Multidrug-resistant bacteria isolated from cell phones in five intensive care units: Exploratory dispersion analysis

Reservoirs of Nosocomial Pathogens in Intensive Care Units: A Systematic Review

Background

Nosocomial pathogens are known to exacerbate morbidity and mortality in contemporary critical healthcare. Hospital fomites, which include inanimate surfaces, have been identified as "breeding grounds" for pathogens that cause nosocomial infections. This systematic review aimed to deliver incisive insights on nosocomial pathogens in intensive care units (ICUs) and the role of fomites as potential reservoirs for their transmission.

Method

An extensive exploration of electronic databases, including PubMed and Scopus, from 1990 to 2023, was carried out between 25th and 29th May 2023, per standard PRISMA guidelines. Information were extracted from articles that reported on fomites in the ICU. Studies that did not quantitatively report the fomite contamination, and those that exclusively took samples from patients in the ICU were excluded from the analysis.

Results

About 40% of the total samples collected on fomites from all the studies yielded microbial growth, with species of Staphylococcus being the most predominant. Other prevalent microbes were Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Candida spp., Enterococcus sp., and Enterobacter sp. The neonatal intensive care unit (NICU) had the highest proportion of contaminated fomites. Among known fomites, the sphygmomanometer exhibited a 100% detection rate of nosocomial pathogens. This included E. aerogenes, Staphylococcus aureus, coagulase-negative Staphylococci (CoNS), E. coli, and K. pneumoniae. Multidrug-resistant (MDR) bacteria, such as methicillin-resistant S. aureus (MRSA), vancomycin-resistant Enterococci (VRE), extended-spectrum beta-lactamase (ESBL)-producing E. coli, and MDR Pseudomonas aeruginosa were commonly isolated on fomites in the ICUs.

Conclusion

Many fomites that are readily used in patient care in the ICU harbour nosocomial pathogens. The most common fomite appeared to be mobile phones, sphygmomanometers, and stethoscopes, with Staphylococcus being the most common contaminant. Consequently, the need for rigorous disinfection and sterilization protocols on fomites in the ICU cannot be overemphasized. Additionally, heightened awareness on the subject among health professionals is crucial to mitigating the risk and burden of nosocomial infections caused by drug-resistant bacteria.

Contamination by Antibiotic-Resistant Bacteria on Cell Phones of Vendors in a Peruvian Market

Background and Objectives. Multiple studies have evaluated the presence of bacterial contamination on cell phones in clinical settings; however, the presence and transmission of antibiotic-resistant bacteria on cell phones in the community have not been adequately elucidated. Material and Methods. A cross-sectional study was carried out to determine the presence of bacteria resistant to antibiotics on the cell phones of vendors in a Peruvian market and the associated factors. A sample of 127 vendors was obtained through stratified probabilistic sampling using a data collection form validated by experts. Cell phone samples were cultured using a standard technique, and antibiotic sensitivity was determined using the Kirby–Bauer technique. Chi-squared and Mann-Whitney U tests were used to determine factors associated with resistance in cell phone cultures. Results. Among the cell phones, 92.1% showed bacterial growth, predominantly Gram-positive bacteria (coagulase-negative staphylococci and Staphylococcus aureus), and 17% of the cultures showed resistance to at least three antibiotics evaluated. Two strains fell into the category of methicillin-resistant S. aureus, and three strains of E. coli had resistance to carbapenems. Conclusions. A short distance between customers and vendors, lack of a cell phone case, and having a cell phone with touchscreen are factors associated with antibiotic-resistant bacteria on cell phones.

Biofilm formation by E. coli and S. aureus on cellphone cover: sensitivity to commercially available sanitizers

Presence of pathogens on the cellphones and their accessories poses a significant risk for public health. This study aimed to determine the biofilm-forming capability of S. aureus and E. coli on pieces made from a different commercially available cell phone and aadditionally to test the effectiveness of the most common commercially available sanitizers. Therefore, bacterial biofilm biomasses were quantitatively determined on cellphone covers using crystal violet assay in the presence and absence of common sanitizers. This study revealed that S. aureus and E. coli could form biofilms on the surfaces of all cellphones covers. Additionally, the sanitizers that contain sodium hypochlorite 5.25% and those composed of 38.9% ethanol and 0.05% dodecyl dimethyl ammonium chloride showed the highest log reduction in the number of viable cells after 5 minutes of exposure against biofilms formed by both E. coli and S. aureus compared to other tested sanitizers (chloroxylenol 4.8%, 2-propanol 64%, and ethanol 70%). Moreover, 4.8% chloroxylenol and 70% ethanol-based sanitizers showed log reductions significantly higher than 2-propanol-based ones. In conclusion, cellphone covers were shown to be suitable surfaces for microbial biofilm formation produced by S. aureus and E. coli. The antimicrobial activity of commercially available sanitizers against these bacterial biofilms was variable, with sodium hypochlorite and ethanol/dodecyl dimethyl ammonium chloride sanitizer being the most effective.

Worrying levels of antimicrobial resistance in Gram-negative bacteria isolated from cell phones and uniforms of Peruvian intensive care unit workers

BACKGROUND

Healthcare worker (HCW) uniforms and cell phones are involved in pathogen transmission. This study aimed to characterize pathogenic microorganism isolates from HCW uniforms and cell phones.

METHODS

Gram-negative microorganisms were recovered from HCW uniforms and cell phones. Antimicrobial susceptibility and the presence of extended-spectrum β-lactamases (ESBL) and carbapenemases were determined.

RESULTS

Escherichia coli was the most prevalent microorganism. Overall, high levels of resistance to cephalosporins, quinolones, co-trimoxazole and colistin were found. ESBL were mainly related to blaCTX-M-15 and blaSHV- genes. Carbapenem-resistant isolates presented as blaKPC or blaNDM.

