1
|
Boyce JM. Hand and environmental hygiene: respective roles for MRSA, multi-resistant gram negatives, Clostridioides difficile, and Candida spp. Antimicrob Resist Infect Control 2024; 13:110. [PMID: 39334403 PMCID: PMC11437781 DOI: 10.1186/s13756-024-01461-x] [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: 06/27/2024] [Accepted: 09/04/2024] [Indexed: 09/30/2024] Open
Abstract
Healthcare-associated infections (HAIs) caused by multidrug-resistant organisms (MDROs) represent a global threat to human health and well-being. Because transmission of MDROs to patients often occurs via transiently contaminated hands of healthcare personnel (HCP), hand hygiene is considered the most important measure for preventing HAIs. Environmental surfaces contaminated with MDROs from colonized or infected patients represent an important source of HCP hand contamination and contribute to transmission of pathogens. Accordingly, facilities are encouraged to adopt and implement recommendations included in the World Health Organization hand hygiene guidelines and those from the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America/Association for Professionals in Infection Control and Epidemiology. Alcohol-based hand rubs are efficacious against MDROs with the exception of Clostridiodes difficile, for which soap and water handwashing is indicated. Monitoring hand hygiene adherence and providing HCP with feedback are of paramount importance. Environmental hygiene measures to curtail MDROs include disinfecting high-touch surfaces in rooms of patients with C. difficile infection daily with a sporicidal agent such as sodium hypochlorite. Some experts recommend also using a sporicidal agent in rooms of patients colonized with C. difficile, and for patients with multidrug-resistant Gram-negative bacteria. Sodium hypochlorite, hydrogen peroxide, or peracetic acid solutions are often used for daily and/or terminal disinfection of rooms housing patients with Candida auris or other MDROs. Products containing only a quaternary ammonium agent are not as effective as other agents against C. auris. Portable medical equipment should be cleaned and disinfected between use on different patients. Detergents are not recommended for cleaning high-touch surfaces in MDRO patient rooms, unless their use is followed by using a disinfectant. Facilities should consider using a disinfectant instead of detergents for terminal cleaning of floors in MDRO patient rooms. Education and training of environmental services employees is essential in assuring effective disinfection practices. Monitoring disinfection practices and providing personnel with performance feedback using fluorescent markers, adenosine triphosphate assays, or less commonly cultures of surfaces, can help reduce MDRO transmission. No-touch disinfection methods such as electrostatic spraying, hydrogen peroxide vapor, or ultraviolet light devices should be considered for terminal disinfection of MDRO patient rooms. Bundles with additional measures are usually necessary to reduce MDRO transmission.
Collapse
Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, 214 Hudson View Terrace, Hyde Park, NY, USA.
| |
Collapse
|
2
|
Guo Z, Qin C, Zhang L. Distribution and Characterization of Quaternary Ammonium Biocides Resistant Bacteria in Different Soils, in South-Western China. Microorganisms 2024; 12:1742. [PMID: 39203584 PMCID: PMC11357233 DOI: 10.3390/microorganisms12081742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 09/03/2024] Open
Abstract
Quaternary ammonium compounds (QACs) are active ingredients in hundreds of disinfectants for controlling the epidemic of infectious diseases like SARS-CoV-2 (COVID-19), and are also widely used in shale gas exploitation. The occurrence of QAC-resistant bacteria in the environment could enlarge the risk of sterilization failure, which is not fully understood. In this study, QAC-resistant bacteria were enumerated and characterized in 25 soils collected from shale gas exploitation areas. Total counts of QAC-resistant bacteria ranged from 6.81 × 103 to 4.48 × 105 cfu/g, accounting for 1.59% to 29.13% of the total bacteria. In total, 29 strains were further purified and identified as Lysinibacillus, Bacillus, and Klebsiella genus. There, bacteria covering many pathogenic bacteria showed different QACs tolerance with MIC (minimum inhibition concentration) varying from 4 mg/L to 64 mg/L and almost 58.6% of isolates have not previously been found to tolerate QACs. Meanwhile, the QAC-resistant strains in the produced water of shale gas were also identified. Phylogenetic trees showed that the resistant species in soil and produced water are distinctly different. That is the first time the distribution and characterization of QAC-resistant bacteria in the soil environment has been analyzed.
Collapse
Affiliation(s)
- Ziyi Guo
- State Key Laboratory of Coal Mine Disaster Dynamics and Control, Chongqing University, Chongqing 400044, China; (Z.G.); (C.Q.)
- Key Laboratory of Three Gorges Reservoir Region’s Eco-Environment, Ministry of Education, Chongqing University, Chongqing 400045, China
| | - Cunli Qin
- State Key Laboratory of Coal Mine Disaster Dynamics and Control, Chongqing University, Chongqing 400044, China; (Z.G.); (C.Q.)
- Key Laboratory of Three Gorges Reservoir Region’s Eco-Environment, Ministry of Education, Chongqing University, Chongqing 400045, China
| | - Lilan Zhang
- State Key Laboratory of Coal Mine Disaster Dynamics and Control, Chongqing University, Chongqing 400044, China; (Z.G.); (C.Q.)
- Key Laboratory of Three Gorges Reservoir Region’s Eco-Environment, Ministry of Education, Chongqing University, Chongqing 400045, China
| |
Collapse
|
3
|
La Bella AA, Molesan A, Wollin DA, Paul S, Flores-Mireles AL. Initial Antimicrobial Testing of a Novel Reusable Intermittent Urinary Catheter System and Catheter Reprocessing Device. Urology 2024:S0090-4295(24)00567-3. [PMID: 39025236 DOI: 10.1016/j.urology.2024.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/03/2024] [Accepted: 07/06/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE To evaluate the efficacy of the Aurie System, a preclinical prototype allowing for standardized intermittent catheter (IC) reuse of novel reusable no-touch ICs. Individuals with neurogenic bladder often require single-use ICs to urinate, but urinary tract infection (UTI) is a common cause of morbidity for IC users. Safer no-touch catheters are not easily affordable, and the Aurie System attempts to provide no-touch catheters at a fraction of the price by allowing for standardized and safe IC reuse. METHODS Standard ICs were inoculated with Escherichia coli and Pseudomonas aeruginosa and incubated for 48 hours to assess microbial burden and biofilm formation (the latter using infrared fluorescence imaging). This procedure was repeated with Aurie ICs, focusing on evaluating catheter microbial burden after inoculation and reprocessing with the prototype washer-disinfector. This was repeated with up to 100 cycles to evaluate repetitive use. RESULTS Standard ICs showed bacterial attachment and biofilm development peaking at 24 hours of incubation. The Aurie catheters produced a similar outcome but, after reprocessing, microbial burden was reduced below the level of detection. Repeat cycles showed pathogen clearance to similar levels. One catheter reached 100 cycles and there was no viable pathogen load after reprocessing. CONCLUSION Intermittent urinary catheters, when cleaned inappropriately, can harbor viable bacteria and biofilm. The Aurie System, when used to disinfect novel reusable ICs within a prototype reprocessing device, can reduce microbial burden below level of detection even after 100 cycles. This suggests the Aurie System may be a feasible technology for safe IC reuse.
Collapse
Affiliation(s)
- Alyssa A La Bella
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN
| | - Alex Molesan
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN
| | - Daniel A Wollin
- CathBuddy, Inc., Syracuse, NY; Department of Urology, Brigham and Women's Hospital, Boston, MA
| | | | | |
Collapse
|
4
|
Cheng LSK, Chau SKY, Chan WS, Chen JHK, Wong BKC, Fung KSC. An outbreak of Burkholderia cepacia complex exit site infection among peritoneal dialysis patients caused by contaminated spray dressing. Infect Prev Pract 2024; 6:100359. [PMID: 38559368 PMCID: PMC10981104 DOI: 10.1016/j.infpip.2024.100359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
Background Wound dressing is intended to provide a physical barrier from microorganisms. Spray dressing is convenient and can be applied to wounds of various contours. In July 2020, a cluster of four Burkholderia cepacia complex (BCC) exit site infections was identified among peritoneal dialysis patients in a regional hospital in Hong Kong. In response, our hospital infection control team conducted an epidemiologic investigation. Methods We conducted a retrospective cohort study of peritoneal dialysis patients with culture-confirmed BCC exit site infections from January 2011 to July 2020. Outbreak investigations, including case finding, molecular typing and post-outbreak surveillance, were performed. Discussion A substantial increase in BCC exit site infections has been observed since 2013, rising from 0.23 in 2012 to 1.09 episodes per 100 patient-year in 2015, with the number of cases in the first half of 2020 already surpassing the total from 2019. The potential source had been traced to a spray dressing introduced to exit site care in December 2012. Burkholderia cepacia complex was isolated from both the unopened and in-use sprays from the same lot. Multilocus sequence typing analysis confirmed their genetic relatedness. The spray dressing was subsequently removed from exit site care. Post-outbreak surveillance over two years showed a marked and sustained decrease in BCC exit site infection. Conclusion Water-based spray dressing can be a source of BCC causing wound infections. The use of contaminated spray dressing, especially in chronic wounds with proximity to indwelling catheters, may pose an inherent risk to patients.
Collapse
Affiliation(s)
- Lily Shui-Kuen Cheng
- Department of Pathology, United Christian Hospital, Hong Kong Special Administrative Region
| | - Sandy Ka-Yee Chau
- Department of Pathology, United Christian Hospital, Hong Kong Special Administrative Region
| | - Wai-Shan Chan
- Infection Control Team, United Christian Hospital, Kowloon East Cluster, Hong Kong Special Administrative Region
| | - Jonathan Hon-Kwan Chen
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Barry Kin-Chung Wong
- Department of Pathology, United Christian Hospital, Hong Kong Special Administrative Region
| | - Kitty Sau-Chun Fung
- Department of Pathology, United Christian Hospital, Hong Kong Special Administrative Region
| |
Collapse
|
5
|
Lompo P, Heroes AS, Ouédraogo K, Okitale P, Wakpo A, Kalema J, Lunguya O, Tinto H, Affolabi D, Sangaré L, Jacobs J. Knowledge, awareness, and risk practices related to bacterial contamination of antiseptics, disinfectants, and hand hygiene products among healthcare workers in sub-saharan Africa: a cross-sectional survey in three tertiary care hospitals (Benin, Burkina Faso, and DR Congo). Antimicrob Resist Infect Control 2024; 13:44. [PMID: 38627805 PMCID: PMC11020199 DOI: 10.1186/s13756-024-01396-3] [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: 10/05/2023] [Accepted: 04/01/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Antiseptics, disinfectants, and hand hygiene products can be contaminated with bacteria and cause healthcare-associated infections, which are underreported from low- and middle-income countries. To better understand the user-related risk factors, we conducted a knowledge, awareness, and practice survey among hospital staff in sub-Saharan Africa. METHODS Self-administered questionnaire distributed among healthcare workers in three tertiary care hospitals (Burkina Faso, Benin, Democratic Republic of the Congo). RESULTS 617 healthcare workers (85.3% (para)medical and 14.7% auxiliary staff) participated. Less than half (45.5%) had been trained in Infection Prevention & Control (IPC), and only 15.7% were trained < 1 year ago. Near two-thirds (64.2%) preferred liquid soap for hand hygiene, versus 33.1% for alcohol-based hand rub (ABHR). Most (58.3%) expressed confidence in the locally available products. Knowledge of product categories, storage conditions and shelf-life was inadequate: eosin was considered as an antiseptic (47.5% of (para)medical staff), the shelf life and storage conditions (non-transparent container) of freshly prepared chlorine 0.5% were known by only 42.6% and 34.8% of participants, respectively. Approximately one-third of participants approved using tap water for preparation of chlorine 0.5% and liquid soap. Most participants (> 80%) disapproved recycling soft-drink bottles as liquid soap containers. Nearly two-thirds (65.0%) declared that bacteria may be resistant to and survive in ABHR, versus 51.0% and 37.4% for povidone iodine and chlorine 0.5%, respectively. Depicted risk practices (n = 4) were ignored by 30 to 40% of participants: they included touching the rim or content of stock containers with compresses or small containers, storing of cotton balls soaked in an antiseptic, and hand-touching the spout of pump dispenser. Filling containers by topping-up was considered good practice by 18.3% of participants. Half (52.1%) of participants acknowledged indefinite reuse of containers. Besides small differences, the findings were similar across the study sites and professional groups. Among IPC-trained staff, proportions recognizing all 4 risk practices were higher compared to non-trained staff (35.9% versus 23.8%, p < 0.0001). CONCLUSIONS The present findings can guide tailored training and IPC implementation at the healthcare facility and national levels, and sensitize stakeholders' and funders' interest.
Collapse
Affiliation(s)
- Palpouguini Lompo
- Clinical Research Unit of Nanoro, Institut de Recherche en Science de la Santé, Ouagadougou, 11 BP 218, Burkina Faso.
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, 2000, Belgium.
