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Antibiotics
Special Issues
Healthcare Infections, Healthcare Environment and Antimicrobial Resistance
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Healthcare Infections, Healthcare Environment and Antimicrobial Resistance

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "The Global Need for Effective Antibiotics".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 17472

Special Issue Editor

Prof. Dr. Anna Maria Spagnolo

E-Mail Website
Guest Editor
Dipartimento di Scienze della salute (DISSAL), Università degli Studi di Genova, 16126 Genova, GE, Italy
Interests: healthcare environment; emerging pathogens; healthcare-associated infections; antimicrobial resistance; infection prevention and control
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Infections in high-risk healthcare wards due to emerging pathogens are responsible for a high mortality rate. The emerging pathogens involved are both Gram-negative (Acinetobacter spp., Klebsiella spp., Pseudomonas spp., etc.) and Gram-positive (MRSA, vancomycin-resistant enterococci, Clostridium difficile, etc.). The severity of these infections is due to the virulence factors of the bacteria, their resistance to multiple antibiotics and the associated difficulty in treating infections, and their occurrence in debilitated patients.

The inanimate environment can act as a reservoir and some studies have demonstrated that the rate of exogenous transmission of these bacteria is important. To better prevent nosocomial infections related to emerging pathogens, the control of the environment, the strict application of hand hygiene, and all recommended procedures and the investigation of potential cross-transmission in the healthcare setting are needed.

This Special Issue seeks research papers on various aspects related to the role of the environment in the spread of emerging pathogens in healthcare settings, prevention, and control of healthcare-associated infections, including waterborne infections.

We, especially, encourage the submission of interdisciplinary work and multi-country collaborative research. We welcome original research papers using different study designs as well as literature review, systematic reviews, and meta-analysis.

Dr. Anna Maria Spagnolo
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Healthcare environment
  • emerging pathogens
  • healthcare-associated infections
  • antimicrobial resistance
  • infection prevention and control

Published Papers (5 papers)

