Hospital surfaces serve as reservoirs for bacterial pathogens, contributing to nosocomial infections and mortality, especially in low- and middle-income countries (LMICs). The BARNARDS study aimed to assess the colonization of hospital surfaces and patient care equipment by Gram-negative bacteria (GNB) carrying antibiotic resistance genes (ARGs) in neonatal wards across LMICs. Here, we report on the prevalence, distribution, and transmission dynamics of extended-spectrum ฮฒ-lactamases (ESBLs) and carbapenemases among GNB, and their potential association with neonatal sepsis.
Key Scientific Findings:
- PCR screening revealed a high prevalence of blaCTX-M-15, blaNDM, and blaOXA-48-like genes among GNB colonizing hospital surfaces and patient care equipment in 10 hospitals across six LMICs.
- MALDI-TOF MS identification and whole genome sequencing confirmed the presence of dominant clones of ๐๐ญ๐ฆ๐ฃ๐ด๐ช๐ฆ๐ญ๐ญ๐ข ๐ฑ๐ฏ๐ฆ๐ถ๐ฎ๐ฐ๐ฏ๐ช๐ข๐ฆ, ๐๐ฏ๐ต๐ฆ๐ณ๐ฐ๐ฃ๐ข๐ค๐ต๐ฆ๐ณ ๐ฉ๐ฐ๐ณ๐ฎ๐ข๐ฆ๐ค๐ฉ๐ฆ๐ช, ๐๐ค๐ช๐ฏ๐ฆ๐ต๐ฐ๐ฃ๐ข๐ค๐ต๐ฆ๐ณ ๐ฃ๐ข๐ถ๐ฎ๐ข๐ฏ๐ฏ๐ช๐ช, ๐๐ฆ๐ณ๐ณ๐ข๐ต๐ช๐ข ๐ฎ๐ข๐ณ๐ค๐ฆ๐ด๐ค๐ฆ๐ฏ๐ด, ๐ข๐ฏ๐ฅ ๐๐ฆ๐ค๐ญ๐ฆ๐ณ๐ค๐ช๐ข ๐ข๐ฅ๐ฆ๐ค๐ข๐ณ๐ฃ๐ฐ๐น๐บ๐ญ๐ข๐ต๐ขcarrying ARGs.
- ๐๐15 ๐. ๐ฑ๐ฏ๐ฆ๐ถ๐ฎ๐ฐ๐ฏ๐ช๐ข๐ฆ was identified as a persistent clone colonizing surfaces over multiple occasions, with identical strains causing neonatal sepsis in Pakistan.
- Horizontal transmission of ARGs, particularly blaNDM, was evidenced by the genetic similarity between plasmids detected within ๐๐ฏ๐ต๐ฆ๐ณ๐ฐ๐ฃ๐ข๐ค๐ต๐ฆ๐ณ๐ข๐ญ๐ฆ๐ด from multiple hospital surfaces.
- ESBL- and carbapenemase-producing ๐๐ฏ๐ต๐ฆ๐ณ๐ฐ๐ฃ๐ข๐ค๐ต๐ฆ๐ณ๐ข๐ญ๐ฆ๐ด were frequently detected near sink drains, suggesting a hotspot for colonization.
- Diversity within species and co-occurrence of dominant sequence types (STs) of ๐. ๐ฉ๐ฐ๐ณ๐ฎ๐ข๐ฆ๐ค๐ฉ๐ฆ๐ช ๐ข๐ฏ๐ฅ ๐. ๐ฑ๐ฏ๐ฆ๐ถ๐ฎ๐ฐ๐ฏ๐ช๐ข๐ฆ were observed, indicating complex transmission dynamics.
- Variability in GNB colonization was observed across countries and hospitals, emphasizing the need for individualized monitoring and intervention strategies.
- High prevalence of antibiotic resistance determinants and diversity of ARG-containing bacteria on hospital surfaces pose a significant threat to patient safety, warranting urgent assessment and improvement of infection prevention and control (IPC) practices.
Methodology:
- Environmental surfaces and patient care equipment from neonatal wards were sampled across 10 hospitals in LMICs.
- PCR screening for ESBLs and carbapenemases, MALDI-TOF MS identification, and whole genome sequencing were performed to characterize GNB carrying ARGs.
- Data analysis included assessment of prevalence, distribution, persistence of dominant clones, and transmission dynamics of antibiotic-resistant GNB.
- In conclusion, our study highlights the widespread colonization of hospital surfaces by antibiotic-resistant GNB carrying ESBLs and carbapenemases in LMICs. The identification of persistent clones and evidence of transmission networks between hospital wards and neonates with sepsis underscores the urgency for improved IPC practices and tailored guidelines to mitigate the threat of antimicrobial resistance in healthcare settings. Further research is needed to understand the impact of bacterial transmission events on neonatal sepsis and to develop targeted interventions to prevent nosocomial infections in LMICs.
