Fig. 3
Relationship between beta-lactam and carbapenem resistance in the urban and hospital environment. A Timeline showing relevant collection dates. The top strip shows the dates when water samples were collected from the urban environment (August 2016 and November 2017). The strip in the middle shows the spanning time period of an outbreak registered in one of the main hospitals in the city caused by a carbapenemase-producing Klebsiella pneumoniae strain (KPC). The bottom strip shows the time when each K. pneumoniae isolate (n = 15) causing the outbreak was reported. B Boxplots showing the relative abundance of genes conferring resistance to beta-lactams (in red) in urban water samples collected in 2016 or 2017. The same is shown for carbapenem-resistance genes (in blue). Level of statistical significance is shown as asterisks (p < 0.01). C Barplot showing the number of nosocomial infections caused by different carbapenem-resistant Enterobacteriaceae in 2016 and 2017, at the same hospital where the KPC outbreak was reported. D Barplot showing the percentage of metagenomic samples collected in 2016 or 2017 that resulted positive for K. pneumoniae. E Relative abundance (logarithmic scale) of K. pneumoniae in all metagenomic samples collected in 2016 or 2017. F Relative abundance (logarithmic scale) of K. pneumoniae in paired metagenomic samples collected from the same sites in 2016 or 2017