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Naamsestraat 22, Box 5401, Leuven, 3000, Belgium.
| | - Anne-Sophie Heroes
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, 2000, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Naamsestraat 22, Box 5401, Leuven, 3000, Belgium
| | - Kadija Ouédraogo
- Clinical Research Unit of Nanoro, Institut de Recherche en Science de la Santé, Ouagadougou, 11 BP 218, Burkina Faso
| | - Patient Okitale
- Département de Microbiologie, Cliniques Universitaires de Kinshasa, BP 127, Kinshasa, Congo
| | - Abel Wakpo
- Centre National Hospitalier Universitaire Hubert Koutoukou Maga, Cotonou, 01 BP 386, Benin
| | - Jocelyne Kalema
- Département de Microbiologie, Cliniques Universitaires de Kinshasa, BP 127, Kinshasa, Congo
- Département de Microbiologie, National Institute of Biomedical Research, Av. De la Démocratie N°5345, Kinshasa, Congo
| | - Octavie Lunguya
- Département de Microbiologie, Cliniques Universitaires de Kinshasa, BP 127, Kinshasa, Congo
- Département de Microbiologie, National Institute of Biomedical Research, Av. De la Démocratie N°5345, Kinshasa, Congo
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Science de la Santé, Ouagadougou, 11 BP 218, Burkina Faso
| | - Dissou Affolabi
- Centre National Hospitalier Universitaire Hubert Koutoukou Maga, Cotonou, 01 BP 386, Benin
| | - Lassana Sangaré
- Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, 03 BP 7022, Burkina Faso
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, 2000, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Naamsestraat 22, Box 5401, Leuven, 3000, Belgium
| |
Collapse
|
6
|
Kamali A, Ferguson D, Dowless H, Ortiz N, Mukhopadhyay R, Schember C, Lunsford R, Hutchinson J, Scherer M, Crandall J, Bauer H, Yu A, Kimura A. Outbreak of Invasive Serratia marcescens among Persons Incarcerated in a State Prison, California, USA, March 2020-December 2022. Emerg Infect Dis 2024; 30:S41-S48. [PMID: 38561639 PMCID: PMC10986826 DOI: 10.3201/eid3013.230801] [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] [Indexed: 04/04/2024] Open
Abstract
Serratia marcescens is an environmental gram-negative bacterium that causes invasive disease in rare cases. During 2020-2022, an outbreak of 21 invasive Serratia infections occurred in a prison in California, USA. Most (95%) patients had a history of recent injection drug use (IDU). We performed whole-genome sequencing and found isolates from 8 patients and 2 pieces of IDU equipment were closely related. We also identified social interactions among patients. We recovered S. marcescens from multiple environmental samples throughout the prison, including personal containers storing Cell Block 64 (CB64), a quaternary ammonium disinfectant solution. CB64 preparation and storage conditions were suboptimal for S. marcescens disinfection. The outbreak was likely caused by contaminated CB64 and propagated by shared IDU equipment and social connections. Ensuring appropriate preparation, storage, and availability of disinfectants and enacting interventions to counteract disease spread through IDU can reduce risks for invasive Serratia infections in California prisons.
Collapse
|
7
|
Ibrahim A, Fahmy HM, Mahmoud GAE, Soliman M, Elshahawy AM. New strategies for sterilization and preservation of fresh fish skin grafts. Sci Rep 2024; 14:1253. [PMID: 38218988 PMCID: PMC10787751 DOI: 10.1038/s41598-024-51608-4] [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: 08/27/2023] [Accepted: 01/07/2024] [Indexed: 01/15/2024] Open
Abstract
The introduction of fish skin as a biological dressing for treating burns and wounds holds great promise, offering an alternative to existing management strategies. However, the risk of disease transmission is a significant concern. Therefore, this study aimed to examine how established sterilization and preservation procedures affected fish skin grafts' microbiological and histological properties for long-term usage. Lyophilization of the fish skin graft followed by rehydration in normal saline for 15 min did not change the collagen content. Furthermore, gamma irradiation of the lyophilized fish skin graft at different lengths 5, 10, and 25 KGy showed a significant reduction in microbial growth (aerobic bacteria, aerobic yeasts, and fungi) at 15- and 30 days after the irradiation. However, exposure to 10 KGy was found to be the most effective intensity among the different gamma irradiation lengths since it preserved the collagen fiber content and intensity in the lyophilized fish skin grafts at 15- and 30 days after the irradiation. These findings provide efficient preservation and sterilization methods for long-term usage of the fresh Tilapia skin grafts used for biological dressings.
Collapse
Affiliation(s)
- Ahmed Ibrahim
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Assiut University, Assiut, 71526, Egypt.
| | - Hossam M Fahmy
- Laboratory and Transfusion Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Mahmoud Soliman
- Department of Veterinary Pathology and Clinical Pathology, Faculty of Veterinary Medicine, Assiut University, Assiut, 71526, Egypt
- Department of Immunology, University of Texas Southwestern Medical Center, Dallas, TX, 75235, USA
| | | |
Collapse
|
8
|
Maillard JY, Pascoe M. Disinfectants and antiseptics: mechanisms of action and resistance. Nat Rev Microbiol 2024; 22:4-17. [PMID: 37648789 DOI: 10.1038/s41579-023-00958-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 09/01/2023]
Abstract
Chemical biocides are used for the prevention and control of infection in health care, targeted home hygiene or controlling microbial contamination for various industrial processes including but not limited to food, water and petroleum. However, their use has substantially increased since the implementation of programmes to control outbreaks of methicillin-resistant Staphylococcus aureus, Clostridioides difficile and severe acute respiratory syndrome coronavirus 2. Biocides interact with multiple targets on the bacterial cells. The number of targets affected and the severity of damage will result in an irreversible bactericidal effect or a reversible bacteriostatic one. Most biocides primarily target the cytoplasmic membrane and enzymes, although the specific bactericidal mechanisms vary among different biocide chemistries. Inappropriate usage or low concentrations of a biocide may act as a stressor while not killing bacterial pathogens, potentially leading to antimicrobial resistance. Biocides can also promote the transfer of antimicrobial resistance genes. In this Review, we explore our current understanding of the mechanisms of action of biocides, the bacterial resistance mechanisms encompassing both intrinsic and acquired resistance and the influence of bacterial biofilms on resistance. We also consider the impact of bacteria that survive biocide exposure in environmental and clinical contexts.
Collapse
Affiliation(s)
- Jean-Yves Maillard
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Wales, UK.
| | - Michael Pascoe
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Wales, UK
| |
Collapse
|
9
|
Abstract
BACKGROUND Skin antiseptics are used for several purposes before surgical procedures, for bathing high-risk patients as a means of reducing central line-associated infections and other health care associated infections. METHODS A PubMed search was performed to update the evidence on skin antiseptic products and practices. RESULTS Current guidelines for prevention of surgical site infections (SSIs) recommend preoperative baths or showers with a plain or antimicrobial soap prior to surgery, but do not make recommendations on the timing of baths, the total number of baths needed, or about the use of chlorhexidine gluconate (CGH)-impregnated cloths. Randomized controlled trials have demonstrated that pre-operative surgical hand antisepsis using an antimicrobial soap or alcohol-based hand rub yields similar SSI rates. Other studies have reported that using an alcohol-based hand rub caused less skin irritation, was easier to use, and required shorter scrub times than using antimicrobial soap. Current SSI prevention guidelines recommend using an alcohol-containing antiseptic for surgical site infection. Commonly used products contain isopropanol combined with either CHG or with povidone-iodine. Surgical site preparation protocols for shoulder surgery in men may need to include coverage for anaerobes. Several studies suggest the need to monitor and improve surgical site preparation techniques. Daily bathing of intensive care unit (ICU) patients with a CHG-containing soap reduces the incidence of central line-associated bloodstream infections (CLABSIs). Evidence for a similar effect in non-ICU patients is mixed. Despite widespread CHG bathing of ICU patients, numerous barriers to its effective implementation exist. Measuring CHG levels on the skin is useful for identifying gaps in coverage and suboptimal skin concentrations. Using alcohol-based products with at least 2% CHG for skin preparation prior to central line insertion reduces CLABSIs. CONCLUSIONS Progress has been made on skin antisepsis products and protocols, but improvements in technique are still needed.
Collapse
|
10
|
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
|
11
|
Damiano P, Silago V, Nyawale HA, Mushi MF, Mirambo MM, Kimaro EE, Mshana SE. Efficacy of disinfectants on control and clinical bacteria strains at a zonal referral hospital in Mwanza, Tanzania: a cross sectional hospital-based study. Sci Rep 2023; 13:17998. [PMID: 37865710 PMCID: PMC10590406 DOI: 10.1038/s41598-023-45228-7] [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: 05/15/2023] [Accepted: 10/17/2023] [Indexed: 10/23/2023] Open
Abstract
Contaminated-hospital surfaces are an important source of pathogenic bacteria causing health-care associated infection (HCAIs). Monitoring the performance of disinfectants that are routinely used to clean hospital surfaces is critical for prevention and control of HCAIs. Nevertheless, the evaluation of the performance of disinfectants and their efficacy are not routinely practiced in most resource-limited countries. This study was designed to determine the efficacy of sodium dichloroisocyanurate (NaDCC) and chloroxylenol against American Type Culture Collection (ATCC) and their respective multidrug resistant (MDR) strains causing neonatal sepsis at a zonal referral hospital in Mwanza, Tanzania. Four ATCC (n = 4) and their respective MDR strains of Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa were used. The suspension test was used with contact time of 1, 5 and 10 min with starting concentration of 105 bacterial colony forming unit per milliliters (CFU/mL). The log10 reduction value at specified bacteria-disinfectant contact time was used to assess the efficacy of 0.5%NaDCC and 4.8% chloroxylenol in-use and freshly prepared solutions. In-use 0.5%NaDCC demonstrated poor log reduction (˂ 5log) against MDR-clinical isolates. Freshly laboratory prepared 0.5% NaDCC had 100% microbial reduction at 1, 5 and 10 min of both ATCC and MDR strains up to 48 h after preparation when compared with freshly prepared 4.8% chloroxylenol (˂ 5log). Freshly, prepared 0.5% NaDCC should be used in health-care facilities for effective disinfection practices.
Collapse
Affiliation(s)
- Prisca Damiano
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania.
| | - Vitus Silago
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
| | - Helmut A Nyawale
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
| | - Martha F Mushi
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
| | - Mariam M Mirambo
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
| | - Emmanuel E Kimaro
- Department of Pharmaceutical Sciences, School of Pharmacy, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
| |
Collapse
|
12
|
Castro VDP, Thomaz DY, Vieira KDL, Lopes LG, Rossi F, Del Negro GMB, Benard G, Pires RH. In vitro activity of sanitizers against mono- and polymicrobial biofilms of C. parapsilosis and S. aureus. Antimicrob Agents Chemother 2023; 67:e0053423. [PMID: 37681981 PMCID: PMC10583669 DOI: 10.1128/aac.00534-23] [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: 04/26/2023] [Accepted: 07/07/2023] [Indexed: 09/09/2023] Open
Abstract
The emergence of disinfectant-resistant microorganisms poses a significant threat to public health. These resilient pathogens can survive and thrive in hospital settings despite routine disinfection practices, leading to persistent infections and the potential for outbreaks. In this study, we investigated the impact of 11 different commercial sanitizers at various concentrations and exposure times on biofilms consisting of clinical and nosocomial environmental isolates of Candida parapsilosis and Staphylococcus aureus. Among the sanitizers tested, 0.5% and 2.0% chlorhexidine (CLX), 10% polyvinyl pyrrolidone (PVP-I), a disinfectant based on quaternary ammonium compound (QAC), 2% glutaraldehyde, and 0.55% orthophthalaldehyde (OPA) demonstrated efficacy against both C. parapsilosis and S. aureus in monospecies and mixed biofilms. Analysis showed that 0.5% CLX and 10% PVP-I had fungicidal and bactericidal activity against all biofilms. However, the sanitizer based on QAC and 0.55% OPA proved to be bacteriostatic and fungicidal against both monospecies and mixed biofilms. In mixed biofilms, despite the last four sanitizers exerting fungicidal action, the reduction of fungal cells was approximately 4 log10 CFU/mL compared to monospecies biofilms, showing that the interaction provided more resistance of the yeast to the sanitizer. Formation of mixed biofilms in hospital settings can create an ecological niche that enhances the survival of pathogens against routine sanitization procedures. Therefore, effective sanitization practices, including regular cleaning with effective sanitizers, should be implemented to prevent C. parapsilosis/S. aureus biofilm formation in healthcare settings.
