Identification and antimicrobial resistance prevalence of pathogenic Escherichia coli strains from treated wastewater effluents in Eastern Cape, South Africa

Antimicrobial resistance (AMR) is a global problem impeding the effective prevention/treatment of an ever-growing array of infections caused by pathogens; a huge challenge threatening the achievements of modern medicine. In this paper, we report the occurrence of multidrug resistance (MDR) in Escherichia coli strains isolated from discharged final effluents of two wastewater treatment facilities in the Eastern Cape Province of South Africa. Standard disk diffusion method was employed to determine the antibiotic susceptibility profile of 223 polymerase chain reaction (PCR)-confirmed E. coli isolates against 17 common antibiotics in human therapy and veterinary medicine. Seven virulence associated and fourteen antibiotic resistance genes were also evaluated by molecular methods. Molecular characterization revealed five pathotypes of E. coli in the following proportions: enterotoxigenic ETEC (1.4%), enteropathogenic EPEC (7.6%), enteroaggregative EAEC (7.6%), neonatal meningitis (NMEC) (14.8%), uropathogenic (41.7%), and others (26.9%). Isolates showed varying (1.7-70.6%) degrees of resistance to 15 of the test antibiotics. Multidrug resistance was exhibited by 32.7% of the isolates, with the commonest multiple antibiotic-resistant phenotype (MARP) being AP-T-CFX (12 isolates), while multiple antibiotic-resistant indices (MARI) estimated are 0.23 (Site 1) and 0.24 (Site 2). Associated antibiotic resistance genes detected in the isolates include: strA (88.2%), aadA (52.9%), cat I (15%), cmlA1 (4.6%), blaTEM (56.4%), tetA (30.4%), tetB (28.4%), tetC (42.2%), tetD (50%), tetK (11.8%), and tetM (68.6%). We conclude that municipal wastewater effluents are important reservoirs for the dissemination of potentially pathogenic E. coli (and possibly other pathogens) and antibiotic resistance genes in the aquatic milieu of the Eastern Cape and a risk to public health.