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Intensive care unit environmental surfaces are contaminated by multidrug-resistant bacteria in biofilms: combined results of conventional culture, pyrosequencing, scanning electron microscopy, and confocal laser microscopy

  • H. Hu
    Affiliations
    Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia
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  • K. Johani
    Affiliations
    Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia

    Division of Microbiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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  • I.B. Gosbell
    Affiliations
    Antibiotic Resistance and Mobile Elements Group (ARMEG), Microbiology and Infectious Diseases Unit, School of Medicine, University of Western Sydney, New South Wales, Australia

    Department of Microbiology and Infectious Diseases, Sydney South-West Pathology Service – Liverpool, New South Wales, Australia
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  • A.S.W. Jacombs
    Affiliations
    Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia
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  • A. Almatroudi
    Affiliations
    Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia

    Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Qassim, Saudi Arabia
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  • G.S. Whiteley
    Affiliations
    Whiteley Corporation, Tomago, Newcastle, NSW, Australia
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  • A.K. Deva
    Affiliations
    Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia
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  • S. Jensen
    Affiliations
    Antibiotic Resistance and Mobile Elements Group (ARMEG), Microbiology and Infectious Diseases Unit, School of Medicine, University of Western Sydney, New South Wales, Australia
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  • K. Vickery
    Correspondence
    Corresponding author. Address: Faculty of Medicine and Health Sciences, Macquarie University, North Ryde, NSW 2109, Australia. Tel.: +61 422256323.
    Affiliations
    Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia
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      Summary

      Background

      Hospital-associated infections cause considerable morbidity and mortality, and are expensive to treat. Organisms causing these infections can be sourced from the inanimate environment around a patient. Could the difficulty in eradicating these organisms from the environment be because they reside in dry surface biofilms?

      Aim

      The intensive care unit (ICU) of a tertiary referral hospital was decommissioned and the opportunity to destructively sample clinical surfaces was taken in order to investigate whether multidrug-resistant organisms (MDROs) had survived the decommissioning process and whether they were present in biofilms.

      Methods

      The ICU had two ‘terminal cleans’ with 500ppm free chlorine solution; items from bedding, surrounds, and furnishings were then sampled with cutting implements. Sections were sonicated in tryptone soya broth and inoculated on to chromogenic plates to demonstrate MDROs, which were confirmed with the Vitek2 system. Genomic DNA was extracted directly from ICU samples, and subjected to polymerase chain reaction (PCR) for femA to detect Staphylococcus aureus and the microbiome by bacterial tag-encoded FLX amplicon pyrosequencing. Confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM) were performed on environmental samples.

      Findings

      Multidrug-resistant bacteria were cultured from 52% (23/44) of samples cultured. S. aureus PCR was positive in 50%. Biofilm was demonstrated in 93% (41/44) of samples by CLSM and/or SEM. Pyrosequencing demonstrated that the biofilms were polymicrobial and contained species that had multidrug-resistant strains.

      Conclusion

      Dry surface biofilms containing MDROs are found on ICU surfaces despite terminal cleaning with chlorine solution. How these arise and how they might be removed requires further study.

      Keywords

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