Collapse
Affiliation(s)
- Vitor de Paula Castro
- Laboratory of Mycology and Environmental Diagnosis, Universidade de Franca, Franca, São Paulo, Brazil
| | - Danilo Yamamoto Thomaz
- Laboratory of Medical Mycology (LIM-53), Instituto de Medicina Tropical e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Kayro de Lima Vieira
- Laboratory of Mycology and Environmental Diagnosis, Universidade de Franca, Franca, São Paulo, Brazil
| | - Leonardo Guedes Lopes
- Laboratory of Mycology and Environmental Diagnosis, Universidade de Franca, Franca, São Paulo, Brazil
| | - Flavia Rossi
- Central Laboratory Division (LIM 03) – Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Gilda M. B. Del Negro
- Laboratory of Medical Mycology (LIM-53), Instituto de Medicina Tropical e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Gil Benard
- Laboratory of Medical Mycology (LIM-53), Instituto de Medicina Tropical e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Regina Helena Pires
- Laboratory of Mycology and Environmental Diagnosis, Universidade de Franca, Franca, São Paulo, Brazil
| |
Collapse
|
13
|
Schulz LM, Dreier F, de Sousa Miranda LM, Rismondo J. Adaptation mechanisms of Listeria monocytogenes to quaternary ammonium compounds. Microbiol Spectr 2023; 11:e0144123. [PMID: 37695041 PMCID: PMC10580936 DOI: 10.1128/spectrum.01441-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/13/2023] [Indexed: 09/12/2023] Open
Abstract
Listeria monocytogenes is ubiquitously found in nature and can easily enter food-processing facilities due to contaminations of raw materials. Several countermeasures are used to combat contamination of food products, for instance, the use of disinfectants that contain quaternary ammonium compounds, such as benzalkonium chloride (BAC) and cetyltrimethylammonium bromide (CTAB). In this study, we assessed the potential of the commonly used wild-type strain EGD-e to adapt to BAC and CTAB under laboratory growth conditions. All BAC-tolerant suppressors exclusively carried mutations in fepR, encoding a TetR-like transcriptional regulator, or its promoter region, likely resulting in the overproduction of the efflux pump FepA. In contrast, CTAB tolerance was associated with mutations in sugR, which regulates the expression of the efflux pumps SugE1 and SugE2. L. monocytogenes strains lacking either FepA or SugE1/2 could still acquire tolerance toward BAC and CTAB. Genomic analysis revealed that the overproduction of the remaining efflux system could compensate for the deleted one, and even in the absence of both efflux systems, tolerant strains could be isolated, which all carried mutations in the diacylglycerol kinase-encoding gene lmo1753 (dgkB). DgkB converts diacylglycerol to phosphatidic acid, which is subsequently reused for the synthesis of phospholipids, suggesting that alterations in membrane composition could be the third adaptation mechanism. IMPORTANCE Survival and proliferation of Listeria monocytogenes in the food industry are ongoing concerns, and while there are various countermeasures to combat contamination of food products, the pathogen still successfully manages to withstand the harsh conditions present in food-processing facilities, resulting in reoccurring outbreaks, subsequent infection, and disease. To counteract the spread of L. monocytogenes, it is crucial to understand and elucidate the underlying mechanism that permits their successful evasion. We present various adaptation mechanisms of L. monocytogenes to withstand two important quaternary ammonium compounds.
Collapse
Affiliation(s)
- Lisa Maria Schulz
- Department of General Microbiology, Institute of Microbiology and Genetics, GZMB, Georg-August University Göttingen, Göttingen, Germany
| | - Fabienne Dreier
- Department of General Microbiology, Institute of Microbiology and Genetics, GZMB, Georg-August University Göttingen, Göttingen, Germany
| | - Lisa Marie de Sousa Miranda
- Department of General Microbiology, Institute of Microbiology and Genetics, GZMB, Georg-August University Göttingen, Göttingen, Germany
| | - Jeanine Rismondo
- Department of General Microbiology, Institute of Microbiology and Genetics, GZMB, Georg-August University Göttingen, Göttingen, Germany
| |
Collapse
|
14
|
Ferguson D, Ryder R, Lunsford R, Dash A, Kamali A, Kimura A, Crandall J, Mukhopadhyay R, Dowless H, Ortiz N, Jue NK. Serratia marcescens Outbreak at a Correctional Facility: Environmental Sampling, Laboratory Analyses and Genomic Characterization to Assess Sources and Persistence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6709. [PMID: 37681849 PMCID: PMC10487681 DOI: 10.3390/ijerph20176709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/12/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
Serratia marcescens is an environmental bacterium and clinical pathogen that can cause an array of infections. We describe an environmental sampling and comparative genomics approach used to investigate a multi-year outbreak of S. marcescens at a correctional facility. Whole genome sequencing analysis revealed a predominant cluster of clonally related S. marcescens from nine patient cases and items associated with illicit drug use. Closely related strains found among items associated with case-patient cells and diluted Cell Block 64 (CB64), a quaternary ammonium disinfectant, and Break Out (BO), a multipurpose cleaner, highlighted their role as environmental reservoirs for S. marcescens in this outbreak. Comparative genomic analysis suggested outbreak strains were both persistent (identical strains found over long periods and in multiple locations of the correctional facility) and diverse (strains clustered with multiple global samples from NCBI database). No correlation was found between antimicrobial resistance (AMR) genes of outbreak strains; NCBI strains have more AMR genes. Principal component analysis (PCA) of virulence factors associated with persistence and infectivity indicated variation based on phylogroups, including the predominant cluster; identifiable variations among environmental versus clinical strains were not observed. Identification of multiple distinct genetic groups highlights the importance of putting epidemiological genomic studies in a proper genetic context.
Collapse
Affiliation(s)
- Donna Ferguson
- Public Health Laboratory, County of Monterey Health Department, Salinas, CA 93906, USA
| | - Rahil Ryder
- Public Health Laboratory, County of Monterey Health Department, Salinas, CA 93906, USA
| | - Rawni Lunsford
- Public Health Laboratory, County of Monterey Health Department, Salinas, CA 93906, USA
| | - Arie Dash
- Public Health Laboratory, County of Monterey Health Department, Salinas, CA 93906, USA
| | - Amanda Kamali
- Public Health, Medical Services Division, California Correctional Health Care Services, Elk Grove, CA 95758, USA
| | - Akiko Kimura
- Infectious Diseases Branch, Center for Infectious Diseases, California Department of Public Health, Richmond, CA 94804, USA
| | - John Crandall
- Microbial Diseases Laboratory Branch, Center for Laboratory Sciences, California Department of Public Health, Richmond, CA 94804, USA
| | - Rituparna Mukhopadhyay
- Microbial Diseases Laboratory Branch, Center for Laboratory Sciences, California Department of Public Health, Richmond, CA 94804, USA
| | - Heather Dowless
- Public Health, Medical Services Division, California Correctional Health Care Services, Elk Grove, CA 95758, USA
| | - Nancy Ortiz
- Infectious Diseases Branch, Center for Infectious Diseases, California Department of Public Health, Richmond, CA 94804, USA
| | - Nathaniel K. Jue
- Department of Biology and Chemistry, California State University, Monterey Bay, Seaside, CA 93955, USA
| |
Collapse
|
15
|
Bonsaglia ECR, Calvo GH, Sordelli DO, Silva NCC, Rall VLM, Casas A, Buzzola F. The Impact of Low-Level Benzalkonium Chloride Exposure on Staphylococcus spp. Strains and Control by Photoinactivation. Antibiotics (Basel) 2023; 12:1244. [PMID: 37627664 PMCID: PMC10451822 DOI: 10.3390/antibiotics12081244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
Exposure of bacteria to low concentrations of biocides can facilitate horizontal gene transfer, which may lead to bacterial adaptive responses and resistance to antimicrobial agents. The emergence of antibacterial resistance not only poses a significant concern to the dairy industry but also adds to the complexity and cost of mastitis treatment. This study was aimed to evaluate how selective stress induced by benzalkonium chloride (BC) promotes antibiotic non-susceptibility in Staphylococcus spp. In addition, we investigated the efficacy of photodynamic inactivation (PDI) in both resistant and susceptible strains. The study determined the minimum inhibitory concentration (MIC) of BC using the broth microdilution method for different Staphylococcus strains. The experiments involved pairing strains carrying the qacA/qacC resistance genes with susceptible strains and exposing them to subinhibitory concentrations of BC for 72 h. The recovered isolates were tested for MIC BC and subjected to disc diffusion tests to assess changes in susceptibility patterns. The results demonstrated that subinhibitory concentrations of BC could select strains with reduced susceptibility and antibiotic resistance, particularly in the presence of S. pasteuri. The results of PDI mediated by toluidine blue (100 µM) followed by 60 min irradiation (total light dose of 2.5 J/cm2) were highly effective, showing complete inactivation for some bacterial strains and a reduction of up to 5 logs in others.
Collapse
Affiliation(s)
- Erika C. R. Bonsaglia
- Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), Facultad de Medicina, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires 1121, Argentina; (E.C.R.B.); (G.H.C.); (D.O.S.)
| | - Gustavo H. Calvo
- Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), Facultad de Medicina, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires 1121, Argentina; (E.C.R.B.); (G.H.C.); (D.O.S.)
| | - Daniel O. Sordelli
- Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), Facultad de Medicina, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires 1121, Argentina; (E.C.R.B.); (G.H.C.); (D.O.S.)
| | - Nathalia C. C. Silva
- Department of Food Science, Faculty of Food Engineering (FEA), University of Campinas (UNICAMP), Campinas 13083-862, Brazil;
| | - Vera L. M. Rall
- Department of Chemical and Biological Sciences, Institute of Biosciences, Sao Paulo State University, Botucatu 18618-691, Brazil;
| | - Adriana Casas
- Centro de Investigaciones sobre Porfirinas y Porfirias (CIPYP), Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires 1121, Argentina;
| | - Fernanda Buzzola
- Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), Facultad de Medicina, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires 1121, Argentina; (E.C.R.B.); (G.H.C.); (D.O.S.)
| |
Collapse
|
16
|
Lompo P, Heroes AS, Agbobli E, Kazienga A, Peeters M, Tinto H, Lagrou K, Sangaré L, Affolabi D, Jacobs J. Growth of Gram-Negative Bacteria in Antiseptics, Disinfectants and Hand Hygiene Products in Two Tertiary Care Hospitals in West Africa-A Cross-Sectional Survey. Pathogens 2023; 12:917. [PMID: 37513763 PMCID: PMC10384974 DOI: 10.3390/pathogens12070917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Antiseptics, disinfectants, and hand hygiene products can act as reservoirs of Gram-negative bacteria causing healthcare-associated infections. This problem is rarely documented in low- and middle-income countries, particularly in sub-Saharan Africa. In a cross-sectional survey, we assessed the bacterial contamination of antiseptics, disinfectants, and hand hygiene products in two university hospitals in Burkina Faso and Benin. During ward visits and staff interviews, in-use products were cultured for the presence of Gram-negative bacteria. The growth of Gram-negative bacteria was absent or rare in alcohol-based products, povidone iodine, and Dakin solution. Contamination was highest (73.9% (51/69)) for liquid soap products (versus antiseptic/disinfectants (4.5%, 7/157) (p < 0.0001)), mostly used in high-risk areas and associated with high total bacterial counts (>10,000 colony-forming units/mL). Contaminating flora (105 isolates) included Enterobacterales and the Vibrio non-cholerae/Aeromonas group (17.1%) and non-fermentative Gram-negative rods (82.8%). Multidrug resistance was present among 9/16 Enterobacterales (Klebsiella and Enterobacter spp.) and 3/12 Acinetobacter spp., including carbapenem resistance (Acinetobacter baumannii: NDM, Pseudomonas stutzeri: VIM). The risk factors for contamination included the type of product (cleaning grade and in-house prepared liquid soap), use of recycled disposable containers and soft drink bottles, absence of labeling, topping-up of containers, dilution with tap water (pharmacy and ward), and poor-quality management (procurement, stock management, expiry dates, and period after opening).
Collapse
Affiliation(s)
- Palpouguini Lompo
- Clinical Research Unit of Nanoro, Institut de Recherche en Science de la Santé, Nanoro, Ouagadougou 11 BP 218, Burkina Faso
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Naamsestraat 22 Box 5401, 3000 Leuven, Belgium
| | - Anne-Sophie Heroes
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Naamsestraat 22 Box 5401, 3000 Leuven, Belgium
| | - Esenam Agbobli
- Centre National Hospitalier Universitaire Hubert Koutoukou Maga, Cotonou 01 BP 386, Benin
| | - Adama Kazienga
- Clinical Research Unit of Nanoro, Institut de Recherche en Science de la Santé, Nanoro, Ouagadougou 11 BP 218, Burkina Faso
| | - Marjan Peeters
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Science de la Santé, Nanoro, Ouagadougou 11 BP 218, Burkina Faso
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Naamsestraat 22 Box 5401, 3000 Leuven, Belgium
| | - Lassana Sangaré
- Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou 03 BP 7022, Burkina Faso
| | - Dissou Affolabi
- Centre National Hospitalier Universitaire Hubert Koutoukou Maga, Cotonou 01 BP 386, Benin
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Naamsestraat 22 Box 5401, 3000 Leuven, Belgium
| |
Collapse
|
17
|
Frantz AL. Chronic quaternary ammonium compound exposure during the COVID-19 pandemic and the impact on human health. TOXICOLOGY AND ENVIRONMENTAL HEALTH SCIENCES 2023; 15:199-206. [PMCID: PMC10252167 DOI: 10.1007/s13530-023-00173-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 03/27/2024]
Abstract
Objective This review examines a relevant, and underacknowledged, emerging global public health concern—the widespread exposure to quaternary ammonium compounds (QACs) during the COVID-19 pandemic. QACs are a widely used class of cationic surfactants with broad spectrum antimicrobial activity that serve as the active ingredients in antimicrobial products. While these compounds have been used for decades, the production and consumer use of QAC-containing products have steeply risen during the COVID-19 pandemic to control and prevent the spread of the SARS-Cov-2 virus. As a result, human exposure to QACs has also drastically increased. Methods This critical review was conducted by searching the key terms “quaternary ammonium compounds,” “disinfectants,” “COVID-19,” “SARS-Cov-2,” “human health,” and “human exposure” in the major search engines, including Google Scholar, PubMed and Science Direct. Results QACs are generally considered safe and effective, yet the magnitude of QAC exposure and the subsequent health effects have not been adequately investigated. Recent studies have revealed the potential for bioaccumulation of QACs in blood and tissue. Inhalation and dermal absorption of QACs are identified as the most significant exposure routes for adults, while children and infants may be significantly more vulnerable to QAC exposure and potential adverse health effects. Conclusions QACs are an important tool to protect individual and public health, but understanding the impact of widespread QAC exposure is vital to guide best practices for QAC use and minimize the associated health risks. These pandemic era results warrant further investigation and raise additional questions about the short-term and long-term health effects of chronic QAC exposure. Clinical trial registration Not applicable.