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13 pages, 1496 KiB  
Article
Evaluation of Multidrug-Resistant P. aeruginosa in Healthcare Facility Water Systems
by Maria Luisa Cristina, Marina Sartini, Elisa Schinca, Gianluca Ottria, Beatrice Casini and Anna Maria Spagnolo
Antibiotics 2021, 10(12), 1500; https://doi.org/10.3390/antibiotics10121500 - 7 Dec 2021
Cited by 3 | Viewed by 2819
Abstract
According to the WHO, P. aeruginosa is one of the antibiotic-resistant bacteria that represent the biggest threat to public health. The aim of the study was to establish the prevalence of antibiotic-resistant P. aeruginosa in the water systems of various healthcare facilities over [...] Read more.
According to the WHO, P. aeruginosa is one of the antibiotic-resistant bacteria that represent the biggest threat to public health. The aim of the study was to establish the prevalence of antibiotic-resistant P. aeruginosa in the water systems of various healthcare facilities over the course of nine years. A total of 4500 tap water system samples were taken from seventeen healthcare facilities. The culture method was used to detect P. aeruginosa, and the isolates were then tested for antibiotic resistance using the standardised disc diffusion method. Eleven antibiotics from five different classes were tested. P. aeruginosa was found to have contaminated 2.07% (no. 93) of the water samples. The majority of positive samples came from the dental units (30.11%) and the ward kitchens (23.66%). Considering the total isolates, 56.99% (no. 3) were resistant to at least one of the antibiotics tested. A total of 71.43% of P. aeruginosa isolated from water emerging from dental unit handpieces was antibiotic-resistant, with 45% of it resistant to ≥3 classes of antibiotics. Out of the total isolates, 19.35% showed resistance to carbapenems. It would be advisable to systematically screen tap water for opportunistic micro-organisms such as P. aeruginosa, as many countries already do, including this in the Water Safety Plan. Full article
(This article belongs to the Special Issue Healthcare Infections, Healthcare Environment and Antimicrobial Resistance)
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10 pages, 685 KiB  
Article
Microbiological Contamination of the Office Environment in Dental and Medical Practice
by Alexandre Baudet, Monique Guillaso, Léonie Grimmer, MEDIQAI Study Group, Marie Regad and Arnaud Florentin
Antibiotics 2021, 10(11), 1375; https://doi.org/10.3390/antibiotics10111375 - 10 Nov 2021
Cited by 5 | Viewed by 2286
Abstract
The microbiological contamination of the environment in independent healthcare facilities such as dental and general practitioner offices was poorly studied. The aims of this study were to describe qualitatively and quantitatively the bacterial and fungal contamination in these healthcare facilities and to analyze [...] Read more.
The microbiological contamination of the environment in independent healthcare facilities such as dental and general practitioner offices was poorly studied. The aims of this study were to describe qualitatively and quantitatively the bacterial and fungal contamination in these healthcare facilities and to analyze the antibiotic resistance of bacterial pathogens identified. Microbiological samples were taken from the surfaces of waiting, consulting, and sterilization rooms and from the air of waiting room of ten dental and general practitioner offices. Six surface samples were collected in each sampled room using agar contact plates and swabs. Indoor air samples were collected in waiting rooms using a single-stage impactor. Bacteria and fungi were cultured, then counted and identified. Antibiograms were performed to test the antibiotic susceptibility of bacterial pathogens. On the surfaces, median concentrations of bacteria and fungi were 126 (range: 0–1280) and 26 (range: 0–188) CFU/100 cm2, respectively. In indoor air, those concentrations were 403 (range: 118–732) and 327 (range: 32–806) CFU/m3, respectively. The main micro-organisms identified were Gram-positive cocci and filamentous fungi, including six ubiquitous genera: Micrococcus, Staphylococcus, Cladosporium, Penicillium, Aspergillus, and Alternaria. Some antibiotic-resistant bacteria were identified in general practitioner offices (penicillin- and erythromycin-resistant Staphylococcus aureus), but none in dental offices. The dental and general practitioner offices present a poor microbiological contamination with rare pathogenic micro-organisms. Full article
(This article belongs to the Special Issue Healthcare Infections, Healthcare Environment and Antimicrobial Resistance)
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19 pages, 2994 KiB  
Article
Prevalence and Antimicrobial Resistance of Klebsiella Strains Isolated from a County Hospital in Romania
by Alice Elena Ghenea, Ramona Cioboată, Andrei Ioan Drocaş, Eugen Nicolae Țieranu, Corina Maria Vasile, Aritina Moroşanu, Cristian George Țieranu, Alex-Ioan Salan, Mihaela Popescu, Adriana Turculeanu, Vlad Padureanu, Anca-Loredana Udriștoiu, Daniela Calina, Dan Cȃrţu and Ovidiu Mircea Zlatian
Antibiotics 2021, 10(7), 868; https://doi.org/10.3390/antibiotics10070868 - 16 Jul 2021
Cited by 19 | Viewed by 3492
Abstract
The study evaluated the evolution of the incidence of infections with Klebsiella in the County Clinical Emergency Hospital of Craiova (SCJUC), Romania. Also, we monitored antibiotic resistance over more than two years and detected changes in resistance to various antimicrobial agents. Our study [...] Read more.
