Carbapenem-resistant bacteria on hand-held and hands-free electronic devices of healthcare workers and non-healthcare workers in Delhi, India.

BACKGROUND: Monitoring sensitivity profiles of circulating hospital strains is a key activity of a hospital infection control policy. The hospital environment and equipment may be reservoirs for carbapenem-resistant bacteria. Mobile phones have been shown to be a potential source for the transmission of bacteria in the healthcare environment. METHODS: Bacteria were cultured from seven common electronic devices. These included touchpads, chargers, hands-free headphones/microphones, laptops, digital wristwatches and computer mice which were used by healthcare workers and non-healthcare workers including family members and patient attendants. The Gram-negative bacteria were further analysed for phenotypic and genotypic (bla KPC, bla NDM-1 genes) carbapenem resistance. RESULTS: 110 Gram-negative bacteria were isolated Mobile phones were found to be the most heavily contaminated devices and hands-free devices the least. 53.6% (n=59/110) Gram-negative bacteria were phenotypically carbapenem-resistant of which 36.37% (n=40) were metallo-ß-lactamase positive. 40% (n=44/110) were genotypically resistant and 30% (n=33) were bla NDM-1 gene positive. 9% (n=10) bacteria had both bla NDM-1and bla KPC genes. CONCLUSIONS: Carbapenem-resistant bacteria are widespread in India's hospital environment and present a challenge in healthcare. Electronic devices are a potential vehicle for the transmission of carbapenem-resistant bacteria. The results of the study support that hands-free electronic devices are less likely to be contaminated with carbapenem-resistant bacteria and that promoting the use of hands-free devices may help to reduce the spread of multidrug resistant bacteria in healthcare.

Detection of New Delhi metallo-beta-lactamase enzyme gene bla NDM-1 associated with the Int-1 gene in Gram-negative bacteria collected from the effluent treatment plant of a tuberculosis care hospital in Delhi, India.

BACKGROUND: Organisms possessing the bla NDM-1 gene (responsible for carbapenem resistance) with a class-1 integron can acquire many other antibiotic resistance genes from the community sewage pool and become multidrug-resistant superbugs. In this regard, hospital sewage, which contains a large quantity of residual antibiotics, metals and disinfectants, is being recognized as a significant cause of antimicrobial resistance (AMR) origination and spread across the major centres of the world and is thus routinely investigated as a marker for tracing the origin of drug resistance. Therefore, in this study, an attempt has been made to identify and characterize the carbapenem-resistant microbes associated with integron genes amongst the organisms isolated from the effluent treatment plant (ETP) installed in a tertiary respiratory care hospital in Delhi, India. METHODS: One hundred and thirty-eight organisms belonging to Escherichia , Klebsiella , Pseudomonas and Acinetobacter spp. were collected from the incoming and outgoing sewage lines of the ETP. Carbapenem sensitivity and characterization was performed by the imipenem and imipenem-EDTA disc diffusion method. Later DNA extraction and PCR steps were performed for the Int-1 and bla NDM-1 genes. RESULTS: Of the 138 organisms, 86 (62.3 %) were imipenem-resistant (P<0.05). One hundred and twenty-four (89.9 %) organisms had one or both of the genes. Overall, the bla NDM-1 gene (genotypic resistance) was present in 71 % (98/138) of organisms. 53.6 % (74/138) organisms were double gene-positive (bla NDM-1 + Int-1), of which 40 were producing the metallo-beta-lactamase enzyme, making up almost 28.9 % (40/138) of the collected organisms. CONCLUSION: The current study strengthens the hypothesis that Carbapenem resistant organisms are in a high-circulation burden through the human gut and hospital ETPs are providing an environment for resistance origination and amplification.