Methicillin-resistant Staphylococcus aureus (MRSA) Detected at Four U.S. wastewater treatment plants

Rachel E. Rosenberg Goldstein; Shirley A. Micallef; Shawn G. Gibbs; Johnnie A. Davis; Xin He; Ashish George; Lara M. Kleinfelter; Nicole A. Schreiber; Sampa Mukherjee; Amir Sapkota; Sam W. Joseph; Amy R. Sapkota

doi:10.1289/ehp.1205436

Methicillin-resistant Staphylococcus aureus (MRSA) Detected at Four U.S. wastewater treatment plants

Rachel E. Rosenberg Goldstein, Shirley A. Micallef, Shawn G. Gibbs, Johnnie A. Davis, Xin He, Ashish George, Lara M. Kleinfelter, Nicole A. Schreiber, Sampa Mukherjee, Amir Sapkota, Sam W. Joseph, Amy R. Sapkota

Research output: Contribution to journal › Article

65 Scopus citations

Abstract

Background: The incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections is increasing in the United States, and it is possible that municipal wastewater could be a reservoir of this microorganism. To date, no U.S. studies have evaluated the occurrence of MRSA in wastewater. Objective: We examined the occurrence of MRSA and methicillin-susceptible S. aureus (MSSA) at U.S. wastewater treatment plants. Methods: We collected wastewater samples from two Mid-Atlantic and two Midwest wastewater treatment plants between October 2009 and October 2010. Samples were analyzed for MRSA and MSSA using membrane filtration. Isolates were confirmed using biochemical tests and PCR (polymerase chain reaction). Antimicrobial susceptibility testing was performed by Sensititre® microbroth dilution. Staphylococcal cassette chromosome mec (SCCmec) typing, Panton-Valentine leucocidin (PVL) screening, and pulsed field gel electrophoresis (PFGE) were performed to further characterize the strains. Data were analyzed by two-sample proportion tests and analysis of variance. R esults: We detected MRSA (n = 240) and MSSA (n = 119) in 22 of 44 (50%) and 24 of 44 (55%) wastewater samples, respectively. The odds of samples being MRSA-positive decreased as treatment progressed: 10 of 12 (83%) influent samples were MRSA-positive, while only one of 12 (8%) effluent samples was MRSA-positive. Ninety-three percent and 29% of unique MRSA and MSSA isolates, respectively, were multidrug resistant. SCCmec types II and IV, the pvl gene, and USA types 100, 300, and 700 (PFGE strain types commonly found in the United States) were identified among the MRSA isolates. C onclusions: Our findings raise potential public health concerns for wastewater treatment plant workers and individuals exposed to reclaimed wastewater. Because of increasing use of reclaimed wastewater, further study is needed to evaluate the risk of exposure to antibiotic-resistant bacteria in treated wastewater.

Original language	English (US)
Pages (from-to)	1551-1558
Number of pages	8
Journal	Environmental Health Perspectives
Volume	120
Issue number	11
DOIs	https://doi.org/10.1289/ehp.1205436
State	Published - Nov 2012
Externally published	Yes

Keywords

Antibiotic resistance
Community-acquired methicillin-resistant Staphylococcus aureus
MRSA
MSSA
Methicillin-resistant Staphylococcus aureus
Methicillin-susceptible Staphylococcus aureus
Reclaimed wastewater
Wastewater
Wastewater treatment plant

ASJC Scopus subject areas

Public Health, Environmental and Occupational Health
Health, Toxicology and Mutagenesis

Access to Document

10.1289/ehp.1205436

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Cite this

Rosenberg Goldstein, R. E., Micallef, S. A., Gibbs, S. G., Davis, J. A., He, X., George, A., Kleinfelter, L. M., Schreiber, N. A., Mukherjee, S., Sapkota, A., Joseph, S. W., & Sapkota, A. R. (2012). Methicillin-resistant Staphylococcus aureus (MRSA) Detected at Four U.S. wastewater treatment plants. Environmental Health Perspectives, 120(11), 1551-1558. https://doi.org/10.1289/ehp.1205436

Methicillin-resistant Staphylococcus aureus (MRSA) Detected at Four U.S. wastewater treatment plants. / Rosenberg Goldstein, Rachel E.; Micallef, Shirley A.; Gibbs, Shawn G.; Davis, Johnnie A.; He, Xin; George, Ashish; Kleinfelter, Lara M.; Schreiber, Nicole A.; Mukherjee, Sampa; Sapkota, Amir; Joseph, Sam W.; Sapkota, Amy R.