The study evaluated the evolution of the incidence of infections with Klebsiella in the County Clinical Emergency Hospital of Craiova (SCJUC), Romania. Also, we monitored antibiotic resistance over more than two years and detected changes in resistance to various antimicrobial agents. Our study included 2062 patients (823 women and 1239 men) hospitalised in SCJUC during the period 1st of September 2017 to 30 June 2019. In 458 patients (22.21%) from the 2062 total patients, the collected samples (1116) were positive and from those, we isolated 251 strains of Klebsiella spp. We conducted a longitudinal analysis of the prevalence of Klebsiella spp. over calendar months, which showed a prevalence in surgical wards that ranged between 5.25% and 19.49% in June 2018, while in medical wards the variation was much wider, between 5.15% and 17.36% in April 2018. Klebsiella spp. strains showed significant resistance to Amoxicillin/Clavulanate, Aztreonam and Cephalosporins such as Ceftriaxone, Ceftazidime and Cefepime. We examined the possible link with the consumption of antibiotics in the same month by performing a multiple linear regression analysis. The evolution of antibiotic resistance in Klebsiella was correlated with the variation of resistance in other bacteria, which suggests common resistance mechanisms in the hospital environment. By performing the regression for dependency between antibiotic resistance and antibiotic consumption, we observed some correlations between antibiotic consumption and the development of antibiotic resistance after 1, 2 and even 3 months (e.g., resistance to meropenem was influenced by the consumption in the hospital ward of imipenem 1 month and two months before, but only 1 month before by the consumption of meropenem). The clustering of strains showed filiation between multiresistant Klebsiella spp. strains isolated from specific patients from the ICU. The evolution of prevalence and antibiotic resistance in Klebsiella correlated with the resistance in other bacteria, which suggest common resistance mechanisms in the hospital environment, and also with the consumption of antibiotics. Full article
(This article belongs to the Special Issue Healthcare Infections, Healthcare Environment and Antimicrobial Resistance)
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10 pages, 685 KiB  
Article
Multidrug-Resistant Coagulase-Negative Staphylococci Isolated from Bloodstream in the uMgungundlovu District of KwaZulu-Natal Province in South Africa: Emerging Pathogens
by Jonathan Asante, Bakoena A. Hetsa, Daniel G. Amoako, Akebe Luther King Abia, Linda A. Bester and Sabiha Y. Essack
Antibiotics 2021, 10(2), 198; https://doi.org/10.3390/antibiotics10020198 - 18 Feb 2021
Cited by 22 | Viewed by 2776
Abstract
Coagulase-negative staphylococci (CoNS) are increasingly associated with nosocomial infections, especially among the immunocompromised and those with invasive medical devices, posing a significant concern. We report on clinical multidrug-resistant CoNS from the uMgungundlovu District, KwaZulu-Natal Province, South Africa, as emerging pathogens. One hundred and [...] Read more.
Coagulase-negative staphylococci (CoNS) are increasingly associated with nosocomial infections, especially among the immunocompromised and those with invasive medical devices, posing a significant concern. We report on clinical multidrug-resistant CoNS from the uMgungundlovu District, KwaZulu-Natal Province, South Africa, as emerging pathogens. One hundred and thirty presumptive CoNS were obtained from blood cultures. Culture, biochemical tests, and the Staphaurex™ Latex Agglutination Test were used for the initial identification of CoNS isolates; confirmation and speciation were undertaken by the VITEK 2 system. Susceptibilities of isolates against a panel of 20 antibiotics were determined using the Kirby-Bauer disk diffusion method, and the multiple antibiotic resistance (MAR) indices of the isolates were determined. The polymerase chain reaction (PCR) was used to amplify the mecA gene to confirm methicillin resistance. Overall, 89/130 presumptive CoNS isolates were confirmed as CoNS by the VITEK 2 system. Of these, 68 (76.4%) isolates were putatively methicillin-resistant by the phenotypic cefoxitin screen test and 63 (92.6%) were mecA positive. Staphylococcus epidermidis (19.1%), S. hominis ssp. hominis (15.7%), and S. haemolyticus (16.9%) were the most common CoNS species. Isolates showed high percentage resistance against penicillin (100.0%), erythromycin (74.2%), and azithromycin (74.2%) while displaying high susceptibilities to linezolid (95.5%), gentamicin (95.5%), and tigecycline (94.4%). Multidrug resistance (MDR) was observed in 76.4% of isolates. MAR index calculation revealed 71.9% of isolates with MAR index >0.2 and 20.2% >0.5. Isolates with the highest MAR indices (0.7 and 0.8) were recovered from the neonatal intensive care unit. Fifty-one MDR antibiograms were observed. The high prevalence of methicillin resistance and multidrug resistance in several species of CoNS necessitates surveillance of this emerging pathogen, currently considered a contaminant of microbial cultures. Full article
(This article belongs to the Special Issue Healthcare Infections, Healthcare Environment and Antimicrobial Resistance)
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19 pages, 3138 KiB  
Systematic Review
Global Prevalence of Nosocomial Multidrug-Resistant Klebsiella pneumoniae: A Systematic Review and Meta-Analysis
by Nur Ain Mohd Asri, Suhana Ahmad, Rohimah Mohamud, Nurmardhiah Mohd Hanafi, Nur Fatihah Mohd Zaidi, Ahmad Adebayo Irekeola, Rafidah Hanim Shueb, Leow Chiuan Yee, Norhayati Mohd Noor, Fatin Hamimi Mustafa, Chan Yean Yean and Nik Yusnoraini Yusof
Antibiotics 2021, 10(12), 1508; https://doi.org/10.3390/antibiotics10121508 - 8 Dec 2021
Cited by 46 | Viewed by 5126
Abstract
The emergence of nosocomial multidrug-resistant Klebsiella pneumoniae is an escalating public health threat worldwide. The prevalence of nosocomial infections due to K. pneumoniae was recorded up to 10%. In this systematic review and meta-analysis, which were conducted according to the guidelines of Preferred [...] Read more.
The emergence of nosocomial multidrug-resistant Klebsiella pneumoniae is an escalating public health threat worldwide. The prevalence of nosocomial infections due to K. pneumoniae was recorded up to 10%. In this systematic review and meta-analysis, which were conducted according to the guidelines of Preferred Reporting Items for Systematic Review and Meta-Analysis, 1092 articles were screened from four databases of which 47 studies fulfilled the selected criteria. By performing a random-effect model, the pooled prevalence of nosocomial multidrug-resistant K. pneumoniae was estimated at 32.8% (95% CI, 23.6–43.6), with high heterogeneity (I2 98.29%, p-value < 0.001). The estimated prevalence of this pathogen and a few related studies were discussed, raising awareness of the spread of multidrug-resistant K. pneumoniae in the healthcare setting. The emergence of nosocomial multidrug-resistant K. pneumoniae is expected to increase globally in the future, and the best treatments for treating and preventing this pathogen should be acknowledged by healthcare staff. Full article
(This article belongs to the Special Issue Healthcare Infections, Healthcare Environment and Antimicrobial Resistance)
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