New Delhi metallo-beta-lactamase (NDM)-producing Providencia stuartii has been reported from European Union/European Economic Area (EU/EEA) countries with increasing frequency. During 2018 to 2022, 355 cases of NDM-producing P. stuartii were detected in seven hospitals reporting on NDM-production in Enterobacterales in Romania.

Our aim was to determine the extent of spread of NDM-producing P. stuartii in hospitals in Romania.

We analysed whole genome sequences and epidemiological data of 74 P. stuartii isolates collected in six hospitals from December 2021 to September 2023.

We identified four multi-hospital clusters including isolates detected over more than a year, indicating sustained spread of blaNDM-1-carrying P. stuartii within the healthcare system. These clusters consisted of isolates from up to four hospitals and three regions. Three multi-hospital clusters were caused by a specific multidrug-resistant P. stuartii sequence type 46 lineage carrying blaNDM-1 and a large set of additional resistance markers. Investigation in an international context showed that this lineage had already been detected in nine countries (Bulgaria, France, Germany, Ireland, the Netherlands, Romania, Switzerland, United Kingdom, United States) since 2015.

Our results alert about the risk of carbapenem-resistant P. stuartii transmission in healthcare settings. Enhanced infection prevention and control measures should be instituted as soon as cases are detected in healthcare facilities. National surveillance systems in EU/EEA countries should, in addition to carbapenem-resistant and/or carbapenemase-producing Klebsiella pneumoniae and Escherichia coli, consider reporting carbapenem-resistant and/or carbapenemase-producing P. stuartii and other Enterobacterales where relevant.

Antimicrobial resistance (AMR) is a global threat. Monitoring using an integrated One Health approach is essential to detect changes in AMR occurrence.

We aimed to detect AMR genes in pathogenic and commensal Escherichia coli collected 2013–2020 within monitoring programmes and research from food animals, food (fresh retail raw meat) and humans in six European countries, to compare vertical and horizontal transmission.

We whole genome sequenced (WGS) 3,745 E. coli isolates, detected AMR genes using ResFinder and performed phylogenetic analysis to determine isolate relatedness and transmission. A BLASTn-based bioinformatic method compared draft IncI1 genomes to conserved plasmid references from Europe.

Resistance genes to medically important antimicrobials (MIA) such as extended-spectrum cephalosporins (ESC) were widespread but predicted resistance to MIAs authorised for human use (carbapenem, tigecycline) was detected only in two human and three cattle isolates. Phylogenetic analysis clustered E. coli according to phylogroups; commensal animal isolates showed greater diversity than those from human patients. Only 18 vertical animal-food and human-animal transmission events of E. coli clones were detected. However, IncI1 plasmids from different sources and/or countries carrying resistance to ESCs were conserved and widely distributed, although these variants were rarely detected in human pathogens.

Using WGS we demonstrated AMR is driven vertically and horizontally. Human clinical isolates were more closely related, but their IncI1 plasmids were more diverse, while animal or food isolates were less similar with more conserved IncI1 plasmids. These differences likely arose from variations in selective pressure, influencing AMR evolution and transmission.

Wastewater surveillance may support early and comprehensive detection of infectious diseases’ community transmission, particularly in settings where other health surveillance systems provide biased or limited information. Amid the SARS-CoV-2 pandemic, deploying passive samplers to monitor targeted populations gained importance. Evaluation of the added public health value of this approach in the field can support its broader adoption.

We aimed to assess the feasibility and utility of on-demand wastewater surveillance, employing passive samplers, for SARS-CoV-2 and monkeypox virus (MPXV) in small/targeted populations, also considering ethical aspects.

Pilot case studies in the Rotterdam-Rijnmond region were used for a systematic assessment of the feasibility and utility of wastewater monitoring of SARS-CoV-2 (variants) and MPXV using passive sampling. Each case study was instigated by actual questions from the Public Health Service about disease transmission.

Case study results demonstrated the feasibility and utility of on-demand wastewater surveillance with successful identification of a local peak in SARS-CoV-2 transmission, early detection of wider Omicron variant transmission after the first case was reported, as well as indication of no emerging local MPXV transmission. Ethical considerations led to the abandonment of one case study involving a displaced population.

The study confirms the feasibility and utility of passive sampling for real-time infectious disease surveillance, at desired spatiotemporal resolution. Ethical concerns and operational challenges were identified, highlighting the need for early stakeholder engagement and ethical guideline adherence. The method could be used to study under-surveyed populations and be extended beyond SARS-CoV-2 and MPXV to other pathogens.