In: Environmental Health Perspectives, Vol. 120, No. 11, 11.2012, p. 1551-1558.

Research output: Contribution to journal › Article

Rosenberg Goldstein, RE, Micallef, SA, Gibbs, SG, Davis, JA, He, X, George, A, Kleinfelter, LM, Schreiber, NA, Mukherjee, S, Sapkota, A, Joseph, SW & Sapkota, AR 2012, 'Methicillin-resistant Staphylococcus aureus (MRSA) Detected at Four U.S. wastewater treatment plants', Environmental Health Perspectives, vol. 120, no. 11, pp. 1551-1558. https://doi.org/10.1289/ehp.1205436

Rosenberg Goldstein, Rachel E. ; Micallef, Shirley A. ; Gibbs, Shawn G. ; Davis, Johnnie A. ; He, Xin ; George, Ashish ; Kleinfelter, Lara M. ; Schreiber, Nicole A. ; Mukherjee, Sampa ; Sapkota, Amir ; Joseph, Sam W. ; Sapkota, Amy R. / Methicillin-resistant Staphylococcus aureus (MRSA) Detected at Four U.S. wastewater treatment plants. In: Environmental Health Perspectives. 2012 ; Vol. 120, No. 11. pp. 1551-1558.

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abstract = "Background: The incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections is increasing in the United States, and it is possible that municipal wastewater could be a reservoir of this microorganism. To date, no U.S. studies have evaluated the occurrence of MRSA in wastewater. Objective: We examined the occurrence of MRSA and methicillin-susceptible S. aureus (MSSA) at U.S. wastewater treatment plants. Methods: We collected wastewater samples from two Mid-Atlantic and two Midwest wastewater treatment plants between October 2009 and October 2010. Samples were analyzed for MRSA and MSSA using membrane filtration. Isolates were confirmed using biochemical tests and PCR (polymerase chain reaction). Antimicrobial susceptibility testing was performed by Sensititre{\textregistered} microbroth dilution. Staphylococcal cassette chromosome mec (SCCmec) typing, Panton-Valentine leucocidin (PVL) screening, and pulsed field gel electrophoresis (PFGE) were performed to further characterize the strains. Data were analyzed by two-sample proportion tests and analysis of variance. R esults: We detected MRSA (n = 240) and MSSA (n = 119) in 22 of 44 (50%) and 24 of 44 (55%) wastewater samples, respectively. The odds of samples being MRSA-positive decreased as treatment progressed: 10 of 12 (83%) influent samples were MRSA-positive, while only one of 12 (8%) effluent samples was MRSA-positive. Ninety-three percent and 29% of unique MRSA and MSSA isolates, respectively, were multidrug resistant. SCCmec types II and IV, the pvl gene, and USA types 100, 300, and 700 (PFGE strain types commonly found in the United States) were identified among the MRSA isolates. C onclusions: Our findings raise potential public health concerns for wastewater treatment plant workers and individuals exposed to reclaimed wastewater. Because of increasing use of reclaimed wastewater, further study is needed to evaluate the risk of exposure to antibiotic-resistant bacteria in treated wastewater.",

keywords = "Antibiotic resistance, Community-acquired methicillin-resistant Staphylococcus aureus, MRSA, MSSA, Methicillin-resistant Staphylococcus aureus, Methicillin-susceptible Staphylococcus aureus, Reclaimed wastewater, Wastewater, Wastewater treatment plant",

author = "{Rosenberg Goldstein}, {Rachel E.} and Micallef, {Shirley A.} and Gibbs, {Shawn G.} and Davis, {Johnnie A.} and Xin He and Ashish George and Kleinfelter, {Lara M.} and Schreiber, {Nicole A.} and Sampa Mukherjee and Amir Sapkota and Joseph, {Sam W.} and Sapkota, {Amy R.}",

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AU - Micallef, Shirley A.

