1
|
Gao M, Manos J, Whiteley G, Zablotska-Manos I. Antibiofilm Agents for the Treatment and Prevention of Bacterial Vaginosis: A Systematic Narrative Review. J Infect Dis 2024; 230:e508-e517. [PMID: 38680027 PMCID: PMC11420799 DOI: 10.1093/infdis/jiae134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Bacterial vaginosis (BV) is difficult to eradicate due to BV biofilms protecting BV bacteria (Gardnerella, Prevotella, and other genera). With the growing understanding of biofilms, we systematically reviewed the current knowledge on the efficacy of anti-BV biofilm agents. METHODS We searched literature in the Scopus, Medline, and Embase databases for empirical studies investigating substances for the treatment of BV biofilms or prevention of their recurrence and their efficacy and/or safety. RESULTS Of 201 unique titles, 35 satisfied the inclusion criteria. Most studies (89%) reported on preclinical laboratory research on the efficacy of experimental antibiofilm agents (80%) rather than their safety. Over 50% were published within the past 5 years. Agents were classified into 7 groups: antibiotics, antiseptics, cationic peptides, enzymes, plant extracts, probiotics, and surfactants/surfactant components. Enzymes and probiotics were most commonly investigated. Earlier reports of antibiotics having anti-BV biofilm activity have not been confirmed. Some compounds from other classes demonstrated promising anti-BV biofilm efficacy in early studies. CONCLUSIONS Further research is anticipated on successful antibiofilm agents. If confirmed as effective and safe in human clinical trials, they may offer a breakthrough in BV treatment. With rising antibiotic resistance, antibiofilm agents will significantly improve the current standard of care for BV management.
Collapse
Affiliation(s)
- Michael Gao
- Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Westmead, NSW, Australia
- Faculty of Medicine and Health, Westmead Clinical School, Westmead, NSW, Australia
| | - Jim Manos
- Infection Immunity and Inflammation, Faculty of Medicine and Health, School of Medical Sciences, University of Sydney, Westmead, NSW, Australia
- Sydney Institute of Infectious Diseases, The University of Sydney, Westmead, NSWAustralia
| | - Greg Whiteley
- Infection Immunity and Inflammation, Faculty of Medicine and Health, School of Medical Sciences, University of Sydney, Westmead, NSW, Australia
- Sydney Institute of Infectious Diseases, The University of Sydney, Westmead, NSWAustralia
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Whiteley Corporation, North Sydney, NSW, Australia
| | - Iryna Zablotska-Manos
- Sydney Institute of Infectious Diseases, The University of Sydney, Westmead, NSWAustralia
- Faculty of Medicine and Health, Westmead Clinical School, Westmead, NSW, Australia
- Western Sydney Sexual Health Centre, Parramatta, NSW, Australia
| |
Collapse
|
2
|
Nkemngong C, Teska P. Biofilms, mobile genetic elements and the persistence of pathogens on environmental surfaces in healthcare and food processing environments. Front Microbiol 2024; 15:1405428. [PMID: 38894974 PMCID: PMC11183103 DOI: 10.3389/fmicb.2024.1405428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Peter Teska
- Diversey-A Solenis Company, Fort Mill, SC, United States
| |
Collapse
|
3
|
Okomo U, Gon G, Darboe S, Sey ICM, Nkereuwem O, Leigh L, Camara N, Makalo L, Keita A, Dancer SJ, Graham W, Aiken AM. Assessing the impact of a cleaning programme on environmental hygiene in labour and neonatal wards: an exploratory study in The Gambia. Antimicrob Resist Infect Control 2024; 13:36. [PMID: 38589973 PMCID: PMC11003010 DOI: 10.1186/s13756-024-01393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/31/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Effective surface cleaning in hospitals is crucial to prevent the transmission of pathogens. However, hospitals in low- and middle-income countries face cleaning challenges due to limited resources and inadequate training. METHODS We assessed the effectiveness of a modified TEACH CLEAN programme for trainers in reducing surface microbiological contamination in the newborn unit of a tertiary referral hospital in The Gambia. We utilised a quasi-experimental design and compared data against those from the labour ward. Direct observations of cleaning practices and key informant interviews were also conducted to clarify the programme's impact. RESULTS Between July and September 2021 (pre-intervention) and October and December 2021 (post-intervention), weekly surface sampling was performed in the newborn unit and labour ward. The training package was delivered in October 2021, after which their surface microbiological contamination deteriorated in both clinical settings. While some cleaning standards improved, critical aspects such as using fresh cleaning cloths and the one-swipe method did not. Interviews with senior departmental and hospital management staff revealed ongoing challenges in the health system that hindered the ability to improve cleaning practices, including COVID-19, understaffing, disruptions to water supply and shortages of cleaning materials. CONCLUSIONS Keeping a hospital clean is fundamental to good care, but training hospital cleaning staff in this low-income country neonatal unit failed to reduce surface contamination levels. Further qualitative investigation revealed multiple external factors that challenged any possible impact of the cleaning programme. Further work is needed to address barriers to hospital cleaning in low-income hospitals.
Collapse
Affiliation(s)
- Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia at LSHTM, Atlantic Boulevard, Fajara, The Gambia.
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK.
| | - Giorgia Gon
- Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Saffiatou Darboe
- Research Microbiology Laboratory, MRC Unit The Gambia at LSHTM, Fajara, The Gambia
- AMR Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Isatou C M Sey
- Research Microbiology Laboratory, MRC Unit The Gambia at LSHTM, Fajara, The Gambia
| | - Oluwatosin Nkereuwem
- Vaccines and Immunity Theme, MRC Unit The Gambia at LSHTM, Atlantic Boulevard, Fajara, The Gambia
| | - Lamin Leigh
- Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Nfamara Camara
- Vaccines and Immunity Theme, MRC Unit The Gambia at LSHTM, Atlantic Boulevard, Fajara, The Gambia
| | - Lamin Makalo
- Department of Paediatrics, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Abdoulie Keita
- Department of Obstetrics and Gynaecology, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Stephanie J Dancer
- Department of Microbiology, NHS Lanarkshire and School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Wendy Graham
- Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Alexander M Aiken
- Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
4
|
Norkaew S, Narikawa S, Nagashima U, Uemura R, Noda J. Efficacy of treating bacterial bioaerosols with weakly acidic hypochlorous water: A simulation chamber study. Heliyon 2024; 10:e26574. [PMID: 38434335 PMCID: PMC10907660 DOI: 10.1016/j.heliyon.2024.e26574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/25/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
The COVID-19 pandemic highlighted the dangers of airborne transmission and the risks of pathogen-containing small airborne droplet inhalation as an infection route. As a pathogen control, Weakly Acidic Hypochlorous Water (WAHW) is used for surface disinfection. However, there are limited assessments of air disinfection by WAHW against airborne pathogens like bioaerosols. This was an empirical study evaluating the disinfection efficacy of WAHW in an atmospheric simulation chamber system against four selected model bacteria. The strains tested included Staphylococcus aureus (SA), Escherichia coli (EC), Pseudomonas aeruginosa (PA), and Pseudomonas aeruginosa (PAO1). Each bacterial solution was nebulized into the chamber system as the initial step, and bioaerosol was collected into the liquid medium by a bio-sampler for colony forming units (CFU) determination. Secondly, the nebulized bacterial bioaerosol was exposed to nebulized double distilled water (DDW) as the control and nebulized 150 ppm of WAHW as the experimental groups. After the 3 and 30-min reaction periods, the aerosol mixture inside the chamber was sampled in liquid media and then cultured on agar plates with different dilution factors to determine the CFU. Survival rates were calculated by a pre-exposed CFU value as a reference point. The use of WAHW decreased bacterial survival rates to 1.65-30.15% compared to the DDW control. PAO1 showed the highest survival rates and stability at 3 min was higher than 30 min in all experiments. Statistical analysis indicated that bacteria survival rates were significantly reduced compared to the controls. This work verifies the bactericidal effects against Gram-positive/negative bioaerosols of WAHW treatment. As WAHW contains chlorine in the acid solution, residual chlorine air concentration is a concern and the disinfection effect at different concentrations also requires investigation. Future studies should identify optimal times to minimize the treated time range and require measurements in a real environment.
Collapse
Affiliation(s)
- Saowanee Norkaew
- Faculty of Public Health, Thammasat University, Khlong Nueng, Klong Luang, Pathum Thani, 12121, Thailand
- Research Unit in Occupational Ergonomics, Thammasat University, Khlong Nueng, Klong Luang, Pathum Thani, 12121, Thailand
| | - Sumiyo Narikawa
- School of Veterinary Medicine, Rakuno Gakuen University, Bunkyodai-Midorimachi, Ebetsu, Hokkaido, 069-8501, Japan
| | - Ukyo Nagashima
- School of Veterinary Medicine, Rakuno Gakuen University, Bunkyodai-Midorimachi, Ebetsu, Hokkaido, 069-8501, Japan
| | - Ryoko Uemura
- Department of Veterinary Sciences, Faculty of Agriculture, University of Miyazaki, GakuenKibanadai-Nishi, Miyazaki, 889-2192, Japan
| | - Jun Noda
- School of Veterinary Medicine, Rakuno Gakuen University, Bunkyodai-Midorimachi, Ebetsu, Hokkaido, 069-8501, Japan
| |
Collapse
|
5
|
Omardien S, Teska P. Skin and hard surface disinfection against Candida auris - What we know today. Front Med (Lausanne) 2024; 11:1312929. [PMID: 38384416 PMCID: PMC10879571 DOI: 10.3389/fmed.2024.1312929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/05/2024] [Indexed: 02/23/2024] Open
Abstract
Candida auris has emerged as a global healthcare threat, displaying resistance to important healthcare antifungal therapies. Infection prevention and control protocols have become paramount in reducing transmission of C. auris in healthcare, of which cleaning and disinfection plays an important role. Candida albicans is used as a surrogate yeast for yeasticidal claims of disinfection products, but reports have been made that sensitivity to disinfectants by C. auris differs from its surrogate. In this review, we aimed to compile the information reported for products used for skin and hard surface disinfection against C. auris in its planktonic or biofilm form. A comparison was made with other Candida species, and information were gathered from laboratory studies and observations made in healthcare settings.
Collapse
Affiliation(s)
| | - Peter Teska
- Diversey Holdings Ltd., Fort Mill, SC, United States
| |
Collapse
|
6
|
Schapira AJ, Dramé M, Olive C, Marion-Sanchez K. Bacterial viability in dry-surface biofilms in healthcare facilities: a systematic review. J Hosp Infect 2024; 144:94-110. [PMID: 38029859 DOI: 10.1016/j.jhin.2023.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Bacteria are known to live inside architectural structures called biofilms. Though standard biofilms have been studied extensively for more than 50 years, little is known about dry-surface biofilms (DSBs). Since 2012, DSBs have been described in several scientific papers, but basic knowledge about the viability and culturability of bacteria remains limited. AIM To conduct a systematic review to determine whether bacteria inside DSBs are viable, culturable, and enumerable. METHODS Eligible articles had to deal with DSBs containing at least one bacterial species involved in healthcare-associated infections, which developed in actual healthcare environments (in-situ) or with the help of any biofilm model (in-vitro). FINDINGS Twenty-four articles were included in the review. Whereas most of them isolated viable bacteria (87% in situ; 100% in vitro), no in-situ study quantified culturable bacteria in the biofilm per unit area. Conversely, 100% of in-vitro studies cultured the bacteria from controls and 94.4% supplied an enumeration of them. Culturable bacteria also grew after 78% of the cleaning, disinfection, or sterilization protocols tested. Microscopic observations after staining the samples with live/dead fluorescent probes (Baclight®) showed large amounts of viable cells in culture-negative samples. CONCLUSION Our study questions the efficacy of current methods for microbiological monitoring of surfaces, since these methods are only based on bacterial culturability. To improve both surface monitoring and cleaning and disinfection protocols, it is necessary to integrate the concept of DSBs which appears to contain a significant amount of viable but non-culturable bacteria.
