Abstract
Healthcare-associated infections (HAIs) affect up to 15% of all hospitalized patients, representing a global concern. Major causes include the persistent microbial contamination of hospital environment, and the growing antimicrobial-resistance (AMR) of HAI-associated microbes. The hospital environment represents in fact a reservoir of potential pathogens, continuously spread by healthcare personnel, visiting persons and hospitalized patients. The control of contamination has been so far addressed by the use of chemical-based sanitation procedures, which however have limitations, as testified by the persistence of contamination itself and by the growing AMR of hospital microbes. Here we review the results collected by a microbial-based sanitation system, inspired by the microbiome balance principles, in obtaining more effective control of microbial contamination and AMR. Whatever the sanitation system used, an important aspect of controlling AMR and HAIs relates to the ability to check any variation of a microbial population rapidly and effectively, thus effective monitoring procedures are also described.
Highlights
antimicrobial resistance (AMR) is dangerous for hospital inpatients, as during hospitalization 5–15% of all hospitalized subjects acquire a so-called Healthcare Associated Infections (HAIs), which are mostly sustained by multidrug-resistant (MDR) or even pan-drug resistant microorganisms [1,2], rendering the therapeutic approach very difficult
Staphylococcus aureus, Enterobacteriaceae (Escherichia Coli, Klebsiella pneumoniae), Acinetobacter baumannii and Pseudomonas aeruginosa are some of the most common HAI-related pathogens, associated with AMR, which are known to persist for a long time in the hospital environment [6,8,11]
Based on these observations, such microorganisms have been included in a global priority pathogen list of antibiotic-resistant bacteria, released in 2017 by the World Health Organization (WHO), where the methicillin-vancomycin resistant Staphylococcus aureus strain (MRSA, VRSA) is included in the “high” priority group and carbapenem-resistant Enterobacteriaceae and Pseudomonas aeruginosa have been included in the “critical” priority group [16]
Summary
The discovery of penicillin in 1928 by Alexander Fleming, followed by continuous discovery and use of new antibiotics in the following decades, opened the so-called ‘antibiotic era’, where the management of bacteria-associated diseases was considered an obvious success, and bacterial infections as something no more representing a threaten for humans or animals. Staphylococcus aureus, Enterobacteriaceae (Escherichia Coli, Klebsiella pneumoniae), Acinetobacter baumannii and Pseudomonas aeruginosa are some of the most common HAI-related pathogens, associated with AMR, which are known to persist for a long time in the hospital environment [6,8,11]. Enterobacteriaceae producing extended-spectrum β-lactamases and carbapenemases are continuously increasing, and their associated infections are often associated with high mortality [15] Based on these observations, such microorganisms have been included in a global priority pathogen list (global PPL) of antibiotic-resistant bacteria, released in 2017 by the World Health Organization (WHO), where the methicillin-vancomycin resistant Staphylococcus aureus strain (MRSA, VRSA) is included in the “high” priority group and carbapenem-resistant Enterobacteriaceae and Pseudomonas aeruginosa have been included in the “critical” priority group [16]
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