In river water samples, the most common PGG was group A (52%) followed by group C (16%) and E (16%), and D (8%) and B (8%). Almost a similar pattern was found among E. coli strains isolated from WWTP samples. The most common PGG in these samples was group A (48.3%) followed by group C (27.6%), B (10.4%), E (6.9%) and finally D (6.9%) (Table 3). Based on the combination of PhP-typing and phylogenetic grouping, 14 isolates were grouped under four common clonal types (CTs) comprising of between two and five isolates each. The remaining 40 isolates belonged to single clonal types (STs) (Table 2).
Phenotyping of ESBL-producing E. coli by PhP
| Types . | Source (number of ısolates) . | |||
|---|---|---|---|---|
| OR1 (18) . | OR2 (7) . | WW1 (15) . | WW2 (14) . | |
| CT1 (2) | 1 | – | 1 | – |
| CT2 (5) | 1 | – | 2 | 2 |
| CT3 (4) | – | 1 | 1 | 2 |
| CT4 (3) | 2 | – | – | 1 |
| STs | 14 | 6 | 11 | 9 |
| Total | 18 | 7 | 15 | 14 |
| Types . | Source (number of ısolates) . | |||
|---|---|---|---|---|
| OR1 (18) . | OR2 (7) . | WW1 (15) . | WW2 (14) . | |
| CT1 (2) | 1 | – | 1 | – |
| CT2 (5) | 1 | – | 2 | 2 |
| CT3 (4) | – | 1 | 1 | 2 |
| CT4 (3) | 2 | – | – | 1 |
| STs | 14 | 6 | 11 | 9 |
| Total | 18 | 7 | 15 | 14 |
Locations of the water samples collected: OR1: from upstream of Orontes River; OR2: from Orontes River after passing the city center; WW1: the influent of WWTP; and WW2: the effluent of WWTP.
Characteristics of ESBL-producing E. coli
| Isolates (n) . | Resistance phenotypes* . | PGGs . | β-lactam gene variant . | Types of int gene . | Types of sul gene . |
|---|---|---|---|---|---|
| Orontes River water samples | |||||
| 1 | FOX, TIC-CLA | E | TEM-1 | – | – |
| 1 | GEN | A | CTX-M-15 | – | – |
| 1 | CIP, LEV | A | CTX-M-15 | – | – |
| 1 | CIP, LEV | C | CTX-M-15 | – | sul1 + sul2 |
| 1 | CIP, LEV | E | CTX-M-15 | – | – |
| 1 | TRI-STX | A | TEM-1 | int1 | sul1 + sul2 |
| 1 | GEN, TRI-STX | A | CTX-M15, TEM-1 | – | sul2 |
| 1 | CIP, LEV, TRI-STX | A | TEM-1 | int1 | sul1 + sul2 |
| 1 | CIP, LEV, GEN, TRI-STX | D | CTX-M-15 | int1 | sul1 + sul2 |
| 1 | CIP, LEV, GEN, TRI-STX | A | CTX-M-15 | int1 | sul1 + sul2 |
| 1 | CIP, LEV, GEN, TRI-STX | E | CTX-M-15 | int1 | sul1 + sul2 |
| 1 | CIP, LEV, GEN, TRI-STX | A | CTX-M-15, TEM-1 | int1 | sul1 + sul2 |
