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

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.

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Change history

  • 11 June 2019

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

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

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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.

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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). https://doi.org/10.1007/s12403-019-00313-z

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Keywords

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