The overlooked reservoirs: ESBL-E and CPE in wastewater and stool samples from people with intellectual disabilities in the Netherlands
1
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
2
Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
3
Wastewater, Urban Water, Nijmegen, Netherlands
Popul. Med. 2026;8(Supplement Supplement 1):A168
ABSTRACT
INTRODUCTION:
Antimicrobial resistance (AMR) poses a significant threat to public health, as it limits treatment options and can lead to outbreaks. While the prevalence of extended-spectrum beta-lactamase-producing and carbapenemase-producing Enterobacterales (ESBL-E, CPE) is well-documented in hospitals and nursing homes for older adults, individuals with intellectual disabilities living in long-term care facilities (ID-LTCFs) have received little attention. To address this gap, we investigated ESBL-E and CPE occurrence among people with ID in LTCFs using wastewater and stool sampling.
METHODS:
Culture-based methods were employed to detect ESBL-E and CPE. Wastewater was sampled with passive samplers, pooled per ID-LTCF and analyzed for total E. coli, ESBL E. coli, ESBL Klebsiella spp., and CPE, quantified in CFU/ passive sampler. For stool samples, prevalence was determined from diaper wearing incontinent individuals, with a sample size of 67, based on an estimated 4.5% ESBL-E prevalence in the Dutch general population.
RESULTS:
ESBL-E was detected in both fecal and wastewater samples, while CPE was only found in wastewater around ID-LTCFs. The proportion of ESBL E. coli compared to sensitive E. coli in wastewater varied across LTCFs (0.003%–2.2% of total E. coli). In stool samples, ESBL E. coli was found in one in 11 samples (9.3%; 95% CI: 3.8–18.3%). No CPE were found in stool samples.
CONCLUSIONS:
Detection of ESBL-E in both wastewater and individual samples, and CPE in wastewater, poses potential public health risks for this group. Although prevalence was similar to the general population, these findings underscore the importance of including people with ID in AMR surveillance, given their increased health vulnerability, communal living, and frequent close contact with care professionals. Therefore, ongoing awareness and prevention efforts are vital, even when prevalence rates seem low. Larger studies are needed to identify AMR risk factors and to support the development of tailored infection prevention policies for ID-LTCFs.
Antimicrobial resistance (AMR) poses a significant threat to public health, as it limits treatment options and can lead to outbreaks. While the prevalence of extended-spectrum beta-lactamase-producing and carbapenemase-producing Enterobacterales (ESBL-E, CPE) is well-documented in hospitals and nursing homes for older adults, individuals with intellectual disabilities living in long-term care facilities (ID-LTCFs) have received little attention. To address this gap, we investigated ESBL-E and CPE occurrence among people with ID in LTCFs using wastewater and stool sampling.
METHODS:
Culture-based methods were employed to detect ESBL-E and CPE. Wastewater was sampled with passive samplers, pooled per ID-LTCF and analyzed for total E. coli, ESBL E. coli, ESBL Klebsiella spp., and CPE, quantified in CFU/ passive sampler. For stool samples, prevalence was determined from diaper wearing incontinent individuals, with a sample size of 67, based on an estimated 4.5% ESBL-E prevalence in the Dutch general population.
RESULTS:
ESBL-E was detected in both fecal and wastewater samples, while CPE was only found in wastewater around ID-LTCFs. The proportion of ESBL E. coli compared to sensitive E. coli in wastewater varied across LTCFs (0.003%–2.2% of total E. coli). In stool samples, ESBL E. coli was found in one in 11 samples (9.3%; 95% CI: 3.8–18.3%). No CPE were found in stool samples.
CONCLUSIONS:
Detection of ESBL-E in both wastewater and individual samples, and CPE in wastewater, poses potential public health risks for this group. Although prevalence was similar to the general population, these findings underscore the importance of including people with ID in AMR surveillance, given their increased health vulnerability, communal living, and frequent close contact with care professionals. Therefore, ongoing awareness and prevention efforts are vital, even when prevalence rates seem low. Larger studies are needed to identify AMR risk factors and to support the development of tailored infection prevention policies for ID-LTCFs.
| eISSN: | 2654-1459 |
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