Plasmids and Bacterial Strains Mediating Multidrug-Resistant Hospital-Acquired Infections Are Coresidents of the Hospital Environment

Most healthcare-associated infections (HCAIs) develop due to the colonisation of patients and healthcare workers by multidrug-resistant organisms (MDRO). Here, we investigated whether the particulate matter from the ventilation systems (Vent-PM) of health facilities can harbour MDRO and other microbes, thereby acting as a potential reservoir of HCAIs. Dust samples collected in the ventilation grilles and adjacent air ducts underwent a detailed analysis of physicochemical properties and biodiversity. All Vent-PM samples included ultrafine PM capable of reaching the alveoli. Strikingly, >70% of Vent-PM samples were contaminated, mostly by viruses (>15%) or multidrug-resistant and biofilm-producing bacterial strains (60% and 48% of all bacteria-contaminated specimens, respectively). Total viable count at 1 m from the ventilation grilles was significantly increased after opening doors and windows, indicating an association between air flow and bacterial contamination. Both chemical and microbial compositions of Vent-PM considerably differed across surgical vs. non-surgical and intensive vs. elective care units and between health facilities located in coal and chemical districts. Reduced diversity among MDRO and increased prevalence ratio in multidrug-resistant to the total Enterococcus spp. in Vent-PM testified to the evolving antibiotic resistance. In conclusion, we suggest Vent-PM as a previously underestimated reservoir of HCAI-causing pathogens in the hospital environment.

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Evolution of Acinetobacter baumannii infections and antimicrobial resistance. A review

Central European Journal of Clinical Research ◽

10.2478/cejcr-2019-0005 ◽

2019 ◽

Vol 2 (1) ◽

pp. 28-36

Author(s):

Sonia Elena Popovici ◽

Ovidiu Horea Bedreag ◽

Dorel Sandesc

Keyword(s):

Antimicrobial Agents ◽

Resistance Mechanisms ◽

Hospital Environment ◽

Medical Community ◽

Molecular Testing ◽

Medical Systems ◽

Antimicrobial Drugs ◽

Hospital Acquired Infections ◽

Acinetobacter Spp ◽

Hospital Acquired

AbstractThe emergence of multi-drug resistantAcinetobacter sppinvolved in hospital-acquired infections, once considered an easily treatable pathogen, is troublesome and an immense burden for the modern medical systems worldwide. In the last 20 years the medical community recorded an increase in the incidence and severity of these infections as therapeutic means tend to be less and less effective on these strains. The ability of these bacteria to rapidly develop resistance to antimicrobial agents by continuously changing and adapting their mechanisms, their ability to survive for long periods of time in the hospital environment and the multitude of transmission possibilities raises serious issues regarding the management of these complex infections. The future lies in developing new and targeted methods for the early diagnosis ofA. baumannii, as well as in the judicious use of antimicrobial drugs. This review details the evolution of the pathogenicity of this microorganism, together with the changes that appeared in resistance mechanisms and the advancements in molecular testing for the early detection of infection.

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Complete Genome Sequence of Klebsiella pneumoniae Phage Sweeny

Microbiology Resource Announcements ◽

10.1128/mra.01047-19 ◽

2019 ◽

Vol 8 (39) ◽

Cited By ~ 1

Author(s):

Nicholas Martinez ◽

Eric Williams ◽

Heather Newkirk ◽

Mei Liu ◽

Jason J. Gill ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Complete Genome Sequence ◽

Protein Level ◽

Multidrug Resistant ◽

Content Type ◽

Hospital Acquired Infections ◽

Multidrug Resistant Bacterium ◽

Protein Encoding ◽

Hospital Acquired ◽

Encoding Genes

Klebsiella pneumoniae is a multidrug-resistant bacterium causing many severe hospital-acquired infections. Here, we describe siphophage Sweeny that infects K. pneumoniae. Of its 78 predicted protein-encoding genes, a functional assignment was given to 36 of them. Sweeny is most closely related to T1-like phages at the protein level.

