Transmission Of Multidrug-resistant Bacteria Research Articles

Investigation of Bacterial Contaminants and Their Antibiotic Susceptibility on Yemeni Banknotes in Aden City, Yemen

Background: Banknotes are among the objects frequently exchanged between people and can serve as a vehicle for the transmission of infectious agents. Therefore, the present study aimed to isolate and identify potentially pathogenic bacteria on Yemeni banknotes collected from various municipal sources in Aden city, south of Yemen. In addition, the susceptibility of the isolated bacterial species to commonly used antibiotics was tested. Methods: A descriptive cross-sectional study was conducted on 240 Yemeni banknotes of various denominations randomly collected from people from different places in Aden city between November 2019 and February 2020. Swabs from the surfaces of banknotes were streaked onto blood agar, chocolate agar, mannitol salt agar and MacConkey agar and incubated at 37 °C for 48 hours. After isolation, bacterial species were identified and tested for their susceptibility to commonly used antibiotics using established techniques. Results: Out of 240 banknotes examined, 98.3% were found to be contaminated with bacteria, with a 95% confidence interval (CI) ranging from 96 to 99. Among the isolated bacteria, 17.4% were Gram-positive cocci, 33% were Gram-negative bacilli and 49.6% were a combination of both. The mean plate counts of bacterial colonies ranged from 163.6±51.0 colony-forming units (CFU)/ml (95% CI: 147.3–179.9) for banknotes with a denomination of 100 Yemeni rials (YRIs) to 257.1±52.0 CFU/ml (95% CI: 240.5–273.7) for banknotes with a denomination of 50 YRIs. Staphylococcus aureus was the most frequently isolated bacterial species, detected on 66.9% of contaminated banknotes, followed by Escherichia coli (60.6%) and Pseudomonas aeruginosa (42.8%). Regarding antibiotic resistance, most S. aureus isolates showed resistance to ceftazidime (80.1%), followed by ceftriaxone (78.2%), ampicillin (77.6%) and co-trimoxazole (69.3%). On the other hand, most E. coli isolates showed resistance to amoxicillin/clavulanate (84.6%), followed by ceftriaxone (79.7%), ceftazidime (76.9%), ampicillin (58.3%) and ciprofloxacin (58.1%), while most P. aeruginosa isolates showed resistance to ceftriaxone (83.5%), followed by ceftazidime (80.2%) and ciprofloxacin (54.9%). Conclusion: Most banknotes in circulation in Aden city are contaminated with bacteria, predominantly S. aureus and E. coli, with lower denomination banknotes tending to have higher contamination levels. The high contamination rate of banknotes raises concerns about their potential in transmitting infectious diseases and emphasizes the advantages of transitioning to cashless payments. A substantial proportion of bacterial species isolated from banknotes exhibit resistance to commonly used antibiotics, raising concerns about the possible transmission of multidrug-resistant bacteria through the exchange of banknotes. Therefore, it is necessary to raise awareness and improve hygiene practices to minimize the transmission of bacteria and antibiotic resistance through the exchange of banknotes.

In vitro study on the transmission of multidrug-resistant bacteria from textiles to pig skin.

