Monitoring Extended-spectrum-β-lactamases-producing Klebsiella pneumoniae: Do Surface Water Phenotypic Patterns Reflect Community and Clinical Resistance?

Abstract Purpose ESBL- Klebsiella pneumoniae (ESBL-Kp) prevalence and resistance profiles were evaluated to determine if Surface water (SW) is an Alternative Antimicrobial-resistance Monitoring System (AlARMS) for nearby community (CM) and clinical (CS) settings. Method Over eight months, 462 (SW), 1,167 (CM), and 244 (CS) K. pneumoniae isolates were screened for ESBL production; antimicrobial susceptibility testing was conducted using VITEK 2. Results ESBL-Kp prevalence varied ( p  < 0.05) among SW (14.9%), CM (6.8%), and CS (17.9%); multidrug resistance (MDR) was highest (94.6%) in CS and lowest in SW (25%). SW and CM isolates showed similar resistance ( p  > 0.05) to amoxicillin-clavulanate, piperacillin-tazobactam, cephalosporins, carbapenems, amikacin, and tigecycline, but differed ( p  < 0.001) for gentamicin, tobramycin, ciprofloxacin, and trimethoprim-sulphamethoxazole. SW and CS were similar ( p  > 0.05) in resistance to cephalosporins, amikacin, gentamicin, and trimethoprim-sulphamethoxazole, but differed for amoxicillin-clavulanic acid, piperacillin-tazobactam, ciprofloxacin, and tigecycline. A non-MDR pattern was common to all sources, with more SW-CM (63.3%) than SW-CS (3.3%) overlap. MDR pattern overlapped was seen in SW-CM but not in SW-CS. Conclusion Surface water isolates did not fully mirror clinical or community phenotypes; nevertheless, shared clinically relevant patterns suggest transmission potential, necessitating refined molecular insights for AlARMS evaluation.