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Hospital-acquired infections due to multidrug-resistant organisms in Hungary, 2005-2010

Eurosurveillance ◽

10.2807/ese.18.02.20352-en ◽

2013 ◽

Vol 18 (2) ◽

Author(s):

S Caini ◽

A Hajdu ◽

A Kurcz ◽

K Böröcz

Keyword(s):

Infection Control ◽

Multidrug Resistant ◽

Special Focus ◽

Gram Negative ◽

Hospital Acquired Infections ◽

Health Authorities ◽

Multidrug Resistant Organisms ◽

Public Health Authorities ◽

Gram Negative Organisms ◽

Hospital Acquired

Healthcare-associated infections caused by multidrug-resistant organisms are associated with prolonged medical care, worse outcome and costly therapies. In Hungary, hospital-acquired infections (HAIs) due to epidemiologically important multidrug-resistant organisms are notifiable by law since 2004. Overall, 6,845 case-patients (59.8% men; median age: 65 years) were notified in Hungary from 2005 to 2010. One third of case-patients died in hospital. The overall incidence of infections increased from 5.4 in 2005 to 14.7 per 100,000 patient-days in 2010. Meticillin-resistant Staphylococcus aureus (MRSA) was the most frequently reported pathogen (52.2%), but while its incidence seemed to stabilise after 2007, notifications of multidrug-resistant Gram-negative organisms have significantly increased from 2005 to 2010. Surgical wound and bloodstream were the most frequently reported sites of infection. Although MRSA incidence has seemingly reached a plateau in recent years, actions aiming at reducing the burden of HAIs with special focus on Gram-negative multidrug-resistant organisms are needed in Hungary. Continuing promotion of antimicrobial stewardship, infection control methodologies, reinforced HAI surveillance among healthcare and infection control practitioners, and engagement of stakeholders, hospital managers and public health authorities to facilitate the implementation of existing guidelines and protocols are essential.

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In Vitro Antifungal Combination of Flucytosine with Amphotericin B, Voriconazole, or Micafungin against Candida auris Shows No Antagonism

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01393-19 ◽

2019 ◽

Vol 63 (12) ◽

Cited By ~ 8

Author(s):

A. L. Bidaud ◽

F. Botterel ◽

A. Chowdhary ◽

E. Dannaoui

Keyword(s):

Amphotericin B ◽

Inhibitory Concentration ◽

Geometric Mean ◽

Multidrug Resistant ◽

Candida Auris ◽

Content Type ◽

Hospital Acquired Infections ◽

Resistant Mutants ◽

Hospital Acquired

ABSTRACT Candida auris is an emerging, multidrug-resistant pathogen responsible for invasive hospital-acquired infections. Flucytosine is an effective anti-Candida species drug, but which cannot be used as a monotherapy because of the risk of development of resistant mutants during treatment. It is, therefore, noteworthy to test possible combinations with flucytosine that may have a synergistic interaction. In this study, we determined the in vitro interaction between flucytosine and amphotericin B, micafungin, or voriconazole. These combinations have been tested against 15 C. auris isolates. The MIC ranges (geometric mean [Gmean]) of flucytosine, amphotericin B, micafungin, and voriconazole were 0.125 to 1 μg/ml (0.42 μg/ml), 0.25 to 1 μg/ml (0.66 μg/ml), 0.125 to 0.5 μg/ml (0.3 μg/ml), and 0.03 to 4 μg/ml (1.05 μg/ml), respectively. When tested in combination, indifferent interactions were mostly observed with fractional inhibitory concentration index values from 0.5 to 1, 0.31 to 1.01, and 0.5 to 1.06 for the combinations of flucytosine with amphotericin B, micafungin, and voriconazole, respectively. A synergy was observed for the strain CBS 10913 from Japan. No antagonism was observed for any combination. The combination of flucytosine with amphotericin B or micafungin may be relevant for the treatment of C. auris infections.

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Avoiding ventilator-associated pneumonia: Curcumin-functionalized endotracheal tube and photodynamic action

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.2006759117 ◽

2020 ◽

Vol 117 (37) ◽

pp. 22967-22973

Author(s):

Amanda C. Zangirolami ◽

Lucas D. Dias ◽

Kate C. Blanco ◽

Carolina S. Vinagreiro ◽

Natalia M. Inada ◽

...