Collapse
Affiliation(s)
- A-J Schapira
- CHU Martinique, Department of Bacteriology, Hygiene and Environment Laboratory, Fort-de-France Cedex, Martinique; Paris Cité University, Faculty of Health, Paris, France
| | - M Dramé
- CHU Martinique, Department of Clinical Research and Innovation, Fort-de-France Cedex, Martinique; University of the French West Indies, Faculty of Medicine, EpiCliV Research Unit, Martinique
| | - C Olive
- CHU Martinique, Department of Bacteriology, Hygiene and Environment Laboratory, Fort-de-France Cedex, Martinique
| | - K Marion-Sanchez
- CHU Martinique, Department of Bacteriology, Hygiene and Environment Laboratory, Fort-de-France Cedex, Martinique; PCCEI, University of Montpellier, University of the Antilles, INSERM, EFS, Montpellier, France.
| |
Collapse
|
7
|
van der Schoor AS, Voor In 't Holt AF, Zandijk WHA, Bruno MJ, Gommers D, van den Akker JPC, Hendriks JM, Severin JA, Klaassen CHW, Vos MC. Dynamics of Staphylococcus aureus in patients and the hospital environment in a tertiary care hospital in the Netherlands. Antimicrob Resist Infect Control 2023; 12:148. [PMID: 38124120 PMCID: PMC10734193 DOI: 10.1186/s13756-023-01349-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The dynamics of Staphylococcus aureus in patients and the hospital environment are relatively unknown. We studied these dynamics in a tertiary care hospital in the Netherlands. METHODS Nasal samples were taken from adult patients at admission and discharge. Isolates cultured from clinical samples taken before and during hospitalization from these patients were included. Environmental samples of patient rooms were taken over a three-year period. Finally, isolates from clinical samples from patients with an epidemiological link to S. aureus positive rooms were included. Staphylococcal protein A (spa) typing was performed. RESULTS Nasal samples were taken from 673 patients. One hundred eighteen (17.5%) were positive at admission and discharge, 15 (2.2%) patients acquired S. aureus during hospitalization. Nineteen patients had a positive clinical sample during hospitalization, 15.9% of the S. aureus were considered as from an exogenous source. One hundred and forty (2.8%) environmental samples were S. aureus positive. No persistent contamination of surfaces was observed. Isolates were highly diverse: spa typing was performed for 893 isolates, identifying 278 different spa types, 161 of these spa types were observed only once. CONCLUSION Limited transmission could be identified between patients and the hospital environment, and from patient-to-patient. Exogenous acquisition was assumed to occur in 15% of clinical samples. Environmental contamination was infrequent, temporarily, and coincided with the strain from the patient admitted to the room at that time. MRSA was rare and not found in the environment.
Collapse
Affiliation(s)
- Adriënne S van der Schoor
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Willemien H A Zandijk
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Diederik Gommers
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Johanna M Hendriks
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Juliëtte A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Corné H W Klaassen
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
8
|
Wormald R, Humphreys PN, Charles CJ, Rout SP. Bacillus-based probiotic cleansers reduce the formation of dry biofilms on common hospital surfaces. Microbiologyopen 2023; 12:e1391. [PMID: 38129979 PMCID: PMC10664183 DOI: 10.1002/mbo3.1391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 12/23/2023] Open
Abstract
In the absence of liquid suspension, dry biofilms can form upon hard surfaces within a hospital environment, representing a healthcare-associated infection risk. Probiotic cleansers using generally recognized as safe organisms, such as those of the Bacillus genus, represent a potential strategy for the reduction of dry biofilm bioburden. The mechanisms of action and efficacy of these cleaners are, however, poorly understood. To address this, a preventative dry biofilm assay was developed using steel, melamine, and ceramic surfaces to assess the ability of a commercially available Bacillus spp. based probiotic cleanser to reduce the surface bioburden of Escherichia coli and Staphylococcus aureus. Via this assay, phosphate-buffered saline controls were able to generate dry biofilms within 7 days of incubation, with the application of the probiotic cleanser able to prevent >97.7% of dry biofilm formation across both pathogen analogs and surface types. Further to this, surfaces treated with the probiotic mixture alone also showed a reduction in dry biofilm across both pathogen and surface types. Confocal laser scanning microscopy imaging indicated that the probiotic bacteria were able to germinate and colonize surfaces, likely forming a protective layer upon these hard surfaces.
Collapse
Affiliation(s)
- Richard Wormald
- Department of Biological and Geographical SciencesUniversity of HuddersfieldHuddersfieldUK
| | - Paul N. Humphreys
- Department of Biological and Geographical SciencesUniversity of HuddersfieldHuddersfieldUK
| | | | - Simon P. Rout
- Department of Biological and Geographical SciencesUniversity of HuddersfieldHuddersfieldUK
| |
Collapse
|
9
|
Marano RBM, Merezhko D, Resnick KA, Moran-Gilad J, Oster Y. Evaluation of a novel surface-coating formulation with time-extended antimicrobial activity for healthcare environment disinfection. Antimicrob Resist Infect Control 2023; 12:133. [PMID: 37996872 PMCID: PMC10666328 DOI: 10.1186/s13756-023-01341-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/18/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The importance of environmental contamination in the transmission of pathogens among hospitalized patients is universally recognized, and disinfection of surfaces is a widely accepted modality for reducing healthcare-associated infections. Nevertheless, hospital disinfection is still suboptimal. In this study, we evaluated the sustained effects of the novel formulation OxiLast™ which extends the antimicrobial effects of chlorine-based disinfectants. METHODS In an experimental lab phase, PVC surfaces were coated with OxiLast™ and then inoculated with representative Gram-positive and Gram-negative pathogenic bacteria. Cells were recovered at different contact times (5, 15, 30 min) to assess the reduction in bacterial counts compared to uncoated surfaces and also subject to various challenges to assess robustness. A similar methodology was then applied in an unoccupied hospital room to evaluate the sustained effect of OxiLast™ on high-touch surfaces. RESULTS OxiLast™ demonstrated notable activity against the range of bacterial strains tested with ≥ 4 log10 reduction in bacterial counts observed for up to seven days following one surface application, for various strains and contact times. Similar results were observed following challenges such as simulated abrasion of coated surfaces, organic contamination or successive inoculations. The results were confirmed in a simulated patient care environment. CONCLUSIONS The addition of OxiLast™ to common chlorine-based disinfectants has shown a substantial and sustained reduction in bacterial pathogen counts for up to 7 days following one application. The consistent results in the laboratory and hospital are promising and should be tested in a real-life clinical scenario.
Collapse
Affiliation(s)
- Roberto Bruno Maria Marano
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Diana Merezhko
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Keren Anat Resnick
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Jacob Moran-Gilad
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
- Clinical Microbiology Laboratory, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - Yonatan Oster
- Clinical Microbiology Laboratory, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|
10
|
Weber DJ, Rutala WA, Anderson DJ, Sickbert-Bennett EE. Biofilms on medical instruments and surfaces: Do they interfere with instrument reprocessing and surface disinfection. Am J Infect Control 2023; 51:A114-A119. [PMID: 37890940 DOI: 10.1016/j.ajic.2023.04.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Biofilms are surface-attached communities of bacteria embedded in an extracellular matrix. This matrix shields the resident cells from desiccation, chemical perturbation, invasion by other bacteria, and confers reduced susceptibility to antibiotics and disinfectants. There is growing evidence that biofilms on medical instruments (especially endoscopes) and environmental surfaces interfere with cleaning and disinfection. METHODS The English literature on the impact of biofilms in medicine was reviewed with a focus on the impact of biofilms on reusable semicritical medical instruments and hospital environmental surfaces. RESULTS Biofilms are frequently present on hospital environmental surfaces and reusable medical equipment. Important health care...associated pathogens that readily form biofilms on environmental surfaces include Staphylococcus aureus, Pseudomonas aeruginosa, and Candida auris. Evidence has demonstrated that biofilms interfere with cleaning and disinfection. DISCUSSION New technologies such as ..úself-disinfecting..Ñ surfaces or continuous room disinfection systems may reduce or disrupt biofilm formation and are under study to reduce the impact of the contaminated surface environment on health care...associated infections. CONCLUSIONS Future research is urgently needed to develop methods to reduce or eliminate biofilms from forming on implantable medical devices, reusable medical equipment, and hospital surfaces.
Collapse
Affiliation(s)
- David J Weber
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Infection Prevention, UNC Medical Center, Chapel Hill, NC.
| | - William A Rutala
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Deverick J Anderson
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, NC
| | - Emily E Sickbert-Bennett
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Infection Prevention, UNC Medical Center, Chapel Hill, NC
| |
Collapse
|
11
|
Watson F, Wilks S, Keevil CW, Chewins J. Modelling hospital disinfectant against multi-drug-resistant dry surface biofilms grown under artificial human sweat. J Hosp Infect 2023; 141:190-197. [PMID: 37343768 DOI: 10.1016/j.jhin.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Dry surface biofilms (DSBs) have been found abundantly across hospital surfaces within intensive care units and may explain how nosocomial pathogens can remain virulent and persist on surfaces for extended periods. Testing standards governing the performance of disinfectant products employ planktonic models under routine growth conditions, which are known to be less tolerant than their biofilm counterpart. AIM To evaluate biofilm models cultured under artificial human sweat (AHS), a source of nutrient expected on touch surfaces, to assess the antimicrobial performance of common cleaning agents, including a quaternary ammonium, hydrogen peroxide and active chlorine. METHODS Five single-species biofilms, using pathogenic bacteria such as Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus faecalis, were generated on stainless-steel substrates using a sedimentation protocol under both AHS and nutrient-rich conditions for a direct comparison of phenotypic tolerance. The biofilm models were grown over five days followed by desiccation cycles, before being submerged into the disinfectant solutions for up to 25 min. Epifluorescence (EF) microscopy using LIVE/DEAD™ stain was used to visualize microcolony viability. FINDINGS The results revealed biofilms cultured under AHS exhibited a greater antimicrobial tolerance and reduced speed of kill for all cleaning agents compared with the routine media; an average reduction of 72.4% vs 96.9%, respectively. EF microscopy revealed traces of viable bacteria across all coupons after disinfection indicating a potential opportunity for regrowth and recontamination. CONCLUSION The notable difference in biocidal performance between the two growth conditions highlights potential pitfalls within current antimicrobial test standards, and the importance of accurate representation of the microbial challenge.
