A novel source of hospital microorganisms in healthcare settings

Background. Most healthcare-associated infections (HAI) develop due to a colonization of patients and healthcare workers by hospital strains of pathogens. The aim to study was to assess whether the dust within the health facilities can harbor microorganisms acting as a reservoir of HAIs.Materials and methods. Dust samples collected in the air ducts and ventilation grilles of health facilities underwent a detailed physicochemical analysis by means of scanning electron microscopy, dynamic light scattering, energy-dispersive X-ray spectroscopy, and high-temperature catalytic oxidation. Bacterial and viral diversity was investigated using an automated biochemical analyzer and polymerase chain reaction, respectively. Investigation of the microenvironment included detection of biofilms using a catalase indicator and quantification of viable microorganisms per 1 m3 air.Results. Dust from the hospital ventilation grilles and air ducts was contaminated with microorganisms in 71.13% of cases. Strikingly, multidrug-resistant and biofilm-forming strains have been found in 69.4% and 48.0% of samples, respectively. The total viable count before and after opening doors and windows was 276 and 462 colony-forming units/m3 respectively (p = 0.046). Biodiversity was represented by 21 genera of microorganisms which were consistently detected upon 6 months of follow-up. All samples contained a nanosized particulate matter. Chemical elements comprising dust were carbon (16.26–50.69%), oxygen (20.02–37.50%), nitrogen (1.59–25.03%), hydrogen (2.03–6.67%), sulfur (0.15–2.38%), calcium (0.19–7.49%), silicon (0.21–4.64%), chlorine (0.05–2.83%), sodium (0.07–1.86%), aluminum (0.36–1.78%), iron (0.08–1.61%), magnesium (0.11–1.40%), potassium (0.04–0.85%), and phosphorus (0.04–0.81%).Discussion. A wide range of multidrug-resistant strains of bacteria, detected in a hospital particulate matter with a diverse chemical composition, indicates the persistence of HAI-causing pathogens in the hospital environment.Conclusion. Dust from the ventilation grilles and adjacent air ducts should be considered as an additional reservoir of multidrug-resistant strains of bacteria in the healthcare settings.

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Ventilation-Associated Particulate Matter Is a Potential Reservoir of Multidrug-Resistant Organisms in Health Facilities

Life ◽

10.3390/life11070639 ◽

2021 ◽

Vol 11 (7) ◽

pp. 639

Author(s):

Evgenia Chezganova ◽

Olga Efimova ◽

Vera Sakharova ◽

Anna Efimova ◽

Sergey Sozinov ◽

...

Keyword(s):

Particulate Matter ◽

Prevalence Ratio ◽

Multidrug Resistant ◽

Viable Count ◽

Health Facilities ◽

Hospital Environment ◽

Bacterial Strains ◽

Multidrug Resistant Organisms ◽

Potential Reservoir ◽

Healthcare Associated

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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Particulate Matter in a Hospital Environment: as Potential Reservoir for Hospital Strains

Epidemiology and Vaccinal Prevention ◽

10.31631/2073-3046-2019-18-4-82-92 ◽

2019 ◽

Vol 18 (4) ◽

pp. 82-92 ◽

Cited By ~ 1

Author(s):

E. A. Chezganova ◽

O. S. Efimova ◽

S. A. Sozinov ◽

A. R. Efimova ◽

V. M. Sakharova ◽

...

Keyword(s):