Collapse
Affiliation(s)
- Aubrey L. Frantz
- Department of Natural Sciences, University of North Texas at Dallas, 7400 University Hills Blvd, Dallas, TX 75241 USA
| |
Collapse
|
18
|
Boyce JM. Quaternary ammonium disinfectants and antiseptics: tolerance, resistance and potential impact on antibiotic resistance. Antimicrob Resist Infect Control 2023; 12:32. [PMID: 37055844 PMCID: PMC10099023 DOI: 10.1186/s13756-023-01241-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Due to the substantial increase in the use of disinfectants containing quaternary ammonion compounds (QACs) in healthcare and community settings during the COVID-19 pandemic, there is increased concern that heavy use might cause bacteria to develop resistance to QACs or contribute to antibiotic resistance. The purpose of this review is to briefly discuss the mechanisms of QAC tolerance and resistance, laboratory-based evidence of tolerance and resistance, their occurrence in healthcare and other real-world settings, and the possible impact of QAC use on antibiotic resistance. METHODS A literature search was conducted using the PubMed database. The search was limited to English language articles dealing with tolerance or resistance to QACs present in disinfectants or antiseptics, and potential impact on antibiotic resistance. The review covered the period from 2000 to mid-Jan 2023. RESULTS Mechanisms of QAC tolerance or resistance include innate bacterial cell wall structure, changes in cell membrane structure and function, efflux pumps, biofilm formation, and QAC degradation. In vitro studies have helped elucidate how bacteria can develop tolerance or resistance to QACs and antibiotics. While relatively uncommon, multiple episodes of contaminated in-use disinfectants and antiseptics, which are often due to inappropriate use of products, have caused outbreaks of healthcare-associated infections. Several studies have identified a correlation between benzalkonium chloride (BAC) tolerance and clinically-defined antibiotic resistance. The occurrence of mobile genetic determinants carrying multiple genes that encode for QAC or antibiotic tolerance raises the concern that widespread QAC use might facilitate the emergence of antibiotic resistance. Despite some evidence from laboratory-based studies, there is insufficient evidence in real-world settings to conclude that frequent use of QAC disinfectants and antiseptics has promoted widespread emergence of antibiotic resistance. CONCLUSIONS Laboratory studies have identified multiple mechanisms by which bacteria can develop tolerance or resistance to QACs and antibiotics. De novo development of tolerance or resistance in real-world settings is uncommon. Increased attention to proper use of disinfectants is needed to prevent contamination of QAC disinfectants. Additional research is needed to answer many questions and concerns related to use of QAC disinfectants and their potential impact on antibiotic resistance.
Collapse
Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, 5123 Town Place, Middletown, CT, Connecticut, USA.
| |
Collapse
|
19
|
Yang K, Chen ML, Zhu D. Exposure to benzalkonium chloride disinfectants promotes antibiotic resistance in sewage sludge microbiomes. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 867:161527. [PMID: 36638983 PMCID: PMC9830840 DOI: 10.1016/j.scitotenv.2023.161527] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/27/2022] [Accepted: 01/07/2023] [Indexed: 06/17/2023]
Abstract
Disinfectants are routinely used in human environments to control and prevent the transmission of microbial disease, and this is particularly true during the current COVID-19 crisis. However, it remains unclear whether the increased disinfectant loadings to wastewater treatment plants facilitate the dissemination of antibiotic resistance genes (ARGs) in sewage sludge microbiomes. Here, we investigated the impacts of benzalkonium chlorides (BACs), widely used disinfectants, on ARGs profiles and microbial community structures in sewage sludge by using high-throughput quantitative PCR and Illumina sequencing. A total of 147 unique ARGs and 39 mobile genetic elements (MGEs) were detected in all sewage sludge samples. Our results show that exposure to BACs disinfectants at environmentally relevant concentrations significantly promotes both the diversity and absolute abundance of ARGs in sludge microbiomes, indicating the co-selection of ARGs by BACs disinfectants. The enrichment of ARGs abundance varied from 2.15-fold to 3.63-fold compared to controls. In addition, BACs exposure significantly alters bacterial and protistan communities, resulting in dysbiosis of the sludge microbiota. The Mantel test and Procrustes analysis confirm that bacterial communities are significantly correlated with ARGs profiles under BACs treatments. The structural equation model explains 83.8 % of the total ARGs variation and further illustrates that the absolute abundance of MGEs exerts greater impacts on the variation of absolute abundance of ARGs than microbial communities under BACs exposure, suggesting BACs may promote antibiotic resistance by enhancing the horizontal gene transfer of ARGs across sludge microbiomes. Collectively, our results provide new insights into the proliferation of antibiotic resistance through disinfectant usage during the pandemic and highlight the necessity to minimize the environmental release of disinfectants into the non-target environment for combating antibiotic resistance.
Collapse
Affiliation(s)
- Kai Yang
- Key Laboratory of Urban Environment and Health, Fujian Key Laboratory of Watershed Ecology, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, China.
| | - Mo-Lian Chen
- Key Laboratory of Urban Environment and Health, Fujian Key Laboratory of Watershed Ecology, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, China; University of Chinese Academy of Sciences, 19A Yuquan Road, Beijing 100049, China
| | - Dong Zhu
- Key Laboratory of Urban Environment and Health, Fujian Key Laboratory of Watershed Ecology, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, China; Zhejiang Key Laboratory of Urban Environmental Processes and Pollution Control, Ningbo Urban Environment Observation and Research Station, Chinese Academy of Sciences, Ningbo 315800, China
| |
Collapse
|
20
|
In-use contamination of a hospital-grade disinfectant. Am J Infect Control 2022; 50:1296-1301. [PMID: 35307473 DOI: 10.1016/j.ajic.2022.03.008] [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: 01/24/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Microbiological monitoring of disinfection of high-touch surfaces identified heavy growth of Serratia marcescens and Achromobacter xylosoxidans not present on surfaces before disinfection, suggesting contamination of the disinfectant used. METHODS An investigation included interview of the housekeeper involved, level of bacterial contamination of the in-use quaternary ammonium (Quat) disinfectant, bactericidal activity of the contaminated disinfectant, pulsed field gel electrophoresis of S.marcescens and Achromobacter isolates, survival of S. marcescens on dry surfaces, and genome sequencing to identify possible Quat resistance genes. RESULTS The housekeeper, who seldom cleaned patient rooms, had used the disinfectant for months without emptying and drying the bucket between uses. The contaminated disinfectant contained 9.3 × 104 CFU of S. marcescens plus A. xylosoxidans. The log10 reduction of S. marcescens by fresh Quat was 102-fold lower than that achieved against a control strain (S. marcescens ATCC 13380). Genome sequencing of S. marcescens isolates identified the following genes previously shown to encode for efflux pumps associated with Quat resistance: sdeXY, sdeAB, smfY, and a sugE-like gene. CONCLUSIONS Failure to follow existing guidelines and manufacturer's instructions for use resulted in contamination by A. xylosoxidans and by S. marcescens that possessed multiple genes associated with Quat resistance.
Collapse
|
21
|
Maillard J. Impact of benzalkonium chloride, benzethonium chloride and chloroxylenol on bacterial antimicrobial resistance. J Appl Microbiol 2022; 133:3322-3346. [PMID: 35882500 PMCID: PMC9826383 DOI: 10.1111/jam.15739] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 01/11/2023]
Abstract
This review examined 3655 articles on benzalkonium chloride (BKC), benzethonium chloride (BZT) and chloroxylenol (CHO) aiming to understand their impact on antimicrobial resistance. Following the application of inclusion/exclusion criteria, only 230 articles were retained for analysis; 212 concerned BKC, with only 18 for CHO and BZT. Seventy-eight percent of studies used MIC to measure BKC efficacy. Very few studies defined the term 'resistance' and 85% of studies defined 'resistance' as <10-fold increase (40% as low as 2-fold) in MIC. Only a few in vitro studies reported on formulated products and when they did, products performed better. In vitro studies looking at the impact of BKC exposure on bacterial resistance used either a stepwise training protocol or exposure to constant BKC concentrations. In these, BKC exposure resulted in elevated MIC or/and MBC, often associated with efflux, and at time, a change in antibiotic susceptibility profile. The clinical relevance of these findings was, however, neither reported nor addressed. Of note, several studies reported that bacterial strains with an elevated MIC or MBC remained susceptible to the in-use BKC concentration. BKC exposure was shown to reduce bacterial diversity in complex microbial microcosms, although the clinical significance of such a change has not been established. The impact of BKC exposure on the dissemination of resistant genes (notably efflux) remains speculative, although it manifests that clinical, veterinary and food isolates with elevated BKC MIC carried multiple efflux pump genes. The correlation between BKC usage and gene carriage, maintenance and dissemination has also not been established. The lack of clinical interpretation and significance in these studies does not allow to establish with certainty the role of BKC on AMR in practice. The limited literature and BZT and CHO do not allow to conclude that these will impact negatively on emerging bacterial resistance in practice.
Collapse
Affiliation(s)
- Jean‐Yves Maillard
- School of Pharmacy and Pharmaceutical SciencesCardiff UniversityCardiffUK
| |
Collapse
|
22
|
Wright JR, Ly TT, Brislawn CJ, Chen See JR, Anderson SLC, Pellegrino JT, Peachey L, Walls CY, Bess JA, Bailey AL, Braun KE, Shope AJ, Lamendella R. cleanSURFACES® intervention reduces microbial activity on surfaces in a senior care facility. Front Cell Infect Microbiol 2022; 12:1040047. [PMID: 36439229 PMCID: PMC9682068 DOI: 10.3389/fcimb.2022.1040047] [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: 09/08/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
As one of the top public health challenges outlined by the Centers for Disease Control (CDC), estimates report that hospital acquired infections (HAIs) claim the lives of 99,000 Americans and cost healthcare providers over $28 billion each year. In addition to underlying conditions related to age, elderly patients in long-term care facilities are at an elevated risk of acquiring HAIs. A large percentage of HAIs is attributable to contaminated surfaces and medical devices. To that end, this study utilized a metatranscriptomic sequencing workflow (CSI-Dx™) to profile active microbial communities from surfaces in the HJ Heinz Community Living Center, a long-term care facility in the Veterans Affairs Pittsburgh Health Care System. Swabs were collected from high-touch surfaces (Keyboard, Ledge, Workstation on Wheels, Worksurfaces) before (Baseline) and after cleanSURFACES® were installed at 4 timepoints (Day 1, Day 7, Day 14, and Day 30). Microbial richness was significantly reduced after cleanSURFACES® intervention (Wilcoxon test with Holm correction, p=0.000179). Beta diversity results revealed distinct clustering between Baseline and Post-intervention samples (Adonis, p<0.001). Reduction in bacterial (Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus hominis) and fungal (Malassezia restricta, Candida albicans, Candida glabrata, and Candida orthopsilosis) expression of opportunistic pathogens was observed. Additionally, a subset of taxa (Corynebacterium, Cutibacterium acnes, and Ralstonia pickettii) was present in specific Post-intervention timepoints and surface types. This study revealed decreased microbial activity, highlighting the potential for the combinatorial application of cleanSURFACES® and regular decontamination practices to reduce the prevalence of microbes causing HAIs.
Collapse
|
23
|
Armando M, Barthélémi L, Couret I, Verdier C, Dupont C, Jumas-Bilak E, Grau D. Recurrent environmental contamination in a centralized radiopharmacy unit by Achromobacter spp: results of a large microbiological investigation. Am J Infect Control 2022; 51:557-562. [PMID: 35870659 DOI: 10.1016/j.ajic.2022.07.004] [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: 04/06/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Radiopharmaceuticals preparation unit, such as every aseptic preparation units, are strictly monitored in terms of microbiological contamination. Despite all biocontamination control procedures, our radiopharmacy unit faced repeated environnmental contamination by Achromobacter spp which necessitated a large environmental investigation. METHOD Microbiological controls were carried out using Count Tact agars (Biomérieux) for flat surfaces, dry swabbing for hard to reach areas and containers were filled with a sterile water solution (then filtrated on 0.45µm membrane and seeded). Microbiological identification was performed by mass spectrometry (MALDI-TOF-MS, Brucker) on each positive sample. RESULTS Achromobacter spp was found in 10% of the 413 samples during the 8 months investigation period. The proportion of positive samples was stable among time but their location was unpredictable. The highest inoculum was finally found in the buckets used for biocleaning. DISCUSSION Samples from cleaning buckets taken by dry swabbing were at first negative, but the use of a non-routinely used sampling method allowed to discover the reservoir of this persistent contamination. CONCLUSION This investigation alerted us on the high microbiological risk associated with reusable plastic containers and the importance of a sampling method adapted to critical locations.