| 1 | CEF-SUL, FOX, CIP, LEV, TIC-CLA | C | – | – | – |
| 1 | CIP, LEV, TIC-CLA, TRI-STX | B | CTX-M-15, TEM-1 | int1 | sul2 |
| 1 | CEF-SUL, PIP-TAZ, TIC-CLA | A | CTX-M-1, TEM-1 | – | – |
| 1 | CEF-SUL, FOX, CIP, LEV, TRI-STX | B | CTX-M-15 | – | sul1 + sul2 |
| 1 | CEF-SUL, GEN, TIC-CLA, TRI-STX | A | CTX-M-15, TEM-1 | int1 | sul1 + sul2 |
| 1 | CEF-SUL, PIP-TAZ, TIC-CLA, TRI-STX | A | TEM-1 | int2 | sul1 + sul2 |
| 1 | CEF-SUL, FOX, CIP, LEV, PIP-TAZ, TIC-CLA | A | CTX-M-15 | – | sul1 + sul2 |
| 1 | CEF-SUL, FOX, CIP, GEN, TIC-CLA, TRI-STX | D | CTX-M-15, TEM-1 | – | sul1 + sul2 |
| 1 | CEF-SUL, CIP, GEN, LEV, TIC-CLA, TRI-STX | E | TEM-1 | int1 | sul1 + sul2 |
| 1 | CIP, LEV, GEN, PIP-TAZ, TIC-CLA, TRI-STX | A | CTX-M-15, TEM-1 | int1 | sul1 + sul2 |
| 1 | CEF-SUL, FOX, CIP, GEN, LEV, TIC-CLA, TRI-STX | C | TEM-1 | – | sul1 + sul2 |
| 1 | CEF-SUL, FOX, CIP, LEV, MER, PIP-TAZ, TIC-CLA | C | TEM-1 | – | – |
| 1 | CEF-SUL, FOX, CIP, LEV, PIP-TAZ, TIC-CLA, TRI-STX | A | CTX-M-15 | – | sul1 + sul2 |
| Waste water treatment samples | |||||
| 1 | A | CTX-M-15, TEM-1 | – | – | |
| 1 | B | TEM-1 | int1 | – | |
| 1 | CIP | A | CTX-M-15 | int1 | – |
| 1 | CIP, LEV | D | CTX-M-15 | int2 | – |
| 1 | TIC-CLA | D | CTX-M-15, TEM-1 | – | – |
| 1 | CIP, LEV | C | CTX-M-15 | – | – |
| 1 | CIP, LEV | C | CTX-M-15 | int1 | – |
| 1 | TRI-STX | B | CTX-M-15, TEM-1 | int1 | sul1 + sul2 |
| 1 | TRI-STX | A | CTX-M-15, TEM-1 | int1 | sul2 |
| 1 | TIC-CLA, TRI-STX | A | TEM-1 | int1 | sul1 + sul2 |
| 2 | CIP, LEV, TRI-STX | A | CTX-M-15 | int1 | sul1 + sul2 |
| 1 | CIP, LEV, TRI-STX | A | CTX-M-15 | int1 | sul2 |
| 1 | CIP, LEV, TRI-STX | C | CTX-M-15 | – | sul1 + sul2 |
| 1 | CIP, LEV, TRI-STX | A | – | int1 | sul1 + sul2 |
| 1 | CIP, GEN, LEV, TRI-STX | A | TEM-1 | int1 | sul1 + sul2 |
| 1 | CIP, LEV, TIC-CLA, TRI-STX | A | CTX-M-15, TEM-1 | int1 | sul1 + sul2 |
| 1 | CIP, GEN, LEV, TIC-CLA | C | CTX-M-15, TEM-1 | int1 | – |
| 1 | CEF-SUL, TIC-CLA, TRI-STX | E | CTX-M-15, TEM-1 | int1 | sul2 |
| 1 | CEF-SUL, TIC-CLA, TRI-STX | B | TEM-1 | int1 | sul1 |
| 1 | CIP, GEN, LEV, TIC-CLA, TRI-STX | A | CTX-M-15, TEM-1 | int1 | sul1 + sul2 |
| 1 | CIP, GEN, LEV, TIC-CLA, TRI-STX | A | – | int1 | sul1 + sul2 |
| 1 | CEF-SUL, CIP, LEV, PIP-TAZ, TIC-CLA | C | CTX-M-15, TEM-1 | int1 | – |
