Resistance In Healthcare Facilities Research Articles

Biofilms, mobile genetic elements and the persistence of pathogens on environmental surfaces in healthcare and food processing environments.

Biofilms are the natural state for bacterial and fungal species. To achieve surface hygiene in commercial facilities, the presence of biofilms must be adequately considered. However, standard disinfectant and sanitizer efficacy tests required by the US-EPA and the European Committee for Standardization (CEN) do not currently consider the role of environmental biofilms. This selective review will discuss what biofilms are and why they are important. We will also cover where they are commonly found in healthcare and food processing facilities and explore how current antimicrobial test methods required for product registration do not test for the presence of biofilms. Additionally, we will explore how a lack of efficacy against biofilms may play a role in the development of antimicrobial resistance in healthcare facilities due to the exchange of mobile genetic elements that occur readily in a biofilm matrix.

Phenomics and genomic features of Enterococcus avium IRMC1622a isolated from a clinical sample of hospitalized patient

BackgroundEnterococcus avium (E. avium) is a Gram-positive nosocomial pathogen that is commonly isolated from the alimentary tract. The objective of this functional genomics study was to identify the resistant genes by analyzing the genome of E. avium IRMC1622a, a type of bacteria found in feces collected from a patient at a Saudi Arabian tertiary hospital. MethodsThe bacterial strain IRMC1622a was identified by 16 S rRNA sequencing as Enterococcus sp. The resistance phenomics were performed using VITEK® 2, and morphological analysis was achieved using a scanning electron microscope (SEM). Finally, the whole bacterial genome of the bacterial strain IRMC1622a was subjected to sequencing during October 2023 using Oxford Nanopore long-read sequencing technology, and mining for resistant genes. ResultsThe results of antimicrobial resistant phenomics indicated that the IRMC1622a strain was sensitive to all tested antimicrobial agents except for erythromycin, and the same result was confirmed by genomic analysis in addition to other classes of antibiotics. SEM showed E. avium IRMC1622a is ovoid shape, in single cells (L 1.2797 ± 0.1490 µm), in pairs (L 1.7333 ± 0.1054 µm), and in chains (L 2.44033 ± 0.1978 µm). The E. avium IRMC1622a genome has 14 (in CARD) antimicrobial resistance genes that were identified with several mechanisms of antimicrobial resistance, such as the efflux pump and conferring antibiotic resistance. The present study revealed that the E. avium IRMC1622a genome contains a high number of genes associated with virulence factors, and 14 matched pathogenic protein families and predicted as human pathogen (probability score 0.855). We report two (ISEnfa4 and ISEfa5) mobile genetic elements for the first time in the E. avium genome. ConclusionsThe study concludes that E. avium IRMC1622a is susceptible to all tested antibacterials except erythromycin. The IRMC1622a has 14 genes encoding antimicrobial resistance mechanisms, including the efflux pump and conferring antibiotic resistance. This could indicate a potential rise in E. avium resistance in healthcare facilities. These observations may raise concerns regarding E. avium resistance in healthcare. We need more research to understand the pathophysiology of E. avium, which leads to hospital-acquired infections.

Antimicrobial susceptibility pattern and mupirocin resistance among methicillin-resistant Staphylococcus aureus isolated from skin and soft-tissue infection patients attending a tertiary care hospital in North India

Background: Antimicrobial susceptibility among bacterial isolates varies from center to center. Mupirocin is a topical antibacterial antibiotic used to treat wound infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Aim and Objectives: This study was conducted to know the prevalence of high and low levels of mupirocin resistance along with antimicrobial susceptibility in MRSA isolates from skin and soft-tissue infection in patients admitted to a tertiary care hospital in North India. Materials and Methods: A total of 97 non-repetitive isolates of MRSA from various pus samples over a period of 1 year were included in this study. These strains were identified as per standard laboratory protocols given by the Clinical Laboratory Standards Institute. High- and low-level mupirocin resistance of the isolates was tested by using mupirocin discs of 200 μg and 5 μg, respectively. Mupirocin strips of 256 μg and 512 μg were used for the E-test to detect low-level and high-level mupirocin resistance, respectively. The isolates were reported as sensitive to mupirocin, with minimum inhibitory concentrations of <4 mg/L. Results: Overall, 9.27% of mupirocin resistance was found, of which 2.06% of isolates were high-level resistant to mupirocin, while 7.21% had low-level resistance. All MRSA strains were susceptible to vancomycin, followed by linezolid (94.84%), teicoplanin (91.75%), and fusidic acid (88.65%). Conclusion: Regular monitoring, good infection control practices, and proper awareness about utilizing mupirocin therapeutically and prophylactically may help prevent the emergence of mupirocin resistance in health-care facilities.