Collapse
Affiliation(s)
- M Armando
- Radiopharmacy Unit, Department of Preparations and controls, University Teaching Hospital (UTH) of Montpellier, France
| | - L Barthélémi
- Radiopharmacy Unit, Department of Preparations and controls, University Teaching Hospital (UTH) of Montpellier, France
| | - I Couret
- Radiopharmacy Unit, Department of Preparations and controls, University Teaching Hospital (UTH) of Montpellier, France; Unit 1194 INSERM, Team Radiobiology and targeted radiotherapy, Cancer Research Institute of Montpellier, Montpellier, France
| | - C Verdier
- Pharmaceutical Controls Laboratory, Department of Preparations and controls, UTH of Montpellier, France
| | - C Dupont
- UMR 5569 HSM, Team "Pathogènes Hydriques Santé et Environnements", Unit of Bacteriology, University of Pharmacy, Montpellier, France
| | - E Jumas-Bilak
- Infection Control Department, UTH of Montpellier, France; UMR 5569 HSM, Team "Pathogènes Hydriques Santé et Environnements", Unit of Bacteriology, University of Pharmacy, Montpellier, France
| | - D Grau
- Infection Control Department, UTH of Montpellier, France; UMR 5569 HSM, Team "Pathogènes Hydriques Santé et Environnements", Unit of Bacteriology, University of Pharmacy, Montpellier, France
| |
Collapse
|
24
|
Cao M, Liu C, Li M, Zhang X, Peng L, Liu L, Liao J, Yang J. Recent Research on Hybrid Hydrogels for Infection Treatment and Bone Repair. Gels 2022; 8:306. [PMID: 35621604 PMCID: PMC9140391 DOI: 10.3390/gels8050306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/16/2022] Open
Abstract
The repair of infected bone defects (IBDs) is still a great challenge in clinic. A successful treatment for IBDs should simultaneously resolve both infection control and bone defect repair. Hydrogels are water-swollen hydrophilic materials that maintain a distinct three-dimensional structure, helping load various antibacterial drugs and biomolecules. Hybrid hydrogels may potentially possess antibacterial ability and osteogenic activity. This review summarizes the recent progress of different kinds of antibacterial agents (including inorganic, organic, and natural) encapsulated in hydrogels. Several representative hydrogels of each category and their antibacterial mechanism and effect on bone repair are presented. Moreover, the advantages and disadvantages of antibacterial agent hybrid hydrogels are discussed. The challenge and future research directions are further prospected.
Collapse
Affiliation(s)
- Mengjiao Cao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China; (M.C.); (M.L.); (L.L.)
| | - Chengcheng Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China;
| | - Mengxin Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China; (M.C.); (M.L.); (L.L.)
| | - Xu Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China;
| | - Li Peng
- Key Laboratory of Bio-Resource and Eco-Environment of Ministry of Education, College of Life Sciences, Sichuan University, Chengdu 610065, China;
| | - Lijia Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China; (M.C.); (M.L.); (L.L.)
| | - Jinfeng Liao
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China;
| | - Jing Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China; (M.C.); (M.L.); (L.L.)
| |
Collapse
|
25
|
Lee HR, Lee YS, You YS, Huh JY, Kim K, Hong YC, Kim CH. Antimicrobial effects of microwave plasma-activated water with skin protective effect for novel disinfectants in pandemic era. Sci Rep 2022; 12:5968. [PMID: 35396389 PMCID: PMC8992786 DOI: 10.1038/s41598-022-10009-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/21/2022] [Indexed: 12/19/2022] Open
Abstract
Skin antiseptics have important implications for public health and medicine. Although conventional antiseptics have considerable antimicrobial activity, skin toxicity and the development of resistance are common problems. Plasma-treated water has sterilization and tissue-regenerative effects. Therefore, the aim of this study was to identify whether plasma-activated water (PAW) manufactured by our microwave plasma system can be used as a novel antiseptic solution for skin protection. PAW was produced by dissolving reactive nitrogen oxide gas using microwave plasma in deionized water. The antibacterial effects of PAW against Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Bacillus cereus, and Salmonella typhimurium and effective concentrations were investigated by a solid agar plate assay. The factors mediating the effects of PAW were evaluated by the addition of reactive species scavengers. Cytotoxicity and cell viability assays were performed to examine the protective effect of PAW on normal skin cells. PAW exhibited excellent sterilization and no toxicity in normal skin cells. Experiments also confirmed the potential of PAW as a sanitizer for SARS-CoV-2. Our findings support the use of PAW as an effective skin disinfectant with good safety in the current situation of a global pandemic.
Collapse
Affiliation(s)
- Hye Ran Lee
- Department of Otolaryngology-Head and Neck Surgery, Catholic Kwandong University International St. Mary's Hospital, Incheon, 22711, Republic of Korea
| | - Yun Sang Lee
- Department of Otolaryngology, School of Medicine, Ajou University, 164 World-Cup Street, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Young Suk You
- Plarit Co., Ltd., 443 Samnye-ro Samnye-eup, Wanju-gun, Jeollabuk-do, 565-701, Republic of Korea
| | - Jin Young Huh
- ICD Co., Ltd., 274 Manse-ro, Daedeok-myeon, Anseong-si, Gyeonggi-do, 17542, Republic of Korea
| | - Kangil Kim
- Institute of Plasma Technology, Korea Institute of Fusion Energy, 814-2 Ohsikdo-dong, Gunsan, 573-540, Republic of Korea
| | - Yong Cheol Hong
- Division of Applied Technology Research, National Fusion Research Institute, 113 Gwahangno, Yuseong-gu, Daejeon, 305-333, Republic of Korea
| | - Chul-Ho Kim
- Department of Otolaryngology, School of Medicine, Ajou University, 164 World-Cup Street, Yeongtong-gu, Suwon, 16499, Republic of Korea.
| |
Collapse
|
26
|
Allen JL, Doidge NP, Bushell RN, Browning GF, Marenda MS. Healthcare-associated infections caused by chlorhexidine-tolerant Serratia marcescens carrying a promiscuous IncHI2 multi-drug resistance plasmid in a veterinary hospital. PLoS One 2022; 17:e0264848. [PMID: 35298517 PMCID: PMC8929579 DOI: 10.1371/journal.pone.0264848] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/17/2022] [Indexed: 11/19/2022] Open
Abstract
The bacterium Serratia marcescens can cause opportunistic infections in humans and in animals. In veterinary settings, the diversity, reservoirs and modes of transmission of this pathogen are poorly understood. The phenotypes and genotypes of Serratia spp. isolated from dogs, cats, horses, a bird and a rabbit examined at an Australian veterinary hospital between 2008 and 2019 were characterised. The isolates were identified as S. marcescens (n = 15) or S. ureilytica (n = 3) and were placed into four distinct phylogenetic groups. Nine quasi-clonal isolates associated with post-surgical complications in different patients displayed high levels of resistance to the antimicrobials fluoroquinolones, cephalosporins, aminoglycosides, and to the disinfectant chlorhexidine. A Serratia sp. with a similar resistance profile was also isolated from chlorhexidine solutions used across the Hospital, suggesting that these infections had a nosocomial origin. A genomic island encoding a homolog of the Pseudomonas MexCD-OprJ biocide efflux system was detected in the chlorhexidine-tolerant Serratia. The nine multi-drug resistant Serratia isolates also possessed a Ser-83-Ile mutation in GyrA conferring fluoroquinolone resistance, and carried a large IncHI2 conjugative plasmid encoding antimicrobial and heavy metal resistances. This replicon was highly similar to a plasmid previously detected in a strain of Enterobacter hormaechei recovered from the Hospital environment. IncHI2 plasmids are commonly found in Enterobacteriaceae, but are rarely present in Serratia spp., suggesting that this plasmid was acquired from another organism. A chlorhexidine-tolerant Serratia isolate which lacked the IncHI2 plasmid was used in mating experiments to demonstrate the transfer of multi-drug resistance from a E. hormaechei donor. This study illustrates the importance of environmental surveillance of biocide-resistance in veterinary hospitals.
Collapse
Affiliation(s)
- Joanne L. Allen
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Nicholas P. Doidge
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Rhys N. Bushell
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, Victoria, Australia
| | - Glenn F. Browning
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Marc S. Marenda
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, Victoria, Australia
- * E-mail:
| |
Collapse
|
27
|
Van den Poel B, Saegeman V, Schuermans A. Increasing usage of chlorhexidine in health care settings: blessing or curse? A narrative review of the risk of chlorhexidine resistance and the implications for infection prevention and control. Eur J Clin Microbiol Infect Dis 2022; 41:349-362. [DOI: 10.1007/s10096-022-04403-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/11/2022] [Indexed: 12/18/2022]
|
28
|
van Dijk HFG, Verbrugh HA, Abee T, Andriessen JW, van Dijk HFG, ter Kuile BH, Mevius DJ, Montforts MHMM, van Schaik W, Schmitt H, Smidt H, Veening JW, Voss A. Resisting disinfectants. COMMUNICATIONS MEDICINE 2022; 2:6. [PMID: 35603291 PMCID: PMC9053202 DOI: 10.1038/s43856-021-00070-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/16/2021] [Indexed: 12/03/2022] Open
Abstract
van Dijk et al. discuss the potential for antimicrobial resistance as a consequence of disinfectant use. The authors advocate for the prudent use of disinfectants in all sectors of society.
Collapse
|
29
|
Clara L, Staneloni MI, Salazar E, Greco G, Visus M, Lizzi A, Alexander V, Gutkind G, Radice M, Papalia M. Report of two events of nosocomial outbreak and pseudo-outbreak due to contamination with Achromobacter spp. Rev Argent Microbiol 2022; 54:175-180. [PMID: 35012807 DOI: 10.1016/j.ram.2021.10.004] [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: 02/20/2021] [Revised: 04/24/2021] [Accepted: 10/03/2021] [Indexed: 10/19/2022] Open
Abstract
Achromobacter spp. are increasingly recognized as emerging pathogens in immunocompromised patients or suffering cystic fibrosis, but unusual in immunocompetent hosts or individuals that underwent surgery. In this study we describe two simultaneous events attributable to two different Achromobacter spp. contaminated sources. One event was related to an episode of pseudo-bacteremia due to sodium citrate blood collection tubes contaminated with Achromobacter insuavis and the other to Achromobacter genogroup 20 infection and colonization caused by an intrinsically contaminated chlorhexidine soap solution. Both threatened the appropriate use of antimicrobials. Molecular approaches were critical to achieving the accurate species identification and to assess the clonal relationship, strengthening the need for dedicated, multidisciplinary and collaborative work of microbiologists, specialists in infectious diseases, epidemiologists and nurses in the control of infections to clarify these epidemiological situations.
Collapse
Affiliation(s)
- Liliana Clara
- Hospital Italiano de Buenos Aires, Sección Infectología, Servicio de Clínica Médica, Pres. Tte. Gral. Juan Domingo Perón 4190, Ciudad Autónoma de Buenos Aires, C1199, Argentina; Hospital Italiano de Buenos Aires, Comité de Control de Infecciones, Pres. Tte. Gral. Juan Domingo Perón 4190, Ciudad Autónoma de Buenos Aires, C1199, Argentina
| | - María Ines Staneloni
- Hospital Italiano de Buenos Aires, Sección Infectología, Servicio de Clínica Médica, Pres. Tte. Gral. Juan Domingo Perón 4190, Ciudad Autónoma de Buenos Aires, C1199, Argentina; Hospital Italiano de Buenos Aires, Comité de Control de Infecciones, Pres. Tte. Gral. Juan Domingo Perón 4190, Ciudad Autónoma de Buenos Aires, C1199, Argentina
| | - Estela Salazar
- Hospital Italiano de Buenos Aires, Sección Infectología, Servicio de Clínica Médica, Pres. Tte. Gral. Juan Domingo Perón 4190, Ciudad Autónoma de Buenos Aires, C1199, Argentina
| | - Graciela Greco
- Hospital Italiano de Buenos Aires, Sección Bacteriología Laboratorio Central, Pres. Tte. Gral. Juan Domingo Perón 4190, Ciudad Autónoma de Buenos Aires, C1199, Argentina
| | - Mariangeles Visus
- Hospital Italiano de Buenos Aires, Sección Bacteriología Laboratorio Central, Pres. Tte. Gral. Juan Domingo Perón 4190, Ciudad Autónoma de Buenos Aires, C1199, Argentina
| | - Alicia Lizzi
- Hospital Italiano de Buenos Aires, Comité de Control de Infecciones, Pres. Tte. Gral. Juan Domingo Perón 4190, Ciudad Autónoma de Buenos Aires, C1199, Argentina
| | - Valeria Alexander
- Hospital Italiano de Buenos Aires, Sección Bacteriología Laboratorio Central, Pres. Tte. Gral. Juan Domingo Perón 4190, Ciudad Autónoma de Buenos Aires, C1199, Argentina
| | - Gabriel Gutkind
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, IBaViM, Laboratorio de Resistencia Bacteriana, Junín 956, 8vo. Piso, Ciudad Autónoma de Buenos Aires, CP 1113, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Marcela Radice
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, IBaViM, Laboratorio de Resistencia Bacteriana, Junín 956, 8vo. Piso, Ciudad Autónoma de Buenos Aires, CP 1113, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina (CONICET), Ciudad Autónoma de Buenos Aires, Argentina.
| | - Mariana Papalia
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, IBaViM, Laboratorio de Resistencia Bacteriana, Junín 956, 8vo. Piso, Ciudad Autónoma de Buenos Aires, CP 1113, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| |
Collapse
|
30
|
Romani M, Warscheid T, Nicole L, Marcon L, Di Martino P, Suzuki MT, Lebaron P, Lami R. Current and future chemical treatments to fight biodeterioration of outdoor building materials and associated biofilms: Moving away from ecotoxic and towards efficient, sustainable solutions. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 802:149846. [PMID: 34464791 DOI: 10.1016/j.scitotenv.2021.149846] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 06/13/2023]
Abstract
All types of building materials are rapidly colonized by microorganisms, initially through an invisible and then later a visible biofilm that leads to their biodeterioration. Over centuries, this natural phenomenon has been managed using mechanical procedures, oils, or even wax. In modern history, many treatments such as high-pressure cleaners, biocides (mainly isothiazolinones and quaternary ammonium compounds) are commercially available, as well as preventive ones, such as the use of water-repellent coatings in the fabrication process. While all these cleaning techniques offer excellent cost-benefit ratios, their limitations are numerous. Indeed, building materials are often quickly recolonized after application, and microorganisms are increasingly reported as resistant to chemical treatments. Furthermore, many antifouling compounds are ecotoxic, harmful to human health and the environment, and new regulations tend to limit their use and constrain their commercialization. The current state-of-the-art highlights an urgent need to develop innovative antifouling strategies and the widespread use of safe and eco-friendly solutions to biodeterioration. Interestingly, innovative approaches and compounds have recently been identified, including the use of photocatalysts or natural compounds such as essential oils or quorum sensing inhibitors. Most of these solutions developed in laboratory settings appear very promising, although their efficiency and ecotoxicological features remain to be further tested before being widely marketed. This review highlights the complexity of choosing the adequate antifouling compounds when fighting biodeterioration and proposes developing case-to-case innovative strategies to raise this challenge, relying on integrative and multidisciplinary approaches.
