{"id":"https://openalex.org/W7220744526","doi":"https://doi.org/10.64898/2026.10.02.26364587","title":"Wastewater is Not a Reliable Proxy for Clinical Carbapenem Resistance Prevalence in E. coli","display_name":"Wastewater is Not a Reliable Proxy for Clinical Carbapenem Resistance Prevalence in E. coli","publication_year":2026,"publication_date":"2026-10-06","ids":{"openalex":"https://openalex.org/W7220744526","doi":"https://doi.org/10.64898/2026.10.02.26364587"},"language":"en","primary_location":{"id":"doi:10.64898/2026.10.02.26364587","doi":"https://doi.org/10.64898/2026.10.02.26364587","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.10.02.26364587","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/10/06/2026.10.02.26364587.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.medrxiv.org/content/medrxiv/early/2026/10/06/2026.10.02.26364587.full.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5151631330","display_name":"Bj\u00f6rn Berglund","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I123387679","display_name":"Uppsala University","ror":"https://ror.org/048a87296","country_code":"SE","type":"education","lineage":["https://openalex.org/I123387679"]}],"countries":["SE"],"is_corresponding":false,"raw_author_name":"Bj\u00f6rn Berglund","raw_affiliation_strings":["Department of Cell and Molecular Biology, Uppsala University, Sweden"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Cell and Molecular Biology, Uppsala University, Sweden","institution_ids":["https://openalex.org/I123387679"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5151690040","display_name":"Vaishnavi Divya Shridar","orcid":"https://orcid.org/0009-0002-5927-7672","observed_orcids":["https://orcid.org/0009-0002-5927-7672"]},"institutions":[{"id":"https://openalex.org/I123387679","display_name":"Uppsala University","ror":"https://ror.org/048a87296","country_code":"SE","type":"education","lineage":["https://openalex.org/I123387679"]}],"countries":["SE"],"is_corresponding":false,"raw_author_name":"Vaishnavi Divya Shridar","raw_affiliation_strings":["Department of Information Technology, Uppsala University, Uppsala, Sweden,"],"raw_orcid":"https://orcid.org/0009-0002-5927-7672","affiliations":[{"raw_affiliation_string":"Department of Information Technology, Uppsala University, Uppsala, Sweden,","institution_ids":["https://openalex.org/I123387679"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5059396296","display_name":"Marie Wrande","orcid":"https://orcid.org/0009-0009-9902-9527","observed_orcids":["https://orcid.org/0009-0009-9902-9527"]},"institutions":[{"id":"https://openalex.org/I123387679","display_name":"Uppsala University","ror":"https://ror.org/048a87296","country_code":"SE","type":"education","lineage":["https://openalex.org/I123387679"]}],"countries":["SE"],"is_corresponding":false,"raw_author_name":"Marie Wrande","raw_affiliation_strings":["Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden","institution_ids":["https://openalex.org/I123387679"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5073603610","display_name":"Jon Jerlstr\u00f6m-Hultqvist","orcid":"https://orcid.org/0000-0002-7992-7970","observed_orcids":["https://orcid.org/0000-0002-7992-7970"]},"institutions":[{"id":"https://openalex.org/I123387679","display_name":"Uppsala University","ror":"https://ror.org/048a87296","country_code":"SE","type":"education","lineage":["https://openalex.org/I123387679"]}],"countries":["SE"],"is_corresponding":false,"raw_author_name":"Jon Jerlstr\u00f6m-Hultqvist","raw_affiliation_strings":["Department of Cell and Molecular Biology, Uppsala University, Sweden"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Cell and Molecular Biology, Uppsala University, Sweden","institution_ids":["https://openalex.org/I123387679"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5019497989","display_name":"Stefan Engblom","orcid":"https://orcid.org/0000-0002-3614-1732","observed_orcids":["https://orcid.org/0000-0002-3614-1732"]},"institutions":[{"id":"https://openalex.org/I123387679","display_name":"Uppsala University","ror":"https://ror.org/048a87296","country_code":"SE","type":"education","lineage":["https://openalex.org/I123387679"]},{"id":"https://openalex.org/I2800139495","display_name":"Science for Life Laboratory","ror":"https://ror.org/04ev03g22","country_code":"SE","type":"facility","lineage":["https://openalex.org/I2800139495"]}],"countries":["SE"],"is_corresponding":false,"raw_author_name":"Stefan Engblom","raw_affiliation_strings":["Department of Information Technology, Uppsala University, Uppsala, Sweden,","Science for Life Laboratory, Department of Information Technology, Uppsala