Horizontal Transfer of Antibiotic Resistance Genes on Abiotic Touch Surfaces: Implications for Public Health
ABSTRACTHorizontal gene transfer (HGT) is largely responsible for increasing the incidence of antibiotic-resistant infections worldwide. While studies have focused on HGTin vivo, this work investigates whether the ability of pathogens to persist in the environment, particularly on touch surfaces, may also play an important role.Escherichia coli, virulent clone ST131, andKlebsiella pneumoniaeharboring extended-spectrum-β-lactamase (ESBL)blaCTX-M-15and metallo-β-lactamaseblaNDM-1, respectively, exhibited prolonged survival on stainless steel, with approximately 104viable cells remaining from an inoculum of 107 CFU per cm2after 1 month at 21°C. HGT ofblato an antibiotic-sensitive but azide-resistant recipientE. colistrain occurred on stainless steel dry touch surfaces and in suspension but not on dry copper. The conjugation frequency was approximately 10 to 50 times greater and occurred immediately, and resulting transconjugants were more stable with ESBLE. colias the donor cell than withK. pneumoniae, butblaNDM-1transfer increased with time. Transconjugants also exhibited the same resistance profile as the donor, suggesting multiple gene transfer. Rapid death, inhibition of respiration, and destruction of genomic and plasmid DNA of both pathogens occurred on copper alloys accompanied by a reduction inblacopy number. NakedE. coliDNA degraded on copper at 21°C and 37°C but slowly at 4°C, suggesting a direct role for the metal. Persistence of viable pathogenic bacteria on touch surfaces may not only increase the risk of infection transmission but may also contribute to the spread of antibiotic resistance by HGT. The use of copper alloys as antimicrobial touch surfaces may help reduce infection and HGT.IMPORTANCEHorizontal gene transfer (HGT) conferring resistance to many classes of antimicrobials has resulted in a worldwide epidemic of nosocomial and community infections caused by multidrug-resistant microorganisms, leading to suggestions that we are in effect returning to the preantibiotic era. While studies have focused on HGTin vivo, this work investigates whether the ability of pathogens to persist in the environment, particularly on touch surfaces, may also play an important role. Here we show prolonged (several-week) survival of multidrug-resistantEscherichia coliandKlebsiella pneumoniaeon stainless steel surfaces. Plasmid-mediated HGT of β-lactamase genes to an azide-resistant recipientE. colistrain occurred when the donor and recipient cells were mixed together on stainless steel and in suspension but not on copper surfaces. In addition, rapid death of both antibiotic-resistant strains and destruction of plasmid and genomic DNA were observed on copper and copper alloy surfaces, which could be useful in the prevention of infection spread and gene transfer.