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Gholipour S, Nikaeen M, Mohammadi F, Rabbani D. Antibiotic resistance pattern of waterborne causative agents of healthcare-associated infections: A call for biofilm control in hospital water systems. J Infect Public Health 2024; 17:102469. [PMID: 38838607 DOI: 10.1016/j.jiph.2024.102469] [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: 03/05/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND In recent years, the global spread of antimicrobial resistance has become a concerning issue, often referred to as a "silent pandemic". Healthcare-associated infections (HAIs) caused by antibiotic-resistant bacteria (ARB) are a recurring problem, with some originating from waterborne route. The study aimed to investigate the presence of clinically relevant opportunistic bacteria and antibiotic resistance genes (ARGs) in hospital water distribution systems (WDSs). METHODS Water and biofilm samples (n = 192) were collected from nine hospitals in Isfahan and Kashan, located in central Iran, between May 2022 and June 2023. The samples were analyzed to determine the presence and quantities of opportunistic bacteria and ARGs using cultural and molecular methods. RESULTS Staphylococcus spp. were highly detected in WDS samples (90 isolates), with 33 % of them harboring mecA gene. However, the occurrences of E. coli (1 isolate), Acinetobacter baumannii (3 isolates), and Pseudomonas aeruginosa (14 isolates) were low. Moreover, several Gram-negative bacteria containing ARGs were identified in the samples, mainly belonging to Stenotrophomonas, Sphingomonas and Brevundimonas genera. Various ARGs, as well as intI1, were found in hospital WDSs (ranging from 14 % to 60 %), with higher occurrences in the biofilm samples. CONCLUSION Our results underscore the importance of biofilms in water taps as hotspots for the dissemination of opportunistic bacteria and ARG within hospital environments. The identification of multiple opportunistic bacteria and ARGs raises concerns about the potential exposure and acquisition of HAIs, emphasizing the need for proactive measures, particularly in controlling biofilms, to mitigate infection risks in healthcare settings.
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Affiliation(s)
- Sahar Gholipour
- Department of Environmental Health Engineering, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahnaz Nikaeen
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Farzaneh Mohammadi
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davarkhah Rabbani
- Department of Environmental Health Engineering, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran
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Assaad C, Chaibi K, Jaureguy F, Plésiat P, Carbonnelle E, Cohen Y, Zahar JR, Pilmis B. Risk factors for Pseudomonas aeruginosa VIM colonization/infection in the ICU: Case control study. Am J Infect Control 2024:S0196-6553(24)00574-1. [PMID: 38925502 DOI: 10.1016/j.ajic.2024.06.013] [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: 03/25/2024] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Carbapenem-resistant strains of Pseudomonas aeruginosa (CRPA) have become a major healthcare concern in many countries, against which anti-infective strategies are limited and which require adequate infection control interventions. Knowing the different modes of transmission of CRPA in intensive care units (ICUs) would be helpful to adapt the means of prevention. METHODS The aim of this retrospective case-control study was conducted between 01/01/2017 and 02/28/2022 to identify the risk factors for the acquisition of CRPA in ICUs. RESULTS During the study period, 147 patients were included (49 cases and 98 controls). Among the 49 patients, 31 (63%) acquired CRPA in clusters and 18 (37%) sporadically. An univariate analysis showed that five variables were associated with CRPA acquisition including (i) prior antibiotic prescriptions, (ii) admission to rooms 203 and 207, (iii) severity of illness at admission, and (iv) use of mechanical ventilation. Multivariate analysis identified three factors of CRPA acquisition including admission to room 203 (OR = 29.5 [3.52-247.09]), previous antibiotic therapy (OR = 3.44 [1.02 - 11.76]) and severity of condition at admission (OR = 1.02 [1 - 1.04]). CONCLUSION Our study suggests the role of a contaminated environment in the acquisition of CRPA in the ICU, along with antibiotic use.