University, Uppsala. Sweden"],"raw_orcid":"https://orcid.org/0000-0002-3614-1732","affiliations":[{"raw_affiliation_string":"Department of Information Technology, Uppsala University, Uppsala, Sweden,","institution_ids":["https://openalex.org/I123387679"]},{"raw_affiliation_string":"Science for Life Laboratory, Department of Information Technology, Uppsala University, Uppsala. Sweden","institution_ids":["https://openalex.org/I123387679","https://openalex.org/I2800139495"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5084196794","display_name":"Linus Sandegren","orcid":"https://orcid.org/0000-0001-7382-9782","observed_orcids":["https://orcid.org/0000-0001-7382-9782"]},"institutions":[{"id":"https://openalex.org/I123387679","display_name":"Uppsala University","ror":"https://ror.org/048a87296","country_code":"SE","type":"education","lineage":["https://openalex.org/I123387679"]}],"countries":["SE"],"is_corresponding":false,"raw_author_name":"Linus Sandegren","raw_affiliation_strings":["Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden","Uppsala Antibiotic Center, Uppsala University, Uppsala, Sweden"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden","institution_ids":["https://openalex.org/I123387679"]},{"raw_affiliation_string":"Uppsala Antibiotic Center, Uppsala University, Uppsala, Sweden","institution_ids":["https://openalex.org/I123387679"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5072427425","display_name":"Sanna Koskiniemi","orcid":"https://orcid.org/0000-0002-3275-0936","observed_orcids":["https://orcid.org/0000-0002-3275-0936"]},"institutions":[{"id":"https://openalex.org/I123387679","display_name":"Uppsala University","ror":"https://ror.org/048a87296","country_code":"SE","type":"education","lineage":["https://openalex.org/I123387679"]}],"countries":["SE"],"is_corresponding":true,"raw_author_name":"Sanna Koskiniemi","raw_affiliation_strings":["Department of Cell and Molecular Biology, Uppsala University, Sweden"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Cell and Molecular Biology, Uppsala University, Sweden","institution_ids":["https://openalex.org/I123387679"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5072427425"],"corresponding_institution_ids":["https://openalex.org/I123387679"],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10419","display_name":"Pharmaceutical and Antibiotic Environmental Impacts","score":0.9297000169754028,"subfield":{"id":"https://openalex.org/subfields/2310","display_name":"Pollution"},"field":{"id":"https://openalex.org/fields/23","display_name":"Environmental Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},"topics":[{"id":"https://openalex.org/T10419","display_name":"Pharmaceutical and Antibiotic Environmental Impacts","score":0.9297000169754028,"subfield":{"id":"https://openalex.org/subfields/2310","display_name":"Pollution"},"field":{"id":"https://openalex.org/fields/23","display_name":"Environmental Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},{"id":"https://openalex.org/T10147","display_name":"Antibiotic Resistance in Bacteria","score":0.060499999672174454,"subfield":{"id":"https://openalex.org/subfields/2726","display_name":"Microbiology (medical)"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10897","display_name":"Antibiotic Use and Resistance","score":0.006500000134110451,"subfield":{"id":"https://openalex.org/subfields/2725","display_name":"Infectious Diseases"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/carbapenem-resistant-escherichia-coli","display_name":"carbapenem-resistant Escherichia coli","score":0.9710000157356262},{"id":"https://openalex.org/keywords/wastewater-based-epidemiology","display_name":"wastewater-based epidemiology","score":0.8870000243186951},{"id":"https://openalex.org/keywords/antimicrobial-resistance-surveillance","display_name":"antimicrobial resistance surveillance","score":0.8820000290870667},{"id":"https://openalex.org/keywords/clinical-isolates","display_name":"clinical isolates","score":0.7490000128746033},{"id":"https://openalex.org/keywords/hospital-wastewater","display_name":"hospital wastewater","score":0.8830000162124634},{"id":"https://openalex.org/keywords/resistance-gene-detection","display_name":"resistance gene detection","score":0.7509999871253967},{"id":"https://openalex.org/keywords/metagenomic-sequencing","display_name":"metagenomic sequencing","score":0.7770000100135803},{"id":"https://openalex.org/keywords/target-enrichment","display_name":"target enrichment","score":0.8230000138282776},{"id":"https://openalex.org/keywords/one-health","display_name":"One