Keyword(s):

Endotracheal Tube ◽

Bacterial Infections ◽

Bacterial Resistance ◽

Multidrug Resistant ◽

Resistant Bacteria ◽

Ventilator Associated Pneumonia ◽

Hospital Acquired Infection ◽

Hospital Acquired Infections ◽

Hospitalization Costs ◽

Hospital Acquired

Hospital-acquired infections are a global health problem that threatens patients’ treatment in intensive care units, causing thousands of deaths and a considerable increase in hospitalization costs. The endotracheal tube (ETT) is a medical device placed in the patient’s trachea to assist breathing and delivering oxygen into the lungs. However, bacterial biofilms forming at the surface of the ETT and the development of multidrug-resistant bacteria are considered the primary causes of ventilator-associated pneumonia (VAP), a severe hospital-acquired infection for significant mortality. Under these circumstances, there has been a need to administrate antibiotics together. Although necessary, it has led to a rapid increase in bacterial resistance to antibiotics. Therefore, it becomes necessary to develop alternatives to prevent and combat these bacterial infections. One possibility is to turn the ETT itself into a bactericide. Some examples reported in the literature present drawbacks. To overcome those issues, we have designed a photosensitizer-containing ETT to be used in photodynamic inactivation (PDI) to avoid bacteria biofilm formation and prevent VAP occurrence during tracheal intubation. This work describes ETT’s functionalization with curcumin photosensitizer, as well as its evaluation in PDI against Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli. A significant photoinactivation (up to 95%) against Gram-negative and Gram-positive bacteria was observed when curcumin-functionalized endotracheal (ETT-curc) was used. These remarkable results demonstrate this strategy’s potential to combat hospital-acquired infections and contribute to fighting antimicrobial resistance.

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Characterization of the Enterobacter Phage vB_EclM_CIP9

Microbiology Resource Announcements ◽

10.1128/mra.01600-19 ◽

2020 ◽

Vol 9 (13) ◽

Author(s):

Klara Wang ◽

Marielou G. Tamayo ◽

Tiffany V. Penner ◽

Bradley W. M. Cook ◽

Deborah A. Court ◽

...

Keyword(s):

Enterobacter Cloacae ◽

Opportunistic Pathogen ◽

Multidrug Resistant ◽

Open Reading Frames ◽

Resistant Isolate ◽

Content Type ◽

Hospital Acquired Infections ◽

Hospital Acquired ◽

Reading Frames

Enterobacter cloacae is an opportunistic pathogen that causes hospital-acquired infections in immunocompromised patients. Here, we describe vB_EclM_CIP9, a novel Enterobacter phage that infects a multidrug-resistant isolate of E. cloacae. Phage vB_EclM_CIP9 is a myovirus that has a 174,924-bp genome, with 296 predicted open reading frames.

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In Vitro Activity of Pentamidine Alone and in Combination with Antibiotics against Multidrug-Resistant Clinical Pseudomonas aeruginosa Strains

Antibiotics ◽

10.3390/antibiotics9120885 ◽

2020 ◽

Vol 9 (12) ◽

pp. 885

Author(s):

Soraya Herrera-Espejo ◽

Tania Cebrero-Cangueiro ◽

Gema Labrador-Herrera ◽

Jerónimo Pachón ◽

María Eugenia Pachón-Ibáñez ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Public Health Problem ◽

Multidrug Resistant ◽

Vitro Activity ◽

Synergistic Activity ◽

In Vitro Activity ◽

Hospital Acquired Infections ◽

Time Kill ◽

Hospital Acquired

Multidrug-resistant (MDR) Pseudomonas aeruginosa is a public health problem causing both community and hospital-acquired infections, and thus the development of new therapies for these infections is critical. The objective of this study was to analyze in vitro the activity of pentamidine as adjuvant in combinations to antibiotics against seven clinical P. aeruginosa strains. The Minimum Inhibitory Concentration (MIC) was determined following standard protocols, and the results were interpreted according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints; however, the gentamicin activity was interpreted according to the Clinical and Laboratory Standards Institute (CLSI) recommendations. The bactericidal in vitro activity was studied at 1×MIC concentrations by time–kill curves, and also performed in three selected strains at 1/2×MIC of pentamidine. All studies were performed in triplicate. The pentamidine MIC range was 400–1600 μg/mL. Four of the strains were MDR, and the other three were resistant to two antibiotic families. The combinations of pentamidine at 1×MIC showed synergistic activity against all the tested strains, except for pentamidine plus colistin. Pentamidine plus imipenem and meropenem were the combinations that showed synergistic activity against the most strains. At 1/2×MIC, pentamidine plus antibiotics were synergistic with all three analyzed strains. In summary, pentamidine in combination with antibiotics showed in vitro synergy against multidrug-resistant P. aeruginosa clinical strains, which suggests its possible use as adjuvant to antibiotics for the therapy of infections from MDR P. aeruginosa.

