Prospective study of nucleic acids in wastewater solids in 190 wastewater treatment plants in the United States suggests widespread occurrence.

UNLABELLED

is an emerging, multidrug-resistant fungal pathogen that poses a significant public health threat in healthcare settings. Despite yearly clinical cases rapidly increasing from 77 to 8,131 in the last decade, surveillance data on its distribution and prevalence remain limited. We implemented a novel assay for detection on a nationwide scale prospectively from September 2023 to March 2024, analyzing a total of 13,842 samples from 190 wastewater treatment plants across 41 U.S. states. Assays were extensively validated through comparison to other known assays and internal controls. Of these 190 wastewater treatment plants, was detected in the wastewater solids of 65 of them (34.2%) with 1.45% of all samples having detectable levels of nucleic-acids. Detections varied seasonally, with 2.00% of samples positive in autumn vs 1.01% in winter ( < 0.0001). The frequency of detection in wastewater was significantly associated with states having older populations ( < 0.001), sewersheds containing more hospitals ( < 0.0001), and sewersheds containing more nursing homes ( < 0.001). These associations are in agreement with known epidemiology. This nationwide study demonstrates the viability of wastewater surveillance for surveillance and further highlights the value of wastewater surveillance when clinical testing is constrained.

IMPORTANCE

This study highlights the viability of wastewater surveillance when dealing with emerging pathogens. By leveraging an existing framework of wastewater surveillance, we reveal the widespread presence of in the United States. We further demonstrate that these wastewater detections are consistent with demographic factors relevant to epidemiology like age and number of hospitals or nursing homes. As and other pathogens continue to emerge, the low-cost and rapid nature of wastewater surveillance will provide public health officials with the information necessary to enact targeted prevention and control strategies.