Analysis of Klebsiella spp in wastewater from a hospital drain and WWTP influent in South West England.

Many, if not all, Klebsiella species occupy a wide range of environmental and animal niches, and occasionally cause opportunistic infections that are resistant to multiple antibiotics. In particular, Klebsiella pneumoniae has gained notoriety as a major nosocomial pathogen, due principally to the rise in non-susceptibility to carbapenems and other beta-lactam antibiotics. Whilst it has been proposed that the urban water cycle facilitates transmission of pathogens between clinical settings and the environment, the level of risk specifically posed by resistant Klebsiella strains in hospital wastewater remains unclear. We used whole genome sequencing to compare the prevalence and distribution of Klebsiella species, and associated virulence and resistance determinants, in contemporaneous samples of hospital wastewater and influent to the wastewater treatment plant which processes wastewater from the hospital and the community. As we aimed to characterise representative samples of Klebsiella communities, we did not actively select for antibiotic resistance (other than for ampicillin), nor for any specific Klebsiella species.