Knowledge and Perception of Healthcare Workers about Safe Water Supplies and Antibiotic-Resistant Bacteria at Primary Health Care Facilities in Gaza, Palestine

Background: While concerns about the spread of Antimicrobial resistance (AMR) in HCF have long been identified, the links with environmental issues - such as water, sanitation, and hygiene (WASH) - are much less well understood. Indeed, misperceptions of links between WASH and AMR are identified as one of the hindrances of infection control programs. This study assessed the gap in knowledge in healthcare facilities (HCFs), by analyzing the perceptions of healthcare workers. Methods: A cross-sectional survey was conducted in governmental primary healthcare facilities in Gaza, Palestine between April and August 2022. Out of 1802 workers, 322 were randomly recruited to fill out a self-administer questionnaire. The workers were representing both genders (50.3% females) and aged between (19- 60 years). Data was analyzed using Statistical Package for Social Sciences (SPSS) software, version 23. Results: About half of the respondents (52.5%) did not know what the “WASH” term stands for, and nearly a quarter (22.7%) were unable to define AMR bacteria correctly. The perception of water safety was higher for domestic (66.1%) than for drinking water (54.7%) with a lower perception among females (p value=0.005) and medical staff (p value=0.000). At HCFs, only 40.7% of respondents had the perception that regular water safety monitoring occurs and 30.4% declared that water pollution was reported at their facilities. Only 20.0% of health workers think that they play a role in monitoring water safety and 24.8% think that they play a role in preventing and controlling AMR bacteria. Conclusion: Hybrid educational and awareness programs about water safety and prevention of AMR bacteria need to be implemented within the context of the One Health approach. The investment in WASH infrastructure at HCFs requires parallel investment in capacity building and raising awareness of workers.

Biofilm aggravates antibiotic resistance

It is possible for a variety of bacteria, including pathogens, to form biofilms, which serve as a mechanism for these organisms to defend themselves against antimicrobial agents in the environment.In order to explain this phenomenon of resistance within biofilms, several mechanisms have been proposed.These include delayed penetration of the antimicrobial into the biofilm extracellular matrix, slowing of the growth rate of organisms within the biofilm, and other physiologic changes brought about by interaction of the organisms with a surface.The existence of bacteria within a self-produced polymeric matrix, known as a biofilm, is another old survival strategy that is still used to this day. Biofilms, in a similar way, enable bacteria to adapt to their environment and promote the transfer of antibiotic resistance genes between different bacterial species.Because of its ability to spread antibiotic resistance genes as well as its innate phenotypic tolerance to antibiotics, biofilm must be considered synonymous with antibiotic resistance. Despite the fact that environmental biofilm does not fall under the current definition of antimicrobial stewardship, increased awareness of the existence, prevalence, and consequences of environmental biofilm among healthcare practitioners is critical to improving hygiene practises and preventing the emergence and spread of antibiotic resistance in healthcare facilities.

BIOFILMS AND ANTIBIOTIC RESISTANCE

<p>The physician and health practitioner’s attention and alertness to biofilm existence and the consequences of biofilm in the biotic and abiotic environment are important to improve hygiene practice, rational antibiotic prescription, controlling the spread and emergence of emergency antibiotic resistance in healthcare facilities and community. The majority of chronic persistence and recurrent infection because of antibiotic resistance is biofilm infection, so needed precision and power alternative approach of management and therapy.</p>

Polyphasic characterization of carbapenem-resistant Klebsiella pneumoniae clinical isolates suggests vertical transmission of the blaKPC-3 gene.

Carbapenem-resistant Klebsiella pneumoniae are a major global threat in healthcare facilities. The propagation of carbapenem resistance determinants can occur through vertical transmission, with genetic elements being transmitted by the host bacterium, or by horizontal transmission, with the same genetic elements being transferred among distinct bacterial hosts. This work aimed to track carbapenem resistance transmission by K. pneumoniae in a healthcare facility. The study involved a polyphasic approach based on conjugation assays, resistance phenotype and genotype analyses, whole genome sequencing, and plasmid characterization by pulsed field gel electrophoresis and optical DNA mapping. Out of 40 K. pneumoniae clinical isolates recovered over two years, five were carbapenem- and multidrug-resistant and belonged to multilocus sequence type ST147. These isolates harboured the carbapenemase encoding blaKPC-3 gene, integrated in conjugative plasmids of 140 kbp or 55 kbp, belonging to replicon types incFIA/incFIIK or incN/incFIIK, respectively. The two distinct plasmids encoding the blaKPC-3 gene were associated with distinct genetic lineages, as confirmed by optical DNA mapping and whole genome sequence analyses. These results suggested vertical (bacterial strain-based) transmission of the carbapenem-resistance genetic elements. Determination of the mode of transmission of antibiotic resistance in healthcare facilities, only possible based on polyphasic approaches as described here, is essential to control resistance propagation.