Health","score":0.8169999718666077},{"id":"https://openalex.org/keywords/uppsala","display_name":"Uppsala","score":0.7369999885559082}],"concepts":[{"id":"https://openalex.org/C94061648","wikidata":"https://www.wikidata.org/wiki/Q336191","display_name":"Wastewater","level":2,"score":0.6992999911308289},{"id":"https://openalex.org/C160798450","wikidata":"https://www.wikidata.org/wiki/Q4230870","display_name":"Concordance","level":2,"score":0.4422000050544739},{"id":"https://openalex.org/C86803240","wikidata":"https://www.wikidata.org/wiki/Q420","display_name":"Biology","level":0,"score":0.43389999866485596},{"id":"https://openalex.org/C15151743","wikidata":"https://www.wikidata.org/wiki/Q903778","display_name":"Metagenomics","level":3,"score":0.42080000042915344},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.41359999775886536},{"id":"https://openalex.org/C89423630","wikidata":"https://www.wikidata.org/wiki/Q7193","display_name":"Microbiology","level":1,"score":0.398499995470047},{"id":"https://openalex.org/C94665300","wikidata":"https://www.wikidata.org/wiki/Q63391344","display_name":"Antibiotic resistance","level":3,"score":0.38260000944137573},{"id":"https://openalex.org/C114851261","wikidata":"https://www.wikidata.org/wiki/Q12147416","display_name":"Drug resistance","level":2,"score":0.37119999527931213},{"id":"https://openalex.org/C547475151","wikidata":"https://www.wikidata.org/wiki/Q25419","display_name":"Escherichia coli","level":3,"score":0.35530000925064087},{"id":"https://openalex.org/C57442070","wikidata":"https://www.wikidata.org/wiki/Q221275","display_name":"Sewage treatment","level":2,"score":0.3528999984264374},{"id":"https://openalex.org/C150903083","wikidata":"https://www.wikidata.org/wiki/Q7108","display_name":"Biotechnology","level":1,"score":0.34940001368522644},{"id":"https://openalex.org/C2780148112","wikidata":"https://www.wikidata.org/wiki/Q1432581","display_name":"Proxy (statistics)","level":2,"score":0.3287000060081482},{"id":"https://openalex.org/C2992965680","wikidata":"https://www.wikidata.org/wiki/Q598976","display_name":"Clinical microbiology","level":2,"score":0.3025999963283539},{"id":"https://openalex.org/C2779443120","wikidata":"https://www.wikidata.org/wiki/Q650912","display_name":"Bacteremia","level":3,"score":0.29980000853538513},{"id":"https://openalex.org/C186079640","wikidata":"https://www.wikidata.org/wiki/Q719602","display_name":"Prevalence","level":3,"score":0.27810001373291016},{"id":"https://openalex.org/C2776666601","wikidata":"https://www.wikidata.org/wiki/Q3457855","display_name":"Resistome","level":5,"score":0.2759000062942505},{"id":"https://openalex.org/C2776685102","wikidata":"https://www.wikidata.org/wiki/Q410897","display_name":"Carbapenem","level":3,"score":0.2711000144481659},{"id":"https://openalex.org/C177713679","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care medicine","level":1,"score":0.2680000066757202},{"id":"https://openalex.org/C157585117","wikidata":"https://www.wikidata.org/wiki/Q158666","display_name":"Omics","level":2,"score":0.26649999618530273},{"id":"https://openalex.org/C4937899","wikidata":"https://www.wikidata.org/wiki/Q68541106","display_name":"Antimicrobial","level":2,"score":0.25999999046325684},{"id":"https://openalex.org/C99454951","wikidata":"https://www.wikidata.org/wiki/Q932068","display_name":"Environmental health","level":1,"score":0.25119999051094055}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.64898/2026.10.02.26364587","doi":"https://doi.org/10.64898/2026.10.02.26364587","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.10.02.26364587","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/10/06/2026.10.02.26364587.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.64898/2026.10.02.26364587","doi":"https://doi.org/10.64898/2026.10.02.26364587","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.10.02.26364587","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/10/06/2026.10.02.26364587.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"sustainable_development_goals":[{"score":0.98580002784729,"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3"},{"score":0.9090999960899353,"display_name":"Clean water and sanitation","id":"https://metadata.un.org/sdg/6"}],"study_designs":[],"awards":[{"id":"https://openalex.org/G5404377299","display_name":null,"funder_award_id":"2022-06725","funder_id":"https://openalex.org/F4320321040","funder_display_name":"National Science Council"},{"id":"https://openalex.org/G7932042682","display_name":"Pandemic situation awareness: towards trustworthy model-based epidemiological