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A global multinational survey of cefotaxime-resistant coliforms in urban wastewater treatment plants

Lookup NU author(s): Marcos Quintela-Baluja, Joshua Bunce



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


© 2020 The Authors. The World Health Organization Global Action Plan recommends integrated surveillance programs as crucial strategies for monitoring antibiotic resistance. Although several national surveillance programs are in place for clinical and veterinary settings, no such schemes exist for monitoring antibiotic-resistant bacteria in the environment. In this transnational study, we developed, validated, and tested a low-cost surveillance and easy to implement approach to evaluate antibiotic resistance in wastewater treatment plants (WWTPs) by targeting cefotaxime-resistant (CTX-R) coliforms as indicators. The rationale for this approach was: i) coliform quantification methods are internationally accepted as indicators of fecal contamination in recreational waters and are therefore routinely applied in analytical labs; ii) CTX-R coliforms are clinically relevant, associated with extended-spectrum β-lactamases (ESBLs), and are rare in pristine environments. We analyzed 57 WWTPs in 22 countries across Europe, Asia, Africa, Australia, and North America. CTX-R coliforms were ubiquitous in raw sewage and their relative abundance varied significantly (<0.1% to 38.3%), being positively correlated (p < 0.001) with regional atmospheric temperatures. Although most WWTPs removed large proportions of CTX-R coliforms, loads over 103 colony-forming units per mL were occasionally observed in final effluents. We demonstrate that CTX-R coliform monitoring is a feasible and affordable approach to assess wastewater antibiotic resistance status.

Publication metadata

Author(s): Marano RBM, Fernandes T, Manaia CM, Nunes O, Morrison D, Berendonk TU, Kreuzinger N, Telson T, Corno G, Fatta-Kassinos D, Merlin C, Topp E, Jurkevitch E, Henn L, Scott A, Hess S, Slipko K, Laht M, Kisand V, Di Cesare A, Karaolia P, Michael SG, Petre AL, Rosal R, Pruden A, Riquelme V, Aguera A, Esteban B, Luczkiewicz A, Kalinowska A, Leonard A, Gaze WH, Adegoke AA, Stenstrom TA, Pollice A, Salerno C, Schwermer CU, Krzeminski P, Guilloteau H, Donner E, Drigo B, Libralato G, Guida M, Burgmann H, Beck K, Garelick H, Tacao M, Henriques I, Martinez-Alcala I, Guillen-Navarro JM, Popowska M, Piotrowska M, Quintela-Baluja M, Bunce JT, Polo-Lopez MI, Nahim-Granados S, Pons M-N, Milakovic M, Udikovic-Kolic N, Ory J, Ousmane T, Caballero P, Oliver A, Rodriguez-Mozaz S, Balcazar JL, Jager T, Schwartz T, Yang Y, Zou S, Lee Y, Yoon Y, Herzog B, Mayrhofer H, Prakash O, Nimonkar Y, Heath E, Baraniak A, Abreu-Silva J, Choudhury M, Munoz LP, Krizanovic S, Brunetti G, Maile-Moskowitz A, Brown C, Cytryn E

Publication type: Article

Publication status: Published

Journal: Environment International

Year: 2020

Volume: 144

Print publication date: 01/11/2020

Online publication date: 21/08/2020

Acceptance date: 03/08/2020

Date deposited: 19/10/2020

ISSN (print): 0160-4120

ISSN (electronic): 1873-6750

Publisher: Elsevier Ltd


DOI: 10.1016/j.envint.2020.106035


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Funder referenceFunder name
WaterJPI/0001/ 2013 STARE – “Stopping Antibiotic Resistance Evolution”