| 1 | FOX, CIP, LEV, PIP-TAZ, TIC-CLA, TRI-STX | C | CTX-M-15 | int1 | sul1 + sul2 |
| 1 | FOX, CIP, LEV, PIP-TAZ, TIC-CLA, TRI-STX | E | TEM-1 | – | sul1 + sul2 |
| 1 | FOX, CEF-SUL, CIP, GEN, LEV, PIP-TAZ, TIC-CLA | C | TEM-1 | – | – |
| 1 | CEF-SUL, FOX, CIP, LEV, PIP-TAZ, TIC-CLA, TRI-STX | A | TEM-1 | int1 | sul1 + sul2 |
| 1 | CEF-SUL, FOX, CIP, GEN, LEV, PIP-TAZ, TIC-CLA, TRI-STX | C | – | – | sul1 + sul2 |
| 1 | CEF-SUL, FOX, CIP, GEN, LEV, PIP-TAZ, TIC-CLA, TRI-STX | A | CTX-M-15 | int1 | sul1 + sul2 |
| Isolates (n) . | Resistance phenotypes* . | PGGs . | β-lactam gene variant . | Types of int gene . | Types of sul gene . |
|---|---|---|---|---|---|
| Orontes River water samples | |||||
| 1 | FOX, TIC-CLA | E | TEM-1 | – | – |
| 1 | GEN | A | CTX-M-15 | – | – |
| 1 | CIP, LEV | A | CTX-M-15 | – | – |
| 1 | CIP, LEV | C | CTX-M-15 | – | sul1 + sul2 |
| 1 | CIP, LEV | E | CTX-M-15 | – | – |
| 1 | TRI-STX | A | TEM-1 | int1 | sul1 + sul2 |
| 1 | GEN, TRI-STX | A | CTX-M15, TEM-1 | – | sul2 |
| 1 | CIP, LEV, TRI-STX | A | TEM-1 | int1 | sul1 + sul2 |
| 1 | CIP, LEV, GEN, TRI-STX | D | CTX-M-15 | int1 | sul1 + sul2 |
| 1 | CIP, LEV, GEN, TRI-STX | A | CTX-M-15 | int1 | sul1 + sul2 |
| 1 | CIP, LEV, GEN, TRI-STX | E | CTX-M-15 | int1 | sul1 + sul2 |
| 1 | CIP, LEV, GEN, TRI-STX | A | CTX-M-15, TEM-1 | int1 | sul1 + sul2 |
| 1 | CEF-SUL, FOX, CIP, LEV, TIC-CLA | C | – | – | – |
| 1 | CIP, LEV, TIC-CLA, TRI-STX | B | CTX-M-15, TEM-1 | int1 | sul2 |
| 1 | CEF-SUL, PIP-TAZ, TIC-CLA | A | CTX-M-1, TEM-1 | – | – |
| 1 | CEF-SUL, FOX, CIP, LEV, TRI-STX | B | CTX-M-15 | – | sul1 + sul2 |
| 1 | CEF-SUL, GEN, TIC-CLA, TRI-STX | A | CTX-M-15, TEM-1 | int1 | sul1 + sul2 |
| 1 | CEF-SUL, PIP-TAZ, TIC-CLA, TRI-STX | A | TEM-1 | int2 | sul1 + sul2 |
| 1 | CEF-SUL, FOX, CIP, LEV, PIP-TAZ, TIC-CLA | A | CTX-M-15 | – | sul1 + sul2 |
| 1 | CEF-SUL, FOX, CIP, GEN, TIC-CLA, TRI-STX | D | CTX-M-15, TEM-1 | – | sul1 + sul2 |
| 1 | CEF-SUL, CIP, GEN, LEV, TIC-CLA, TRI-STX | E | TEM-1 | int1 | sul1 + sul2 |
| 1 | CIP, LEV, GEN, PIP-TAZ, TIC-CLA, TRI-STX | A | CTX-M-15, TEM-1 | int1 | sul1 + sul2 |
| 1 | CEF-SUL, FOX, CIP, GEN, LEV, TIC-CLA, TRI-STX | C | TEM-1 | – | sul1 + sul2 |
| 1 | CEF-SUL, FOX, CIP, LEV, MER, PIP-TAZ, TIC-CLA | C | TEM-1 | – | – |
