Tracking Extended-Spectrum Beta Lactamase-Producing Enterobacterales Across One Health Among Bedouin Communities

Background. Health inequality is an important determinant of antimicrobial resistance (AMR), which is often understudied. The objective of this study was to investigate extended-spectrum beta lactamase-producing (ESBL-P) Enterobacterales from a One Health perspective (holistically approaching human, animal, and environmental health as linked), among the Bedouin, an indigenous pastoralist community. Methods. Extended-spectrum beta lactamase-producing isolates from clinical urinary samples (n = 98), greywater (n = 47), sewage (n = 11), surface water (n = 24), animal fecal (n = 9), and milk (n = 1) were subject to phenotypic testing using VITEK-2 and short-read sequencing followed by analyses of resistomes, mobilomes, and phylogeny. Results. Extended-spectrum beta lactamase-producing isolates from diverse sources, mainly Escherichia coli and Klebsiella sp., exhibited a wide range of significant antibiotic resistance genes (ARGs) with blaCTX-M as the key ESBL gene. High-risk clones (eg, ST131 and ST38) were noted, most commonly among environmental and clinical E. coli isolates. Environmental and clinical isolates exhibited potential relatedness, despite coming from different locations and sample types. Most predicted plasmids were lnc-type and harbored at least one beta-lactamase gene, including blaCTX-M-15. Conclusions. Extended-spectrum beta lactamase-producing isolates from the living environment of Bedouins exhibited a wide range of ARGs of public health interest. Environment-human and environment-animal clusters of isolates and plasmids were identified. Further research is needed to establish the transmission dynamics of AMR and related mobile elements across One health in this setting and related risks.