Collapse
Affiliation(s)
- Mattea Romani
- Sorbonne Université, CNRS, Laboratoire de Biodiversité et Biotechnologies Microbiennes (LBBM), Observatoire Océanologique de Banyuls sur Mer, Avenue Pierre Fabre, 66650 Banyuls-sur-Mer, France
| | | | - Lionel Nicole
- Sorbonne Université, CNRS, Laboratoire de chimie de la matière condensée de Paris (LCMCP), 4 Place Jussieu, 75005 Paris, France
| | - Lionel Marcon
- Sorbonne Université, CNRS, Laboratoire de Biodiversité et Biotechnologies Microbiennes (LBBM), Observatoire Océanologique de Banyuls sur Mer, Avenue Pierre Fabre, 66650 Banyuls-sur-Mer, France
| | - Patrick Di Martino
- Université de Cergy-Pontoise, Laboratoire ERRMECe, rue Descartes site de Neuville-sur-Oise, 95031 Cergy-Pontoise, France
| | - Marcelino T Suzuki
- Sorbonne Université, CNRS, Laboratoire de Biodiversité et Biotechnologies Microbiennes (LBBM), Observatoire Océanologique de Banyuls sur Mer, Avenue Pierre Fabre, 66650 Banyuls-sur-Mer, France
| | - Philippe Lebaron
- Sorbonne Université, CNRS, Laboratoire de Biodiversité et Biotechnologies Microbiennes (LBBM), Observatoire Océanologique de Banyuls sur Mer, Avenue Pierre Fabre, 66650 Banyuls-sur-Mer, France
| | - Raphaël Lami
- Sorbonne Université, CNRS, Laboratoire de Biodiversité et Biotechnologies Microbiennes (LBBM), Observatoire Océanologique de Banyuls sur Mer, Avenue Pierre Fabre, 66650 Banyuls-sur-Mer, France.
| |
Collapse
|
31
|
Understanding Skin Antiseptics. Plast Surg Nurs 2021; 41:188-190. [PMID: 34871284 DOI: 10.1097/psn.0000000000000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
32
|
O'Rourke M, Knowles SJ, Curry A, Kealy N, Barry P, Khan R. In vitro study examining the effectiveness of antiseptic prophylaxis for antibiotic-resistant bacterial endophthalmitis. J Cataract Refract Surg 2021; 47:1581-1586. [PMID: 34846336 DOI: 10.1097/j.jcrs.0000000000000599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/21/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the effectiveness of current antiseptic agents on multidrug-resistant (MDR) isolates in an in vitro setting. SETTING Department of Microbiology, The National Maternity Hospital, Dublin, Ireland. DESIGN Organisms were selected based on current review of endophthalmitis literature: methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus epidermidis (MRSE), Pseudomonas aeruginosa, carbapenem-resistant and extended-spectrum β-lactamase Klebsiella pneumoniae, and vancomycin-resistant (VRE) Enterococcus faecalis. METHODS Samples were exposed to povidone-iodine (PVI) 5% and chlorhexidine (CHX) 0.05% for 0.5 minutes, 1 minute, 3 minutes, and 5 minutes. After inactivation, organisms were incubated under standard conditions and growth assessed after 16 hours. RESULTS MRSA and MRSE responded to 3-minute PVI exposure. CHX eradicated MRSA growth after 5 minutes but failed to completely suppress MRSE. Pseudomonas and Klebsiella required 3-minute CHX exposure and 5-minute PVI exposure for complete clearance. Eradication of enterococci (VRE positive and negative) was not achieved at 10 minutes of CHX or PVI exposure. Comparison of PVI vs CHX showed a benefit for PVI in MRSA (P < .01) and MRSE (P < .001) eradication at 3 minutes. CONCLUSIONS Current recommendations of 3 minutes of antisepsis prior to intraocular surgery are not sufficient for complete eradication of MDR organisms from the ocular surface. A bespoke approach is suggested to patients at risk for carriage of MDR organisms to minimize the risk of endophthalmitis.
Collapse
Affiliation(s)
- Micheal O'Rourke
- From the Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland (O'Rourke, Barry, Khan); Department of Microbiology, The National Maternity Hospital, Dublin, Ireland (Knowles, Curry, Kealy); European Society of Cataract and Refractive Surgeons, Dublin, Ireland (Barry, Khan)
| | | | | | | | | | | |
Collapse
|
33
|
Firesbhat A, Tigabu A, Tegene B, Gelaw B. Bacterial profile of high-touch surfaces, leftover drugs and antiseptics together with their antimicrobial susceptibility patterns at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. BMC Microbiol 2021; 21:309. [PMID: 34749674 PMCID: PMC8573887 DOI: 10.1186/s12866-021-02378-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background The hospital environment serves as a source of nosocomial infections, which pose a major therapeutic challenge. Although many bacteria species are common in hospital environments, their distribution, frequency, and antimicrobial susceptibility pattern from high-touch surfaces, leftover drugs, and antiseptics in different wards remain largely unknown. Hence, the aim of this study was to assess the magnitude and frequency of bacterial contaminants and their antimicrobial susceptibility patterns. Methods A total of 384 samples were collected from five selected wards and processed according to standard bacteriological procedures. Samples were collected from high-touch surface using swabs and inoculated on Blood agar, MacConkey agar, Chocolate agar and Mannitol salt agar plates, and incubated at 37 °C for 24 h. On the other hand, the leftover drugs and 80% ethanol samples were collected using sterile cotton swab immersed in sterile tryptone soy broth then inoculated on culture medias and incubated at 37 °C for 24 h. Identification of bacteria species was done using the morphological characteristics, Gram stain, and biochemical tests while antimicrobial susceptibility tests were done using modified Kirby-Bauer disk diffusion technique following the Clinical Laboratory Standards Institute 2021guidelines. Results Among the 384 samples processed, 102 (26.6%) were culture positive and a total of 114 bacterial isolates were identified. Gram-positive bacterial isolates were predominant, 64.9%, while Gram-negatives were 35.1%. The most frequently isolated bacteria were coagulase negative Staphylococci (38.6%) followed by S. aureus (13.2%) and P. aeruginosa (11.4%). On the other hand, the proportion of bacteria isolated from surgical ward, post-natal ward, orthopedic ward, trauma ward, and neonatal intensive care unit ward were 24.6, 21, 20.2, 18.4,15.8%, respectively. Sinks were mainly contaminated with Klebsiella species (81.8%) and A. baumannii (55.6%), while A. baumannii (22.2%) was the most contaminant for 80% ethanol. Gram-positive bacteria had significantly high resistance levels to penicillin (67.6%), cotrimoxazole (67.8%), and cefepime (80%). On the other hand, Gram-negative bacteria revealed the highest resistance levels to tetracycline (82.4%), amoxicillin-clavulanic acid (76.5%), cefepime (66.7%), ceftazidime (67.5%), and piperacillin (92.3%). Moreover, the proportion of multidrug resistant bacteria isolates was 44.7%. Conclusions Data of the present study showed that coagulase negative Staphylococci was the dominant bacterial isolates followed by S. aureus and P. aeruginosa. The proportion of multi-drug resistant bacteria isolates was relatively high. Therefore, appropriate infection prevention and control measures should be implemented.
Collapse
Affiliation(s)
- Atsedewoyn Firesbhat
- Unit of Biomedical Sciences, College of Veterinary Medicine and Animal Sciences, University of Gondar, P O. box: 196, Gondar, Ethiopia
| | - Abiye Tigabu
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P O. box: 196, Gondar, Ethiopia.
| | - Birhanemeskel Tegene
- Department of Medical Microbiology, St. Paul's Hospital Millennium Medical College, P. O. box 1271, Addis Abeba, Ethiopia
| | - Baye Gelaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P O. box: 196, Gondar, Ethiopia
| |
Collapse
|
34
|
Dewey HM, Jones JM, Keating MR, Budhathoki-Uprety J. Increased Use of Disinfectants During the COVID-19 Pandemic and Its Potential Impacts on Health and Safety. ACS CHEMICAL HEALTH & SAFETY 2021. [DOI: 10.1021/acs.chas.1c00026] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Hannah M. Dewey
- Department of Textile Engineering, Chemistry and Science, Wilson College of Textiles, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Jaron M. Jones
- Department of Textile Engineering, Chemistry and Science, Wilson College of Textiles, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Mike R. Keating
- Department of Textile Engineering, Chemistry and Science, Wilson College of Textiles, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Januka Budhathoki-Uprety
- Department of Textile Engineering, Chemistry and Science, Wilson College of Textiles, North Carolina State University, Raleigh, North Carolina 27695, United States
| |
Collapse
|
35
|
Tognetto D, Pastore MR, Guerin GM, Decorti G, Franzin M, Lagatolla C, Cirigliano G. Bactericidal activity of three different antiseptic ophthalmic preparations as surgical prophylaxis. Graefes Arch Clin Exp Ophthalmol 2021; 260:289-293. [PMID: 34427741 PMCID: PMC8763824 DOI: 10.1007/s00417-021-05361-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/24/2021] [Accepted: 07/29/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose In the era of antibiotic resistance, there is an increased interest in antiseptic solutions that might represent a reliable option for ocular surface disinfection. The objective of this study is to compare for the first time three different antiseptic ophthalmic preparations to assess their in vitro antimicrobial activity.
Methods The antiseptic activity of three commercial ophthalmic solutions, IODIM (povidone-iodine 0.6% in hyaluronic acid vehicle—Medivis, Catania, Italy), OZODROP (nanoemulsion with ozonated oil—concentration not specified—FBVision, Ophthalmic Pharmaceuticals, Rome, Italy), and DROPSEPT (chlorhexidine 0.02% and vitamin E 0.5% Tocopherol Polyethylene Glycol 1000 Succinate—TPGS, Sooft Italia, Montegiorgio, Italy), was tested in vitro on six reference strains by time-killing assays. Viable cells were evaluated after 1, 15, 30 min; 2, 6, and 24 h exposure by seeding 100 µl of the suspension (or appropriate dilutions) on LB agar or Sabouraud-dextrose agar. All plates were incubated at 37 °C for 24 h and evaluated by manually counting the colonies. Results IODIM solution showed a very rapid microbicidal activity: the number of viable cells for all the tested strains was under the detection limit (less than 10 CFU/ml) already after 1 min exposure, and this result was maintained at every incubation time. The rapid antimicrobial activity of povidone-iodine was not replicated when testing the other two antiseptics. Conclusions The study reports the great efficacy in reducing bacterial load in a very short time of povidone-iodine 0.6% compared with other antiseptic preparations.
Collapse
Affiliation(s)
- Daniele Tognetto
- Department of Medical, Surgical Sciences and Health, Eye Clinic, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
| | - Marco R Pastore
- Department of Medical, Surgical Sciences and Health, Eye Clinic, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy.
| | - Gian Marco Guerin
- Department of Medical, Surgical Sciences and Health, Eye Clinic, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
| | - Giuliana Decorti
- Institute for Maternal, Child Health IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
| | - Martina Franzin
- Science of Reproduction and Development, University of Trieste, Trieste, Italy
| | | | - Gabriella Cirigliano
- Department of Medical, Surgical Sciences and Health, Eye Clinic, University of Trieste, Piazza dell'Ospitale 1, 34129, Trieste, Italy
| |
Collapse
|
36
|
Clare S, Rowley S. Best practice skin antisepsis for insertion of peripheral catheters. ACTA ACUST UNITED AC 2021; 30:8-14. [PMID: 33433273 DOI: 10.12968/bjon.2021.30.1.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article discusses the importance of effective skin antisepsis prior to the insertion of peripheral intravenous catheters (PIVCs) and how best clinical practice is promoted by application of an appropriate method of skin disinfection integrated effectively with a proprietary aseptic non touch technique, or other standard aseptic technique. Historically under-reported, incidence of infection and risk to patients from PIVCs is now increasingly being recognised, with new research and evidence raising concern and helping to drive new clinical guidance and improvement. The risks posed by PIVCs are particularly significant given increasing PIVC dwell times, due to cannula removal now being determined by new guidance for clinical indication, rather than predefined time frames. Clinical 'best practice' is considered in context of the evidence base, importantly including availability and access to appropriate skin antisepsis products. In the UK, and other countries, ChloraPrep is the only skin antisepsis applicator licensed as a drug to disinfect skin and help prevent infections before invasive medical procedures, such as injections, blood sampling, insertion of PIVCs and minor or major surgery.