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Affiliation(s)
- Charbel Assaad
- Unité de Prévention du Risque Infectieux, Département de Microbiologie Clinique. Groupe Hospitalier Paris Seine Saint-Denis, Université Paris 13; Université de Franche-Comté, UMR CNRS 6249 Chrono-Environnement, Besançon, France
| | - Khalil Chaibi
- Service de Réanimation médico chirurgicale, Groupe Hospitalier Paris Seine Saint-Denis, Université Paris 13; Université de Franche-Comté, UMR CNRS 6249 Chrono-Environnement, Besançon, France
| | - Françoise Jaureguy
- Unité de Prévention du Risque Infectieux, Département de Microbiologie Clinique. Groupe Hospitalier Paris Seine Saint-Denis, Université Paris 13; Université de Franche-Comté, UMR CNRS 6249 Chrono-Environnement, Besançon, France
| | - Patrick Plésiat
- Laboratoire associé du Centre National de Référence de la Résistance aux Antibiotiques, Centre Hospitalier Universitaire de Besançon, Besançon, France; Université de Franche-Comté, UMR CNRS 6249 Chrono-Environnement, Besançon, France
| | - Etienne Carbonnelle
- Unité de Prévention du Risque Infectieux, Département de Microbiologie Clinique. Groupe Hospitalier Paris Seine Saint-Denis, Université Paris 13; Université de Franche-Comté, UMR CNRS 6249 Chrono-Environnement, Besançon, France
| | - Yves Cohen
- Service de Réanimation médico chirurgicale, Groupe Hospitalier Paris Seine Saint-Denis, Université Paris 13; Université de Franche-Comté, UMR CNRS 6249 Chrono-Environnement, Besançon, France
| | - Jean-Ralph Zahar
- Service de Réanimation médico chirurgicale, Groupe Hospitalier Paris Seine Saint-Denis, Université Paris 13; Université de Franche-Comté, UMR CNRS 6249 Chrono-Environnement, Besançon, France.
| | - Benoit Pilmis
- Université de Franche-Comté, UMR CNRS 6249 Chrono-Environnement, Besançon, France; Service de Microbiologie et plateforme de dosage des anti-infection, équipe mobile de microbiologie clinique, Hôpitaux Saint-Joseph & Marie Lannelongue, Paris, France; Université Paris-Saclay, INRAE, AgroParisTech, UMR 1319, Micalis Institute, 78350, Jouy-en-Josas, France
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Frantzis I, Levasseur S, Huebner J, Mahida M, Larussa P, James W, Abebe W, Ngwenya C, Mupere E, Rosenthal SL, Patterson J, Johnson J, Strehlau R, Lulseged S, Stanberry LR, Saiman L. Infection prevention and control and related practices in African neonatal units: The Pan-African neonatal care assessment study (PANCAS). Int J Hyg Environ Health 2024; 259:114357. [PMID: 38564877 PMCID: PMC11163474 DOI: 10.1016/j.ijheh.2024.114357] [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: 12/27/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The burden of neonatal mortality is primarily borne by low- and middle-income countries (LMICs), including deaths due to healthcare-associated infections (HAIs). Few studies have assessed infection prevention and control (IP&C) practices in African units caring for small and/or sick newborns aimed to reduce HAIs. METHODS We performed a mixed-methods study composed of a survey and virtual tour to assess IP&C and related practices. We created a survey composed of multiple-choice and open-ended questions delivered to site respondents via Zoom or video equivalent. Respondents provided a virtual tour of their unit via video and the study team used a checklist to evaluate specific practices. RESULTS We recruited 45 units caring for small and sick newborns in 20 African countries. Opportunities to optimize hand hygiene, Water, Sanitation and Hygiene (WASH) practices, Kangaroo Mother Care, and IP&C training were noted. The virtual tour offered further understanding of IP&C challenges unique to individual sites. All respondents expressed the need for additional space, equipment, supplies, education, and IP&C staff and emphasized that attention to maternal comfort was important to IP&C success. DISCUSSION This study identified opportunities to improve IP&C practices using low-cost measures including further education and peer support through learning collaboratives. Virtual tours can be used to provide site-specific assessment and feedback from peers, IP&C specialists and environmental engineering experts.