Collapse
Affiliation(s)
- F Watson
- School of Biological Sciences, University of Southampton, Southampton, UK; Bioquell UK Ltd, Andover, UK
| | - S Wilks
- School of Biological Sciences, University of Southampton, Southampton, UK; School of Health Sciences, University of Southampton, Southampton, UK
| | - C W Keevil
- School of Biological Sciences, University of Southampton, Southampton, UK
| | | |
Collapse
|
12
|
Watson F, Chewins J, Wilks S, Keevil B. An automated contact model for transmission of dry surface biofilms of Acinetobacter baumannii in healthcare. J Hosp Infect 2023; 141:175-183. [PMID: 37348564 DOI: 10.1016/j.jhin.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Dry surface biofilms (DSBs) have been recognized across environmental and equipment surfaces in hospitals and could explain how microbial contamination can survive for an extended period and may play a key role in the transmission of hospital-acquired infections. Despite little being known on how they form and proliferate in clinical settings, DSB models for disinfectant efficacy testing exist. AIM In this study we develop a novel biofilm model to represent formation within hospitals, by emulating patient to surface interactions. METHODS The model generates a DSB through the transmission of artificial human sweat (AHS) and clinically relevant pathogens using a synthetic thumb capable of emulating human contact. The DNA, glycoconjugates and protein composition of the model biofilm, along with structural features of the micro-colonies was determined using fluorescent stains visualized by epifluorescence microscopy and compared with published clinical data. RESULTS Micrographs revealed the heterogeneity of the biofilm across the surface; and reveal protein as the principal component within the matrix, followed by glycoconjugates and DNA. The model repeatably transferred trace amounts of micro-organisms and AHS, every 5 min for up to 120 h on to stainless-steel coupons to generate a biofilm model averaging 1.16 × 103 cfu/cm2 falling within the reported range for clinical DSB (4.20 × 102 to 1.60 × 107 bacteria/cm2). CONCLUSION Our in vitro DSB model exhibits many phenotypical characteristics and traits to those reported in situ. The model highlights key features often overlooked and the potential for downstream applications such as antibiofilm claims using more realistic microbial challenges.
Collapse
Affiliation(s)
- F Watson
- School of Biological Sciences, University of Southampton, Southampton, UK; Bioquell UK Ltd, Andover, UK.
| | | | - S Wilks
- School of Biological Sciences, University of Southampton, Southampton, UK; School of Health Sciences, University of Southampton, Southampton, UK
| | - B Keevil
- School of Biological Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
13
|
Rutala WA, Boyce JM, Weber DJ. Disinfection, sterilization and antisepsis: An overview. Am J Infect Control 2023; 51:A3-A12. [PMID: 37890951 DOI: 10.1016/j.ajic.2023.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Each year in the United States there are approximately 100,000,000 outpatient/inpatient surgical procedures. Each of these procedures involves contact by a medical device or surgical instrument with a patient's sterile tissue and/or mucous membrane. A major risk of all such procedures is the introduction of infection. METHODS We searched published literature for articles on the use and effectiveness of disinfectants, sterilization methods and antiseptics. RESULTS The level of disinfection is dependent on the intended use of the object: critical (items that contact sterile tissue such as surgical instruments), semicritical (items that contact mucous membrane such as endoscopes), and noncritical (devices that contact only intact skin such as stethoscopes) items require sterilization, high-level disinfection and low-level disinfection, respectively. Cleaning must always precede high-level disinfection and sterilization. Antiseptics are essential to infection prevention as part of a hand hygiene program as well as other uses such as surgical hand antisepsis and pre-operative patient skin preparation. CONCLUSIONS When properly used, disinfection and sterilization can ensure the safe use of invasive and non-invasive medical devices. Cleaning should always precede high-level disinfection and sterilization. Strict adherence to current disinfection and sterilization guidelines is essential to prevent patient infections and exposures to infectious agents.
Collapse
Affiliation(s)
- William A Rutala
- Statewide Program for Infection Control and Epidemiology, UNC School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - John M Boyce
- J.M. Boyce Consulting, Boyce Consulting, LLC, Middletown, CT
| | - David J Weber
- Statewide Program for Infection Control and Epidemiology, UNC School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
| |
Collapse
|
14
|
Luna-Solorza JM, Ayala-Zavala JF, Cruz-Valenzuela MR, González-Aguilar GA, Bernal-Mercado AT, Gutierrez-Pacheco MM, Silva-Espinoza BA. Oregano Essential Oil versus Conventional Disinfectants against Salmonella Typhimurium and Escherichia coli O157:H7 Biofilms and Damage to Stainless-Steel Surfaces. Pathogens 2023; 12:1245. [PMID: 37887761 PMCID: PMC10609779 DOI: 10.3390/pathogens12101245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
This study compared the effect of oregano essential oil versus sodium hypochlorite, hydrogen peroxide, and benzalkonium chloride against the viability of adhered Salmonella Typhimurium and Escherichia coli O157:H7 on 304 stainless steel. Oregano essential oil was effective in disrupting the biofilms of both bacteria at concentrations ranging from 0.15 to 0.52 mg mL-1. In addition, damage to stainless-steel surfaces following disinfection treatments was assessed by weight loss analysis and via visual inspection using light microscopy. Compared to the other treatments, oregano oil caused the least damage to stainless steel (~0.001% weight loss), whereas sodium hypochlorite caused the most severe damage (0.00817% weight loss) when applied at 0.5 mg mL-1. Moreover, oregano oil also had an apparent protective impact on the stainless steel as weight losses were less than for the control surfaces (distilled water only). On the other hand, sodium hypochlorite caused the most severe damage to stainless steel (0.00817% weight loss). In conclusion, oregano oil eliminated monoculture biofilms of two important foodborne pathogens on 304 stainless-steel surfaces, while at the same time minimizing damage to the surfaces compared with conventional disinfectant treatments.
Collapse
Affiliation(s)
- Jesus M. Luna-Solorza
- Centro de Investigación en Alimentación y Desarrollo, Asociación Civil, Carretera Gustavo Enrique Astiazarán Rosas, No. 46, Col. La Victoria, Hermosillo 83304, Sonora, Mexico (J.F.A.-Z.); (M.R.C.-V.); (G.A.G.-A.)
| | - J. Fernando Ayala-Zavala
- Centro de Investigación en Alimentación y Desarrollo, Asociación Civil, Carretera Gustavo Enrique Astiazarán Rosas, No. 46, Col. La Victoria, Hermosillo 83304, Sonora, Mexico (J.F.A.-Z.); (M.R.C.-V.); (G.A.G.-A.)
| | - M. Reynaldo Cruz-Valenzuela
- Centro de Investigación en Alimentación y Desarrollo, Asociación Civil, Carretera Gustavo Enrique Astiazarán Rosas, No. 46, Col. La Victoria, Hermosillo 83304, Sonora, Mexico (J.F.A.-Z.); (M.R.C.-V.); (G.A.G.-A.)
| | - Gustavo A. González-Aguilar
- Centro de Investigación en Alimentación y Desarrollo, Asociación Civil, Carretera Gustavo Enrique Astiazarán Rosas, No. 46, Col. La Victoria, Hermosillo 83304, Sonora, Mexico (J.F.A.-Z.); (M.R.C.-V.); (G.A.G.-A.)
| | - Ariadna T. Bernal-Mercado
- Departamento de Investigación y Posgrado en Alimentos, Universidad de Sonora. Blvd. Luis Encinas y Rosales S/N, Col. Centro, Hermosillo 83000, Sonora, Mexico;
| | - M. Melissa Gutierrez-Pacheco
- Ciencias de la Salud, Universidad Estatal de Sonora, Campus San Luis Rio Colorado, Carretera San Luis Rio Colorado-Sonoyta Km 6.5. Col. Industrial CP, San Luis Río Colorado 83430, Sonora, Mexico;
| | - Brenda A. Silva-Espinoza
- Centro de Investigación en Alimentación y Desarrollo, Asociación Civil, Carretera Gustavo Enrique Astiazarán Rosas, No. 46, Col. La Victoria, Hermosillo 83304, Sonora, Mexico (J.F.A.-Z.); (M.R.C.-V.); (G.A.G.-A.)
| |
Collapse
|
15
|
Moore G, Barry A, Carter J, Ready J, Wan Y, Elsayed M, Haill C, Khashu M, Williams OM, Brown CS, Demirjian A, Ready D. Detection, survival, and persistence of Staphylococcus capitis NRCS-A in neonatal units in England. J Hosp Infect 2023; 140:8-14. [PMID: 37487793 DOI: 10.1016/j.jhin.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The multidrug-resistant Staphylococcus capitis clone, NRCS-A, is increasingly associated with late-onset sepsis in low birthweight newborns in neonatal intensive care units (NICUs) in England and globally. Understanding where this bacterium survives and persists within the NICU environment is key to developing and implementing effective control measures. AIM To investigate the potential for S. capitis to colonize surfaces within NICUs. METHODS Surface swabs were collected from four NICUs with and without known NRCS-A colonizations/infections present at the time of sampling. Samples were cultured and S. capitis isolates analysed via whole-genome sequencing. Survival of NRCS-A on plastic surfaces was assessed over time and compared to that of non-NRCS-A isolates. The bactericidal activity of commonly used chemical disinfectants against S. capitis was assessed. FINDINGS Of 173 surfaces sampled, 40 (21.1%) harboured S. capitis with 30 isolates (75%) being NRCS-A. Whereas S. capitis was recovered from surfaces across the NICU, the NRCS-A clone was rarely recovered from outside the immediate neonatal bedspace. Incubators and other bedside equipment were contaminated with NRCS-A regardless of clinical case detection. In the absence of cleaning, S. capitis was able to survive for three days with minimal losses in viability (<0.5 log10 reduction). Sodium troclosene and a QAC-based detergent/disinfectant reduced S. capitis to below detectable levels. CONCLUSION S. capitis NRCS-A can be readily recovered from the NICU environment, even in units with no recent reported clinical cases of S. capitis infection, highlighting a need for appropriate national guidance on cleaning within the neonatal care environment.
Collapse
Affiliation(s)
- G Moore
- UK Health Security Agency, UK.
| | - A Barry
- UK Health Security Agency, UK
| | | | - J Ready
- UK Health Security Agency, UK
| | - Y Wan
- UK Health Security Agency, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | - M Elsayed
- Royal United Hospital, Bath NHS Foundation Trust, Bath, UK; Southmead Hospital, North Bristol Trust, Bristol, UK
| | - C Haill
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - M Khashu
- University Hospitals Dorset, Poole, UK
| | - O M Williams
- UK Health Security Agency, UK; Bristol Royal Infirmary, Bristol NHS Foundation Trust, UK
| | - C S Brown
- UK Health Security Agency, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | - A Demirjian
- UK Health Security Agency, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK; Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, London, UK; Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - D Ready
- UK Health Security Agency, UK; Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| |
Collapse
|
16
|
Maillard JY, Centeleghe I. How biofilm changes our understanding of cleaning and disinfection. Antimicrob Resist Infect Control 2023; 12:95. [PMID: 37679831 PMCID: PMC10483709 DOI: 10.1186/s13756-023-01290-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/15/2023] [Indexed: 09/09/2023] Open
Abstract
Biofilms are ubiquitous in healthcare settings. By nature, biofilms are less susceptible to antimicrobials and are associated with healthcare-associated infections (HAI). Resistance of biofilm to antimicrobials is multifactorial with the presence of a matrix composed of extracellular polymeric substances and eDNA, being a major contributing factor. The usual multispecies composition of environmental biofilms can also impact on antimicrobial efficacy. In healthcare settings, two main types of biofilms are present: hydrated biofilms, for example, in drains and parts of some medical devices and equipment, and environmental dry biofilms (DSB) on surfaces and possibly in medical devices. Biofilms act as a reservoir for pathogens including multi-drug resistant organisms and their elimination requires different approaches. The control of hydrated (drain) biofilms should be informed by a reduction or elimination of microbial bioburden together with measuring biofilm regrowth time. The control of DSB should be measured by a combination of a reduction or elimination in microbial bioburden on surfaces together with a decrease in bacterial transfer post-intervention. Failure to control biofilms increases the risk for HAI, but biofilms are not solely responsible for disinfection failure or shortcoming. The limited number of standardised biofilm efficacy tests is a hindrance for end users and manufacturers, whilst in Europe there are no approved standard protocols. Education of stakeholders about biofilms and ad hoc efficacy tests, often academic in nature, is thus paramount, to achieve a better control of biofilms in healthcare settings.
