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Assessment of the Prevalence of Antibiotic-Resistant Bacteria and the Concentration of Antibiotics in EU Bathing Waters in Western Germany

  • Manuel DöhlaEmail author
  • Esther Sib
  • Barbara Dericks
  • Susanne Grobe
  • Katja Behringer
  • Monika Frechen
  • Katharina Simon
  • Harald Färber
  • Franziska Lenz
  • Marijo Parcina
  • Dirk Skutlarek
  • Alexander Voigt
  • Carsten Felder
  • Martin Exner
  • Ricarda Maria Schmithausen
Original Paper

Abstract

Recreational use of bathing waters is very popular in Germany and the European Union (EU). Therefore, the spread of antibiotic-resistant facultative-pathogenic bacteria (ARB) presents a possible public health issue. During the 2018 summer bathing season, a prevalence study involving 16 selected EU bathing waters in North Rhine-Westphalia was conducted. The aim was to identify the presence of ARB, antibiotic residues or resistance genes, and to develop a tool that assists advisers on prevention measures for individuals and the health authorities. The study included (i) hygienic-microbiological analyses according to the EU Bathing Water Directive, (ii) antibiotic residue measurements, (iii) cultural and molecular analyses to identify ARB and resistance genes and (iv) development of a risk assessment tool based on the burden of the bathing water and the vulnerability of bathing persons. All bathing waters were complied with the EU Bathing Water Directive. Three samples were found to contain very small amounts of ARB. Small quantities of antibiotic residues were detected in three bathing waters. Only one sample contained a resistance gene. In total, only 2 bathing waters were assumed to be systemically burdened with ARB and antibiotic residues or resistance genes. 4 bathing waters indicated single contamination events, 10 bathing waters were unburdened. In conclusion, bathing waters fulfilling criteria of the EU bathing water directive did not show high contaminations with ARB, antibiotic residues or resistance genes. However, we propose that people with risk factors should avoid swimming in burdened waters; people with immune deficiency should avoid swimming at all.

Keywords

Multidrug resistance Antibiotic-resistant bacteria Surface water Bathing water Swimming 

Abbreviations

AR

District “Arnsberg”

ARB

Antibiotic-resistant bacteria

CDC

Centres for disease control

CFU

Colony-forming units

D

District “Düsseldorf”

DDD

Defined daily doses

DIN

German institute for norming

DT

District “Detmold”

E. coli

Escherichia coli

EN

European norm

ESBL

Extended spectrum ß-lactamase

EU

European Union

EUCAST

European Committee on Antimicrobial Susceptibility Testing

IE

Intestinal Enterococci

IHPH

Institute for Hygiene and Public Health, University Hospital Bonn

IMI

Imipenem-hydrolysing β-lactamase

K

District “Köln”

KRINKO

German commission for hospital hygiene and infection prevention

McC

MacConkey agar

MRGN

Multiresistant gram-negative bacteria

MRSA

Methicillin-resistant staphylococcus aureus

MS

District “Münster

ISO

International Organization for Standardization

LANUV

North Rhine-Westphalian State Agency for Nature, Environment and Consumer Protection

LOD

Level of detection

LOQ

Limit of quantification

MIC

Minimal inhibitory concentration

MPN

Most probably number

NRW

North Rhine-Westphalia

OR

Odds ratio

PCR

Polymerase chain reaction

PNEC

Predicted no-effect concentration for resistance selection

PPI

Proton pump inhibitors

VRE

Vancomycin-resistant Enterococcus

Notes

Acknowledgements

We thank Cornelia Dümling, Ludger Heuer, Klaus Selent and the sampling staff from LANUV. The study was supported by the Ministry for Environment, Agriculture, Conservation and Consumer Protection of the State of North Rhine-Westphalia (Department IV, Dr. Friederike Vietoris). We also thank Dr. Liane Marciano and Daniela Zahn; all persons who helped to collect water samples for analysis in this study; and Gero Wilbring and Sylvia Hack for giving expert advice and support regarding water sampling. Many thanks go to Prof. Gabriele Bierbaum for her professional support and for her expert advice as well as for proofreading. Thanks are also due to Ri-yadarshinee Hoolasee, MBBS, for language proofreading. Financial support was provided by MULNV.

Author Contributions

MD undertook the data analysis, directed and evaluated the laboratory diagnosis and drafted the manuscript. MD and KS performed the sample processing. MD, ES, KB and MF performed the culture analysis. ES, FL and MP undertook the molecular analyses. HF, AV, DS and CF managed the chemical water analyses. BD and SG provided initial support for the special investigation programme. MD, ES, ME and RS developed the risk assessment tool. ME and RS supervised the programme. RS conducted the planning, writing and coordination of the project.

Compliance with Ethical Standards

Conflict of interest

All the authors declare that there are no conflicts of interest.

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Manuel Döhla
    • 1
    Email author
  • Esther Sib
    • 1
  • Barbara Dericks
    • 2
  • Susanne Grobe
    • 2
  • Katja Behringer
    • 1
  • Monika Frechen
    • 1
  • Katharina Simon
    • 1
  • Harald Färber
    • 1
  • Franziska Lenz
    • 3
  • Marijo Parcina
    • 3
  • Dirk Skutlarek
    • 1
  • Alexander Voigt
    • 1
  • Carsten Felder
    • 1
  • Martin Exner
    • 1
  • Ricarda Maria Schmithausen
    • 1
  1. 1.Institute for Hygiene and Public HealthUniversity Hospital BonnBonnGermany
  2. 2.North Rhine-Westphalian State Agency for Nature, Environment and Consumer ProtectionRecklinghausenGermany
  3. 3.Institute of Medical Microbiology, Immunology and ParasitologyUniversity Hospital BonnBonnGermany

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