<p>Impact of a probiotic-based hospital sanitation on antimicrobial resistance and HAI-associated antimicrobial consumption and costs: a multicenter study</p>

Abstract

Purpose Antimicrobial resistance (AMR) is one of the major threats to human health, and the high frequency of resistant pathogens in the hospital environment can contribute to the transmission of difficult-to-treat health care-associated infections (HAIs). We recently reported that, compared with conventional chemical cleaning, the use of a microbial-based sanitation strategy (Probiotic Cleaning Hygiene System [PCHS]) was associated with remodulation of hospital microbiota and reduction of HAI incidence. Here, we aimed to analyze the impact of PCHS on AMR and related effects, such as HAI-associated antimicrobial drug consumption and costs. Patients and methods Five Italian hospitals, enrolled in a multicenter study where conventional sanitation methods were replaced with PCHS, were included in the analysis. The study period included a 6-month observation for each sanitation type. Surface microbiota AMR was analyzed using microarray, nested PCR, antibiogram, and microdilution tests. Drug consumption data and related costs were obtained from the medical records of all hospitalized patients affected by HAIs. Results PCHS use was associated with up to 99% decrease of the AMR genes harbored by surface hospital microbiota, independently of the resistance types originally present in each individual setting ( P c <0.01). Functional assays confirmed the molecular data, demonstrating a 33%–100% decrease of resistant strains depending on the antibiotic type. Antimicrobial drug consumption associated with HAI onset showed a global 60.3% decrease, with a 75.4% decrease of the associated costs. Conclusion The spread of AMR in the hospital environment can be limited by the use of sanitation methods to remodulate the hospital microbiota, leading to lower antimicrobial consumption and costs. This approach might be considered as part of broader infection prevention and control strategies.

Effective elimination of Staphylococcal contamination from hospital surfaces by a bacteriophage–probiotic sanitation strategy: a monocentric study

“…Notably, such a decontamination strategy appears to be economically sustainable, as PCHS costs are comparable with those associated with conventional chemical‐based sanitation, and the additional costs associated with phage production and application impact minimally on PCHS costs. Rather, as PCHS alone was proven to be associated with significant cost savings related to the reduction in HAIs and of consequent antimicrobial therapy (Caselli et al ., , ), the use of a more effective sanitation strategy (probiotic plus phages) might further reduce the infection rate, allowing additional significant cost savings in terms of HAI management.…”

“…Furthermore, chemical sanitizers kill microbes indiscriminately; thus, both the pathogenic and the potentially beneficial normal microbiota are targeted equally. In the search for ideal decontamination systems, we investigated the potential of a probiotic‐based system (PCHS, Probiotic Cleaning Hygiene System), showing that, contrarily to chemical‐based ones, it can decrease in a stable way the pathogen contamination on hospital surfaces (Vandini et al ., ), also leading to reduction in AMR species (Caselli et al ., ) and finally inducing a significant decrease in the risk of acquiring a hospital infection and in the consequent antimicrobial consumption and costs (Caselli et al ., ; Caselli et al ., ). However, because such a system is essentially based on the replacement of pathogens by probiotics through a competitive exclusion mechanism, its action is slow and gradual, and cannot be considered as a rapid mean for the eradication of specifically targeted pathogens, but rather as a preventive and stabilizer system.…”

Cartography of opportunistic pathogens and antibiotic resistance genes in a tertiary hospital environment

“…waiting areas in clinics) might help explore these questions further. Studies across wards or hospitals with different cleaning protocols could also be illuminating for understanding how antibiotic resistance reservoirs in hospitals can be shaped by infection control practices 65,66 .…”

Introduction of NGS in Environmental Surveillance for Healthcare-Associated Infection Control

“…Molecular methods based on DNA technologies might overcome such limitations, providing accurate information in real time and helping to characterize in detail the whole microbial population colonizing hospital surfaces. To address this aim, specific PCRs and real-time PCRs have been set up and developed [19,22,24,25]. However, the advent of modern technologies based on DNA sequencing has considerably improved microbiome investigation allowing definition of complex populations in deep detail [26], and could also be employed for environmental surveillance [22].…”