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


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.

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Change history

  • 11 June 2019

    A missing/incomplete table caption for table 4 was discovered after article was published.



District “Arnsberg”


Antibiotic-resistant bacteria


Centres for disease control


Colony-forming units


District “Düsseldorf”


Defined daily doses


German institute for norming


District “Detmold”

E. coli :

Escherichia coli


European norm


Extended spectrum ß-lactamase


European Union


European Committee on Antimicrobial Susceptibility Testing


Intestinal Enterococci


Institute for Hygiene and Public Health, University Hospital Bonn


Imipenem-hydrolysing β-lactamase


District “Köln”


German commission for hospital hygiene and infection prevention


MacConkey agar


Multiresistant gram-negative bacteria


Methicillin-resistant staphylococcus aureus


District “Münster


International Organization for Standardization


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


Level of detection


Limit of quantification


Minimal inhibitory concentration


Most probably number


North Rhine-Westphalia


Odds ratio


Polymerase chain reaction


Predicted no-effect concentration for resistance selection


Proton pump inhibitors


Vancomycin-resistant Enterococcus


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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.

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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.

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Correspondence to Manuel Döhla.

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Döhla, M., Sib, E., Dericks, B. et al. Assessment of the Prevalence of Antibiotic-Resistant Bacteria and the Concentration of Antibiotics in EU Bathing Waters in Western Germany. Expo Health 12, 323–334 (2020).

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  • Multidrug resistance
  • Antibiotic-resistant bacteria
  • Surface water
  • Bathing water
  • Swimming