Antibiotic Resistance ◽

Particulate Matter ◽

Calcium Content ◽

Multidrug Resistant ◽

Hospital Environment ◽

Scientific Debate ◽

Microbial Profiling ◽

Potential Reservoir ◽

Resistant Strains ◽

Calcium Compounds

Relevance. For decades, many aspects of aerosol transmission of hospital pathogens have been and remain the subject of scientific debate. Despite fairly detailed studies of the mechanism of microbial aerosols formation, distribution, the role of particulate matter in the formation of antibiotic resistance and multidrug-resistant hospital clones of microorganisms is still unclear. Aim. To investigate physicochemical properties and microbiological diversity of hospital particulate matter. Materials and Methods. Shape and size of particulates was assessed by means of scanning electron microscopy and dynamic light scattering while elemental analysis was performed using energy-dispersive X-ray spectroscopy and high-temperature catalytic oxidation. Microbial profiling was conducted using polymerase chain reaction and Vitek 2 biochemical analyzer. Results. Hospital particulate matter included globular and fibrillary particles consisting of carbon, oxygen, calcium, silicon, aluminium, and sulfur. Intriguingly, microfiber particles had higher oxygen and calcium content along with the lower level of carbon in mineral but not organic component. Differential localisation of silicon and calcium in elemental mapping suggested that hospital particulate matter was composed of aluminosilicate minerals and calcium compounds. Among the microorganisms, we found multidrug-resistant strains Raoultella ornithinolytica, Staphylococcus pseudintermedius, Pantoea spp., Pseudomonas aeruginosa, Enterococcus faecium and additionally Pasteurella canis in hospital particulate matter samples. Conclusions. Particulate matter in the hospital environment might be considered as a potential reservoir for the evolution of antibiotic resistance and multidrug-resistant strains.

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MRSA contamination in ambulances: a systematic review

European Journal of Public Health ◽

10.1093/eurpub/ckz186.500 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

M Fattorini ◽

C Quercioli ◽

G Messina ◽

N Nante

Keyword(s):

Systematic Review ◽

Medical Equipment ◽

Bloodstream Infections ◽

Multidrug Resistant ◽

European Countries ◽

Hospital Environment ◽

Resistant Organism ◽

Healthcare Settings ◽

Search Terms ◽

Potential Reservoir

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) is a multidrug resistant organism (MDRO) frequently involved in skin, soft tissue and bone infections. Moreover, it is one of the most frequently isolated pathogen in bloodstream infections in European countries. Because of its capacity to survive on inanimate surfaces, this microorganism could be detected not only on hospital environment, but also in other healthcare settings such as ambulances. We performed a systematic review in order to study the level of MRSA contamination in ambulances (vehicle surfaces and medical equipment). Methods In March 2019 we searched studies in PubMed using the key search terms “MRSA, ambulance”. We included different designs of studies in English. Results The research yielded 18 publications: after title, abstract and full text’s analysis, 9 manuscripts were included in this review. Studies were conducted from 2007 to 2018 in USA, Egypt, Poland, Germany and South Korea. Overall, the number of ambulances sampled for MRSA was 511 (min. 3-max. 150), and 64 (12.5%) resulted contaminated by MRSA. Sampling points examined for each vehicle varied from 5 to 33, for a total of 5872 (min. 39-max. 2136) samplings performed. The amount of MRSA positive samplings was 145/5872 (2.5%) (min. 1-max. 43). Stretcher resulted the most frequently contaminated fomite (29 of the 145 MRSA positive samplings, 20%). Conclusions Despite MRSA prevalence is decreasing in Europe, recent studies showed how this MDRO could still be responsible of a remarkable burden in terms of attributable deaths and costs. Implementing effective sanitation procedures with a continuative monitoring of the processes is highly recommended in all the healthcare settings, including ambulances. Automated terminal disinfection of these vehicles, adopting technologies such as ultraviolet germicidal irradiation or hydrogen peroxide aerosol, could reduce bacterial contamination hosted on surfaces and medical equipment. Key messages Although the percentage of isolates of MRSA in European countries is decreasing, the burden this multidrug resistant organism in terms of mortality and costs remains remarkable. Ambulances must be considered as a potential reservoir of MRSA because of its ability to survive on inanimate surfaces, and adequate sanitation procedures should be frequently performed.

