Hospital Premises as a Potential Reservoir of Antimicrobial Resistance

Abstract

Soil in hospital premises can be a potential reservoir of organisms with Antimicrobial Resistance (AMR) due to their spread from hospital environment including pre-treated hospital waste. Thus, studying AMR in the soil samples from hospital premises at periodic interval could be helpful in monitoring the trend of its load and spectrum in hospital environment. Prevalence of Extended-Spectrum Beta-Lactamase (ESBL), carbapenemase and New Delhi Metallo-Beta-Lactamase (NDM) varieties of AMR were estimated in Escherichia coli and Klebsiella pneumoniae as indicator organisms in surface soil samples from hospital premises viz. hospital grounds and pedestrian tracks in relation to the pre-monsoon and post-monsoon seasons at an interval of four years between 2014 and 2018. There was significant increase in the prevalence of ESBL (mainly CTX-M variety), carbapenemase and NDM varieties of AMR in isolates from soil samples collected from hospital premises during post-monsoon season compared to pre-monsoon isolates regardless of the year of sampling although monsoon season did not affect the prevalence of AMR in clinical samples processed during the same period. There was gradual rise in resistance to other antibiotics viz. co-trimoxazole, tetracycline, fluoroquinolones and amoxyclav in soil samples collected from hospital premises during the four years interval. Prevalence of various categories of AMR were higher in samples collected during the post-monsoon season compared to prevalence in clinical isolates from hospital attending population during the corresponding period regardless of the year of sampling. Increasing prevalence of various categories of AMR recorded in hospital premises could indicate inadequate containment measures towards prevention of their spread from hospital environment warranting adaption of requisite measures for prevention.