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Affiliation(s)
- Irene Frantzis
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA.
| | - Stéphanie Levasseur
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Jack Huebner
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Maitry Mahida
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Philip Larussa
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Wilmot James
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Workeabeba Abebe
- Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - Crispen Ngwenya
- Paediatrics department at Midlands State University faculty of Medicine, Gweru, Zimbabwe
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | - Susan L Rosenthal
- Departments of Pediatrics and Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Janna Patterson
- Global Child Health and Life Support, American Academia of Pediatrics, Itasca, IL, USA
| | - Julia Johnson
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Renate Strehlau
- VIDA Nkanyezi Research Unit, Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sileshi Lulseged
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Abbaba, Ethiopia
| | - Lawrence R Stanberry
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA; Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY, USA
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Shepherd MJ, Fu T, Harrington NE, Kottara A, Cagney K, Chalmers JD, Paterson S, Fothergill JL, Brockhurst MA. Ecological and evolutionary mechanisms driving within-patient emergence of antimicrobial resistance. Nat Rev Microbiol 2024:10.1038/s41579-024-01041-1. [PMID: 38689039 DOI: 10.1038/s41579-024-01041-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 05/02/2024]
Abstract
The ecological and evolutionary mechanisms of antimicrobial resistance (AMR) emergence within patients and how these vary across bacterial infections are poorly understood. Increasingly widespread use of pathogen genome sequencing in the clinic enables a deeper understanding of these processes. In this Review, we explore the clinical evidence to support four major mechanisms of within-patient AMR emergence in bacteria: spontaneous resistance mutations; in situ horizontal gene transfer of resistance genes; selection of pre-existing resistance; and immigration of resistant lineages. Within-patient AMR emergence occurs across a wide range of host niches and bacterial species, but the importance of each mechanism varies between bacterial species and infection sites within the body. We identify potential drivers of such differences and discuss how ecological and evolutionary analysis could be embedded within clinical trials of antimicrobials, which are powerful but underused tools for understanding why these mechanisms vary between pathogens, infections and individuals. Ultimately, improving understanding of how host niche, bacterial species and antibiotic mode of action combine to govern the ecological and evolutionary mechanism of AMR emergence in patients will enable more predictive and personalized diagnosis and antimicrobial therapies.
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Affiliation(s)
- Matthew J Shepherd
- Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK.
| | - Taoran Fu
- Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Niamh E Harrington
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Anastasia Kottara
- Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Kendall Cagney
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Steve Paterson
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Joanne L Fothergill
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Michael A Brockhurst
- Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK.
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Cao X, Xiong H, Fan Y, Xiong L. Comparing the Effects of Two Culture Methods to Determine the Total Heterotrophic Bacterial Colony Count in Hospital Purified Water. J Epidemiol Glob Health 2024; 14:184-192. [PMID: 38358615 PMCID: PMC11043230 DOI: 10.1007/s44197-023-00186-1] [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: 09/05/2023] [Accepted: 12/26/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Accurately detecting the quantity of microorganisms in hospital purified water is of significant importance for early identification of microbial contamination and reducing the occurrence of water-borne hospital infections. The choice of detection method is a prerequisite for ensuring accurate results. Traditional Plate Count Agar (PCA) belongs to a high-nutrient medium, and there may be limitations in terms of accuracy or sensitivity in detecting microorganisms in hospital purified water. On the other hand, Reasoner's 2A agar (R2A) has characteristics, such as low-nutrient levels, low cultivation temperature, and extended incubation time, providing advantages in promoting the growth of aquatic microorganisms. This study, through comparing the differences in total colony counts between two detection methods, aims to select the method more suitable for the growth of aquatic microorganisms, offering new practical insights for accurately detecting the total count of heterotrophic bacteria in hospital purified water. METHODS The most commonly used plate count agar (PCA) method, and the R2A agar culture were adopted to detect microorganisms and determine the total number of bacterial colonies in the water for oral diagnosis and treatment water and terminal rinse water for endoscopes in medical institutions. The two water samples were inoculated by pour plate and membrane filtration methods, respectively. Using statistical methods including Spearman and Pearson correlation, Wilcoxon signed-rank sum test, paired-Chi-square test, and linear regression, we analyze the differences and associations in the bacterial counts cultivated through two different methods. RESULTS In 142 specimens of the water, the median and interquartile range of the heterotrophic bacterial colony number under the R2A culture method and under the PCA culture method were 200 (Q1-Q3: 25-18,000) and 6 (Q1-Q3: 0-3700). The total number of heterotrophic bacteria colonies cultured in R2A medium for 7 days was more than that cultured in PCA medium for 2 days (P < 0.05). The linear regression results showed a relatively strong linear correlation between the number of colonies cultured by the R2A method and that cultured by the PCA method (R2 = 0.7264). The number of bacterial species detected on R2A agar medium is greater than that on PCA agar medium. CONCLUSION The R2A culture method can better reflect the actual number of heterotrophic bacterial colonies in hospital purified water. After logarithmic transformation, the number of colonies cultured by the two methods showed a linear correlation.