| 1 | CEF-SUL, FOX, CIP, LEV, PIP-TAZ, TIC-CLA, TRI-STX | A | CTX-M-15 | – | sul1 + sul2 |
| Waste water treatment samples | |||||
| 1 | A | CTX-M-15, TEM-1 | – | – | |
| 1 | B | TEM-1 | int1 | – | |
| 1 | CIP | A | CTX-M-15 | int1 | – |
| 1 | CIP, LEV | D | CTX-M-15 | int2 | – |
| 1 | TIC-CLA | D | CTX-M-15, TEM-1 | – | – |
| 1 | CIP, LEV | C | CTX-M-15 | – | – |
| 1 | CIP, LEV | C | CTX-M-15 | int1 | – |
| 1 | TRI-STX | B | CTX-M-15, TEM-1 | int1 | sul1 + sul2 |
| 1 | TRI-STX | A | CTX-M-15, TEM-1 | int1 | sul2 |
| 1 | TIC-CLA, TRI-STX | A | TEM-1 | int1 | sul1 + sul2 |
| 2 | CIP, LEV, TRI-STX | A | CTX-M-15 | int1 | sul1 + sul2 |
| 1 | CIP, LEV, TRI-STX | A | CTX-M-15 | int1 | sul2 |
| 1 | CIP, LEV, TRI-STX | C | CTX-M-15 | – | sul1 + sul2 |
| 1 | CIP, LEV, TRI-STX | A | – | int1 | sul1 + sul2 |
| 1 | CIP, GEN, LEV, TRI-STX | A | TEM-1 | int1 | sul1 + sul2 |
| 1 | CIP, LEV, TIC-CLA, TRI-STX | A | CTX-M-15, TEM-1 | int1 | sul1 + sul2 |
| 1 | CIP, GEN, LEV, TIC-CLA | C | CTX-M-15, TEM-1 | int1 | – |
| 1 | CEF-SUL, TIC-CLA, TRI-STX | E | CTX-M-15, TEM-1 | int1 | sul2 |
| 1 | CEF-SUL, TIC-CLA, TRI-STX | B | TEM-1 | int1 | sul1 |
| 1 | CIP, GEN, LEV, TIC-CLA, TRI-STX | A | CTX-M-15, TEM-1 | int1 | sul1 + sul2 |
| 1 | CIP, GEN, LEV, TIC-CLA, TRI-STX | A | – | int1 | sul1 + sul2 |
| 1 | CEF-SUL, CIP, LEV, PIP-TAZ, TIC-CLA | C | CTX-M-15, TEM-1 | int1 | – |
| 1 | FOX, CIP, LEV, PIP-TAZ, TIC-CLA, TRI-STX | C | CTX-M-15 | int1 | sul1 + sul2 |
| 1 | FOX, CIP, LEV, PIP-TAZ, TIC-CLA, TRI-STX | E | TEM-1 | – | sul1 + sul2 |
| 1 | FOX, CEF-SUL, CIP, GEN, LEV, PIP-TAZ, TIC-CLA | C | TEM-1 | – | – |
| 1 | CEF-SUL, FOX, CIP, LEV, PIP-TAZ, TIC-CLA, TRI-STX | A | TEM-1 | int1 | sul1 + sul2 |
| 1 | CEF-SUL, FOX, CIP, GEN, LEV, PIP-TAZ, TIC-CLA, TRI-STX | C | – | – | sul1 + sul2 |
| 1 | CEF-SUL, FOX, CIP, GEN, LEV, PIP-TAZ, TIC-CLA, TRI-STX | A | CTX-M-15 | int1 | sul1 + sul2 |
*Resistance phenotypes for the antimicrobials tested apart from the cephalosporin and monobactam; AMP-SUL, ampicillin-sulbactam; AZT, aztreonam; CFZ, cefazolin; FEP, cefepime; CEF-SUL, cefoperazone-sulbactam; FOX, cefoxitin; CAZ, ceftazidime; CTR, ceftriaxone; CIP, ciprofloxacin; GEN, gentamicin; LEV, levofloxacin; PIP-TAZ, piperacillin-tazobactam; TIC-CLA, ticarcillin-clavulanate; TRI-STX, trimethoprim-sulfamethoxazole.