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Drug Resistance Mechanism among Acinetobacter Species

Journal of Pure and Applied Microbiology ◽

10.22207/jpam.15.2.44 ◽

2021 ◽

Author(s):

S. Jayashree ◽

K.G. Rajeshwari ◽

Mita D. Wadekar

Keyword(s):

Drug Resistance ◽

Resistance Mechanism ◽

Multidrug Resistant ◽

Hospital Environment ◽

Diffusion Method ◽

Multi Drug Resistance ◽

Intrinsic Resistance ◽

Acinetobacter Species ◽

Beta Lactamases ◽

Resistant Strains

Acinetobacter species cause infections that are difficult to control due to multi-drug resistance and are noted for their intrinsic resistance to antibiotics and for their ability to acquire genes encoding resistance for the production of beta-lactamases and Aminoglycoside-modifying enzymes. MBLs are molecular class B and functional group 3 beta-lactamases which have the capability of hydrolyzing all β-lactams except the Monobactam, Aztreonam. Of several MBLs, only IMP, VIM and SIM types have been detected in these species. To analyze the antibiotic resistance patterns among Acinetobacter isolates and to detect Carbapenemase and MBL among MDR Acinetobacter isolates. The descriptive study of all phenotypically identified strains and multidrug-resistant strains of Acinetobacter species was conducted. A total of 303 isolates were isolated from various samples. They were processed and identified by standard Microbiological procedures. The antibiotics susceptibility testing was performed by Kirby- Bauer disc diffusion method using CLSI guidelines. Carbapenemase production was detected by employing 3 phenotypic test methods (MHT, CDM and DDST). Of 6355 samples processed, 303 were found to be Acinetobacter species, among those 50 were multidrug-resistant strains. The highest isolation of MDR Acinetobacter was from endotracheal tube tip (42%) and pus sample (32%). The majority of MDR Acinetobacter infection was found in male patients 36 (72%) compared to female patients 14 (28%). The majority of the strains were isolated from patients >/ 60 years of age group (%). A number of these isolates were more from ICU wards (30%) followed by Surgery wards (24%). Higher resistance for the Piperacillin/tazobactam ((82%), followed by Ceftazidime (80%), Imipenem (76%) etc. and the most susceptible drug was found to be the Tigecycline (82%) followed by Colistin (80%). Carbapenemase production was detected by MHT and 24 (48%) isolates were MHT positive. MBL production was detected by CDM and 34 (68%) isolates were CDM positive and by DDST 30 (60%) isolates were positive. Acinetobacter species are increasingly important nosocomial pathogens and are capable of rapid adaptation to the hospital environment. The variety of potential source of contamination or infection with these species in the hospital environment makes control of outbreaks caused by these difficult.

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The Diversified O-Superfamily in Californiconus californicus Presents a Conotoxin with Antimycobacterial Activity

Toxins ◽

10.3390/toxins11020128 ◽

2019 ◽

Vol 11 (2) ◽

pp. 128 ◽

Cited By ~ 1

Author(s):

Johanna Bernáldez-Sarabia ◽

Andrea Figueroa-Montiel ◽

Salvador Dueñas ◽

Karla Cervantes-Luévano ◽

Jesús Beltrán ◽

...

Keyword(s):

High Performance ◽

Reference Strain ◽

Antimycobacterial Activity ◽

Venom Gland ◽

Multidrug Resistant ◽

Rp Hplc ◽

Wide Range ◽

Resistant Strains ◽

Unique Species ◽

Strain H37rv

Californiconus californicus, previously named Conus californicus, has always been considered a unique species within cone snails, because of its molecular, toxicological and morphological singularities; including the wide range of its diet, since it is capable of preying indifferently on fish, snails, octopus, shrimps, and worms. We report here a new cysteine pattern conotoxin assigned to the O1-superfamily capable of inhibiting the growth of Mycobacterium tuberculosis (Mtb). The conotoxin was tested on a pathogen reference strain (H37Rv) and multidrug-resistant strains, having an inhibition effect on growth with a minimal inhibitory concentration (MIC) range of 3.52–0.22 μM, similar concentrations to drugs used in clinics. The peptide was purified from the venom using reverse phase high-performance liquid chromatography (RP-HPLC), a partial sequence was constructed by Edman degradation, completed by RACE and confirmed with venom gland transcriptome. The 32-mer peptide containing eight cysteine residues was named O1_cal29b, according to the current nomenclature for this type of molecule. Moreover, transcriptomic analysis of O-superfamily toxins present in the venom gland of the snail allowed us to assign several signal peptides to O2 and O3 superfamilies not described before in C. californicus, with new conotoxins frameworks.

