Hospital sanitary facilities on wards with high antibiotic exposure play an important role in maintaining a reservoir of resistant pathogens, even over many years
Abstract Background Hospitals with their high antimicrobial selection pressure represent the presumably most important reservoir of multidrug-resistant human pathogens. Antibiotics administered in the course of treatment are excreted and discharged into the wastewater system. Not only in patients, b...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | Antimicrobial Resistance and Infection Control |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13756-023-01236-w |
| _version_ | 1797845780446314496 |
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| author | Claudio Neidhöfer Esther Sib Marcel Neuenhoff Oliver Schwengers Tobias Dummin Christian Buechler Niklas Klein Julian Balks Katharina Axtmann Katjana Schwab Tobias A. W. Holderried Georg Feldmann Peter Brossart Steffen Engelhart Nico T. Mutters Gabriele Bierbaum Marijo Parčina |
| author_facet | Claudio Neidhöfer Esther Sib Marcel Neuenhoff Oliver Schwengers Tobias Dummin Christian Buechler Niklas Klein Julian Balks Katharina Axtmann Katjana Schwab Tobias A. W. Holderried Georg Feldmann Peter Brossart Steffen Engelhart Nico T. Mutters Gabriele Bierbaum Marijo Parčina |
| author_sort | Claudio Neidhöfer |
| collection | DOAJ |
| description | Abstract Background Hospitals with their high antimicrobial selection pressure represent the presumably most important reservoir of multidrug-resistant human pathogens. Antibiotics administered in the course of treatment are excreted and discharged into the wastewater system. Not only in patients, but also in the sewers, antimicrobial substances exert selection pressure on existing bacteria and promote the emergence and dissemination of multidrug-resistant clones. In previous studies, two main clusters were identified in all sections of the hospital wastewater network that was investigated, one K. pneumoniae ST147 cluster encoding NDM- and OXA-48 carbapenemases and one VIM-encoding P. aeruginosa ST823 cluster. In the current study, we investigated if NDM- and OXA-48-encoding K. pneumoniae and VIM-encoding P. aeruginosa isolates recovered between 2014 and 2021 from oncological patients belonged to those same clusters. Methods The 32 isolates were re-cultured, whole-genome sequenced, phenotypically tested for their antimicrobial susceptibility, and analyzed for clonality and resistance genes in silico. Results Among these strains, 25 belonged to the two clusters that had been predominant in the wastewater, while two others belonged to a sequence-type less prominently detected in the drains of the patient rooms. Conclusion Patients constantly exposed to antibiotics can, in interaction with their persistently antibiotic-exposed sanitary facilities, form a niche that might be supportive for the emergence, the development, the dissemination, and the maintenance of certain nosocomial pathogen populations in the hospital, due to antibiotic-induced selection pressure. Technical and infection control solutions might help preventing transmission of microorganisms from the wastewater system to the patient and vice versa, particularly concerning the shower and toilet drainage. However, a major driving force might also be antibiotic induced selection pressure and parallel antimicrobial stewardship efforts could be essential. |
| first_indexed | 2024-04-09T17:44:28Z |
| format | Article |
| id | doaj.art-f55e9aef5f514f97ad547deec3ed7ce5 |
| institution | Directory Open Access Journal |
| issn | 2047-2994 |
| language | English |
| last_indexed | 2024-04-09T17:44:28Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Antimicrobial Resistance and Infection Control |
| spelling | doaj.art-f55e9aef5f514f97ad547deec3ed7ce52023-04-16T11:25:32ZengBMCAntimicrobial Resistance and Infection Control2047-29942023-04-0112111710.1186/s13756-023-01236-wHospital sanitary facilities on wards with high antibiotic exposure play an important role in maintaining a reservoir of resistant pathogens, even over many yearsClaudio Neidhöfer0Esther Sib1Marcel Neuenhoff2Oliver Schwengers3Tobias Dummin4Christian Buechler5Niklas Klein6Julian Balks7Katharina Axtmann8Katjana Schwab9Tobias A. W. Holderried10Georg Feldmann11Peter Brossart12Steffen Engelhart13Nico T. Mutters14Gabriele Bierbaum15Marijo Parčina16Institute of Medical Microbiology, Immunology and Parasitology, University Hospital BonnInstitute for Hygiene and Public Health, University Hospital BonnInstitute of Medical Microbiology, Immunology and Parasitology, University Hospital BonnBioinformatics and Systems Biology, Justus Liebig University GiessenInstitute of Medical Microbiology, Immunology and Parasitology, University Hospital BonnInstitute of Medical Microbiology, Immunology and Parasitology, University Hospital BonnInstitute of Medical Microbiology, Immunology and Parasitology, University