Electus dg 1611/3/2022 ![]() ![]() Though studies clearly demonstrate that bacterial pathogens exist on hospital surfaces, key knowledge gaps exist regarding the levels, types, and dynamics of contamination in hospitals from different geographies 15, 19. Some putatively pathogenic strains of bacteria persist for months on hospital surfaces, and they may even survive surface decontamination efforts, partly aided by biofilm formation 21, 22, 23, 24. The presence of these microorganisms on surfaces in healthcare settings is a local and global public health concern 20. Patients harboring these putative pathogens can transmit these bacteria to healthcare workers, other patients, medical equipment, and hospital surfaces 19, but the relative contribution of this contamination route compared to other routes in unknown. These ESKAPE pathogens can be acquired while hospitalized, but some patients may be colonized or infected prior to hospital admission 19. and Staphylococcus aureus, and the gram-negative microorganisms Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp 18. ![]() These include the gram-positive microorganisms Enterococcus spp. The “ESKAPE” pathogens, named by the Infectious Disease Society of America, are common causes of HAIs and the most common MDROs 18. Hospitalized patients are more vulnerable to bacterial infections than the general population 15, and healthcare-associated infections (HAIs) acutely threaten patient safety worldwide 16, 17. Improved surveillance and understanding of MDRO and ARG transmission are key factors in reducing these death tolls 1, 12. The annual global death toll from MDROs is at least 700,000 people 14. Resistant infections cause over 23,000 annual deaths in the United States of America (USA) and cost the economy over 55 billion dollars 13. Through international travel, clonal expansion, and promiscuous mobile genetic elements, MDROs and the ARGs they harbor have rapidly swept across the globe 1, 5, 6, 7, 8, 9, 10, 11, 12. Infections caused by MDROs are associated with increased mortality risk compared to infections by matched species susceptible isolates 2, 3, 4. Global treatment of bacterial infections is increasingly compromised by evolution and transmission of multidrug-resistant organisms (MDROs) and their antibiotic resistance genes (ARGs) between multiple habitats 1. Our results highlight substantial MDR pathogen burdens in hospital built-environments, provide evidence for spatiotemporal-dependent transmission, and demonstrate potential mechanisms for multi-species surface persistence. We identify Acinetobacter baumannii and Enterococcus faecium co-association on multiple surfaces, and demonstrate these species establish synergistic biofilms in vitro. Many resistance genes (e.g., bla NDM, bla OXA carbapenamases), are shared by multiple species and flanked by mobilization elements. Common nosocomial isolates are dominated by single lineages of different clones, are phenotypically MDR, and have high resistance gene burdens. MDR bacteria isolated from 3.3% and 86.7% of US and Pakistani surfaces, respectively, include common nosocomial pathogens, rare opportunistic pathogens, and novel taxa. ![]() Here we investigate spatiotemporal and phylogenetic relationships of multidrug resistant (MDR) bacteria on intensive care unit surfaces from two hospitals in the United States (US) and Pakistan collected over one year. These contaminants impact hospital infection control and epidemiology, prompting quantitative examination of their transmission dynamics. Bacterial pathogens that infect patients also contaminate hospital surfaces. ![]()
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