Collapse
Affiliation(s)
- Jean-Yves Maillard
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, Wales, UK.
| | - Isabella Centeleghe
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff, CF10 3NB, Wales, UK
| |
Collapse
|
17
|
Staphylococcus aureus Cell Wall Phenotypic Changes Associated with Biofilm Maturation and Water Availability: A Key Contributing Factor for Chlorine Resistance. Int J Mol Sci 2023; 24:ijms24054983. [PMID: 36902413 PMCID: PMC10003762 DOI: 10.3390/ijms24054983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/25/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Staphylococcus aureus biofilms are resistant to both antibiotics and disinfectants. As Staphylococci cell walls are an important defence mechanism, we sought to examine changes to the bacterial cell wall under different growth conditions. Cell walls of S. aureus grown as 3-day hydrated biofilm, 12-day hydrated biofilm, and 12-day dry surface biofilm (DSB) were compared to cell walls of planktonic organisms. Additionally, proteomic analysis using high-throughput tandem mass tag-based mass spectrometry was performed. Proteins involved in cell wall synthesis in biofilms were upregulated in comparison to planktonic growth. Bacterial cell wall width (measured by transmission electron microscopy) and peptidoglycan production (detected using a silkworm larva plasma system) increased with biofilm culture duration (p < 0.001) and dehydration (p = 0.002). Similarly, disinfectant tolerance was greatest in DSB, followed by 12-day hydrated biofilm and then 3-day biofilm, and it was least in the planktonic bacteria--suggesting that changes to the cell wall may be a key factor for S. aureus biofilm biocide resistance. Our findings shed light on possible new targets to combat biofilm-related infections and hospital dry surface biofilms.
Collapse
|
18
|
Biofilme em parafusos ortopédicos prontos para uso adquiridos por meio de sistema de consiganação/comodato. ACTA PAUL ENFERM 2023. [DOI: 10.37689/acta-ape/2023ao00811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|
19
|
Watson F, Wilks SA, Keevil CW, Chewins J. Evaluating the environmental microbiota across four National Health Service hospitals within England. J Hosp Infect 2023; 131:203-212. [PMID: 36343745 DOI: 10.1016/j.jhin.2022.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
Hospital surfaces contaminated with microbial soiling, such as dry surface biofilms (DSBs), can act as a reservoir for pathogenic micro-organisms, and inhibit their detection and removal during routine cleaning. Studies have recognized that such increases in bioburden can hinder the impact of disinfectants and mask the detection of potential pathogens. Cleanliness within healthcare settings is often determined through routine culture-based analysis, whereby surfaces that exhibit >2.5 colony-forming units (CFU) per cm2 pose a risk to patient health; therefore, any underestimation could have detrimental effects. This study quantified microbial growth on high-touch surfaces in four hospitals in England over 19 months. This was achieved using environmental swabs to sample a variety of surfaces within close proximity of the patient, and plating these on to non-specific low nutrient detection agar. The presence of DSBs on surfaces physically removed from the environment was confirmed using real-time imaging through episcopic differential interference contrast microscopy combined with epifluorescence. Approximately two-thirds of surfaces tested exceeded the limit for cleanliness (median 2230 CFU/cm2), whilst 83% of surfaces imaged with BacLight LIVE/DEAD staining confirmed traces of biofilm. Differences in infection control methods, such as choice of surface disinfectants and cleaning personnel, were not reflected in the microbial variation observed and resulting risk to patients. This highlights a potential limitation in the effectiveness of the current standards for all hospital cleaning, and further development using representative clinical data is required to overcome this limitation.
Collapse
Affiliation(s)
- F Watson
- School of Biological Sciences, University of Southampton, Southampton, UK; Bioquell UK Ltd, Andover, UK
| | - S A Wilks
- School of Health Sciences, University of Southampton, Southampton, UK
| | - C W Keevil
- School of Biological Sciences, University of Southampton, Southampton, UK
| | | |
Collapse
|
20
|
Chavignon M, Coignet L, Bonhomme M, Bergot M, Tristan A, Verhoeven P, Josse J, Laurent F, Butin M. Environmental Persistence of Staphylococcus capitis NRCS-A in Neonatal Intensive Care Units: Role of Biofilm Formation, Desiccation, and Disinfectant Tolerance. Microbiol Spectr 2022; 10:e0421522. [PMID: 36409142 PMCID: PMC9769769 DOI: 10.1128/spectrum.04215-22] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/02/2022] [Indexed: 11/23/2022] Open
Abstract
The clone Staphylococcus capitis NRCS-A is responsible for late-onset sepsis in neonatal intensive care units (NICUs) worldwide. Over time, this clone has evolved into three subgroups that are increasingly adapted to the NICU environment. This study aimed to decipher the mechanisms involved in NRCS-A persistence in NICUs. Twenty-six S. capitis strains belonging to each of the three NRCS-A clone subgroups and two other non-NRCS-A groups from neonates (alpha clone) or from adult patients ("other strains") were compared based on growth kinetics and ability to form biofilm as well as tolerance to desiccation and to different disinfectants. S. capitis biofilm formation was enhanced in rich medium and decreased under conditions of nutrient stress for all strains. However, under conditions of nutrient stress, NRCS-A strains presented an enhanced ability to adhere and form a thin biofilm containing more viable and culturable bacteria (mean 5.7 log10 CFU) than the strains from alpha clone (mean, 1.1 log10 CFU) and the "other strains" (mean, 4.2 log10 CFU) (P < 0.0001). The biofilm is composed of bacterial aggregates with a matrix mainly composed of polysaccharides. The NRCS-A clone also showed better persistence after a 48-h desiccation. However, disinfectant tolerance was not enhanced in the NRCS-A clone in comparison with that of strains from adult patients. In conclusion, the ability to form biofilm under nutrient stress and to survive desiccation are two major advantages for clone NRCS-A that could explain its ability to persist and settle in the specific environment of NICU settings. IMPORTANCE Neonatal intensive care units (NICUs) host extremely fragile newborns, including preterm neonates. These patients are very susceptible to nosocomial infections, with coagulase-negative staphylococci being the species most frequently involved. In particular, a Staphylococcus capitis clone named NRCS-A has emerged worldwide specifically in NICUs and is responsible for severe nosocomial sepsis in preterm neonates. This clone is specifically adapted to the NICU environment and is able to colonize and maintain on NICU surfaces. The present work explored the mechanisms involved in the persistence of the NRCS-A clone in the NICU environment despite strict hygiene measures. The ability to produce biofilm under nutritional stress and to resist desiccation appear to be the two main advantages of NRCS-A in comparison with other strains. These findings are pivotal to provide clues for subsequent development of targeted methods to combat NRCS-A and to stop its dissemination.
Collapse
Affiliation(s)
- Marie Chavignon
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Ludivine Coignet
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Mélanie Bonhomme
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Marine Bergot
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Anne Tristan
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
- Institut des Agents Infectieux, Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Paul Verhoeven
- Centre International de Recherche en Infectiologie (CIRI), Team GIMAP (Groupe sur l’Immunité des Muqueuses et Agents Pathogènes), INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
- Department of Infectious Agents and Hygiene, University-Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jérôme Josse
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - Frédéric Laurent
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
- Institut des Agents Infectieux, Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Marine Butin
- Centre International de Recherche en Infectiologie (CIRI), Team Pathogénie des Staphylocoques, INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon, Lyon, France
- Service de Néonatologie et Réanimation Néonatale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| |
Collapse
|
21
|
Piletić K, Linšak DT, Kovač B, Mežnarić S, Repustić M, Radmanović-Skrbić M, Gobin I. Ozone disinfection efficiency against airborne microorganisms in hospital environment: a case study. Arh Hig Rada Toksikol 2022; 73:270-276. [PMID: 36607720 PMCID: PMC9985346 DOI: 10.2478/aiht-2022-73-3651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/01/2022] [Accepted: 12/01/2022] [Indexed: 01/07/2023] Open
Abstract
Even though ozone has shown its potential for air disinfection in hospital environment, its more frequent use has earned attention only with the COVID-19 pandemic due to its proven antimicrobial effect and low cost of production. The aim of this study was to determine its antimicrobial efficiency against the most common bacterial species in a real-life setting, that is, in the air of one postoperative room of the General Hospital Dr Ivo Pedišić (Sisak, Croatia). Air was sampled for aiborne bacteria before and after treatment with the ozone concentration of 15.71 mg/m3 for one hour. The most dominant Gram-positive bacteria of the genera Micrococcus, Staphylococcus, and Bacillus were reduced by 33 %, 58 %, and 61 %, respectively. The genus Micrococcus proved to be the most resistant. Considering our findings, we recommend longer air treatment with higher ozone concentrations in combination with mechanical cleaning and frequent ventilation.