The survival of microorganisms on textiles and specifically on healthcare professionals' (HCP) attire has been demonstrated in several studies. The ability of microorganisms to adhere and remain on textiles for up to hours or days raises questions as to their possible role in transmission from textile to skin via HCP to patients. To evaluate the presence, survival and transmission of different multidrug-resistant bacteria (MDRB) from HCP attire onto skin. Three MDRB [methicillin-resistant Staphylococcus aureus (MRSA); vancomycin-resistant Enterococcus faecium (VRE); carbapenem-resistant Klebsiella pneumoniae, CRKP)] were inoculated on textiles from scrubs (60% cotton-40% polyester) and white coat (100% cotton) at concentrations of 108 colony-forming units (CFU), 105 CFU, and 103 CFU per mL. The inoculation of swatches was divided in time intervals of 1 min, 5 min, 15 min, 30 min, 1 h, 2 h, 3 h, 4 h, 5 h, and 6 h. At the end of each period, textiles were imprinted onto pig skins and each skin square was inverted onto three different selective chromogenic media. Growth from the pig skin squares was recorded for the 3 MDRB at the three above concentrations, for the whole length of the 6-h experiment. MRSA was recovered from pig skins at all concentrations for the whole duration of the 6-h study. VRE was recovered from the concentration of 108 CFU/mL for 6 h and from 105 CFU/mL for up to 3 h, while showing no growth at 103 CFU/mL. CRKP was recovered from 108 CFU/mL for 6 h, up to 30 min from 105 CFU/mL and for 1 min from the concentration of 103 CFU/mL. Evidence from the current study shows that MRSA can persist on textiles and transmit to skin for 6 h even at low concentrations. The fact that all MDRB can be sustained and transferred to skin even at lower concentrations, supports that textiles are implicated as vectors of bacterial spread.

Equine Gram-Negative Oral Microbiota: An Antimicrobial Resistances Watcher?

Horses are considered as reservoirs of multidrug resistant bacteria that can be spread through the environment and possibly to humans. The aim of this study was to characterize the oral Gram-negative microbiota of healthy horses and evaluate their antimicrobial susceptibility profile in a One Health approach. For this purpose, samples were collected from the gingival margin of healthy horses, free of antimicrobial therapy, cultured in selective mediums, identified, and tested for antimicrobial susceptibility. Fifty-five Gram-negative isolates were identified, with 89.5% being zoonotic and 62% affecting humans, which were also found commonly in the environment. Forty-eight isolates (96%) were MDR. The phenotypic resistance presented as higher to macrolides (81.8%), β-lactams (55.4%), and quinolones (50%), and lower to sulfonamides (27.3%), tetracyclines, and amphenicols (both with 30.9%). In total, 51.5% of the isolates presented resistance to carbapenems. In addition to being the first report on the commensal oral microbiota of horses and respective susceptibility profile, this study highlights the horse as a valuable sentinel that can control the evolution and transmission of multidrug-resistant bacteria between the "One Health triad" since it is in contact with humans, other animals, and the environment, in different geographic locations.

Occurrence and characteristics of extended-spectrum-β-lactamase producing Escherichia coli (blaTEM-128) isolated from Mus musculus captured from a veterinary clinic and houses in Tunis, Tunisia

Antimicrobial resistance in Enterobacteriaceae is a public health problem. Rodents, can be a potential vector for transmission of multidrug resistant bacteria between animals, humans, and environment. The aim of our study was to assess the level of Enterobacteriaceae present in the intestines of rats collected from different locations in Tunisia, then to determine their antimicrobial susceptibility profiles, to screen extended spectrum β-lactamases-producing strains and determine the molecular mechanism of β-lactams resistance.Between July 2017 and June 2018, 55 strains of Enterobacteriaceae were isolated from 71 rats captured in various locations in Tunisia. Antibiotic susceptibility testing was performed using the disc diffusion method. Genes encoding ESBL and mcr genes were investigated by RT-PCR, standard PCR and sequencing when these genes were found.Fifty-five strains of Enterobacteriaceae were identified. The overall prevalence of ESBL production found in our study was 12.7 % (7/55) of which two E. coli strains were DDST positive, one isolated from a house-caught rat and one from the veterinary clinic and harbored the blaTEM-128 gene. In addition, the other five strains were DDST negative and harbored the blaTEM gene, including three strains isolated from collective restaurant (n = 2: blaTEM-163; n = 1: blaTEM-1), one strain isolated from the veterinary clinic (blaTEM-82), and one strain isolated from a house (blaTEM-128).The results of our study suggest that rodents may play a role in the spread of antimicrobial resistant E. coli, highlighting the need to protect the environment and monitor antimicrobial resistant bacteria in rodents to prevent their spread to other wildlife and humans.

