Ambulance vehicles as a source of multidrug-resistant infections: a multicenter study in Assiut City, Egypt

Abstract

BackgroundAmbulances may represent a potential source of infection to patients, patients’ relatives, and paramedical staffs. In this study, we analyzed the extent of bacterial contamination in ambulance vehicles and measured the degree of antimicrobial resistance among isolated pathogens.Materials and methodsTwenty-five vehicles were included and 16 sampling points were swabbed in each vehicle. Then the swabs were immediately transferred to the laboratory to identify bacterial contaminants utilizing standard microbiological procedures and API® systems. Antibiotic susceptibility testing and screening for methicillin-resistant staphylococci and extended spectrum β-lactamases (ESBLs)-producing Gram-negative rods were carried out.ResultsA total of 400 samples were collected, 589 bacteria were isolated and 286 (48.6%) of the isolates were potentially pathogenic. The highest contamination rate with pathogenic bacteria was detected in suction devices (75.8%) and stethoscopes (67.7%). Staphylococci were the most frequently detected microorganisms (n=184) followed by Klebsiella spp. (49), Escherichia coli (40), Citrobacter spp. (7), and Proteus spp. (6). Staphylococci were mostly sensitive to vancomycin, whereas Gram-negative bacteria were sensitive to imipenem. Overall, 46.1% of Staphylococcus aureus were methicillin resistant, whereas 20.4% of the coagulase-negative staphylococci were methicillin resistant. Moreover, 36.7% of Klebsiella spp. and 27.5% of E. coli were ESBL producers.ConclusionOur study provides evidence that ambulances represent a source of prehospital multidrug-resistant infections.

<p>Predictors of Severity and Co-Infection Resistance Profile in COVID-19 Patients: First Report from Upper Egypt</p>

“… 60 , 61 Interestingly, about half of Staphylococci aureus isolated from ambulance vehicles were MRSA. 52 A recent study from our university hospital also reported that all staphylococci isolated from patients with nosocomial pneumonia were methicillin resistant. 62 Regarding Gram-negative clinical isolates, mostly they were ESBL and/or carbapenemase producers.…”

“…45 Of particular importance, is the application of strict infection control measures since most of the detected pathogens are important causes of nosocomial infections within the hospital environment. [50][51][52][53] We noticed the predominance of Gram-negative coinfections in COVID-19 patients, which may be attributed to the administration of azithromycin in the regimen of COVID-19 therapy that acts primarily against Grampositive bacteria. 54 Besides, in line with our results, a study performed at Assiut University Hospitals identified Gram-negative bacteria (Klebsiella pneumoniae and H. influenzae) as the main bacteria isolated from hospitalized patients with chronic obstructive pulmonary disease.…”

Emerging MDR-Pseudomonas aeruginosa in fish commonly harbor oprL and toxA virulence genes and blaTEM, blaCTX-M, and tetA antibiotic-resistance genes

“…The indiscriminate use of antibiotics, as well as the emerging antibiotic resistance genes, could result in the occurrence of multi-drug resistant (MDR) strains [47][48][49][50] . Therefore, the routine application of antibiotic sensitivity testing is significant to select the specifically effective antibiotic and overcome such a problem [51][52][53] .…”

<p>Prevalence and Some Possible Mechanisms of Colistin Resistance Among Multidrug-Resistant and Extensively Drug-Resistant <em>Pseudomonas aeruginosa</em></p>

“…Many studies reported the increase of mortality and morbidity of infections associated with P. aeruginosa, especially those showing multi-drug resistance patterns. [1][2][3] The emergence of multidrug-resistant (MDR) or extensively drug-resistant (XDR) or pandrug-resistant (PDR) P. aeruginosa becomes a significant public health problem that can lead to delayed antimicrobial therapy or its failure and the increase in the mortality rate especially with the appearance of carbapenem-resistant P. aeruginosa. So, attention is required because these resistant strains may show resistance to all available antimicrobials or showed susceptibility only to toxic ones such as colistin or polymyxins leaving no choices for the health-care team in the treatment of severe infections associated with MDR P. Aeruginosa.…”