Collapse
Affiliation(s)
- Simon Clare
- Research and Practice Development Director ANTT, The Association for Safe Aseptic Practice
| | - Stephen Rowley
- Clinical Director ANTT, The Association for Safe Aseptic Practice
| |
Collapse
|
37
|
Adams RJ, Mollenkopf DF, Mathys DA, Whittle A, Ballash GA, Mudge M, Daniels JB, Barr B, Wittum TE. Prevalence of extended-spectrum cephalosporin-, carbapenem-, and fluoroquinolone-resistant members of the family Enterobacteriaceae isolated from the feces of horses and hospital surfaces at two equine specialty hospitals. J Am Vet Med Assoc 2021; 258:758-766. [PMID: 33754819 DOI: 10.2460/javma.258.7.758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To estimate the prevalence of extended-spectrum cephalosporin-, carbapenem-, and fluoroquinolone-resistant bacteria of the family Enterobacteriaceae in the feces of hospitalized horses and on hospital surfaces. SAMPLE Fecal and environmental samples were collected from The Ohio State University Galbreath Equine Center (OSUGEC) and a private referral equine hospital in Kentucky (KYEH). Feces were sampled within 24 hours after hospital admission and after 48 hours and 3 to 7 days of hospitalization. PROCEDURES Fecal and environmental samples were enriched, and then selective media were inoculated to support growth of Enterobacteriaceae bacteria that expressed resistance phenotypes to extended-spectrum cephalosporins, carbapenems, and fluoroquinolones. RESULTS 358 fecal samples were obtained from 143 horses. More samples yielded growth of Enterobacteriaceae bacteria that expressed resistance phenotypes (AmpC β-lactamase, OR = 4.2; extended-spectrum beta-lactamase, OR = 3.2; and fluoroquinolone resistance, OR = 4.0) after 48 hours of hospitalization, versus within 24 hours of hospital admission. Horses hospitalized at KYEH were at greater odds of having fluoroquinolone-resistant bacteria (OR = 2.2). At OSUGEC, 82%, 64%, 0%, and 55% of 164 surfaces had Enterobacteriaceae bacteria with AmpC β-lactamase phenotype, extended-spectrum beta-lactamase phenotype, resistance to carbapenem, and resistance to fluoroquinolones, respectively; prevalences at KYEH were similarly distributed (52%, 32%, 1%, and 35% of 315 surfaces). CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that antimicrobial-resistant Enterobacteriaceae may be isolated from the feces of hospitalized horses and from the hospital environment. Hospitalization may lead to increased fecal carriage of clinically important antimicrobial-resistance genes.
Collapse
|
38
|
Zhelev G. Bacterial resistance to antiseptics and disinfectants – minireview. BULGARIAN JOURNAL OF VETERINARY MEDICINE 2021. [DOI: 10.15547/bjvm.2019-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The appearance of bacterial resistance to disinfectants and antiseptics is an issue of substantial health concern, resulting in low efficiency of epidemic control activities and emergence of microorganisms with cross-resistance to antibiotics and biocides. A synopsis of the main mechanisms of development of resistance to biocides is presented. The emphasis is placed to health risks and impact on medical practice. The main methods for detection of resistance, and prevention measures of key importance for its control are outlined.
Collapse
Affiliation(s)
- G. Zhelev
- Department of Veterinary Microbiology, Infectious and Parasitic Diseases, Faculty of Veterinary Medicine , Trakia University, 6000 Stara Zagora, Bulgaria
| |
Collapse
|
39
|
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
|
40
|
Ibrahim A, Hassan D, Kelany N, Kotb S, Soliman M. Validation of Three Different Sterilization Methods of Tilapia Skin Dressing: Impact on Microbiological Enumeration and Collagen Content. Front Vet Sci 2020; 7:597751. [PMID: 33426019 PMCID: PMC7785820 DOI: 10.3389/fvets.2020.597751] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/02/2020] [Indexed: 11/13/2022] Open
Abstract
Tilapia fish skin has demonstrated promise as a stable and practical biological dressing to be used in wound and burn management. However, the appropriate sterilization technique of the Tilapia fish skin is crucial before its clinical application. The standard sterilization technique must eliminate harmful pathogens but maintain the structural and biochemical properties that could compromise the dressing function. This study investigated and compared the efficiency of three sterilizing agents; chlorhexidine gluconate 4% (CHG), povidone iodine 10% (PVP-I), and silver nanoparticles (25 μg/mL) (AgNPs), at three different times (5, 10, and 15 min) on Tilapia fish skin based on the microbial count, histological and collagen properties. Among the sterilization procedures, AgNPs showed rapid and complete antimicrobial activity, with a 100% reduction in microbial growth of the fish skin throughout the treated times. Furthermore, AgNPs did not impair the cellular structure or collagen fibers content of the fish skin. However, CHG and PVP-I caused alterations in the collagen content. This study demonstrated that the AgNPs treatment of Tilapia fish skin provided sterile skin while preserving the histological properties and structural integrity. These findings provide an efficient and quick sterilization method suitable for Tilapia fish skin that could be adopted as a biological dressing.
Collapse
Affiliation(s)
- Ahmed Ibrahim
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt
| | - Dalia Hassan
- Department of Animal and Poultry Hygiene, and Environmental Sanitation, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt
| | - Noura Kelany
- Department of Animal and Poultry Hygiene, and Environmental Sanitation, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt
| | - Saber Kotb
- Department of Animal and Poultry Hygiene, and Environmental Sanitation, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt
| | - Mahmoud Soliman
- Department of Veterinary Pathology and Clinical Pathology, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt.,Laboratory of Veterinary Pathology, College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea
| |
Collapse
|
41
|
Falkinham JO. Living with Legionella and Other Waterborne Pathogens. Microorganisms 2020; 8:E2026. [PMID: 33352932 PMCID: PMC7766883 DOI: 10.3390/microorganisms8122026] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/04/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023] Open
Abstract
Legionella spp. and other opportunistic premise plumbing pathogens (OPPPs), including Pseudomonas aeruginosa, Mycobacterium avium, Stenotrophomonas maltophilia, and Acinetobacter baumannii, are normal inhabitants of natural waters, drinking water distribution systems and premise plumbing. Thus, humans are regularly exposed to these pathogens. Unfortunately, Legionella spp. and the other OPPPs share a number of features that allow them to grow and persist in premise plumbing. They form biofilms and are also relatively disinfectant-resistant, able to grow at low organic matter concentrations, and able to grow under stagnant conditions. Infections have been traced to exposure to premise plumbing or aerosols generated in showers. A number of measures can lead to reduction in OPPP numbers in premise plumbing, including elevation of water heater temperatures.
Collapse
Affiliation(s)
- Joseph O Falkinham
- Department of Biological Sciences, Virginia Tech, Blacksburg, VA 24061, USA
| |
Collapse
|
42
|
Ferro P, Vaz-Moreira I, Manaia CM. Evolution of gentamicin and arsenite resistance acquisition in Ralstonia pickettii water isolates. Res Microbiol 2020; 172:103790. [PMID: 33197514 DOI: 10.1016/j.resmic.2020.11.001] [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: 09/05/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
Ralstonia pickettii are ubiquitous in water environments. Members of this species are frequently, but not always, resistant to both gentamicin and arsenite. Gentamicin and arsenite co-resistance and the putative molecular mechanisms were investigated. A group of 37 R. pickettii strains isolated from drinking water and hospital wastewater were characterized for gentamicin and arsenite resistance phenotypes, the number and size of plasmids, and screened for genetic elements associated with arsenite tolerance, Integrative and Conjugative Elements (ICEs), among other. The genomes of three representative strains were compared. Most gentamicin resistant (GR) isolates (32/33) were resistant to arsenite, and harbored ICE- and ars operon-related genes. These genetic elements were not detected in any of the five arsenite susceptible strains, regardless of the GR (n = 1) or gentamicin susceptibility (GS) (n = 4) phenotype. The comparison of the genomes of two GR (one resistant and one susceptible to arsenite) and one GS strains suggested that these phenotypes correspond to three phylogroups, distinguished by presence of some genes only in GR isolates, in addition to point mutations in functional genes. The presence of ICEs and ars operon-related genes suggest that arsenite resistance might have been acquired by GR lineages.
Collapse
Affiliation(s)
- Pompeyo Ferro
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Rua Diogo Botelho, 1327, 4169-005, Porto, Portugal
| | - Ivone Vaz-Moreira
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Rua Diogo Botelho, 1327, 4169-005, Porto, Portugal
| | - Célia M Manaia
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Rua Diogo Botelho, 1327, 4169-005, Porto, Portugal.
| |
Collapse
|
43
|
Chittrakanwong J, Charoenlap N, Mongkolsuk S, Vattanaviboon P. mfsQ encoding an MFS efflux pump mediates adaptive protection of Stenotrophomonas maltophilia against benzalkonium chloride. Can J Microbiol 2020; 67:491-495. [PMID: 33151759 DOI: 10.1139/cjm-2020-0341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The persistence of Stenotrophomonas maltophilia, especially in hospital environments where disinfectants are used intensively, is one of the important factors that allow this opportunistic pathogen to establish nosocomial infections. In the present study, we illustrated that S. maltophilia possesses adaptive resistance to the disinfectant benzalkonium chloride (BAC). This BAC adaptation was abolished in the ΔmfsQ mutant, in which a gene encoding an efflux transporter belonging to the major facilitator superfamily (MFS) was deleted. The ΔmfsQ mutant also showed increased susceptibility to BAC and chlorhexidine gluconate compared with a parental wild type. The expression of mfsQ increased upon exposure to quaternary ammonium compounds, including BAC. Thus, the results of this study suggest that mfsQ plays a role in both adaptive and nonadaptive protection of S. maltophilia from the toxicity of the disinfectant BAC.
Collapse
Affiliation(s)
- Jurairat Chittrakanwong
- Laboratory of Biotechnology, Chulabhorn Research Institute, Bangkok 10210, Thailand.,Program in Applied Biological Sciences, Environmental Health, Chulabhorn Graduate Institute, Chulabhorn Royal Academy, Bangkok 10210, Thailand
| | - Nisanart Charoenlap
- Laboratory of Biotechnology, Chulabhorn Research Institute, Bangkok 10210, Thailand
| | - Skorn Mongkolsuk
- Laboratory of Biotechnology, Chulabhorn Research Institute, Bangkok 10210, Thailand.,Center of Excellence on Environmental Health and Toxicology, Ministry of Education, Bangkok 10400, Thailand
| | - Paiboon Vattanaviboon
- Laboratory of Biotechnology, Chulabhorn Research Institute, Bangkok 10210, Thailand.,Program in Applied Biological Sciences, Environmental Health, Chulabhorn Graduate Institute, Chulabhorn Royal Academy, Bangkok 10210, Thailand.,Center of Excellence on Environmental Health and Toxicology, Ministry of Education, Bangkok 10400, Thailand
| |
Collapse
|
44
|
Brzozowski M, Krukowska Ż, Galant K, Jursa-Kulesza J, Kosik-Bogacka D. Genotypic characterisation and antimicrobial resistance of Pseudomonas aeruginosa strains isolated from patients of different hospitals and medical centres in Poland. BMC Infect Dis 2020; 20:693. [PMID: 32962640 PMCID: PMC7507710 DOI: 10.1186/s12879-020-05404-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background Pseudomonas aeruginosa is a Gram-negative bacteria responsible for infections in immunocompromised patients and is one of the most common causes of nosocomial infections particularly in intensive care and burn units. We aimed to investigate the population structure of P. aeruginosa strains isolated from patients at different hospital wards. Methods: We analysed the possible presence of P. aeruginosa epidemic or endemic strains in hospitals of the selected region. A genotyping analysis was performed for P. aeruginosa isolates (n = 202) collected from patients of eleven hospitals in north-western Poland. Collections of P. aeruginosa were genotyped using pulsed-field gel electrophoresis (PFGE). Phenotypic screening for antibiotic susceptibility was performed for the common antimicrobial agents. Results Pseudomonas aeruginosa isolates were distributed among 116 different pulsotype groups. We identified 30 groups of clonally related strains, each containing from 2 to 17 isolates and typed the obtained 13 unique patterns, designated as A, D, E, J, K, M, N, Ó, P, T, X, AC, AD, and AH. The two largest clusters, D and E, contained 17 and 13 isolates, respectively. Strains of these groups were continuously isolated from patients at intensive care units and burn units, indicating transmission of these strains. Conclusions In this study, we demonstrate the clonal relatedness of P. aeruginosa strains and their constant exchange in hospitals over a period of 15 months. The obtained results indicate a predominantly non-clonal structure of P. aeruginosa.