Collapse
Affiliation(s)
- Kaća Piletić
- University of Rijeka Faculty of Medicine, Department of Microbiology and Parasitology, Rijeka, Croatia
| | - Dijana Tomić Linšak
- University of Rijeka Faculty of Medicine, Department of Health Ecology, Rijeka, Croatia
| | - Bruno Kovač
- University of Rijeka Faculty of Medicine, Department of Microbiology and Parasitology, Rijeka, Croatia
| | - Silvestar Mežnarić
- University of Rijeka Faculty of Medicine, Department of Microbiology and Parasitology, Rijeka, Croatia
| | | | | | - Ivana Gobin
- University of Rijeka Faculty of Medicine, Department of Microbiology and Parasitology, Rijeka, Croatia
| |
Collapse
|
22
|
Baede VO, Tavakol M, Vos MC, Knight GM, van Wamel WJB. Dehydration Tolerance in Epidemic versus Nonepidemic MRSA Demonstrated by Isothermal Microcalorimetry. Microbiol Spectr 2022; 10:e0061522. [PMID: 35972129 PMCID: PMC9602581 DOI: 10.1128/spectrum.00615-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) clusters are considered epidemic or nonepidemic based on their ability to spread effectively. Successful transmission could be influenced by dehydration tolerance. Current methods for determination of dehydration tolerance lack accuracy. Here, a climate-controlled in vitro dehydration assay using isothermal microcalorimetry (IMC) was developed and linked with mathematical modeling to determine survival of 44 epidemic versus 54 nonepidemic MRSA strains from France, the United Kingdom, and the Netherlands after 1 week of dehydration. For each MRSA strain, the growth parameters time to end of first growth phase (tmax [h]) and maximal exponential growth rate (μm) were deduced from IMC data for 3 experimental replicates, 3 different starting inocula, and before and after dehydration. If the maximal exponential growth rate was within predefined margins (±36% of the mean), a linear relationship between tmax and starting inoculum could be utilized to predict log reduction after dehydration for individual strains. With these criteria, 1,330 of 1,764 heat flow curves (data sets) (75%) could be analyzed to calculate the post-dehydration inoculum size, and thus the log reduction due to dehydration, for 90 of 98 strains (92%). Overall reduction was ~1 log after 1 week. No difference in dehydration tolerance was found between the epidemic and nonepidemic strains. Log reduction was negatively correlated with starting inoculum, indicating better survival of higher inocula. This study presents a framework to quantify bacterial survival. MRSA strains showed great capacity to persist in the environment, irrespective of epidemiological success. This finding strengthens the need for effective surface cleaning to contain MRSA transmission. IMPORTANCE Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of infections globally. While some MRSA clusters have spread worldwide, others are not able to disseminate successfully beyond certain regions despite frequent introduction. Dehydration tolerance facilitates transmission in hospital environments through enhanced survival on surfaces and fomites, potentially explaining differences in transmission success between MRSA clusters. Unfortunately, the currently available techniques to determine dehydration tolerance of cluster-forming bacteria like S. aureus are labor-intensive and unreliable due to their dependence on quantitative culturing. In this study, bacterial survival was assessed in a newly developed assay using isothermal microcalorimetry. With this technique, the effect of drying can be determined without the disadvantages of quantitative culturing. In combination with a newly developed mathematical algorithm, we determined dehydration tolerance of a large number of MRSA strains in a systematic, unbiased, and robust manner.
Collapse
Affiliation(s)
- Valérie O. Baede
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mehri Tavakol
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Margreet C. Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Gwenan M. Knight
- Centre for Mathematical Modelling of Infectious Diseases, Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Willem J. B. van Wamel
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
23
|
Fallon M, Kennedy S, Daniels S, Humphreys H. Technologies to decontaminate bacterial biofilm on hospital surfaces: a potential new role for cold plasma? J Med Microbiol 2022; 71. [PMID: 36201343 DOI: 10.1099/jmm.0.001582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022] Open
Abstract
Healthcare-associated infections (HCAIs) are a major challenge and the near patient surface is important in harbouring causes such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile. Current approaches to decontamination are sub-optimal and many studies have demonstrated that microbial causes of HCAIs may persist with onward transmission. This may be due to the capacity of these microbes to survive in biofilms on surfaces. New technologies to enhance hospital decontamination may have a role in addressing this challenge. We have reviewed current technologies such as UV light and hydrogen peroxide and also assessed the potential use of cold atmospheric pressure plasma (CAPP) in surface decontamination. The antimicrobial mechanisms of CAPP are not fully understood but the production of reactive oxygen and other species is believed to be important. CAPP systems have been shown to partially or completely remove a variety of biofilms including those caused by Candida albicans, and multi-drug-resistant bacteria such as MRSA. There are some studies that suggest promise for CAPP in the challenge of surface decontamination in the healthcare setting. However, further work is required to define better the mechanism of action. We need to know what surfaces are most amenable to treatment, how microbial components and the maturity of biofilms may affect successful treatment, and how would CAPP be used in the clinical setting.
Collapse
Affiliation(s)
- Muireann Fallon
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Sarah Kennedy
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Stephen Daniels
- National Centre for Plasma Science and Technology, Dublin City University, Dublin, Ireland
| | - Hilary Humphreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland.,Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| |
Collapse
|
24
|
Su Y, Yrastorza JT, Matis M, Cusick J, Zhao S, Wang G, Xie J. Biofilms: Formation, Research Models, Potential Targets, and Methods for Prevention and Treatment. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2203291. [PMID: 36031384 PMCID: PMC9561771 DOI: 10.1002/advs.202203291] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/31/2022] [Indexed: 05/28/2023]
Abstract
Due to the continuous rise in biofilm-related infections, biofilms seriously threaten human health. The formation of biofilms makes conventional antibiotics ineffective and dampens immune clearance. Therefore, it is important to understand the mechanisms of biofilm formation and develop novel strategies to treat biofilms more effectively. This review article begins with an introduction to biofilm formation in various clinical scenarios and their corresponding therapy. Established biofilm models used in research are then summarized. The potential targets which may assist in the development of new strategies for combating biofilms are further discussed. The novel technologies developed recently for the prevention and treatment of biofilms including antimicrobial surface coatings, physical removal of biofilms, development of new antimicrobial molecules, and delivery of antimicrobial agents are subsequently presented. Finally, directions for future studies are pointed out.
Collapse
Affiliation(s)
- Yajuan Su
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Jaime T. Yrastorza
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Mitchell Matis
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Jenna Cusick
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Siwei Zhao
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Guangshun Wang
- Department of Pathology and MicrobiologyCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Jingwei Xie
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
- Department of Mechanical and Materials EngineeringCollege of EngineeringUniversity of Nebraska‐LincolnLincolnNE68588USA
| |
Collapse
|
25
|
Tahir S, Emanuel S, Inglis DW, Vickery K, Deva AK, Hu H. Mild Positive Pressure Improves the Efficacy of Benzalkonium Chloride against Staphylococcus aureus Biofilm. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 9:bioengineering9090461. [PMID: 36135007 PMCID: PMC9495741 DOI: 10.3390/bioengineering9090461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/01/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022]
Abstract
Current protocols using liquid disinfectants to disinfect heat-sensitive hospital items frequently fail, as evidenced by the continued isolation of bacteria following decontamination. The contamination is, in part, due to biofilm formation. We hypothesize that mild positive pressure (PP) will disrupt this biofilm structure and improve liquid disinfectant/detergent penetration to biofilm bacteria for improved killing. Staphylococcus aureus biofilm, grown on polycarbonate coupons in the biofilm reactor under shear at 35 °C for 3 days, was treated for 10 min and 60 min with various dilutions of benzalkonium chloride without PP at 1 atmosphere (atm), and with PP at 3, 5, 7, and 10 atm. The effect on biofilm and residual bacterial viability was determined by standard plate counts, confocal laser scanning microscopy, and scanning electron microscopy. Combined use of benzalkonium chloride and PP up to 10 atm significantly increased biofilm killing up to 4.27 logs, as compared to the treatment using disinfectant alone. Microscopy results were consistent with the viability plate count results. PP improved disinfectant efficacy against bacterial biofilm. The use of mild PP is possible in many flow situations or if equipment/contaminated surfaces can be placed in a pressure chamber.
Collapse
Affiliation(s)
- Shamaila Tahir
- Surgical Infection Research Group, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Sarah Emanuel
- Surgical Infection Research Group, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
- School of Engineering, Macquarie University, Sydney, NSW 2109, Australia
| | - David W. Inglis
- School of Engineering, Macquarie University, Sydney, NSW 2109, Australia
| | - Karen Vickery
- Surgical Infection Research Group, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Anand K. Deva
- Surgical Infection Research Group, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Honghua Hu
- Surgical Infection Research Group, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
- Correspondence:
| |
Collapse
|
26
|
Ledwoch K, Vickery K, Maillard JY. Dry surface biofilms: what you need to know. Br J Hosp Med (Lond) 2022; 83:1-3. [DOI: 10.12968/hmed.2022.0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Environmental dry surface biofilms are a new type of biofilm found on dry surfaces, that are not visible to the human eye. Dry surface biofilms harbour multidrug-resistant organisms, are resistant to cleaning and disinfection and cannot be detected by wet or dry swabbing, so may play an important role in the persistence of pathogens in the healthcare environment.
Collapse
Affiliation(s)
- K Ledwoch
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - K Vickery
- Department of Biomedical Sciences, Macquarie University, Sydney, Australia
| | - J-Y Maillard
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| |
Collapse
|
27
|
Ferradas C, Cotter C, Shahbazian JH, Iverson SA, Baron P, Misic AM, Brazil AM, Rankin SC, Nachamkin I, Ferguson JM, Peng RD, Bilker WB, Lautenbach E, Morris DO, Lescano AG, Davis MF. Risk factors for antimicrobial resistance among Staphylococcus isolated from pets living with a patient diagnosed with methicillin-resistant Staphylococcus aureus infection. Zoonoses Public Health 2022; 69:550-559. [PMID: 35420715 PMCID: PMC9543542 DOI: 10.1111/zph.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/04/2022] [Accepted: 03/23/2022] [Indexed: 01/26/2023]
Abstract
It has been suggested that pets play a critical role in the maintenance of methicillin-resistant (MR) and multidrug-resistant (MDR) Staphylococcus spp. in the household. We examined risk factors for carriage of antimicrobial-resistant coagulase-positive staphylococci, with particular attention to Staphylococcus aureus and Staphylococcus pseudintermedius isolated from pets living in households of people diagnosed with methicillin-resistant S. aureus (MRSA) skin or soft-tissue infection. We analyzed data collected cross-sectionally from a study conducted in 2012 that evaluated the transmission of MRSA and other staphylococci from humans, their pets and the environment (Pets and Environmental Transmission of Staphylococci [PETS] study). We used unadjusted and adjusted stratified logistic regression analyses with household-clustered standard errors to evaluate the association between demographic, healthcare-related, contact-related and environmental risk factors and MDR Staphylococcus spp. isolated from dogs and cats. Staphylococcal isolates obtained from dogs (n = 63) and cats (n = 47) were included in these analyses. The use of oral or injectable antimicrobials by the pets during the prior year was the main risk factor of interest. Based on our results, 50% (12/24) of S. aureus, 3.3% (1/30) of S. pseudintermedius and 25% (14/56) of other coagulase-positive staphylococci (CPS) were determined to be MDR. S. aureus isolates were more likely to be MDR compared with S. pseudintermedius. We did not find a significant statistical association between the use of oral or injectable antimicrobials in the prior year and the presence of MDR bacteria. The results suggest that drivers of antimicrobial resistance in household staphylococci may vary by bacterial species, which could have implications for one health intervention strategies for staphylococci and inform the investigation of other reverse zoonoses, such as COVID-19.