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The Epidemiology of Multidrug-ResistantAcinetobacter BaumanniiDoes the Community Represent a Reservoir?

Infection Control and Hospital Epidemiology ◽

10.1086/502209 ◽

2003 ◽

Vol 24 (4) ◽

pp. 275-279 ◽

Cited By ~ 50

Author(s):

Cosmina Zeana ◽

Elaine Larson ◽

Jyoti Sahni ◽

S. J. Bayuga ◽

Fann Wu ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Molecular Typing ◽

Multidrug Resistant ◽

Hospital Environment ◽

Community Members ◽

Community Residents ◽

Potential Reservoir ◽

Resistance Patterns ◽

Resistant Strains

AbstractObjective:To explore the role of the community as a potential reservoir forAcinetobacter baumannii.Design:Antimicrobial resistance patterns and genotypes ofA. baumanniiisolates from patients in two Manhattan hospitals were compared with those ofA. baumanniiisolates from the hands of community members.Results:A total of 103 isolates from two hospitals (hospital A, 81; hospital B, 22) and 23 isolates from community residents were studied. Of the hospital isolates, 36.6% were multidrug resistant (hospital A, 68.2%; hospital B, 27.8%). In contrast, there were no multidrug-resistant isolates from the community (P< .005 between hospital and community). The prevalence ofA. baumanniion the hands of community residents was 10.4% (23 of 222). By molecular typing, 42 strains of A.baumanniiwere identified. Of the isolates from hospital A and hospital B, 55.6% (45 of 81) and 68.2% (15 of 22), respectively, were indistinguishable or closely related. In contrast, most community (83.3%) isolates were unrelated (P= .001 between hospital and community).Conclusion:Acinetobacterisolates from the community, characterized by a large variety of unrelated strains (83.3%), were distinct from the hospital isolates, of which 58.3% were closely related. The absence of multidrug-resistant strains in the community compared with 36.6% prevalence among hospital isolates suggests that the reservoir for epidemic strains resides in the hospital environment itself. To our knowledge, this is the first study to examine the community as a potential reservoir for hospital strains ofA. baumannii.

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Epidemic process of respiratory infections and particulate matter as a route for transmission of multidrug-resistant microorganisms in medical organisations

Fundamental and Clinical Medicine ◽

10.23946/2500-0764-2021-6-1-47-52 ◽

2021 ◽

Vol 6 (1) ◽

pp. 47-52

Author(s):

E. A. Chezganova ◽

N. V. Medvedeva ◽

V. M. Sakharova ◽

E. B. Brusina

Keyword(s):

Particulate Matter ◽

Respiratory Infections ◽

Multidrug Resistant ◽

Community Acquired Pneumonia ◽

Acute Respiratory Infections ◽

Healthcare Settings ◽

Hospitalised Patients ◽

High Prevalence ◽

Biochemical Analyzer ◽

Tract Infections

Aim. To study the trends in the prevalence of respiratory tract infections in the population of Kemerovo Region and to interrogate the particulate matter as a possible route for the transmission of multidrug-resistant microorganisms into medical organisations.Materials and Methods. We investigated the prevalence of acute respiratory infections and community-acquired pneumonia among the population of Kuzbass (Kemerovo Region) according to the offcial medical records collected from 2004 to 2020. The study included 10,320,384 cases of acute respiratory infections, 145,357 cases of community-acquired pneumonia, 344,703 hospitalisations of the adults (subjects ≥ 18 years of age) and 75,041 hospitalisations of children (< 18 years of age). Collection of particulate matter samples (n = 97) was performed using sterile gloves and containers from ventilation grilles and adjacent air ducts of the exhaust ventilation systems in various healthcare settings. Bacterial composition of the dust was examined using a VITEK 2 Compact biochemical analyzer. Viral diversity was screened by polymerase chain reaction.Results. Over the study period, respiratory infections were common in Kemerovo Region (average prevalence 22,155.9 per 100,000 population) and showed an increasing incidence. Frequency of respiratory infections among the hospitalised patients was 207.14 per 1,000, being 1.63-fold higher in children than in adults (304.15 and 186.02, respectively). In 2020, the proportion of cefotaxime-resistant Klebsiella spp. was 26.20% that was strikingly high compared to 2019. Hospital particulate matter frequently (71.13% samples) harboured multidrug-resistant microorganisms.Conclusions. High prevalence and morbidity from respiratory infections in Kemerovo Region are combined with high prevalence and biodiversity of airborne microorganisms, in particular multidrug-resistant microbes contaminating the hospital particulate matter.

