Antibiotic resistant Kiebsiella spp. from a hospital, hospital effluents and wastewater treatment plants in the uMgungundlovu District, KwaZulu-Natal, South Africa

Hospital effluents are crucial hotspots for the dissemination of antibiotic resistant microorganisms. This study analysed hospital effluent and proximate wastewater treatment plants for the presence of antibiotic resistant Klebsiella spp. Water samples were obtained twice over a three-month period from an urban and rural hospital at three effluent points each, and from two proximate wastewater treatment plants (WWTPs) comprising influent and effluent and river water samples up downstream the WVVTPs. Presumptive Kiebsiella spp. were enumerated, isolated, and phenotypically confirmed using a well-established commercial test system for Enterobacteriaceae (API20E). Clinical Klebsiella pneumoniae isolates were provided by a hospital for compaiison. The antibiotic resistance profiles of Klebsiella spp. isolates to 16 selected antibiotics were established according to EUCAST (European Committee on Antimicrobial Susceptibility Testing). In addition, extended spectrum beta-lactamase (ESBL) and carbapenemase production was analysed. A total of 93 confirmed Kiebsiella spp. isolates from hospital effluents and 37 from WVVIPs were obtained, comprising K. pneunioniae and K. oxytoca. The viable counts for confirmed Kiebsiella spp. for hospital effluents ranged from 138 x 10(2) to 1.0(3) x 10(4), while those for WWTP influent were in a range of 1.76 x 10(3) to 5.10 x 10(3) CEU/ml. A higher proportion of Klebsiellu spp. from urban hospital effluent was categorized as mullidrug-resistani (MDR) (23%) compared to rural hospital effluent (9%). Resistance was observed to all antibiotic classes tested. Several clinical isolates presented resistance to four carbapenem antibiotics, while certain isolates from hospital effluent and WWTPs exhibited ertapenem and cloripenem resislance. Fifteen Klebsiellu spp. isolates (clinical and from urban hospital effluent) produced carbapenemases. Hospital effluents in South Africa contain antibiotic resistant Klebsiellu spp. and may pose a risk to proximate informal communities if inadequately treated. Moreover, common phenotypic resistance profiles among isolates from the clinical hospital effluent-wastewater works continuum suggest a need for further treatment of such effluent. (C) 2019 Elsevier B.V. All rights reserved.