Collapse
Affiliation(s)
- Cusi Ferradas
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
- Emerging Diseases and Climate Change Research UnitSchool of Public Health and AdministrationUniversidad Peruana Cayetano Heredia (UPCH)San Martin de PorresPeru
- School of Veterinary MedicineUniversidad Peruana Cayetano Heredia (UPCH)San Martin de PorresPeru
| | - Caitlin Cotter
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Sally Ann Iverson
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Patrick Baron
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of Health and Human ValuesDavidson CollegeDavidsonNorth CarolinaUSA
| | - Ana M. Misic
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Amy M. Brazil
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Shelley C. Rankin
- School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Irving Nachamkin
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Roger D. Peng
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Warren B. Bilker
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ebbing Lautenbach
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Daniel O. Morris
- School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Andrés G. Lescano
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
- Emerging Diseases and Climate Change Research UnitSchool of Public Health and AdministrationUniversidad Peruana Cayetano Heredia (UPCH)San Martin de PorresPeru
| | - Meghan F. Davis
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| |
Collapse
|
28
|
Tewes TJ, Centeleghe I, Maillard JY, Platte F, Bockmühl DP. Raman Microscopic Analysis of Dry-Surface Biofilms on Clinically Relevant Materials. Microorganisms 2022; 10:microorganisms10071369. [PMID: 35889088 PMCID: PMC9319561 DOI: 10.3390/microorganisms10071369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/21/2022] [Accepted: 07/04/2022] [Indexed: 12/04/2022] Open
Abstract
Moist/hydrated biofilms have been well-studied in the medical area, and their association with infections is widely recognized. In contrast, dry-surface biofilms (DSBs) on environmental surfaces in healthcare settings have received less attention. DSBs have been shown to be widespread on commonly used items in hospitals and to harbor bacterial pathogens that are known to cause healthcare-acquired infections (HAI). DSBs cannot be detected by routine surface swabbing or contact plates, and studies have shown DSBs to be less susceptible to cleaning/disinfection products. As DSBs are increasingly reported in the medical field, and there is a likelihood they also occur in food production and manufacturing areas, there is a growing demand for the rapid in situ detection of DSBs and the identification of pathogens within DSBs. Raman microspectroscopy allows users to obtain spatially resolved information about the chemical composition of biofilms, and to identify microbial species. In this study, we investigated Staphylococcus aureus mono-species DSB on polyvinylchloride blanks and stainless steel coupons, and dual-species (S. aureus/Bacillus licheniformis) DSB on steel coupons. We demonstrated that Raman microspectroscopy is not only suitable for identifying specific species, but it also enables the differentiation of vegetative cells from their sporulated form. Our findings provide the first step towards the rapid identification and characterization of the distribution and composition of DSBs on different surface areas.
Collapse
Affiliation(s)
- Thomas J. Tewes
- Faculty of Life Sciences, Rhine-Waal University of Applied Sciences, Marie-Curie-Straße 1, 47533 Kleve, Germany; (T.J.T.); (F.P.)
| | - Isabella Centeleghe
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff CF10 3NB, Wales, UK; (I.C.); (J.-Y.M.)
| | - Jean-Yves Maillard
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff CF10 3NB, Wales, UK; (I.C.); (J.-Y.M.)
| | - Frank Platte
- Faculty of Life Sciences, Rhine-Waal University of Applied Sciences, Marie-Curie-Straße 1, 47533 Kleve, Germany; (T.J.T.); (F.P.)
| | - Dirk P. Bockmühl
- Faculty of Life Sciences, Rhine-Waal University of Applied Sciences, Marie-Curie-Straße 1, 47533 Kleve, Germany; (T.J.T.); (F.P.)
- Correspondence: ; Tel.: +49-2821-806-73208
| |
Collapse
|
29
|
Artificial Human Sweat as a Novel Growth Condition for Clinically Relevant Pathogens on Hospital Surfaces. Microbiol Spectr 2022; 10:e0213721. [PMID: 35357242 PMCID: PMC9045197 DOI: 10.1128/spectrum.02137-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The emergence of biofilms on dry hospital surfaces has led to the development of numerous models designed to challenge the efficacious properties of common antimicrobial agents used in cleaning. This is in spite of limited research defining how dry surfaces are able to facilitate biofilm growth and formation in such desiccating and nutrient-deprived environments. While it is well established that the phenotypical response of biofilms is dependent on the conditions in which they are formed, most models incorporate a nutrient-enriched, hydrated environment dissimilar to the clinical setting. In this study, we piloted a novel culture medium, artificial human sweat (AHS), which is perceived to be more indicative of the nutrient sources available on hospital surfaces, particularly those in close proximity to patients. AHS was capable of sustaining the proliferation of four clinically relevant multidrug-resistant pathogens (Acinetobacter baumannii, Staphylococcus aureus, Enterococcus faecalis, and Pseudomonas aeruginosa) and achieved biofilm formation at concentration levels equivalent to those found in situ (average, 6.00 log10 CFU/cm2) with similar visual characteristics upon microscopy. The AHS model presented here could be used for downstream applications, including efficacy testing of hospital cleaning products, due to its resemblance to clinical biofilms on dry surfaces. This may contribute to a better understanding of the true impact these products have on surface hygiene. IMPORTANCE Precise modeling of dry surface biofilms in hospitals is critical for understanding their role in hospital-acquired infection transmission and surface contamination. Using a representative culture condition which includes a nutrient source is key to developing a phenotypically accurate biofilm community. This will enable accurate laboratory testing of cleaning products and their efficacy against dry surface biofilms.
Collapse
|
30
|
Chaggar GK, Nkemngong CA, Li X, Teska PJ, Oliver HF. Hydrogen peroxide, sodium dichloro-s-triazinetriones and quaternary alcohols significantly inactivate the dry-surface biofilms of Staphylococcus aureus and Pseudomonas aeruginosa more than quaternary ammoniums. MICROBIOLOGY (READING, ENGLAND) 2022; 168. [PMID: 35275049 PMCID: PMC9558353 DOI: 10.1099/mic.0.001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Globally, healthcare-associated infections (HAI) are the most frequent adverse outcome in healthcare delivery. Although bacterial biofilms contribute significantly to the incidence of HAI, few studies have investigated the efficacy of common disinfectants against dry-surface biofilms (DSB). The objective of this study was to evaluate the bactericidal efficacy of seven Environmental Protection Agency (EPA)-registered liquid disinfectants against DSB of Staphylococcus aureus and Pseudomonas aeruginosa. We hypothesized that overall, there will be significant differences among the bactericidal efficacies of tested disinfectants by product type and active ingredient class. We also hypothesized that depending on the species, higher bactericidal efficacies against DSB will be exhibited after 24 h of dehydration compared to 72 h. Wet-surface biofilms of S. aureus and P. aeruginosa were grown following EPA-MLB-SOP-MB-19 and dehydrated for 24 and 72 h to establish DSB. Seven EPA-registered disinfectants were tested against dehydrated DSB following EPA-MLB-SOP-MB-20. Overall, quaternary ammonium plus alcohol, sodium dichloro-s-triazinetrione and hydrogen peroxide products were more efficacious against DSB than quaternary ammoniums for both tested species. While there was no significant difference in the log10 reductions between 24 and 72 h S. aureus biofilms, significantly higher log10 reductions were observed when products were challenged with 24 h P. aeruginosa DSB compared to 72 h P. aeruginosa DSB. Species type, active ingredient class and dry time significantly impact disinfectant efficacy against DSB of S. aureus or P. aeruginosa.
Collapse
Affiliation(s)
- Gurpreet K. Chaggar
- Department of Food Science, Purdue University, West Lafayette, IN 47907, USA
| | - Carine A. Nkemngong
- Department of Food Science, Purdue University, West Lafayette, IN 47907, USA
- Diversey Inc., Charlotte, NC 28273, USA
| | | | | | - Haley F. Oliver
- Department of Food Science, Purdue University, West Lafayette, IN 47907, USA
- *Correspondence: Haley F. Oliver,
| |
Collapse
|
31
|
Fallon M, Conway J, Kennedy S, Kumar S, Daniels S, Humphreys H. The effect of cold plasma operating parameters on the production of reactive oxygen and nitrogen species and the resulting antibacterial and antibiofilm efficiency. PLASMA MEDICINE 2022. [DOI: 10.1615/plasmamed.2022043043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
32
|
Wound Antiseptics and European Guidelines for Antiseptic Application in Wound Treatment. Pharmaceuticals (Basel) 2021; 14:ph14121253. [PMID: 34959654 PMCID: PMC8708894 DOI: 10.3390/ph14121253] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 01/21/2023] Open
Abstract
Issues arising in wound healing are very common, and chronic wound infections affect approximately 1.5% of the population. The main substances used in wound washing, cleansing and treatment are antiseptics. Today, there are many compounds with a known antiseptic activity. Older antiseptics (e.g., boric acid, ethacridine lactate, potassium permanganate, hydrogen peroxide, iodoform, iodine and dyes) are not recommended for wound treatment due to a number of disadvantages. According to the newest guidelines of the Polish Society for Wound Treatment and the German Consensus on Wound Antisepsis, only the following antiseptics should be taken into account for wound treatment: octenidine (OCT), polihexanide (PHMB), povidone-iodine (PVP-I), sodium hypochlorite (NaOCl) and nanosilver. This article provides an overview of the five antiseptics mentioned above, their chemical properties, wound applications, side effects and safety.
Collapse
|
33
|
Barr KL, Sturdivant RX, Williams DN, Harris D. Bacteria Associated with Healthcare-Associated Infections on Environmental Samples Obtained from Two Fire Departments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211885. [PMID: 34831638 PMCID: PMC8621870 DOI: 10.3390/ijerph182211885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 12/14/2022]
Abstract
(1) Background: Firefighters spend about 64% of their time responding to medical emergencies and providing medical care without a patient history, which can render them vulnerable to healthcare-associated infections (HAI). Infection prevention, control, and surveillance systems have been instituted at hospitals. However, the prevalence of firefighters’ exposure to HAI is unknown. The objective of this study was to document evidence of HAI on surfaces in fire stations and engines to inform disinfection procedures and identify which pathogens might contribute to occupational exposures. (2) Methods: High-touch or high-use surfaces of two fire departments were sampled during five separate occasions. One fire station from one fire department was sampled over a 4-week period, whereas four fire stations were sampled from a different fire department only once. Sampled surfaces included: entryway floor, washing machine, medical bag, back seat of engine, keyboard of reporting computer, engine console, and uniform pants. (3) Results: Multiple statistical models determined that bacterial contamination was similar between the two fire departments and their stations. Keyboards were the most contaminated surface for all fire stations and departments, E. coli was the most common bacteria detected, and C. difficile was the least detected bacteria. Adjustments for rates of contamination found that contamination rates varied between fire stations. (4) Conclusions: Comprehensive environmental sampling and clinical studies are needed to better understand occupational exposures of firefighters to HAI.
Collapse
Affiliation(s)
- Kelli L. Barr
- Center for Global Health Infectious Disease Research, College of Public Health, University of South Florida, Tampa, FL 10921, USA;
| | | | - Denise N. Williams
- Department of Human Sciences and Design, College of Health and Human Science, Baylor University, Waco, TX 76798, USA;
| | - Debra Harris
- Department of Human Sciences and Design, College of Health and Human Science, Baylor University, Waco, TX 76798, USA;
- Correspondence: ; Tel.: +1-254-710-7255
| |
Collapse
|
34
|
Bacteriophage treatment before chemical disinfection can enhance removal of plastic surface-associated Pseudomonas aeruginosa. Appl Environ Microbiol 2021; 87:e0098021. [PMID: 34347517 PMCID: PMC8478462 DOI: 10.1128/aem.00980-21] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Opportunistic pathogens can linger on surfaces in hospital and building plumbing environments, leading to infections in at-risk populations. Further, biofilm-associated bacteria are protected from removal and inactivation protocols, such as disinfection. Bacteriophages show promise as tools to treat antibiotic resistant infections. As such, phages may also be useful in environmental applications to prevent newly acquired infections. In the current study, the potential of synergies between bacteriophage and chemical disinfection of the opportunistic pathogen Pseudomonas aeruginosa was assessed under various conditions. Specifically, surface-associated P. aeruginosa was treated with various concentrations of phages (P1 or JG004), chemical disinfectant (sodium hypochlorite or benzalkonium chloride), or combined sequential treatments under three distinct attachment models (spot inoculations, dry biofilms, and wet biofilms). Phages were very effective at removing bacteria in spot inoculation (>3.2 log10 removal) and wet biofilms (up to 2.6 log10 removal), while phages prevented regrowth of dry biofilms in the application time. In addition, phage treatment followed by chemical disinfection inactivated more P. aeruginosa under wet biofilm conditions better than either treatment alone. This effect was hindered when chemical disinfection was applied first, followed by phage treatment, suggesting additive benefits of combination treatments are lost when phage is applied last. Further, we confirm prior evidence of greater phage tolerance to benzalkonium chloride relative to sodium hypochlorite, informing choices for combination phage-disinfectant approaches. Overall, this paper further supports the potential of using combination phage and chemical disinfectant treatments to improve inactivation of surface-associated P. aeruginosa. Importance Phages are already utilized in the healthcare industry to treat antibiotic resistant infections, such as on implant-associated biofilms and in compassionate care cases. Phage treatment could also be a promising new tool to control pathogens in the built environment, preventing infections from occurring. This study shows that phage can be combined effectively with chemical disinfectants to improve removal of wet biofilms and bacteria spotted onto surfaces while preventing regrowth in dry biofilms. This has the potential to improve pathogen containment within the built environment and drinking water infrastructure to prevent infections of opportunistic pathogens.