AU - Gibbs, Shawn G.

AU - Davis, Johnnie A.

AU - He, Xin

AU - George, Ashish

AU - Kleinfelter, Lara M.

AU - Schreiber, Nicole A.

AU - Mukherjee, Sampa

AU - Sapkota, Amir

AU - Joseph, Sam W.

AU - Sapkota, Amy R.

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N2 - Background: The incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections is increasing in the United States, and it is possible that municipal wastewater could be a reservoir of this microorganism. To date, no U.S. studies have evaluated the occurrence of MRSA in wastewater. Objective: We examined the occurrence of MRSA and methicillin-susceptible S. aureus (MSSA) at U.S. wastewater treatment plants. Methods: We collected wastewater samples from two Mid-Atlantic and two Midwest wastewater treatment plants between October 2009 and October 2010. Samples were analyzed for MRSA and MSSA using membrane filtration. Isolates were confirmed using biochemical tests and PCR (polymerase chain reaction). Antimicrobial susceptibility testing was performed by Sensititre® microbroth dilution. Staphylococcal cassette chromosome mec (SCCmec) typing, Panton-Valentine leucocidin (PVL) screening, and pulsed field gel electrophoresis (PFGE) were performed to further characterize the strains. Data were analyzed by two-sample proportion tests and analysis of variance. R esults: We detected MRSA (n = 240) and MSSA (n = 119) in 22 of 44 (50%) and 24 of 44 (55%) wastewater samples, respectively. The odds of samples being MRSA-positive decreased as treatment progressed: 10 of 12 (83%) influent samples were MRSA-positive, while only one of 12 (8%) effluent samples was MRSA-positive. Ninety-three percent and 29% of unique MRSA and MSSA isolates, respectively, were multidrug resistant. SCCmec types II and IV, the pvl gene, and USA types 100, 300, and 700 (PFGE strain types commonly found in the United States) were identified among the MRSA isolates. C onclusions: Our findings raise potential public health concerns for wastewater treatment plant workers and individuals exposed to reclaimed wastewater. Because of increasing use of reclaimed wastewater, further study is needed to evaluate the risk of exposure to antibiotic-resistant bacteria in treated wastewater.

AB - Background: The incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections is increasing in the United States, and it is possible that municipal wastewater could be a reservoir of this microorganism. To date, no U.S. studies have evaluated the occurrence of MRSA in wastewater. Objective: We examined the occurrence of MRSA and methicillin-susceptible S. aureus (MSSA) at U.S. wastewater treatment plants. Methods: We collected wastewater samples from two Mid-Atlantic and two Midwest wastewater treatment plants between October 2009 and October 2010. Samples were analyzed for MRSA and MSSA using membrane filtration. Isolates were confirmed using biochemical tests and PCR (polymerase chain reaction). Antimicrobial susceptibility testing was performed by Sensititre® microbroth dilution. Staphylococcal cassette chromosome mec (SCCmec) typing, Panton-Valentine leucocidin (PVL) screening, and pulsed field gel electrophoresis (PFGE) were performed to further characterize the strains. Data were analyzed by two-sample proportion tests and analysis of variance. R esults: We detected MRSA (n = 240) and MSSA (n = 119) in 22 of 44 (50%) and 24 of 44 (55%) wastewater samples, respectively. The odds of samples being MRSA-positive decreased as treatment progressed: 10 of 12 (83%) influent samples were MRSA-positive, while only one of 12 (8%) effluent samples was MRSA-positive. Ninety-three percent and 29% of unique MRSA and MSSA isolates, respectively, were multidrug resistant. SCCmec types II and IV, the pvl gene, and USA types 100, 300, and 700 (PFGE strain types commonly found in the United States) were identified among the MRSA isolates. C onclusions: Our findings raise potential public health concerns for wastewater treatment plant workers and individuals exposed to reclaimed wastewater. Because of increasing use of reclaimed wastewater, further study is needed to evaluate the risk of exposure to antibiotic-resistant bacteria in treated wastewater.

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KW - Wastewater

KW - Wastewater treatment plant

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