CTX-M-15 Type Extended-Spectrum Beta-Lactamase-Producing Enterobacter cloacae In Bioaerosol of a Municipal Solid Waste Recycling Plant: A New Possible Reservoir of Infection?

Background: Although there are many reports of antibiotic resistant microorganisms released from the treated municipal wastewater, less attention has been given to other waste treatment activities. We report the occurrence of antibiotic resistant strains isolated from the working setting of a solid waste recycling plant in Italy which serves 195 municipalities. Methods: To assess microbial contamination levels, several sampling points were chosen for their relevance in evaluating exposure of the workers to biological risk, especially during indoor operations. Active sampling was carried out using the Surface Air System and Rodac plate method was applied to surface sampling. Species identification and antimicrobial susceptibilities were obtained by Vitek2 System (bioMérieux, France) and by the agar-diffusion method. The presence of resistance genes was investigated by multiplex PCR assay. Results: In all sampling points a significant contamination of aerosol was detected, although the total microbial counts resulted within the limit proposed by the National authority (10000 CFU/sqm). The counts of Enterobacteriaceae were always above the limit of 100 CFU/sqm and strains of Enterobacter cloacae resistant to third generation cephalosporins were detected, carrying the blaCTX-M15 gene. Conclusions: The contamination of workplace with multidrug-resistant strains is a crucial area for public health actions to avoid the conjunction of factors that promote evolution and spread of antibiotic resistance.