analysis","funder_award_id":"2024-03949","funder_id":"https://openalex.org/F4320322581","funder_display_name":"Vetenskapsr\u00e5det"},{"id":"https://openalex.org/G8869864247","display_name":"NAISS","funder_award_id":"2022-06725","funder_id":"https://openalex.org/F4320322581","funder_display_name":"Vetenskapsr\u00e5det"}],"funders":[{"id":"https://openalex.org/F4320321040","display_name":"National Science Council","ror":"https://ror.org/02kv4zf79"},{"id":"https://openalex.org/F4320322581","display_name":"Vetenskapsr\u00e5det","ror":"https://ror.org/03zttf063"},{"id":"https://openalex.org/F4320325677","display_name":"Science for Life Laboratory","ror":"https://ror.org/04ev03g22"}],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7220744526.pdf","grobid_xml":"https://content.openalex.org/works/W7220744526.grobid-xml"},"referenced_works_count":31,"referenced_works":["https://openalex.org/W2055043387","https://openalex.org/W2111647009","https://openalex.org/W2153325555","https://openalex.org/W2170551349","https://openalex.org/W2178637309","https://openalex.org/W2766408450","https://openalex.org/W2921754832","https://openalex.org/W2937858605","https://openalex.org/W2950891420","https://openalex.org/W2951912016","https://openalex.org/W2972538439","https://openalex.org/W2975239097","https://openalex.org/W2986368336","https://openalex.org/W3036135788","https://openalex.org/W3041651554","https://openalex.org/W3091506611","https://openalex.org/W3109406578","https://openalex.org/W3209528471","https://openalex.org/W3210890336","https://openalex.org/W4205158271","https://openalex.org/W4206677002","https://openalex.org/W4297492875","https://openalex.org/W4312070617","https://openalex.org/W4361301439","https://openalex.org/W4376615269","https://openalex.org/W4385343216","https://openalex.org/W4386143369","https://openalex.org/W4404473753","https://openalex.org/W4409733886","https://openalex.org/W4410348210","https://openalex.org/W7150902616"],"related_works":["https://openalex.org/W3007612455","https://openalex.org/W4284965921","https://openalex.org/W4214893932","https://openalex.org/W7125746704","https://openalex.org/W3047369717","https://openalex.org/W4414147177","https://openalex.org/W6999571716","https://openalex.org/W2913939545","https://openalex.org/W4401639156","https://openalex.org/W6902538483"],"abstract_inverted_index":{"Abstract":[0],"Antimicrobial":[1],"resistance":[2,158],"(AMR)":[3],"is":[4,164,176],"a":[5,19],"major":[6],"threat":[7],"to":[8,22],"modern":[9],"medicine":[10],"and":[11,64,75,83,97,172],"an":[12,103,201],"emerging":[13],"environmental":[14],"pollutant.":[15],"Wastewater-based":[16],"monitoring":[17,28,188],"offers":[18],"scalable":[20],"alternative":[21],"traditional":[23],"surveillance":[24],"by":[25],"enabling":[26],"population-level":[27],"across":[29],"One":[30],"Health":[31],"compartments.":[32],"However,":[33],"it":[34,193],"remains":[35],"unclear":[36],"how":[37],"well":[38],"bacterial":[39],"variants":[40,91],"detected":[41,94,156],"in":[42,59,95,108],"wastewater":[43,60,66,82,96,109,125,136],"reflect":[44,142],"those":[45],"causing":[46],"clinical":[47,69,84,90,120,145,204],"infections.":[48],"Here,":[49],"we":[50],"assessed":[51],"the":[52,72,143,166],"prevalence":[53,101,130,138],"of":[54,105,150,169,203],"carbapenem-resistant":[55],"Escherichia":[56],"coli":[57,153],"(CREC)":[58],"from":[61,71],"Uppsala,":[62],"Sweden,":[63],"compared":[65],"isolates":[67,70],"with":[68,119],"same":[73],"region":[74],"period.":[76],"We":[77],"observed":[78],"partial":[79],"overlap":[80],"between":[81],"CREC":[85,100,129,137,157,162],"populations,":[86],"but":[87],"several":[88],"common":[89],"were":[92],"not":[93,116,140],"vice":[98],"versa.":[99],"was":[102],"order":[104],"magnitude":[106],"higher":[107],"receiving":[110],"hospital":[111,124],"effluent,":[112],"yet":[113],"this":[114,170],"did":[115],"improve":[117],"concordance":[118],"isolates,":[121],"suggesting":[122,160],"that":[123,135,161,173,185],"may":[126],"artificially":[127],"inflate":[128],"estimates.":[131],"These":[132],"findings":[133],"indicate":[134],"does":[139],"necessarily":[141],"regional":[144],"burden.":[146],"Furthermore,":[147],"metagenomic":[148],"sequencing":[149],"wastewater-derived":[151],"E.":[152],"populations":[154],"rarely":[155],"genes,":[159],"abundance":[163],"below":[165],"detection":[167],"limit":[168],"approach":[171],"targeted":[174],"enrichment":[175],"required":[177],"for":[178],"reliable":[179],"monitoring.":[180],"Together,":[181],"our":[182],"results":[183],"show":[184],"while":[186],"wastewater-based":[187],"can":[189],"complement":[190],"AMR":[191],"surveillance,":[192],"should":[194],"be":[195],"interpreted":[196],"cautiously":[197],"when":[198],"used":[199],"as":[200],"indicator":[202],"risk.":[205]},"counts_by_year":[],"updated_date":"2026-11-09T13:22:03.289127","created_date":"2026-10-07T00:00:00"}