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Antimicrobial use and incidence of multidrug-resistant Pseudomonas aeruginosa in a teaching hospital: an ecological approach

Revista da Sociedade Brasileira de Medicina Tropical ◽

10.1590/s0037-86822010000600005 ◽

2010 ◽

Vol 43 (6) ◽

pp. 629-632 ◽

Cited By ~ 9

Author(s):

Mariana Tresoldi das Neves ◽

Mariana Eliza Pinto de Lorenzo ◽

Ricardo Augusto Monteiro Barros Almeida ◽

Carlos Magno Castelo Branco Fortaleza

Keyword(s):

Pseudomonas Aeruginosa ◽

Teaching Hospital ◽

Observational Studies ◽

Univariate Analysis ◽

Multidrug Resistant ◽

Ecological Design ◽

Regression Analyses ◽

Ecological Studies ◽

Healthcare Settings ◽

Resistant Strains

INTRODUCTION: Multidrug-resistant Pseudomonas aeruginosa is a major threat in healthcare settings. The use of antimicrobials can influence the incidence of resistant strains by direct and indirect mechanisms. The latter can be addressed by ecological studies. METHODS: Our group attempted to analyze the relation between the use of antipseudomonal drugs and the incidence of MDR-PA among 18 units from a 400-bed teaching hospital. The study had a retrospective, ecological design, comprising data from 2004 and 2005. Data on the use of four antimicrobials (amikacin, ciprofloxacin, ceftazidime and imipenem) were tested for correlation with the incidence of MDR-PA (defined as isolates resistant to the four antimicrobials of interest) in clinical cultures. Univariate and multivariate linear regression analyses were performed. RESULTS: Significant correlations were determined between use and resistance for all antimicrobials in the univariate analysis: amikacin (standardized correlation coefficient = 0.73, p = 0.001); ciprofloxacin (0.71, p = 0.001); ceftazidime (0.61, p = 0.007) and imipenem (0.87, p < 0.001). In multivariate analysis, only imipenem (0.67, p = 0.01) was independently related to the incidence of multidrug-resistant strains. CONCLUSIONS: These findings share similarities with those reported in individual-based observational studies, with possible implications for infection control.

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Antimicrobial Stewardship: A Collaborative Partnership between Infection Preventionists and Healthcare Epidemiologists

Infection Control and Hospital Epidemiology ◽

10.1086/665037 ◽

2012 ◽

Vol 33 (4) ◽

pp. 328-330 ◽

Cited By ~ 19

Author(s):

Julia Moody ◽

Sara E. Cosgrove ◽

Russell Olmsted ◽

Edward Septimus ◽

Kathy Aureden ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Multidrug Resistant ◽

Therapeutic Benefit ◽

Therapeutic Agents ◽

Collaborative Partnership ◽

Inappropriate Use ◽

Healthcare Settings ◽

Cross Transmission ◽

Resistant Strains ◽

Infection Preventionists

Misuse and overuse of antimicrobials, primarily involving therapeutic agents used to treat infection in humans, is considered one of the world's most pressing public health problems. Not only does such inappropriate use diminish the therapeutic benefit of essential medications, it also facilitates the development and spread of multidrug-resistant organisms (MDROs). Antimicrobial resistance and the rise in MDROs globally are associated with increased morbidity and mortality, cross-transmission within and between healthcare settings, and increased consumption of limited patient-care resources. Despite elevated awareness, publication of guidelines on antimicrobial stewardship, and several initiatives, the proportion of resistant strains causing both health care- and community-associated infections continues to increase and the number of new antimicrobials continues to decline.

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