Hospital BonnInstitute of Medical Microbiology, Immunology and Parasitology, University Hospital BonnInstitute of Medical Microbiology, Immunology and Parasitology, University Hospital BonnDepartment of Oncology, Hematology, and Rheumatology, University Hospital BonnDepartment of Oncology, Hematology, and Rheumatology, University Hospital BonnDepartment of Oncology, Hematology, and Rheumatology, University Hospital BonnDepartment of Oncology, Hematology, and Rheumatology, University Hospital BonnInstitute for Hygiene and Public Health, University Hospital BonnInstitute for Hygiene and Public Health, University Hospital BonnInstitute of Medical Microbiology, Immunology and Parasitology, University Hospital BonnInstitute of Medical Microbiology, Immunology and Parasitology, University Hospital BonnAbstract Background Hospitals with their high antimicrobial selection pressure represent the presumably most important reservoir of multidrug-resistant human pathogens. Antibiotics administered in the course of treatment are excreted and discharged into the wastewater system. Not only in patients, but also in the sewers, antimicrobial substances exert selection pressure on existing bacteria and promote the emergence and dissemination of multidrug-resistant clones. In previous studies, two main clusters were identified in all sections of the hospital wastewater network that was investigated, one K. pneumoniae ST147 cluster encoding NDM- and OXA-48 carbapenemases and one VIM-encoding P. aeruginosa ST823 cluster. In the current study, we investigated if NDM- and OXA-48-encoding K. pneumoniae and VIM-encoding P. aeruginosa isolates recovered between 2014 and 2021 from oncological patients belonged to those same clusters. Methods The 32 isolates were re-cultured, whole-genome sequenced, phenotypically tested for their antimicrobial susceptibility, and analyzed for clonality and resistance genes in silico. Results Among these strains, 25 belonged to the two clusters that had been predominant in the wastewater, while two others belonged to a sequence-type less prominently detected in the drains of the patient rooms. Conclusion Patients constantly exposed to antibiotics can, in interaction with their persistently antibiotic-exposed sanitary facilities, form a niche that might be supportive for the emergence, the development, the dissemination, and the maintenance of certain nosocomial pathogen populations in the hospital, due to antibiotic-induced selection pressure. Technical and infection control solutions might help preventing transmission of microorganisms from the wastewater system to the patient and vice versa, particularly concerning the shower and toilet drainage. However, a major driving force might also be antibiotic induced selection pressure and parallel antimicrobial stewardship efforts could be essential.https://doi.org/10.1186/s13756-023-01236-wMultidrug-resistant bacteriaCarbapenemase-encoding bacteriaAntibiotic-resistanceCRKPCRPsAK. pneumoniae ST147 |
| spellingShingle | Claudio Neidhöfer Esther Sib Marcel Neuenhoff Oliver Schwengers Tobias Dummin Christian Buechler Niklas Klein Julian Balks Katharina Axtmann Katjana Schwab Tobias A. W. Holderried Georg Feldmann Peter Brossart Steffen Engelhart Nico T. Mutters Gabriele Bierbaum Marijo Parčina Hospital sanitary facilities on wards with high antibiotic exposure play an important role in maintaining a reservoir of resistant pathogens, even over many years Antimicrobial Resistance and Infection Control Multidrug-resistant bacteria Carbapenemase-encoding bacteria Antibiotic-resistance CRKP CRPsA K. pneumoniae ST147 |
| title | Hospital sanitary facilities on wards with high antibiotic exposure play an important role in maintaining a reservoir of resistant pathogens, even over many years |
| title_full | Hospital sanitary facilities on wards with high antibiotic exposure play an important role in maintaining a reservoir of resistant pathogens, even over many years |
| title_fullStr | Hospital sanitary facilities on wards with high antibiotic exposure play an important role in maintaining a reservoir of resistant pathogens, even over many years |
| title_full_unstemmed | Hospital sanitary facilities on wards with high antibiotic exposure play an important role in maintaining a reservoir of resistant pathogens, even over many years |
| title_short | Hospital sanitary facilities on wards with high antibiotic exposure play an important role in maintaining a reservoir of resistant pathogens, even over many years |
| title_sort | hospital sanitary facilities on wards with high antibiotic exposure play an important role in maintaining a reservoir of resistant pathogens even over many years |
| topic | Multidrug-resistant bacteria Carbapenemase-encoding bacteria Antibiotic-resistance CRKP CRPsA K. pneumoniae ST147 |
| url | https://doi.org/10.1186/s13756-023-01236-w |
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