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Surfers & Bodyboarders Three Times More Likely to Have Antibiotic-Resistant E. coli in Their Guts Than Non-Surfers, Small Study Shows

Regular surfers and bodyboarders are three times more likely to have antibiotic-resistant E. coli in their guts than non-surfers, new research has revealed. Conducted by the University of Exeter, the “Beach Bums” study asked 300 people, half of whom regularly surf the UK's coastline, to take rectal swabs. Surfers swallow ten times more sea water than sea swimmers, and scientists wanted to find out if that made them more vulnerable to bacteria that pollute seawater, and whether those bacteria are resistant to an antibiotic. Scientists compared fecal samples from surfers and non-surfers to assess whether the surfers' guts contained E. coli bacteria that were able to grow in the presence of cefotaxime, a commonly used and clinically important antibiotic. Cefotaxime has previously been prescribed to kill off these bacteria, but some have acquired genes that enable them to survive this treatment. The study, published online on January 14, 2018 in Environment International, found that 13 of 143 (9%) of surfers were colonized by these resistant bacteria, compared to just four of 130 (3%) of non-surfers swabbed. That meant that the bacteria would continue to grow even if treated with cefotaxime. The open-access article is titled “Exposure to and Colonization by Antibiotic-Resistant E. Coli In UK Coastal Water Users: Environmental Surveillance, Exposure Assessment, and Epidemiological Study (Beach Bum Survey).” Researchers also found that regular surfers were four times as likely to harbor bacteria that contain mobile genes that make bacteria resistant to the antibiotic. This is significant because the genes can be passed between bacteria - potentially spreading the ability to resist antibiotic treatment between bacteria. Recently, the UN Environment Assembly recognized the spread of antibiotic resistance in the environment as one of the world's greatest emerging environmental concerns.

Dr. Anne Leonard, of the University of Exeter Medical School, who led the research, said: "Antimicrobial resistance has been globally recognized as one of the greatest health challenges of our time, and there is now an increasing focus on how resistance can be spread through our natural environments. We urgently need to know more about how humans are exposed to these bacteria and how they colonize our guts. This research is the first of its kind to identify an association between surfing and gut colonization by antibiotic-resistant bacteria."

Despite extensive operations to clean up coastal waters and beaches, bacteria that are potentially harmful to humans still enter the coastal environment through sewage and waste pollution from sources including water run-off from farm crops treated with manure.

In the paper, the authors demonstrated the prevalence of cefotaxime-resistant E. coli in UK bathing waters, as well as the prevalence of the mobile resistance genes that make bacteria cefotaxime-resistant.

They estimated that over 2.5 million water sports sessions occurred in England and Wales in 2015, which involved ingestion of E. coli bacteria harboring these mobile resistance genes. They found that surfers are particularly vulnerable to ingesting the bacteria because they swallow up to ten times more water than sea swimmers.

The World Health Organization (WHO) has warned that we may be entering an era in which antibiotics are no longer effective to kill simple, and previously treatable, bacterial infections. This would mean that infections such as pneumonia, tuberculosis, blood poisoning, gonorrhea, and food and waterborne diseases could be fatal. It would also mean that it would no longer be possible to use antibiotics to prevent infections in routine medical procedures, such as joint replacements and chemotherapy.

The 2016 O'Neill Report (see Science commentary: http://www.sciencemag.org/news/2016/05/long-awaited-report-outlines-how-...) commissioned by the UK government estimated that antimicrobial resistant infections could kill one person every three seconds by the year 2050 if current trends continue.

Up to now, solutions on addressing the issue have largely focused on prescribing and use. However, increasing priority is being placed on the role of the environment in spreading the problem, in addition to transmission within hospitals, between people, and via food.

Dr. Will Gaze, of the University of Exeter Medical School, supervised the research.

He said: "We are not seeking to discourage people from spending time in the sea, an activity which has a lot of benefits in terms of exercise, wellbeing, and connecting with nature. It is important that people understand the risks involved so that they can make informed decisions about their bathing and sporting habits. We now hope that our results will help policy-makers, beach managers, and water companies to make evidence-based decisions to improve water quality even further for the benefit of public health."

The marine conservation charity “Surfers Against Sewage” (SAS) (https://www.sas.org.uk/) is at the forefront of protecting bathing water quality and was involved in recruiting surfers to take part in this study.

SAS Science & Policy Officer David Smith said: "While this research highlights an emerging threat to surfers and bodyboarders in the UK, it should not prevent people from heading to our coasts.”

“Water quality in the UK has improved vastly in the past 30 years and is some of the cleanest in Europe. Recognizing coastal waters as a pathway for antibiotic resistance can allow policy makers to make changes to protect water users and the wider public from the threat of antibiotic resistance.”

“We would always recommend water users check the SAS Safer Seas Service (https://www.sas.org.uk/safer-seas-service/) before heading to the sea to avoid any pollution incidents and ensure the best possible experience in the UK's coastal waters."

[Press release] [Environment International article] [Surfers Against Sewage]