Interconnected reservoirs of multidrug-resistant bacteria and plasmids within hospital plumbing infrastructure
- 1Children's Hospital of Philadelphia; University of Pennsylvania Perelman School of Medicine
Abstract
Hospital sinks and wastewater streams are hotspots for contamination and colonization with multidrug-resistant Gram-negative bacteria (MDR-GNB). While hospital water systems may facilitate MDR-GNB transmission during outbreaks, longitudinal population dynamics of environmental MDR-GNB and their long-term relationship with patient isolates remain unclear. Here we aimed to characterize the diversity and abundance of MDR-GNB within the hospital built environment and evaluate their relationship with clinical isolates. We performed nanopore sequencing on MDR-GNB cultured from sink drains (n=523) and wastewater (n=146) at a New York City hospital between March-August 2023. We assessed spatial and longitudinal genomic strain and plasmid dynamics and quantified relatedness to historical clinical isolates from the same hospital (n=602). Sink drains (54-73%) and wastewater (100%) demonstrated widespread, longitudinal colonization with MDR-GNB, driven primarily by carbapenem-resistant GNB including opportunistic organisms and Enterobacterales encoding blaKPC. While bacterial colonization differed across environmental niches, we identified both MDR-GNB strains and resistance plasmids that were shared between clinical and environmental sources, as well a distinct interplay between clinical and wastewater versus sink drain samples. This study supports the role of hospital plumbing as an important reservoir for clinically relevant MDR-GNB, but highlights differences across environmental sources, which may impact surveillance approaches.
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BibTeX
@misc{annavajhala2026interconnected,
title = {{Interconnected reservoirs of multidrug-resistant bacteria and plasmids within hospital plumbing infrastructure}},
author = {M. K. Annavajhala and T. W. Hokunson and K. Terzoglou and A.-C. Uhlemann and A. Gomez-Simmonds},
howpublished = {bioRxiv},
year = {2026},
month = jul,
doi = {10.64898/2026.07.20.739580},
url = {https://www.biorxiv.org/content/10.64898/2026.07.20.739580v2},
note = {CC BY},
}
RIS
TY - UNPB
TI - Interconnected reservoirs of multidrug-resistant bacteria and plasmids within hospital plumbing infrastructure
AU - M. K. Annavajhala
AU - T. W. Hokunson
AU - K. Terzoglou
AU - A.-C. Uhlemann
AU - A. Gomez-Simmonds
PY - 2026
DA - 2026/07/20
PB - bioRxiv
DO - 10.64898/2026.07.20.739580
UR - https://www.biorxiv.org/content/10.64898/2026.07.20.739580v2
AB - Hospital sinks and wastewater streams are hotspots for contamination and colonization with multidrug-resistant Gram-negative bacteria (MDR-GNB). While hospital water systems may facilitate MDR-GNB transmission during outbreaks, longitudinal population dynamics of environmental MDR-GNB and their long-term relationship with patient isolates remain unclear. Here we aimed to characterize the diversity and abundance of MDR-GNB within the hospital built environment and evaluate their relationship with clinical isolates. We performed nanopore sequencing on MDR-GNB cultured from sink drains (n=523) and wastewater (n=146) at a New York City hospital between March-August 2023. We assessed spatial and longitudinal genomic strain and plasmid dynamics and quantified relatedness to historical clinical isolates from the same hospital (n=602). Sink drains (54-73%) and wastewater (100%) demonstrated widespread, longitudinal colonization with MDR-GNB, driven primarily by carbapenem-resistant GNB including opportunistic organisms and Enterobacterales encoding blaKPC. While bacterial colonization differed across environmental niches, we identified both MDR-GNB strains and resistance plasmids that were shared between clinical and environmental sources, as well a distinct interplay between clinical and wastewater versus sink drain samples. This study supports the role of hospital plumbing as an important reservoir for clinically relevant MDR-GNB, but highlights differences across environmental sources, which may impact surveillance approaches.
ER -