Predictors of carbapenemase-producing bacteria occurrence in polluted coastal waters * Raphael P. Paschoal a , Eloiza H. Campana a, b , Laura de S. Castro c , Renata C. Pic ~ ao a, * a LIMM, Laborat orio de Investigaç~ ao em Microbiologia M edica, Departamento de Microbiologia M edica, Instituto de Microbiologia Paulo de G oes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil b LMC, Laborat orio de Microbiologia Clínica (LMC), Departamento de Ci^ encias Farmac^ euticas, Centro de Ci^ encias da Saúde, Universidade Federal da Paraíba, Jo~ ao Pessoa, Brazil c Departamento de Medicina, Universidade Federal de S~ ao Paulo, S~ ao Paulo, Brazil article info Article history: Received 23 October 2019 Received in revised form 1 May 2020 Accepted 7 May 2020 Available online 10 May 2020 Keywords: Antimicrobial resistance Recreational waters General estimating equation abstract The spread of carbapenemase-producing bacteria is a worldwide concern as it challenges healthcare, especially considering the insufficient development of antimicrobials. These microorganisms have been described not only in hospitals, but also in several environmental settings including recreational waters. Community exposure to antimicrobial-resistant bacteria through recreation might be relevant for human health, but risk assessment studies are lacking. Absence of effective and feasible monitoring in recrea- tional aquatic matrices contributes to such a knowledge gap. Here, we aimed at assessing predictors of occurrence of medically relevant carbapenemase-producing bacteria in coastal waters. We quantitatively assessed recovery of carbapenemase-producing Enterobacteriaceae, Pseudomonas spp., Acinetobacter spp. and Aeromonas spp. in superficial coastal waters showing distinct pollution history across one year, and registered data regarding tide regimen, 7-days pluviosity, salinity, pH, water temperature. We analyzed data using General Estimating Equation (GEE) to assess predictors of such occurrence. Our results suggest that the sampling site had the strongest effect over concentration of these antimicrobial-resistant mi- croorganisms, followed by pollution indexes and tide regimen. Increased salinity, advanced sampling time, water temperature, rainfall and decrease of pH were related to decrease concentrations. We pro- vide a list of factors that could be easily monitored and further included in models aiming at predicting occurrence of carbapenemase producers in coastal waters. Our study may encourage researchers to further improve this list and validate the model proposed, so that monitoring and future public policies can be developed to control the spread of antimicrobial resistance in the environment. © 2020 Elsevier Ltd. All rights reserved. 1. Introduction Antimicrobial resistance is one of the main challenges of hu- mankind in the 21st Century as it transcends the health sphere and threatens global health, economy and security (The Review on Antimicrobial Resistance, 2016; Laurence et al., 2019). Carbapenemase-producing gram-negative rods represent one of the greatest concerns regarding antimicrobial resistance in nosocomial-acquired infections (Rello et al., 2019). However, their dissemination is no longer restricted to hospital environments (Mills and Lee, 2019). These microorganisms are increasingly found in polluted aquatic environments, including those used for recre- ational purposes (Falgenhauer et al., 2019; Mahon et al., 2017; Mahon et al., 2019; Montezzi et al., 2015; Paschoal et al., 2017). Although wildlife in contact with polluted waters were found to carry antimicrobial-resistant bacteria (Dolejska & Papagiannitsis, 2018), consequences of such contact for humans remain un- known (Leonard et al., 2018). The study of antimicrobial resistance in health institutions en- ables identifying risks related to healthcare associated infections, the development of efficient therapeutic choices, and the estab- lishment of measures to limit its spread (Fournier et al., 2018). Antimicrobial resistance in the environment, on the other hand, lacks such understanding. Although lack of sanitation is considered the main factor favoring occurrence of carbapenemase producers in water sources, other factors in this scenario are unknown. This gap * This paper has been recommended for acceptance by Sarah Harmon. * Corresponding author. E-mail address: renata.picao@micro.ufrj.br (R.C. Pic~ ao). Contents lists available at ScienceDirect Environmental Pollution journal homepage: www.elsevier.com/locate/envpol https://doi.org/10.1016/j.envpol.2020.114776 0269-7491/© 2020 Elsevier Ltd. All rights reserved. Environmental Pollution 264 (2020) 114776