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Affiliation(s)
- Xiongjing Cao
- Department of Hospital Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Ave, Wuhan, 430022, China
| | - Huangguo Xiong
- Department of Hospital Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Ave, Wuhan, 430022, China
| | - Yunzhou Fan
- Department of Hospital Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Ave, Wuhan, 430022, China
| | - Lijuan Xiong
- Department of Hospital Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Ave, Wuhan, 430022, China.
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6
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Fucini GB, Hackmann C, Gastmeier P. Sink interventions in the ICU to reduce risk of infection or colonization with Gram-negative pathogens: a systematic review of the literature. J Hosp Infect 2024; 143:82-90. [PMID: 38529781 DOI: 10.1016/j.jhin.2023.10.011] [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: 08/28/2023] [Revised: 10/04/2023] [Accepted: 10/15/2023] [Indexed: 03/27/2024]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are a major problem in intensive care units (ICUs). The hospital water environment is a potential reservoir for Gram-negative bacteria (GNB), and it has been shown that contaminated sinks contribute to the spread of GNB in outbreak and non-outbreak settings. This study aimed to investigate which sink interventions may reduce GNB infection and colonization rates in the ICU. METHODS A database search (MEDLINE via PubMed, EMBASE via Ovid and ClinicalTrials.gov) was undertaken without restrictions on language or date of publication. Studies of any design were included if they described an intervention on the water fixtures in patient rooms, and presented data about HAI or colonization rates in non-outbreak settings. Acquisition (infection and/or colonization) rates of GNB and Pseudomonas aeruginosa were analysed as outcomes. RESULTS In total, 4404 records were identified. Eleven articles were included in the final analysis. No randomized controlled trials were included in the analysis, and all studies were reported to have moderate to serious risk of bias. Removing sinks and applying filters on taps had a significant impact on GNB acquisition, but there was high heterogeneity among reported outcomes and sample size among the studies. CONCLUSION Few studies have investigated the association of sinks in patient rooms with healthcare-associated acquisition of GNB in non-outbreak settings. Heterogeneity in study design made it impossible to generalize the results. Prospective trials are needed to further investigate whether removing sinks from patient rooms can reduce the endemic rate of HAIs in the ICU.
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Affiliation(s)
- G-B Fucini
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany.
| | - C Hackmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - P Gastmeier
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
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Yang QE, Ma X, Zeng L, Wang Q, Li M, Teng L, He M, Liu C, Zhao M, Wang M, Hui D, Madsen JS, Liao H, Walsh TR, Zhou S. Interphylum dissemination of NDM-5-positive plasmids in hospital wastewater from Fuzhou, China: a single-centre, culture-independent, plasmid transmission study. THE LANCET. MICROBE 2024; 5:e13-e23. [PMID: 38006896 DOI: 10.1016/s2666-5247(23)00227-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 07/05/2023] [Accepted: 07/20/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND The global spread of plasmid-borne carbapenem resistance is an ongoing public health challenge; however, the nature of such horizontal gene transfer events among complex bacterial communities remains poorly understood. We examined the in-situ transfer of the globally dominant New Delhi metallo-β-lactamase (NDM)-5-positive IncX3 plasmid (denoted pX3_NDM-5) in hospital wastewater to simulate a real-world, One Health antimicrobial resistance context. METHODS For this transmission study, we tagged pX3_NDM-5 with the green fluorescent protein gene, gfp, using a CRISPR-based method and transferred the plasmid to a donor Escherichia coli strain. Bacteria were extracted from a hospital wastewater treatment plant (Fujian Provincial Maternity and Children's Hospital, Fuzhou, China) as the bacterial recipient community. We mixed this recipient community with the E coli donor strain carrying the gfp-tagged plasmid, both with and without sodium hypochlorite (NaClO) as an environmental stressor, and conducted several