Prevalence of Clinically Relevant Bacteria and Antimicrobial Resistance Genes in Hospital Water and Surfaces

Abstract

Antibiotic resistance has been on the rise, becoming a worldwide environmental and public health problem resulting in more than 250,000 deaths per year, taking humanity back to pre- antibiotic era where people died of minor infections. Unregulated usage, unsafe hospital practices and use of antibiotics in agriculture and livestock contributes to development of multidrug resistance in various bacteria, which ultimately increases mortality rate and cost of treatment. Multiple studies showed water to be the vehicle for dissemination of antibiotic resistant bacteria in the environment and a reservoir for antibiotic resistant genes. It was hypothesized that hospital water, being more exposed to antibiotic load contributes to increase and spread of antibiotic resistance in the urban water systems and environment. In the current study, the microflora of the hospital tap water (ICU, wards and washrooms) and hospital surfaces (faucet, basin and drain) was observed. Out of 162 isolates, 82 were obtained from water sources and 80 from hospital surfaces. The results of the study showed that hospital water comprised of a diverse range of bacteria including the ones that have been identified as clinically relevant. It also showed that the urban water cycle is already contaminated with multidrug resistant microflora of the hospital settings including Aeromonas, Klebsiella, Pseudomonas, Staphylococcus and Vibrio species in abundance that are a threat to hospitalized patients and general public. Six beta-lactamase (SHV, TEM, CTX-M, OXA, KPC, NDM) genes were also investigated in the isolates to better understand the dissemination of antibiotic resistance genes in aquatic and hospital environments. Many of the organisms in the study were found to be extended spectrum beta lactam (ESBL) producers, which manifests as a real threat, especially with blaNDM prevalence on the rise, that results in resistance against carbapenems and colistin, antibiotics reserved as a last resort against infections. The study presented with the ground reality of antibiotic resistance and how it’s subsequent spread poses a great threat to the strides made in the field of medicine and ultimately public health. Strict regulations regarding antibiotic usage, hospital effluent discharge and urban water sanitation must be imposed to curb the devastating effects of this increasing phenomenon.