Molecular characterization and distribution of cephalosporin resistance determinants in Escherichia coli and Klebsiella pneumoniae isolated from patients attending Kampala International University Teaching Hospital in Bushenyi, Western Uganda

ABSTRACT Cephalosporins are the first-line therapy antibiotics used in the treatment of gram-negative bacterial infections. However, high prevalence of cephalosporins resistance in Klebsiella pneumoniae and Escherichia coli has been reported worldwide. Studies conducted in Uganda reported high incidences of cephalosporin resistance (CR). Successive studies at Mulago National Referral Hospital indicated a decline in the resistance levels pointing to the need for regular antibiotic resistance surveillance. Therefore, this study carried out molecular characterization of CR determinants in E. coli and K. pneumoniae isolated from patients attending Kampala International University Teaching Hospital (KIU-TH). A retrospective study using E. coli and K. pnuemoniae samples previously obtained from surgical wounds and urinary tract infections among patients treated at KIU-TH between September 2016 and August 2018 was conducted. Biochemical assays were used to confirm the identity of the samples. Combined disc and boronic acid assays were used to determine the cephalosporine resistance profile of the isolates. Multiplex PCR amplification was used to characterize the extended spectrum beta-lactmase (ESBL) encoding genes. The study revealed that E. coli (130/81.2%) isolates were more predominant than K. pneumoniae (30/18.8%) among the archived samples. K. pneumoniae showed the highest phenotypic resistance with a mean prevalence of 90.6% but comparable to that of E. coli (89.3%). Of the 160 isolates screened, 105 (65.6%) were ESBL producers. Multiplex PCR revealed that the most predominant ESBL encoding gene was bla SHV at a prevalence of 42.0%, followed by bla TEM at 27.3%, bla CTX-M at 22.4% and bla CTX-M-15 at 8.4%. The incidence of phenotypic resistance and distribution of ESBL genes were significantly higher in patients of Ishaka division. Our study reports a high prevalence of cephalosporin-resistant E. coli and K. pnuemoniae isolated from patients attending KIU-TH and highlights the need for routine screening of antimicrobial resistance in health-care facilities so as to guide clinicians on the rational prescription of antibiotics. List of abbreviations: ATCC: American Type Culture Collection; ESBL: extended spectrum beta-lactmases; AmpC: aminopenicillin cephalosporinase; CTX-M: cephotaxime (M-first detected in Munich) hydrolyzing capabilities; CTX-M-U: cephotaxime hydrolyzing capabilities gene Universal primer; SHV: sulfhydryl variables (variant-2); CMY-2: cephamycins (variant-2); TEM: temoneira; ACT-1: AmpC type (variant-1); Bla: Beta lactam; DNA: deoxyribonucleic acid; PCR: Polymerase chain reaction; MNRH: Mulago National Referral Hospital; MRRH: Mbarara Regional Referral Hospital; KRRH: Kabale Regional Referral Hospital (KRRH); KIU-TH: Kampala International University Teaching Hospital; CDL: Central Diagnostic Laboratory; CoVAB: College of Veterinary Medicine, Animal Resources and Biosecurity; CR: cephalosporin resistance