culture-based and culture-independent conjugation assays. The conjugation events were observed microscopically and quantified by fluorescence-activated cell sorting. We analysed the taxonomic composition of the sorted transconjugal pool by 16S rRNA gene amplicon sequencing and assessed the stability of the plasmid in the isolated transconjugants and its ability to transfer back to E coli. FINDINGS We show that the plasmid pX3_NDM-5 has a broad host range and can transfer across various bacterial phyla, including between Gram-negative and Gram-positive bacteria. Although environmental stress with NaClO did not affect the overall plasmid transfer frequency, it reduced the breadth of the transconjugant pool. The taxonomic composition of the transconjugal pool was distinct from that of the recipient communities, and environmental stress modulated the permissiveness of some operational taxonomic units towards the acquisition of pX3_NDM-5. Notably, pX3_NDM-5 transconjugants included the Gram-positive pathogen Enterococcus faecalis, and the plasmid could subsequently be reconjugated back to E coli. These findings suggest that E faecalis could act as a natural shuttle vector for the wide dissemination of pX3_NDM-5 plasmids. INTERPRETATION Our culture-independent conjugation model simulates natural environmental conditions and challenges the established theory that Gram-negative and Gram-positive bacteria rarely exchange clinically important plasmids. The data show that plasmids disseminate more widely across genera and phyla than previously thought. These findings have substantial implications when considering the spread of antimicrobial resistance across One Health sectors. FUNDING The Laboratory of Lingnan Modern Agriculture Project, the National Natural Science Foundation of China, the Natural Science Foundation of Fujian Province of China, and the Outstanding Young Research Talents Program of Fujian Agriculture and Forestry University.
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Affiliation(s)
- Qiu E Yang
- Fujian Provincial Key Laboratory of Soil Environmental Health and Regulation, College of Resources and Environment, Fujian Agriculture and Forestry University, Fuzhou, China
| | - Xiaodan Ma
- Fujian Provincial Key Laboratory of Soil Environmental Health and Regulation, College of Resources and Environment, Fujian Agriculture and Forestry University, Fuzhou, China
| | - Lingshuang Zeng
- Fujian Provincial Key Laboratory of Soil Environmental Health and Regulation, College of Resources and Environment, Fujian Agriculture and Forestry University, Fuzhou, China
| | - Qinqin Wang
- Section of Microbiology, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Minchun Li
- Fujian Provincial Key Laboratory of Soil Environmental Health and Regulation, College of Resources and Environment, Fujian Agriculture and Forestry University, Fuzhou, China
| | - Lin Teng
- Department of Veterinary Medicine, College of Veterinary Medicine, Zhejiang University, Hangzhou, China
| | - Mingzhen He
- Fujian Provincial Key Laboratory of Soil Environmental Health and Regulation, College of Resources and Environment, Fujian Agriculture and Forestry University, Fuzhou, China
| | - Chen Liu
- Fujian Provincial Key Laboratory of Soil Environmental Health and Regulation, College of Resources and Environment, Fujian Agriculture and Forestry University, Fuzhou, China
| | - Mengshi Zhao
- Fujian Key Laboratory of Traditional Chinese Veterinary Medicine and Animal Health, Fujian Agriculture and Forestry University, Fuzhou, China
| | - Mengzhu Wang
- Fujian Key Laboratory of Traditional Chinese Veterinary Medicine and Animal Health, Fujian Agriculture and Forestry University, Fuzhou, China
| | - Deng Hui
- Fujian Key Laboratory of Traditional Chinese Veterinary Medicine and Animal Health, Fujian Agriculture and Forestry University, Fuzhou, China
| | - Jonas Stenløkke Madsen
- Section of Microbiology, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Hanpeng Liao
- Fujian Provincial Key Laboratory of Soil Environmental Health and Regulation, College of Resources and Environment, Fujian Agriculture and Forestry University, Fuzhou, China
| | - Timothy R Walsh
- Ineos Oxford Institute for Antimicrobial Research, Department of Biology, University of Oxford, Oxford, UK.
| | - Shungui Zhou
- Fujian Provincial Key Laboratory of Soil Environmental Health and Regulation, College of Resources and Environment, Fujian Agriculture and Forestry University, Fuzhou, China; Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou, China.