An overview on the current available treatment for COVID-19 and the impact of antibiotic administration during the pandemic.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has caused several problems in healthcare systems around the world, as to date, there is no effective and specific treatment against all forms of COVID-19. Currently, drugs with therapeutic potential are being tested, including antiviral, anti-inflammatory, anti-malarial, immunotherapy, and antibiotics. Although antibiotics have no direct effect on viral infections, they are often used against secondary bacterial infections, or even as empiric treatment to reduce viral load, infection, and replication of coronaviruses. However, there are many concerns about this therapeutic approach as it may accelerate and/or increase the long-term rates of antimicrobial resistance (AMR). We focused this overview on exploring candidate drugs for COVID-19 therapy, including antibiotics, considering the lack of specific treatment and that it is unclear whether the widespread use of antibiotics in the treatment of COVID-19 has implications for the emergence and transmission of multidrug-resistant bacteria.

Occurrence and antimicrobial resistance of bacteria in retail market spices

ABSTRACT: This study aimed to evaluate the microbiological quality and the transmission of multidrug-resistant bacteria in different spices sold in town fairs (local food markets) in the municipalities of Recôncavo Baiano. Samples of black pepper, oregano, and cinnamon were collected over a period of six months and investigated for coliforms at 45 °C, Staphylococcus spp., Staphylococcus aureus, Bacillus spp., Bacillus cereus, Escherichia coli and Salmonella spp. The contamination in the black pepper samples (log 4.66 CFU g-1) was higher (P>0.05), than those of cinnamon (log 2.55 CFU g-1) and oregano (log 2.49 CFU g-1), particularly for B. cereus. E. coli (89%) and Salmonella spp. (67%) were isolated only from black pepper. B. cereus and S. aureus showed greater resistance to β-lactams (penicillin, oxacillin, and cefepime), with approximately 40% of the strains with a multiple antimicrobial resistance (MAR) index of 0.33 (i.e., resistant to three antimicrobials). E. coli was more resistant to ampicillin and Salmonella spp. to nalidixic acid, ampicillin, and ceftriaxone. Salmonella spp. had a MAR index ranging from 0.16 to 0.91 (i.e, resistant to up to 11 antimicrobials), and E. coli to up to 0.58 (i.e., resistant to 7 antimicrobials). In conclusion, the spices sold in the town fairs of Recôncavo Baiano are of low microbiological quality, with the presence of pathogens, of which some display high resistance to antimicrobials that are commonly used for treating foodborne illnesses.

Strategies to control antibiotic resistance: results from a survey in Italian children's hospitals.

Antimicrobial stewardship programs and comprehensive infection control programs represent the main strategies to limit the emergence and transmission of multi-drug resistant bacteria in hospital settings. The purpose of this study was to describe strategies implemented in Italian children's hospitals for controlling antibiotic resistance. Cross sectional multicenter study. Four tertiary care Italian children's hospitals were invited to participate in a survey aimed at collecting information on activities implemented as of December 2015 using a self-administered online questionnaire. The questionnaire was divided in three sections focalizing on: i) policies for prevention and control of hospital-acquired infection, ii) prevention and control of multi-drug resistant bacteria, and iii) antibiotic prescribing policies and Antimicrobial stewardship programs. Questionnaires were compiled between May and July 2016. All hospitals had multidisciplinary infection control committee, procedures on hand hygiene, isolation measures, disinfection/sterilization, waste disposal and prevention on infections associated to invasive procedures. All sites screened patients for multi-drug resistant bacteria colonization in selected units, and adopted contact precautions for colonized patients. Screening during hospitalization, or in case of infections in the same ward were not universally implemented. All hospitals had policies on surgical prophylaxis, while policies on medical prophylaxis and treatment of bacterial infections varied among sites. Two sites recommended to review the appropriateness of antibiotic prescribing after 48-72 hours and one recommended de-escalation therapy. This study highlighted several areas of improvement, such as actions for screening patients in case of occurrence of multi-drug resistant bacteria, antimicrobial stewardship programs and implementation of policies targeting antibiotic prescriptions for therapeutic purposes and medical prophylaxis.