New trends of nanofluids to combat Staphylococcus aureus in clinical isolates

Methicillin-resistant Staphylococcus aureus (MRSA), multi-drug-resistant (MDR) Staphylococcus aureus and sensitive Staphylococcus aureus were selected for this study to check the antibacterial effects of gold nanoparticles and drug-conjugated gold nanoparticles to overcome the emerging drug resistance. Culture and purification of selected bacterial isolates, drug profiling, minimum inhibitory concentration, preparation of gold salt solution, preparation of drug-conjugated gold nanoparticles and susceptibility pattern by well diffusion assay and disk diffusion method is performed to evaluate the results. MRSA (sample MBH-2), sensitive strain (sample MBH-3) and MDR strain (sample MBH-1) showed different patterns of susceptibility. We analyzed that the drug-conjugated nanoparticles showed remarkable antibacterial activity against all three strains of S. aureus. The best bactericidal activity was observed at 100 µL gold nanoparticles concentration for all three strains. The minimal inhibitory concentration was 47, 53 and 51 mM for MRSA, MDR and sensitive S.aureus, respectively, which further approves that drug-conjugated AuNPs are more effective than the drug alone nanoparticles are smaller in size and great antimicrobial activity in our study we have seen remarkable antimicrobial activity of drug-conjugated gold nanoparticles against staphylococcus aureus shown in well diffusion assay and disk diffusion assay, we also analyzed minimum inhibitory concentration of drug-conjugated gold nanoparticles. Its recommended that future use of drug-conjugated gold nanoparticles should be used to overcome the developing drug resistance in health care facilities, because nanoparticles have very smaller size and large surface area thus it can carry large amount of drug on their targets.

Bacterial resistance to biocides in the healthcare environment: should it be of genuine concern?

The emergence of bacterial resistance following exposure in healthcare facilities has been a recurrent topic of interest over the last 10 years. The overwhelming and increasing body of evidence from studies in vitro showed that bacteria have an immense capacity to respond to chemical stress brought upon by biocides. Empirically two major types of mechanisms have been described: intrinsic and acquired. However, the increasing documented response from bacteria exposed to biocide in conditions close to those found in practice suggests that intrinsic resistance does not adequately describe bacterial survival mechanisms, and that other terms such as biofilm resistance and environmental resistance would be therefore more appropriate. In addition, such terms are more relevant when describing in-situ conditions. The lack of evidence of bacterial resistance in practice and the inability to correlate emerging bacterial resistance from in-vitro experiments with practical situations is a major drawback when attempting to ascertain whether emerging bacterial resistance in healthcare facilities is of genuine concern. Microbial resistance to high or in-use concentration of biocides has been described in practice, although it remains uncommon. The efficacy of biocides in eliminating bacterial contaminants within healthcare facilities has to be questioned with the widespread and increasing use of products containing low concentrations of biocide or possessing low bactericidal activity, as is the selection of less susceptible bacteria following such exposure.

Surfing The Web: Navigating the World Wide Web in Search of Resources on Antimicrobial Resistance

This overview gives information on navigating for English-language Web sites on antimicrobial resistance. Web sites were gathered on the basis of personal files, articles, and an exhaustive Web search of cross-links from other Web pages. The Web sites were categorized according to users' needs into 5 broad categories, as follows: comprehensive Web sites, with information on all aspects of antimicrobial resistance-related issues; Web sites with patient information about antimicrobial resistance and about methicillin-resistant Staphylococcus aureus, in particular; Web sites covering current multinational surveillance programs; Web sites on prevention of antimicrobial resistance in health care facilities; and Web sites on control of antimicrobial resistance in the community. We compiled a selection of Web sites that seemed to be useful as starting points for physicians, epidemiologists, researchers, or patients interested in this topic.

Clinicians' perceptions of the problem of antimicrobial resistance in health care facilities.

Many clinicians do not comply with guidelines regarding antimicrobial resistance (AR). In response, the Centers for Disease Control and Prevention developed a national Campaign to Prevent Antimicrobial Resistance in Healthcare Settings that presents 4 strategies and 12 evidence-based steps. To assess clinicians' perceptions of AR, barriers and facilitators to preventing AR, and how best to reach clinicians, a questionnaire and 4 focus groups were conducted after presentation of the Campaign at 4 Pittsburgh Regional Healthcare Initiative hospitals. One hundred seventeen clinicians completed the questionnaire; 28 participated in the focus groups. Clinicians were significantly more likely to perceive that AR was a problem nationally than in their own institution (95% vs 77%; P<.001) or practice (95% vs 65%; P =.002), consistent with focus group results (93% nationally vs 46% institution or practice). The 3 Campaign steps with the most barriers to implementation were "Treat infection, not colonization" (35%), "Stop treatment when infection is cured or unlikely" (35%), and "Practice antimicrobial control" (33%). Clinicians in the focus groups cited the additional barriers of the health care culture, lack of knowledge, and the nursing shortage; facilitators included education, information technology, and consults. Computer programs, posters, and local data were suggested for reaching clinicians about AR. Clinicians perceive AR to be a complex national problem but less relevant to their own institution or practice. Providing clinicians with information and steps for preventing AR, as in the Campaign, may affect their perceptions of the problem and motivate them to take actions to ensure patient safety.