CONCLUSIONS

High levels of antimicrobial resistance, including colistin, were detected. Therefore, strategies are urgently needed to prevent bacterial dissemination.

Clinically relevant materials & applications inspired by food technologies

Food science and technology have a fundamental and considerable overlap with medicine, and many clinically important applications were borne out of translational food science research. Globally, the food industry - through various food processing technologies - generates huge quantities of agro-waste and food processing byproducts that retain a significant biochemical potential for upcycling into important medical applications. This review explores some distinct clinical applications that are fabricable from food-based biopolymers and substances, often originating from food manufacturing side streams. These include antibacterial wound dressings and tissue scaffolding from the biopolymers cellulose and chitosan and antimicrobial food phytochemicals for combating antibiotic-resistant nosocomial infections. Furthermore, fermentation is discussed as the epitome of a translational food technology that unlocks further therapeutic value from recalcitrant food-based substrates and enables sustainable large-scale production of high-value pharmaceuticals, including novel fermented food-derived bioactive peptides (BPs).

Determination of drug-resistant bacteria in palmar surface and touchscreen cell phones from bystanders in an urban community

The dynamic microbiota of the human palmar surface (PS) is related to the various hygienic habits of humans and can be transmitted or exchanged upon contact with objects of daily use, such as the indispensable touchscreen cell phone (TCP); this interaction could allow the development of drug-resistant bacteria. The objective was to determine the drug-resistant bacterial contamination between PSs and TCPs in an urban community. Among the total bacterial colonies isolated and molecular and phylogenetically characterized based on the V4-V6 regions of the 16S rRNA gene from PSs and TCPs, the genera present in both types of samples were Staphylococcus (53.3 and 43.5 %, respectively), Bacillus (37.8, 37 %), Atlantibacter (2.2, 10.8 %) and Microbacterium (2.2, 4.3 %). The genera present in only one type of sample were Rothia, Paenibacillus, Escherichia and Micrococcus (2.2 % each). Resistance to penicillins (35.6-93.5 %) and nonsusceptibility to cephalosporins (8.9-37 %) and nitrofurantoin (13.3 and 15.2 %) were observed. The percentage of multidrug antibiotic resistance was 15.4 %. The prevalence of drug-resistant and multidrug-resistant bacteria in PSs and TCPs in the community could give rise to human health problems, and hygiene measures are recommended.

Process improvement: Use of UV-C for healthcare cell phone disinfection

Cell phones are increasingly used in healthcare on a daily basis. However, development of protocols to ensure cleanliness of these devices has not kept pace. The most common method of disinfecting cell phones is the use of germicidal impregnated disposable wipes, though there are a number of limitations associated with this method. One acute care hospital, part of a multi-hospital system, embarked on a study to compare the efficacy, workflow, and staff satisfaction of germicidal wipes versus a novel UV-C light device, concluding that the UV-C device was superior.

Isolation of Gram-Positive, Antibiotic-Resistant Bacteria from Tactile Mobile Phones in a Northwestern Mexican City

The widespread use of touch-screen mobile devices renders them potential fomites for the transmission of bacterial pathogens among users of different ages. The objectives of the present research were to isolate bacteria from mobile phones, perform molecular and phylogenetic identification, and determine the antibiotic resistance profiles. The surfaces of 50 touch-screen mobile devices owned by bystanders were sampled in the city center of Culiacan, Sinaloa, Mexico. The samples were cultured on nutritive agar; 13 bacterial colonies were isolated and characterized based on their macroscopic and microscopic characteristics and then identified using PCR amplification and sequencing of the 16S rRNA gene V4 and V6 regions. Their taxonomic relationships were determined via a Bayesian inference approach. Antimicrobial resistance was evaluated via disc diffusion and broth microdilution assays. Species of the genera Staphylococcus, Bacillus, and Enterococcus were identified on 84.6, 7.7, and 7.7% of the mobile phones, respectively. A unique subgroup of Staphylococcus epidermidis was identified in strains FBOPL-23, CAEPL-28, and FREPL-28. Staphylococcus hominis novobiosepticus was also identified on mobile phones for the first time. Of the isolated bacteria, 92.3% were resistant to erythromycin, 76.9% to ampicillin and penicillin, 61.5% to dicloxacillin, 38.5% to cephalothin and 7.7% to cefotaxime and ceftriaxone. The presence of antibiotic-resistant bacteria of clinical relevance poses potential risks to users' health and the dissemination of antibiotic resistance mechanisms throughout the community; thus, we recommend regular cleaning to prevent cross-infection by multidrug-resistant bacteria when using touch-screen mobile devices.

Contaminación bacteriológica en teléfonos celulares de trabajadores de la salud en ambiente clínico: revisión sistemática

Se realizó una revisión sistemática para identificar microorganismos reportados como agentes contaminantes en teléfonos celulares de trabajadores de la salud, que realizan actividades en ambientes clínicos. Se incluyeron publicaciones entre 2008 y 2018, mediante búsqueda en seis bases de datos usando palabras clave como “nosocomial pathogen” "healthcare workers" y "cell phone", entre otros. Dos investigadores de forma independiente realizaron la búsqueda y revisión de artículos. La calidad de los mismos se evaluó mediante lista de chequeo STROBE. Veintiún artículos fueron analizados. En todos los estudios se identificó presencia de contaminación en los celulares de los trabajadores de la salud, con una mediana de 84,3%, resaltando la presencia de Staphylococcus aureus (85,7%) y Escherichia coli (61,9%). Se concluye que el uso de los teléfonos celulares en ambiente hospitalario por parte de los trabajadores de la salud se constituye en una fuente potencial de trasmisión de microorganismos de interés clínico.