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Molecular Analysis of VanA Outbreak ofEnterococcus faeciumin Two Warsaw Hospitals: The Importance of Mobile Genetic Elements

BioMed Research International ◽

10.1155/2014/575367 ◽

2014 ◽

Vol 2014 ◽

pp. 1-12 ◽

Cited By ~ 19

Author(s):

Ewa Wardal ◽

Katarzyna Markowska ◽

Dorota Żabicka ◽

Marta Wróblewska ◽

Małgorzata Giemza ◽

...

Keyword(s):

Insertion Sequence ◽

Molecular Data ◽

Multidrug Resistant ◽

Common Source ◽

Hospital Acquired Infections ◽

Vancomycin Resistant ◽

Clonal Variability ◽

Almost All ◽

Hospital Acquired ◽

Vntr Analysis

Vancomycin-resistantEnterococcus faeciumrepresents a growing threat in hospital-acquired infections. Two outbreaks of this pathogen from neighboring Warsaw hospitals have been analyzed in this study. Pulsed-field gel electrophoresis (PFGE) ofSmaI-digested DNA, multilocus VNTR analysis (MLVA), and multilocus sequence typing (MLST) revealed a clonal variability of isolates which belonged to three main lineages (17, 18, and 78) of nosocomialE. faecium. All isolates were multidrug resistant and carried several resistance, virulence, and plasmid-specific genes. Almost all isolates shared the same variant of Tn1546transposon, characterized by the presence of insertion sequence ISEf1and a point mutation in thevanAgene. In the majority of cases, this transposon was located on 50 kb or 100 kb pRUM-related plasmids, which lacked, however, theaxe-txetoxin-antitoxin genes. 100 kb plasmid was easily transferred by conjugation and was found in various clonal backgrounds in both institutions, while 50 kb plasmid was not transferable and occurred solely in MT159/ST78 strains that disseminated clonally in one institution. Although molecular data indicated the spread of VRE between two institutions or a potential common source of this alert pathogen, epidemiological investigations did not reveal the possible route by which outbreak strains disseminated.

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Knowledge, Attitude and Practice of nursing students on Hospital Acquired Infections in Western region of Nepal

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v12i3.16012 ◽

2016 ◽

Vol 12 (3) ◽

pp. 103-107 ◽

Cited By ~ 3

Author(s):

Ishwari Sharama Paudel ◽

Vivek Ghosh ◽

Purushottam Adhikari

Keyword(s):

Nursing Students ◽

Hand Hygiene ◽

Hospital Environment ◽

Good Knowledge ◽

Healthcare Team ◽

Western Region ◽

Hospital Acquired Infections ◽

Attitude And Practice ◽

Hospital Acquired ◽

Knowledge Attitude And Practice

Background & Objectives: Hospital-acquired infections (HAIs) are a common problem and challenge faced by hospitals in all countries around the world. Nurses are an important part of the healthcare team that plays a unique role in the control of HAIs. Compliance on the part of healthcare workers (HCWs) including nurses with standard precautions has been recognized as being an efficient means to prevent and control HAIs. The present study was conducted with objective of understanding the level of Knowledge, attitude and practice (KAP) regarding HAIs among nursing students in the Western Region of Nepal.Materials & Methods: This descriptive cross-sectional study was conducted among nursing students posted in different wards of two hospitals of Pokhara. A self administered questionnaire containing different set of questions regarding knowledge, attitude and practice on HAI were used for data collection.Results: Among the total participants in the study 97% of the participants considered that prevention of HAIs were a valuable part of nurses’ role but only 89% had received formal training regarding hand hygiene. The results show that 74% of the participants had good knowledge regarding HAIs. 82% of the participants felt that they would be less likely to transmit infection to the patient if they performed hand-hygiene. 66% of them identified that hand hygiene agents were not readily available in current settings. Regarding practice, only 6% performed hand hygiene before patient contact.Conclusion: The nursing students had good knowledge regarding HAIs that was reflected in their attitude and practice on hand hygiene for the prevention of HAIs. However there is the need of regular training and performance feedback regarding hand hygiene and the hospital environment should be hand-hygiene friendly with easily accessible to sinks and other facilities.

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