Collapse
|
35
|
Is a reduction in viability enough to determine biofilm susceptibility to a biocide? Infect Control Hosp Epidemiol 2021; 42:1486-1492. [PMID: 33650476 DOI: 10.1017/ice.2021.42] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The abundance and prevalence of dry-surface biofilms (DSBs) in hospitals constitute an emerging problem, yet studies rarely report the cleaning and disinfection efficacy against DSBs. Here, the combined impact of treatments on viability, transferability, and recovery of bacteria from DSBs has been investigated for the first time. METHODS Staphylococcus aureus DSBs were produced in alternating 48-hour wet-dry cycles for 12 days on AISI 430 stainless steel discs. The efficacy of 11 commercially available disinfectants, 4 detergents, and 2 contactless interventions were tested using a modified standardized product test. Reduction in viability, direct transferability, cross transmission (via glove intermediate), and DSB recovery after treatment were measured. RESULTS Of 11 disinfectants, 9 were effective in killing and removing bacteria from S. aureus DSBs with >4 log10 reduction. Only 2 disinfectants, sodium dichloroisocyanurate 1,000 ppm and peracetic acid 3,500 ppm, were able to lower both direct and cross transmission of bacteria (<2 compression contacts positive for bacterial growth). Of 11 disinfectants, 8 could not prevent DSB recovery for >2 days. Treatments not involving mechanical action (vaporized hydrogen peroxide and cold atmospheric plasma) were ineffective, producing <1 log10 reduction in viability, DSB regrowth within 1 day, and 100% transferability of DSB after treatment. CONCLUSIONS Reduction in bacterial viability alone does not determine product performance against biofilm and might give a false sense of security to consumers, manufacturers and regulators. The ability to prevent bacterial transfer and biofilm recovery after treatment requires a better understanding of the effectiveness of biocidal products.
Collapse
|
36
|
Gray JA, Chandry PS, Bowman JP, Fox EM. High-Throughput Screening of Biofilm Formation of Listeria monocytogenes on Stainless Steel Coupons Using a 96-Well Plate Format. Methods Mol Biol 2021; 2220:115-122. [PMID: 32975770 DOI: 10.1007/978-1-0716-0982-8_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Listeria monocytogenes is a foodborne pathogen capable of colonizing and persisting in the food production environment (FPE). While there are a variety of factors involved in L. monocytogenes' ability to persist in FPE, the ability to form biofilms has the potential to increase their chance of survival and long-term colonization. Understanding the mechanisms involved in L. monocytogenes ability to form biofilms may potentially help food safety managers optimize control strategies targeting it in the FPE. In this chapter, a high-throughput method to determine L. monocytogenes ability to attach and form biofilms utilizing FPE-grade stainless steel is described. This method provides fast and efficient results, facilitating scaling up to large numbers of isolates to measure their ability to form biofilms, where lower-throughput approaches can then be utilized to further characterize isolates of interest.
Collapse
Affiliation(s)
| | | | - John P Bowman
- Centre for Food Safety and Innovation, Tasmanian Institute of Agriculture, University of Tasmania, Hobart, TAS, Australia
| | - Edward M Fox
- CSIRO Agriculture and Food, Werribee, VIC, Australia.
- Department of Applied Sciences, Northumbria University, Newcastle Upon Tyne, UK.
| |
Collapse
|
37
|
Boyce JM. A review of wipes used to disinfect hard surfaces in health care facilities. Am J Infect Control 2021; 49:104-114. [PMID: 32569612 DOI: 10.1016/j.ajic.2020.06.183] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite a plethora of wipes available for use in health care facilities, there is a paucity of articles describing wipe composition, potential interactions between wipes and disinfectants, the manner in which wipes are used, and their relative efficacy. The purpose of this article is to provide an in-depth review of wipes used for disinfection of hard surfaces in health care settings. METHODS Comprehensive searches of the Pubmed database and Internet were conducted, and articles published from 1953 through September 2019 and pertinent on-line documents were reviewed. Bibliographies of relevant articles were reviewed. RESULTS Wipes vary considerably in their composition, and the disinfectants with which they are used. With reusable dry wipes, the ratio of wipe material to disinfectant and the amount of disinfectant absorbed by the wipe and delivered to surfaces is difficult to standardize, which may affect their efficacy. The manner in which wipes are used by health care personnel is highly variable, due in part to insufficient instructions for use and inadequate education of relevant personnel. CONCLUSIONS Additional research is needed regarding the best practices for using different types of wipes, improved methods for educating staff, and establishing the relative efficacy of wipes in reducing environmental contamination and health care-associated infections.
Collapse
|
38
|
Nkemngong CA, Voorn MG, Li X, Teska PJ, Oliver HF. A rapid model for developing dry surface biofilms of Staphylococcus aureus and Pseudomonas aeruginosa for in vitro disinfectant efficacy testing. Antimicrob Resist Infect Control 2020; 9:134. [PMID: 32807240 PMCID: PMC7430009 DOI: 10.1186/s13756-020-00792-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 07/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Bacterial biofilms persistent on dry environmental surfaces in healthcare facilities play an important role in the occurrence of healthcare associated infections (HAI). Compared to wet surface biofilms and planktonic bacteria, dry surface biofilms (DSB) are more tolerant to disinfection. However, there is no official method for developing DSB for in vitro disinfectant efficacy testing. The objectives of this study were to (i) develop an in vitro model of DSB of S. aureus and P. aeruginosa for disinfectant efficacy testing and (ii) investigate the effect of drying times and temperatures on DSB development. We hypothesized that a minimum six log10 density of DSB could be achieved on glass coupons by desiccating wet surface biofilms near room temperatures. We also hypothesized that a DSB produced by the model in this study will be encased in extracellular polymeric substances (EPS). Methods S. aureus ATCC-6538 and P. aeruginosa ATCC-15442 wet surface biofilms were grown on glass coupons following EPA MLB SOP MB-19. A DSB model was developed by drying coupons in an incubator and viable bacteria were recovered following a modified version of EPA MLB SOP MB-20. Scanning electron microscopy was used to confirm the EPS presence on DSB. Results Overall, a minimum of six mean log10 densities of DSB for disinfectant efficacy were recovered per coupon after drying at different temperatures and drying times. Regardless of strain, temperature and dry time, 86% of coupons with DSB were confirmed to have EPS. Conclusion A rapid model for developing DSB with characteristic EPS was developed for disinfectant efficacy testing against DSB.
Collapse
Affiliation(s)
- Carine A Nkemngong
- Department of Food Science, Purdue University, 745 Agriculture Mall Drive, West Lafayette, IN, 47907, USA
| | - Maxwell G Voorn
- Department of Food Science, Purdue University, 745 Agriculture Mall Drive, West Lafayette, IN, 47907, USA
| | - Xiaobao Li
- Diversey Inc., Charlotte, NC, 28273, USA
| | | | - Haley F Oliver
- Department of Food Science, Purdue University, 745 Agriculture Mall Drive, West Lafayette, IN, 47907, USA.
| |
Collapse
|
39
|
Mataraci-Kara E, Ataman M, Yilmaz G, Ozbek-Celik B. Evaluation of antifungal and disinfectant-resistant Candida species isolated from hospital wastewater. Arch Microbiol 2020; 202:2543-2550. [DOI: 10.1007/s00203-020-01975-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
|
40
|
Tarricone R, Rognoni C, Arnoldo L, Mazzacane S, Caselli E. A Probiotic-Based Sanitation System for the Reduction of Healthcare Associated Infections and Antimicrobial Resistances: A Budget Impact Analysis. Pathogens 2020; 9:pathogens9060502. [PMID: 32585922 PMCID: PMC7350316 DOI: 10.3390/pathogens9060502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/28/2022] Open
Abstract
Healthcare associated infections (HAIs) and antibiotic resistance have high social and economic burdens. Healthcare environments play an important role in the transmission of HAIs. The Probiotic Cleaning Hygiene System (PCHS) has been shown to decrease hospital surface pathogens up to 90% vs. conventional chemical cleaning (CCC). This study compares PCHS to CCC as to reduction of HAIs and their severity, related antibiotic resistances, and costs. Incidence rates of HAIs/antibiotic resistances were estimated from a previously conducted multicenter pre-post (6 months CCC + 6 months PCHS) intervention study, after applying the propensity score matching technique. A budget impact analysis compared the current scenario of use of CCC with future scenarios considering increasing utilization of PCHS, from 5% to 50% in the next five years, from a hospital perspective in Italy. The cumulative incidence of HAI was 4.6% and 2.4% (p < 0.0001) for CCC (N = 4160) and PCHS (N = 4160) (OR = 0.47, CI 95% 0.37–0.60), with severe HAIs of 1.57% vs. 1% and antibiotic resistances of 1.13% vs. 0.53%, respectively. Increased use of PCHS over CCC in Italian internal medicine/geriatrics and neurology departments in the next 5 years is expected to avert at least about 31,000 HAIs and 8500 antibiotic resistances, and save at least 14 million euros, of which 11.6 for the treatment of resistant HAIs. Innovative, environmentally sustainable sanitation systems, like PCHS, might substantially reduce antibiotic resistance and increase protection of health worldwide.
Collapse
Affiliation(s)
- Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milano, Italy;
- Department of Social and Political Sciences, Bocconi University, 20136 Milano, Italy
| | - Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milano, Italy;
- Correspondence:
| | - Luca Arnoldo
- Department of Medicine, University of Udine, 33100 Udine, Italy;
| | - Sante Mazzacane
- CIAS Interdepartmental Research Centre, Department of Architecture, Department of Chemical and Pharmaceutical Sciences, University of Ferrara, 44122 Ferrara, Italy; (S.M.); (E.C.)
| | - Elisabetta Caselli
- CIAS Interdepartmental Research Centre, Department of Architecture, Department of Chemical and Pharmaceutical Sciences, University of Ferrara, 44122 Ferrara, Italy; (S.M.); (E.C.)
