Abstract
Hospital-built environment colonization by healthcare-associated infections-related bacteria (HAIrB) and the interaction with their occupants have been studied to support more effective tools for HAI control. To investigate HAIrB dynamics and antimicrobial resistance (AMR) profile we carried out a 6-month surveillance program in a developing country public hospital, targeting patients, hospital environment, and healthcare workers, using culture-dependent and culture-independent 16S rRNA gene sequencing methods. The bacterial abundance in both approaches shows that the HAIrB group has important representativeness, with the taxa Enterobacteriaceae, Pseudomonas, Staphylococcus, E. coli, and A. baumannii widely dispersed and abundant over the time at the five different hospital units included in the survey. We observed a high abundance of HAIrB in the patient rectum, hands, and nasal sites. In the healthcare workers, the HAIrB distribution was similar for the hands, protective clothing, and mobile phones. In the hospital environment, the healthcare workers resting areas, bathrooms, and bed equipment presented a wide distribution of HAIrB and AMR, being classified as contamination hotspots. AMR is highest in patients, followed by the environment and healthcare workers. The most frequently detected beta-lactamases genes were, blaSHV–like, blaOXA–23–like, blaOXA–51–like, blaKPC–like, blaCTX–M–1, blaCTX–M–8, and blaCTX–M–9 groups. Our results demonstrate that there is a wide spread of antimicrobial resistance due to HAIrB in the hospital environment, circulating among patients and healthcare workers. The contamination hotspots identified proved to be constant over time. In the fight for patient safety, these findings can reorient practices and help to set up new guidelines for HAI control.
Highlights
Healthcare-associated infections (HAI) are important public health threats of particular concern in the developing world, requiring continuous monitoring and the improvement of surveillance programs (Allegranzi et al, 2011; WHO, 2011).HAI can seriously affect patient’s health, promoting long-term hospital stays and increasing mortality, besides rising costs for the healthcare system (Osme et al, 2020)
For some analyzes we focus on a bacteria group that have been largely related to HAI in developing countries, that we call HAI-related bacteria (HAIrB): Acinetobacter baumannii, Burkholderia cepacia, Escherichia coli, Enterococcus faecium, Enterococcus faecalis, Enterobacter, Enterobacteriaceae, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus mirabilis, and Serratia marcescens
In the healthcare workers (HCW), despite the high abundance of total bacteria in the protective clothing, the median distribution of HAIrB was similar for the hands, clothing and mobile phones
Summary
Healthcare-associated infections (HAI) are important public health threats of particular concern in the developing world, requiring continuous monitoring and the improvement of surveillance programs (Allegranzi et al, 2011; WHO, 2011).HAI can seriously affect patient’s health, promoting long-term hospital stays and increasing mortality, besides rising costs for the healthcare system (Osme et al, 2020). Microbiome studies using high-throughput sequencing (HTS) methodologies have been conducted in health institutions (Lax et al, 2017; Christoff et al, 2020) and can elucidate important questions about HAI These studies have been especially interested in the profile and interaction of microbial communities of the built environment, in addition to understanding the role of healthcare setting actors (patients, HCW, and the environment) in HAI spread. In this scenario, adoption of surveillance programs based on new technologies associated with the rational use of antimicrobials can allow effective HAI control management (Fournier et al, 2013; Tang et al, 2017; Christoff et al, 2019)
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