Progress in strategies to combat antimicrobial resistance

Antimicrobial resistance is on the rise while the number of antibiotics being brought to market continues to drop. Drug-resistant genes and drug-resistant bacteria infection have seriously threatened human health. Therefore, antimicrobial resistance presents an ongoing challenge that requires multifaceted approaches including: biomedical innovation; improved surveillance of antibiotic consumption and antimicrobial resistance generated rates; prevention of health-care-associated infections and transmission of multidrug-resistant bacteria and environmental dissemination; rapid microbiological diagnosis; and curtailed clinical and veterinary misuse. Fortunately, combating antimicrobial resistance has been highly valued and supported by the government, scientists and entrepreneurs of various countries. With the continuous introduction of new technologies, new products, and new management measures, the problem of antimicrobial resistance must be controlled and alleviated.

Transmission of Multiresistant Bacteria from Donor to Recipient

Introduction Infections and colonizations with multi-drug-resistant bacteria (MDR) are rising around the world. Currently, an increasing number of patients admitted to intensive care units (ICUs) are exposed to infections with MDR organisms. Most of the organ donors come from ICUs, so they are susceptible to infections or colonization by MDR, that could potentially transmit to recipients. MDR are of particular concern because of their difficulty to treat which, in turn, results in significant morbidity and mortality, particularly among solid organ transplant recipients. Materials and Methods We registered all consecutive deceased organs donors in a critical care unit from a tertiary hospital with high donation activity and high incidence of MDR appearance. During 30 months we studied organ donors with MDR isolation and followed the organs of these donors as well as the MDR isolates in their corresponding recipients. Our protocol includes an active detection of any colonization by MDR through screening with swabs twice a week. The national critical care infection surveillance registry (ENVIN) has been in existence in our hospital since 1995 and includes data on selected nosocomial infections and colonizations in intensive care unit. The diagnosis of infection is made on the basis of set definitions, which depending on the type of infection include combinations of microbiological, radiological findings in combination with clinical signs of infection. For each case of nosocomial infection, further variables are documented, such as confirmed pathogens, date of infection, and temporal association of the infection with devices (tracheal tube, central venous catheter, urinary catheter). Results and Discussion From 152 deceased organ donors (107 of them in encephalic death and 45 after expected cardiac arrest), in the study period, we detected 14 patients colonized or infected by MDR during our review. They were 67 years median age with an average icu stay of 9 days. From these 14 organ donors, we followed the 27 patients who received a graft from a donor with a positive culture for MDR. Four of them (15%) developed an MDR infection in the following year. Only in one case, the transmission from donor to recipient could be demonstrated. This donor was a patient with MDR bacteremia who was treated with an antibiotic for only 36 hours. Conclusion The transmission of MDR from the donor to the recipient is a very rare occurrence. Close recipient follow-up is mandatory in order to validate this approach. The very limited available experience suggests that, in well-defined conditions, organs from donors who are MDR positive in surveillance studies (rectal axillary or pharyngous swabs), may be considered for transplantation. Nevertheless, when what is colonized or infected, is the environment of the organ to transplant, then avoidance of such donors appears advisable until further data are available.

Canadian Association of Gastroenterology Position Statement on the Impact of Simethicone on Endoscope Reprocessing.

A recent study by Ofstead et al. published in the American Journal of Infection Control described the presence of residual simethicone and non-pathogenic bacterial colonization in endoscopes despite adherence to reprocessing procedures(1). These findings received significant media attention, in part because they were released following a warning issued by the Food and Drug Administration and the Centre for Disease Control regarding the potential transmission of multi-drug resistant bacteria associated with the use of duodenoscopes(2, 3). In light of the findings described by Ofstead et al., the Canadian Association of Gastroenterology (CAG) would like to update its members on what is currently known.

Current Practice of Duodenoscope Reprocessing.

