Environmental trafficking of superbug carbapenem-resistant Klebsiella pneumoniae and its silent spread in an urban population: a sewage-based study
Abstract Background Antibiotic resistance (AR) is an imminent threat to developing nations where poor sanitation and untreated wastewater remain major risk factors. In this study, Cuttack’s raw municipal sewage effluent (RMSE) was leveraged to investigate the potential escape of carbapenem-resistant...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2025-07-01
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| Series: | Environmental Sciences Europe |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12302-025-01187-6 |
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| Summary: | Abstract Background Antibiotic resistance (AR) is an imminent threat to developing nations where poor sanitation and untreated wastewater remain major risk factors. In this study, Cuttack’s raw municipal sewage effluent (RMSE) was leveraged to investigate the potential escape of carbapenem-resistant Klebsiella pneumoniae (CRKP) into the environment and its prevalence in the urban population. Their genetic relatedness with clinical CRKP isolates was evaluated using repetitive element sequence-based PCR (rep-PCR) and (GTG)5-PCR. Results Eleven (n = 11) CRKP isolates, exhibiting variable resistance to 15 antibiotic classes, were recovered from RMSE. These isolates harboured several clinically relevant carbapenemase genes, including bla KPC (18.18%), bla IMP (18.18%), bla NDM (9.09%) with bla VIM (54.54%) and bla OXA-48-like (54.54%) being the most prevalent. In contrast, the clinical CRKP isolates (n = 14) were predominantly characterized by bla NDM (78.5%). The co-carriage of bla VIM + bla OXA-48-like was the most frequent combination in RMSE-derived isolates (45.45%), while clinical isolates were dominated by bla NDM + bla OXA-48-like (42.85%). Notably, many clinical isolates were marked by the confluence of extensively drug-resistant (XDR) (50%) phenotype and hypervirulent markers including iucA, iroB, rmpA, rmpA2 and peg-344. The clinical and environmental CRKP isolates clustered into two separate clades and differed significantly in their Multiple Antibiotic Resistance (MAR) Index (p < 0.00078), Minimum Inhibitory Concentration (MIC) of meropenem (p < 0.028) and imipenem (p < 0.019), number of β-lactamase genes (p < 0.0022), siderophore genes (p < 0.00039), and porin genes (p < 0.0001), as determined by the Mann–Whitney U-test. An XDR strain of the international high-risk clone ST395 harbouring a chromosomally encoded bla NDM-5 gene was also recovered from the RMSE. Conclusion These findings underscore the need for tailored strategies to mitigate community-associated and hospital-acquired CRKP infections, respectively, while identifying Cuttack’s RMSE as an escape gate for CRKP into the environment. The alarming presence of this superbug in RMSE further reflects its prevalence and ongoing cryptic transmission in Cuttack’s urban population. Our study advocates for the integration of sewage surveillance as a robust, cost-effective approach to monitor the environmental spread and current trends of pathogens in human populations. Graphical Abstract |
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| ISSN: | 2190-4715 |