Collapse
Affiliation(s)
- Marcin Brzozowski
- Department of Medical Microbiology, Chair of Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Powstanców Wielkopolskich 72, 70-111, Szczecin, Poland
| | - Żaneta Krukowska
- Department of Medical Microbiology, Chair of Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Powstanców Wielkopolskich 72, 70-111, Szczecin, Poland
| | - Katarzyna Galant
- Department of Laboratory Medicine; Chair of Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Powstanców Wielkopolskich 72, 70-111, Szczecin, Poland
| | - Joanna Jursa-Kulesza
- Department of Medical Microbiology, Chair of Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Powstanców Wielkopolskich 72, 70-111, Szczecin, Poland
| | - Danuta Kosik-Bogacka
- Independent of Pharmaceutical Botany, Pomeranian Medical University in Szczecin, Powstanców Wielkopolskich 72, 70-111, Szczecin, Poland.
| |
Collapse
|
45
|
Bacterial contamination of blood products for transfusion in the Democratic Republic of the Congo: temperature monitoring, qualitative and semi-quantitative culture. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2020; 18:348-358. [PMID: 32931413 DOI: 10.2450/2020.0108-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bacterial contamination of blood for transfusion is rarely investigated in low-income countries. We determined the contamination rate of blood products in the Democratic Republic of the Congo. MATERIAL AND METHODS In this prospective observational study, blood products in one rural and two urban hospitals (paediatric and general) contained a satellite sampling bag by which blood was sampled for culture in a blood culture bottle (4 mL) and on an agar-coated slide to estimate colony forming units (CFU/mL). Bacteria were identified with biochemical tests and MALDI-TOF (Bruker). Exposure time >10 °C was assessed on a subset of blood products. RESULTS In total, 1.4% (41 of 2,959) of blood products were contaminated with 48 bacterial isolates. Skin (e.g., Staphylococcus spp.) and environmental (e.g., Bacillus spp.) bacteria predominated (97.8% of 45 isolates identified). Bacterial counts were ≤103 CFU/mL. Contamination rates for the urban paediatric, urban general and rural hospitals were 1.6%, 2.4% and 0.3%, respectively (p=0.004). None of the following variables was significantly associated with contamination: (i) donor type (voluntary 1.6%, family 1.2%, paid 3.9%); (ii) type of blood product (red cells 1.6%, whole blood 0.6%); (ii) season (dry season 2.4%, rainy season 1.8%); (iv) age of blood product (contaminated 8 days vs non-contaminated 6 days); and (v) exposure time >10 °C (median for contaminated and non-contaminated blood reached maximum test limit of 8 hours). DISCUSSION A bacterial contamination rate of 1.4% of whole blood and red cells is similar to results from high-income countries. Implementation of feasible risk-mitigation measures is needed.
Collapse
|
46
|
Merchel Piovesan Pereira B, Wang X, Tagkopoulos I. Short- and Long-Term Transcriptomic Responses of Escherichia coli to Biocides: a Systems Analysis. Appl Environ Microbiol 2020; 86:e00708-20. [PMID: 32385082 PMCID: PMC7357472 DOI: 10.1128/aem.00708-20] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/01/2020] [Indexed: 12/01/2022] Open
Abstract
The mechanisms of the bacterial response to biocides are poorly understood, despite their broad application. To identify the genetic basis and pathways implicated in the biocide stress response, we exposed Escherichia coli populations to 10 ubiquitous biocides. By comparing the transcriptional responses between a short-term exposure (30 min) and a long-term exposure (8 to 12 h) to biocide stress, we established the common gene and pathway clusters that are implicated in general and biocide-specific stress responses. Our analysis revealed a temporal choreography, starting from the upregulation of chaperones to the subsequent repression of motility and chemotaxis pathways and the induction of an anaerobic pool of enzymes and biofilm regulators. A systematic analysis of the transcriptional data identified a zur-regulated gene cluster to be highly active in the stress response against sodium hypochlorite and peracetic acid, presenting a link between the biocide stress response and zinc homeostasis. Susceptibility assays with knockout mutants further validated our findings and provide clear targets for downstream investigation of the implicated mechanisms of action.IMPORTANCE Antiseptics and disinfectant products are of great importance to control and eliminate pathogens, especially in settings such as hospitals and the food industry. Such products are widely distributed and frequently poorly regulated. Occasional outbreaks have been associated with microbes resistant to such compounds, and researchers have indicated potential cross-resistance with antibiotics. Despite that, there are many gaps in knowledge about the bacterial stress response and the mechanisms of microbial resistance to antiseptics and disinfectants. We investigated the stress response of the bacterium Escherichia coli to 10 common disinfectant and antiseptic chemicals to shed light on the potential mechanisms of tolerance to such compounds.
Collapse
Affiliation(s)
- Beatriz Merchel Piovesan Pereira
- Microbiology Graduate Group, University of California, Davis, California, USA
- Genome Center, University of California, Davis, California, USA
| | - Xiaokang Wang
- Genome Center, University of California, Davis, California, USA
- Biomedical Engineering Graduate Group, University of California, Davis, California, USA
| | - Ilias Tagkopoulos
- Genome Center, University of California, Davis, California, USA
- Department of Computer Science, University of California, Davis, California, USA
| |
Collapse
|
47
|
Tavares M, Kozak M, Balola A, Coutinho CP, Godinho CP, Hassan AA, Cooper VS, Sá-Correia I. Adaptation and Survival of Burkholderia cepacia and B. contaminans During Long-Term Incubation in Saline Solutions Containing Benzalkonium Chloride. Front Bioeng Biotechnol 2020; 8:630. [PMID: 32714902 PMCID: PMC7344210 DOI: 10.3389/fbioe.2020.00630] [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: 04/03/2020] [Accepted: 05/22/2020] [Indexed: 01/28/2023] Open
Abstract
The Burkholderia cepacia complex (Bcc) is a group of opportunistic pathogenic bacteria with a remarkable metabolic capacity and broad genotypic/phenotypic plasticity, allowing their adaptation to hostile conditions, including nutrient depleted solutions containing antimicrobial agents. Bcc bacteria are feared contaminants in pharmaceutical industries and cause nosocomial outbreaks, posing health threats to immunocompromised individuals and cystic fibrosis (CF) patients. In this study, the adaptation and survival of B. cepacia and B. contaminans isolates was investigated after long-term incubation in nutrient depleted saline solutions supplemented with increasing concentrations of the biocidal preservative benzalkonium chloride (BZK), recreating the storage conditions of pharmaceutical products. These epidemiologically related isolates were recovered from intrinsically contaminated saline solutions for nasal application and from two CF patients. Long-term incubation in saline solutions containing BZK led to the development of bacterial sub-populations that survived for at least 16 months, despite an initial 2-3 log decrease in viability, displaying a progressive dose-dependent decrease of colony and cell size, including the appearance of small colony variants (SCVs). Bacterial colonies lost pigmentation, changed the morphotype from rough to smooth and produced more spherical cells during extended incubation with BZK. The development of macroscopically visible cellular aggregates, rich in polysaccharide and harboring viable cells in their interior was triggered by BZK. The existence of a metabolic pathway for BZK degradation was confirmed through genome analysis. This study reveals mechanisms underlying the prevalence of Bcc bacteria as contaminants of pharmaceutical products containing BZK, which often lead to false-negative results during quality control and routine testing.
Collapse
Affiliation(s)
- Mariana Tavares
- iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.,Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Mariya Kozak
- iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.,Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Alexandra Balola
- iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.,Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Carla P Coutinho
- iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Cláudia P Godinho
- iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - A Amir Hassan
- iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.,Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Vaughn S Cooper
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Isabel Sá-Correia
- iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.,Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
48
|
Keck N, Dunie-Merigot A, Dazas M, Hirchaud E, Laurence S, Gervais B, Madec JY, Haenni M. Long-lasting nosocomial persistence of chlorhexidine-resistant Serratia marcescens in a veterinary hospital. Vet Microbiol 2020; 245:108686. [PMID: 32456825 DOI: 10.1016/j.vetmic.2020.108686] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 12/19/2022]
Abstract
Healthcare-associated infections (HAIs) are often overlooked in veterinary medicine. Serratia marcescens isolates were recovered over a ten-year period from companion animals in a French veterinary hospital. The pets were sampled either for diagnostic purposes or to monitor colonization. A retrospective study showed that 32 S. marcescens isolates were identified as HAI cases and a further 22 cases were associated with colonization of the surgical site. Two S. marcescens lineages were responsible for two different outbreaks during the study period. Chlorhexidine solution (1%) used to impregnate gauze was found to be the source of the second S. marcescens outbreak and all isolates had high MIC values for chlorhexidine (MIC = 128 mg/L). This study reports, for the first time to our knowledge, the nosocomial spread of chlorhexidine-resistant S. marcescens in a veterinary setting and highlights consequences of the improper use of disinfectants.
Collapse
Affiliation(s)
- Nicolas Keck
- Laboratoire Départemental Vétérinaire de l'Hérault, 306 rue Croix de Las Cazes, 34967 Montpellier, Cedex 2, France.
| | - Antoine Dunie-Merigot
- Centre Hospitalier Vétérinaire Languedocia, 395 Rue Maurice Béjart, 34080 Montpellier, France
| | - Mélody Dazas
- Unité Antibiorésistance et Virulence Bactériennes, Université de Lyon - ANSES, 31 avenue Tony Garnier, 69007 Lyon cedex, France
| | - Edouard Hirchaud
- Viral Genetic and Biosecurity Unit, BP53, ANSES Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France
| | - Stéphanie Laurence
- Laboratoire Départemental Vétérinaire de l'Hérault, 306 rue Croix de Las Cazes, 34967 Montpellier, Cedex 2, France
| | - Béatrice Gervais
- Laboratoire Départemental Vétérinaire de l'Hérault, 306 rue Croix de Las Cazes, 34967 Montpellier, Cedex 2, France
| | - Jean-Yves Madec
- Unité Antibiorésistance et Virulence Bactériennes, Université de Lyon - ANSES, 31 avenue Tony Garnier, 69007 Lyon cedex, France
| | - Marisa Haenni
- Unité Antibiorésistance et Virulence Bactériennes, Université de Lyon - ANSES, 31 avenue Tony Garnier, 69007 Lyon cedex, France.
| |
Collapse
|
49
|
Burkholderia cepacia Complex Bacteria: a Feared Contamination Risk in Water-Based Pharmaceutical Products. Clin Microbiol Rev 2020; 33:33/3/e00139-19. [PMID: 32295766 DOI: 10.1128/cmr.00139-19] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Burkholderia cepacia (formerly Pseudomonas cepacia) was once thought to be a single bacterial species but has expanded to the Burkholderia cepacia complex (Bcc), comprising 24 closely related opportunistic pathogenic species. These bacteria have a widespread environmental distribution, an extraordinary metabolic versatility, a complex genome with three chromosomes, and a high capacity for rapid mutation and adaptation. Additionally, they present an inherent resistance to antibiotics and antiseptics, as well as the abilities to survive under nutrient-limited conditions and to metabolize the organic matter present in oligotrophic aquatic environments, even using certain antimicrobials as carbon sources. These traits constitute the reason that Bcc bacteria are considered feared contaminants of aqueous pharmaceutical and personal care products and the frequent reason behind nonsterile product recalls. Contamination with Bcc has caused numerous nosocomial outbreaks in health care facilities, presenting a health threat, particularly for patients with cystic fibrosis and chronic granulomatous disease and for immunocompromised individuals. This review addresses the role of Bcc bacteria as a potential public health problem, the mechanisms behind their success as contaminants of pharmaceutical products, particularly in the presence of biocides, the difficulties encountered in their detection, and the preventive measures applied during manufacturing processes to control contamination with these objectionable microorganisms. A summary of Bcc-related outbreaks in different clinical settings, due to contamination of diverse types of pharmaceutical products, is provided.
Collapse
|
50
|
Otter J, Yezli S, Barbut F, Perl T. An overview of automated room disinfection systems: When to use them and how to choose them. DECONTAMINATION IN HOSPITALS AND HEALTHCARE 2020. [PMCID: PMC7153347 DOI: 10.1016/b978-0-08-102565-9.00015-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Conventional disinfection methods are limited by reliance on the operator to ensure appropriate selection, formulation, distribution, and contact time of the agent. Automated room disinfection (ARD) systems remove or reduce reliance on operators and so they have the potential to improve the efficacy of terminal disinfection. The most commonly used systems are hydrogen peroxide vapor (H2O2 vapor), aerosolized hydrogen peroxide (aHP), and ultraviolet (UV) light. These systems have important differences in their active agent, delivery mechanism, efficacy, process time, and ease of use. The choice of ARD system should be influenced by the intended application, the evidence base for effectiveness, practicalities of implementation, and cost considerations.
Collapse
Affiliation(s)
- J.A. Otter
- NIHR Health Protection Research Unit (HPRU) in HCAIs and AMR at Imperial College London, and Imperial College Healthcare NHS Trust, Infection Prevention and Control, London, United Kingdom
| | - S. Yezli
- Global Centre for Mass Gatherings Medicine, WHO Collaborating Centre for Mass Gatherings Medicine, Ministry of Health-Public Health Directorate, Riyadh, Kingdom of Saudi Arabia
| | - F. Barbut
- National Reference Laboratory for C. difficile, Infection Control Unit, Hôpital Saint Antoine, Paris, France,INSERM S-1139, Faculté de Pharmacie de Paris, Université de Paris, Paris, France
| | - T.M. Perl
- Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| |
Collapse
|