collected weekly, over a 10-week period, from 11 sites throughout the wastewater network of Besançon city (France). Total E. coli and ESBLEC loads were determined for each sample. As a control, we analyzed 51 clinical ESBLEC isolates collected at our hospital. We genotyped both environmental and clinical ESBLEC by pulsed-field gel electrophoresis and multilocus sequence typing and identified their blaESBL genes by sequencing. Results. The E. coli load was higher in urban wastewater than in hospital wastewater (7.5 × 105 vs 3.5 × 105 CFU/mL, respectively). ESBLEC was recovered from almost all the environmental samples and accounted for 0.3 % of total E. coli in the untreated water upstream from the wastewater treatment plant (WWTP). The ESBLEC load was higher in hospital wastewater than in community wastewater (27 × 103 vs 0.8 × 103 CFU/mL, respectively). Treatment by the WWTP eliminated 98 % and 94 % of total E. coli and ESBLEC, respectively. The genotyping revealed considerable diversity within both environmental and clinical ESBLEC and the overrepresentation of some clonal complexes. Most of the sequence types displayed by the clinical isolates were also found in the environment. CTX-M enzyme