Abstract
Antibiotic resistance is a major global threat, especially to human health. Bacteria display more and more resistance genes and Multi-Dug Resistant (MDR) bacteria are now endemic worldwide, for instance enterobacteria producing extended spectrum betalactamase (EBLSE) such as CTX-M betalactamase. Extremely resistant bacteria (XDR) are emerging and their epidemiology should be monitored thoroughly. Among XDR bacteria, carbapenemase-producing enterobacteria (CPE) are of particular concern [1,2] because they produce specific enzymes that hydrolyze carbapenems (last ressort antibiotics in severe infections [2,3]) [4] but also most molecules in the β-lactam antibiotic class. In France, the most widespread carbapenemases are firstly oxacillinases of type OXA-48, then NDM metallo-β-lactamases [5]. A second type of emerging XDR bacteria are vancomycin-resistant enterococci (VRE) carrying vanA resistance gene. Surveillance of antibiotic resistance is a key to prevention mainly for emerging XDR [6]. Monitoring of pathogens in wastewater has been effective during the SARS-CoV-2 pandemic. In this study, we developed a strategy to monitor XDR genes blaOXA-48, blaNDM et vanA in wastewater from three hospital buildings occupied by patients with various risk for XDR carriage. We also compared the rate of emerging XDR genes to the rate of blaCTX-M chosen as marker of endemic MDR.