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Taudien S, Leszczynski W, Mayer T, Loderstädt U, Bader O, Kaase M, Scheithauer S. Misidentification as Pseudomonas aeruginosa in hospital water supply samples. J Hosp Infect 2023; 133:23-27. [PMID: 36584942 DOI: 10.1016/j.jhin.2022.12.013] [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: 12/01/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022]
Abstract
Drinking water in hospitals is often tested for Pseudomonas aeruginosa because of its virulence potential. This article describes a case where, based on EN ISO 16266, seven of 11 (64%) samples taken simultaneously from the drinking water system at a single hospital tested positive for P. aeruginosa. This resulted in extensive investigations and interventions, and a number of measures were implemented. However, supplementary analyses with more discriminatory power (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, 16S-rRNA sequencing) ruled out P. aeruginosa completely. The authors wish to raise awareness of this problem, and suggest that diagnostic uncertainty of results obtained by EN ISO 16266 should be indicated on laboratory reports. Wrongly assuming the presence of P. aeruginosa in hospital water supply systems can lead to unnecessary control measures, as analytical uncertainty massively influences the health risk assessment and the remediation measures initiated in medical environments.
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Affiliation(s)
- S Taudien
- Department of Infection Control and Infectious Diseases, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany.
| | - W Leszczynski
- Department of Infection Control and Infectious Diseases, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - T Mayer
- Technical Building Management, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - U Loderstädt
- Department of Infection Control and Infectious Diseases, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - O Bader
- Institute for Medical Microbiology and Virology, University Medical Center Göttingen, Göttingen, Germany
| | - M Kaase
- Department of Infection Control and Infectious Diseases, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - S Scheithauer
- Department of Infection Control and Infectious Diseases, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany
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deKay K. Clinical Issues - February 2023. AORN J 2023; 117:131-137. [PMID: 36705454 DOI: 10.1002/aorn.13869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 01/28/2023]
Abstract
Frequency of OR wall and ceiling cleaning Key words: environmental surfaces, high-touch surfaces, contamination, cleaning frequency, hand contact. Waterborne pathogen development and associated risks Key words: Legionella, premise plumbing system, opportunistic pathogens, biofilm, electronic sensor faucet. Water management program teams and perioperative services Key words: water supply safety, facility water system, waterborne pathogen prevention plan, faucets, drains. Minimizing waterborne pathogens in perioperative areas Key words: waterborne pathogen dispersal, cross contamination, splash guards, high-risk hardware, sinks.
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Yadav M, Dhyani S, Joshi P, Awasthi S, Tanwar S, Gupta V, Rathore DK, Chaudhuri S. Formic acid, an organic acid food preservative, induces viable-but-non-culturable state, and triggers new Antimicrobial Resistance traits in Acinetobacter baumannii and Klebsiella pneumoniae. Front Microbiol 2022; 13:966207. [PMID: 36504816 PMCID: PMC9730046 DOI: 10.3389/fmicb.2022.966207] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/14/2022] [Indexed: 11/25/2022] Open
Abstract
Numerous human pathogens, especially Gram-negative bacteria, are able to enter the viable-but-non-culturable (VBNC) state when they are exposed to environmental stressors and pose the risk of being resuscitated and causing infection after the removal of the trigger. Widely used food preservatives like weak organic acids are potential VBNC inducers in food processing and packaging facilities but have only been reported for food-borne pathogens. In the present study, it is demonstrated for the first time that one such agent, formic acid (FA), can induce a VBNC state at food processing, storage, and distribution temperatures (4, 25, and 37°C) with a varied time of treatment (days 4-10) in pathogenic Gram-negative bacteria Acinetobacter baumannii and Klebsiella pneumoniae. The use of hospital-associated pathogens is critical based on the earlier reports that demonstrated the presence of these bacteria in hospital kitchens and commonly consumed foods. VBNC induction was validated by multiple parameters, e.g., non-culturability, metabolic activity as energy production, respiratory markers, and membrane integrity. Furthermore, it was demonstrated that the removal of FA was able to resuscitate VBNC with an increased expression of multiple virulence and Antimicrobial Resistance (AMR) genes in both pathogens. Since food additives/preservatives are significantly used in most food manufacturing facilities supplying to hospitals, contamination of these packaged foods with pathogenic bacteria and the consequence of exposure to food additives emerge as pertinent issues for infection control, and control of antimicrobial resistance in the hospital setting.
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Affiliation(s)
| | | | | | | | | | | | | | - Susmita Chaudhuri
- Department of Multidisciplinary Clinical and Translational Research, Translational Health Science and Technology Institute, Faridabad, Haryana, India
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