- Section of Microbiology, Department of Chemical & Pharmaceutical Sciences, University of Ferrara, 44121 Ferrara, Italy
| |
Collapse
|
41
|
Amaeze N, Akinbobola A, Chukwuemeka V, Abalkhaila A, Ramage G, Kean R, Staines H, Williams C, Mackay W. Development of a high throughput and low cost model for the study of semi-dry biofilms. BIOFOULING 2020; 36:403-415. [PMID: 32441116 DOI: 10.1080/08927014.2020.1766030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
The persistence of microorganisms as biofilms on dry surfaces resistant to the usual terminal cleaning methods may pose an additional risk of transmission of infections. In this study, the Centre for Disease Control (CDC) dry biofilm model (DBM) was adapted into a microtiter plate format (Model 1) and replicated to create a novel in vitro model that replicates conditions commonly encountered in the healthcare environment (Model 2). Biofilms of Staphylococcus aureus grown in the two models were comparable to the biofilms of the CDC DBM in terms of recovered log10 CFU well-1. Assessment of the antimicrobial tolerance of biofilms grown in the two models showed Model 2 a better model for biofilm formation. Confirmation of the biofilms' phenotype with an extracellular matrix deficient S. aureus suggested stress tolerance through a non-matrix defined mechanism in microorganisms. This study highlights the importance of conditions maintained in bacterial growth as they affect biofilm phenotype and behaviour.
Collapse
Affiliation(s)
- Ngozi Amaeze
- Institute of Healthcare Policy and Practice, School of Health and Life Sciences, University of the West of Scotland, Paisley, UK
- Department of Microbiology, University of Abuja, Abuja, Nigeria
| | - Ayorinde Akinbobola
- Institute of Healthcare Policy and Practice, School of Health and Life Sciences, University of the West of Scotland, Paisley, UK
| | - Valentine Chukwuemeka
- Institute of Healthcare Policy and Practice, School of Health and Life Sciences, University of the West of Scotland, Paisley, UK
| | - Adil Abalkhaila
- Department of Human Health, College of Applied Medical Sciences, Qassim University, Buraydah, KSA
| | - Gordon Ramage
- Oral Sciences Research Group, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Ryan Kean
- Biological and Biomedical Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Craig Williams
- Institute of Healthcare Policy and Practice, School of Health and Life Sciences, University of the West of Scotland, Paisley, UK
| | - William Mackay
- Institute of Healthcare Policy and Practice, School of Health and Life Sciences, University of the West of Scotland, Paisley, UK
| |
Collapse
|
42
|
Silva LN, Costa DM, Vickery K, Melo DS, Leão-Vasconcelos LSNO, Hu H, Ribeiro EL, Tipple AFV. Microbiological contamination of clipboards used for patient records in intensive care units. J Hosp Infect 2020; 104:298-300. [PMID: 31927038 DOI: 10.1016/j.jhin.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
Affiliation(s)
- L N Silva
- Postgraduate Program in Health Sciences, Federal University of Goias, Goiânia, Goiás, Brazil
| | - D M Costa
- Faculty of Nursing, Federal University of Goias, Goiânia, Goiás, Brazil
| | - K Vickery
- Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
| | - D S Melo
- Faculty of Nursing, Federal University of Goias, Goiânia, Goiás, Brazil
| | - L S N O Leão-Vasconcelos
- Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiânia, Goiás, Brazil
| | - H Hu
- Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
| | - E L Ribeiro
- Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiânia, Goiás, Brazil
| | - A F V Tipple
- Faculty of Nursing, Federal University of Goias, Goiânia, Goiás, Brazil.
| |
Collapse
|
43
|
de Mélo Silva IS, do Amorim Costa Gaspar LM, Rocha AMO, da Costa LP, Tada DB, Franceschi E, Padilha FF. Encapsulation of Red Propolis in Polymer Nanoparticles for the Destruction of Pathogenic Biofilms. AAPS PharmSciTech 2020; 21:49. [PMID: 31900606 DOI: 10.1208/s12249-019-1576-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/14/2019] [Indexed: 12/22/2022] Open
Abstract
Microbial biofilms, structured communities of microorganisms, have been often associated to the infection and bacterial multiresistance problem. Conventional treatment of infection involves the use of antibiotics, being an alternative approach is the use of red propolis, a natural product, to prepare polymer nanoparticles. The aim of the present study was to encapsulate red propolis extract in poly(lactic-co-glycolic acid) (PLGA) nanoparticles for destruction in vitro of pathogenic biofilms. Poly(lactic-co-glycolic acid) nanoparticles (PLGA NPs) containing red propolis hydroethanolic extract (2 mg/mL) were produced by emulsification solvent diffusion method. The extract and developed nanoparticles were analyzed for antimicrobial activity and inhibition of bacterial biofilm formation in vitro against Staphylococcus aureus and Pseudomonas aeruginosa. Transmission electron microscopy images confirmed spherical nanoparticles in the range size from 42.4 nm (PLGA NPs) to 69.2 nm (HERP PLGA NPs), with encapsulation efficiencies of 96.99%. The free extract and encapsulated in polymer nanoparticle presented antimicrobial potential, with a minimum inhibitory concentration from 15.6 to 125 μg mL-1 and from 100 to 1560 μg mL-1 to inhibit biofilm formation for the Staphylococcus aureus and Pseudomonas aeruginosa, respectively.
Collapse
|
44
|
Parvin F, Hu H, Whiteley G, Glasbey T, Vickery K. Difficulty in removing biofilm from dry surfaces. J Hosp Infect 2019; 103:465-467. [DOI: 10.1016/j.jhin.2019.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/01/2019] [Indexed: 01/23/2023]
|
45
|
Köhler AT, Rodloff AC, Labahn M, Reinhardt M, Truyen U, Speck S. Evaluation of disinfectant efficacy against multidrug-resistant bacteria: A comprehensive analysis of different methods. Am J Infect Control 2019; 47:1181-1187. [PMID: 31060869 DOI: 10.1016/j.ajic.2019.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Multidrug-resistant gram-negative bacteria (MDR-GNB) constitute a threat to health care worldwide. Disinfectants are used to prevent and control the spread of MDR-GNB in a hospital setting but their efficacy might be impaired by bacterial mechanisms that may act on both antimicrobials and disinfectants. Determination of minimum inhibitory concentrations is mainly used to determine bacterial susceptibility against disinfectants, but practical tests on surfaces might be more suitable to predict in-use conditions. Our objective was to compare and evaluate 4 different methods widely used to assess surface disinfectant efficacy. METHODS The efficacy of benzalkonium chloride (BAC), peracetic acid (PAA), and ethanol (ETH) against multidrug-resistant Acinetobacter, Pseudomonas, and Klebsiella strains was assessed by minimum inhibitory concentration determinations, quantitative suspension tests, qualitative suspension tests, and carrier tests. Test results were compared to ascertain the most appropriate method. RESULTS ETH, PAA, and BAC were highly effective against MDR-GNB, but we observed marked differences in efficacious concentrations (up to 100-fold) as a function of the test method applied. Minimum inhibitory concentration determination was not reliable for evaluating susceptibility or resistance to BAC. CONCLUSIONS Surface tests should be used to determine bacterial susceptibility against disinfectants. Moreover, suitable guidelines are needed that allow for the standardization and comparison of bactericidal values obtained by different investigators.
Collapse
|
46
|
Effect of disinfectant formulation and organic soil on the efficacy of oxidizing disinfectants against biofilms. J Hosp Infect 2019; 103:e33-e41. [DOI: 10.1016/j.jhin.2018.10.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/22/2018] [Indexed: 11/24/2022]
|
47
|
Abstract
The enigmatic yeast Candida auris has emerged over the last decade and rapidly penetrated our consciousness. The global threat from this multidrug-resistant yeast has generated a call to arms from within the medical mycology community. Over the past decade, our understanding of how this yeast has spread globally, its clinical importance, and how it tolerates and resists antifungal agents has expanded. This review highlights the clinical importance of antifungal resistance in C. auris and explores our current understanding of the mechanisms associated with azole, polyene, and echinocandin resistance. We also discuss the impact of phenotypic tolerance, with particular emphasis on biofilm-mediated resistance, and present new pipelines of antifungal drugs that promise new hope in the management of C. auris infection.
Collapse
Affiliation(s)
- Ryan Kean
- Department of Biological and Biomedical Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Gordon Ramage
- Oral Sciences Research Group, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
48
|
Vickery K. Special Issue: Microbial Biofilms in Healthcare: Formation, Prevention and Treatment. MATERIALS 2019; 12:ma12122001. [PMID: 31234513 PMCID: PMC6630215 DOI: 10.3390/ma12122001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 12/20/2022]
Abstract
Biofilms are a structured community of microorganisms that are attached to a surface. Individual bacteria are embedded in a bacterial-secreted matrix. Biofilms have significantly increased tolerance to removal by cleaning agents and killing by disinfectants and antibiotics. This special issue is devoted to diagnosis and treatment of biofilm-related diseases in man. It highlights the differences between the biofilm and planktonic (single cell) lifestyles and the diseases biofilms cause from periodontitis to breast implant capsular contracture. Biofilm-specific treatment options are detailed in experimental and review manuscripts.
Collapse
Affiliation(s)
- Karen Vickery
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney 2109, Australia.
| |
Collapse
|
49
|
Short B, Brown J, Delaney C, Sherry L, Williams C, Ramage G, Kean R. Candida auris exhibits resilient biofilm characteristics in vitro: implications for environmental persistence. J Hosp Infect 2019; 103:92-96. [PMID: 31226270 DOI: 10.1016/j.jhin.2019.06.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/12/2019] [Indexed: 11/28/2022]
Abstract
Surfaces within healthcare play a key role in the transmission of drug-resistant pathogens. Candida auris is an emerging multidrug-resistant yeast which can survive for prolonged periods on environmental surfaces. Here we show that the ability to form cellular aggregates increases survival after 14 days, which coincides with the upregulation of biofilm-associated genes. Additionally, the aggregating strain demonstrated tolerance to clinical concentrations of sodium hypochlorite and remained viable 14 days post treatment. The ability of C. auris to adhere to and persist on environmental surfaces emphasizes our need to better understand the biology of this fungal pathogen.
Collapse
Affiliation(s)
- B Short
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow, UK
| | - J Brown
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow, UK
| | - C Delaney
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow, UK
| | - L Sherry
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow, UK
| | - C Williams
- Institute of Healthcare Policy and Practice, School of Health, Nursing, and Midwifery, University of the West of Scotland, Paisley, UK
| | - G Ramage
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow, UK
| | - R Kean
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, Glasgow, UK; Department of Biological and Biomedical Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
| |
Collapse
|
50
|
Alfa MJ. Biofilms on instruments and environmental surfaces: Do they interfere with instrument reprocessing and surface disinfection? Review of the literature. Am J Infect Control 2019; 47S:A39-A45. [PMID: 31146849 DOI: 10.1016/j.ajic.2019.02.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is a growing appreciation for the role of biofilm-embedded microbes in many different aspects of infection transmission. The format of biofilm includes traditional hydrated biofilm, build-up biofilm, and dry surface biofilm. The objectives of this article are to discuss how traditional biofilm differs from build-up biofilm and dry surface biofilm, and to review the evidence supporting infection transmission from biofilm that accumulates in reprocessed instruments and from dry biofilm that forms environmental reservoirs.
Collapse
Affiliation(s)
- Michelle J Alfa
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.
| |
Collapse
|