Numerous outbreaks of duodenoscope-associated transmission of multi-drug resistant bacteria have recently been reported. Unlike prior episodes of endoscope-transmitted infections, the latest outbreaks have occurred despite strict adherence to duodenoscope reprocessing guidelines. The current standard for all flexible endoscope reprocessing includes pre-cleaning, leak testing, an additional manual cleaning step, and high-level disinfection. When these steps are strictly followed, the risk of infection transmission during endoscopy is exceedingly rare. However, due to its complex design, the duodenoscope may not be able to be adequately disinfected using the current reprocessing standards. Supplemental measures to enhance scope reprocessing have subsequently been recommended to reduce the infection risk in patients undergoing endoscopic retrograde cholangiopancreatography. These methods are likely short-term solutions that have yet to be validated regarded their effectiveness. Additional approaches to monitor the quality of duodenoscope reprocessing may also be useful. Ultimately, a definitive, yet logistically feasible, method of duodenoscope reprocessing is required to ensure the safety of our patients.

559 Recognition and Resolution of Duodenoscope Associated Multi-Drug Resistant Bacterial Transmission

Duodenoscopes have been implicated in the transmission of multi-drug resistant bacteria (MDRB). Our medical center has been voluntarily submitting cultures since 2010 to a state reference laboratory surveying for the emergence of MDRB in hospitals. We were informed In November 2013 that a cluster of patients treated at our institution had a unique hyper-AmpC-E. Coli, with the preponderance of those patients having had one or more ERCPs.

The Spread of Multi-Drug Resistant Bacteria Following ERCP: Time to Redesign the Duodenoscope or Enhance Reprocessing?

Introduction: Endoscopes, particularly duodenoscopes, have been associated and implicated in the transmission of multi-drug resistant bacteria (MDRB). Our medical center has been voluntarily submitting cultures since 2012 to a reference laboratory surveying for the emergence of MDRB. We were informed in September 2013 that a cluster of patients treated at our institution had a unique AmpC-E. coli with a preponderance of those patients having had multiple ERCPs. Methods: Extensive chart reviews were undertaken to identify demographics, co-morbid conditions, procedures performed, and clinical outcomes. The entire endoscope reprocessing procedure was reviewed and investigated for quality assurance. All endoscopes were cultured post-reprocessing. Root-cause analysis and procedure modifications using mistake-proofing and successive checks were undertaken. Results: Thirty patients were identified of whom 17 had an underlying biliary obstruction secondary to carcinoma. The other 13 had benign biliary obstruction from complicated pancreatitis or stricturing biliary disease. All patients identified had undergone multiple ERCPs; the median number of ERCP’s was 2 (range 1 to 13) with all but one patient having had a stent. Eleven patients died during the study period, 7 with pancreatic cancer, 2 with PSC, 1 with pancreatic necrosis, and one after pancreas/kidney transplant. Root cause analysis demonstrated that scope reprocessing was at or exceeded manufacturers’ and professional societies’ recommendations and that the reprocessing room did not harbor MDRB. Despite this, post-reprocessing endoscope cultures continued to identify MDRB. The elevator and channel appeared to be the safe harbor for bacteria. Multiple resolutions were considered including gas sterilization with ethylene oxide, a process that was rejected due to doubts about efficacy. Ultimately, we implemented the “penalty box” solution in which reprocessed endoscopes were routinely cultured and not released for use until the cultures were confirmed negative for MDRB or other pathogenic organisms. Conclusion: Duodenoscopes are difficult to adequately reprocess under current manufacturers’ and professional societies’ recommendations. This can lead to the scopes serving as vectors of transmission for organisms, such as MDRB, into the GI tract. Once there, MDRB can lead to infection and/or colonization. Patients who have undergone multiple ERCPs seem to be at higher risk of MDRB infection, likely due to underlying comorbidities, high antibiotic exposure, and greater chance of inoculation of MDRB. These findings suggest a design flaw and/or inadequate reprocessing recommendations and have significant implications for high-volume ERCP centers.

La prise en charge des BMR en Ehpad

The application of standard and sometimes additional hygiene precautions also concerns nursing homes, in order to prevent the transmission of multi-drug resistant bacteria. If a resident is a carrier or infected by a multi-drug resistant bacteria, the care must be organised accordingly but geographic confinement is rarely adapted.