One Health in hospitals: how understanding the dynamics of people, animals, and the hospital built-environment can be used to better inform interventions for antimicrobial-resistant gram-positive infections

Dalton, Kathryn R.; Rock, Clare; Carroll, Karen C.; Davis, Meghan F.

doi:10.1186/s13756-020-00737-2

Cited by 49 publications

(41 citation statements)

References 167 publications

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“…High-contact subjects had more significantly decreased alpha diversity levels following intervention visits than in control visits, indicating that our canine-centered decolonization had indirect effects on the microbial diversity levels of human subject samples. These data are consistent with previous data on the effects of the hospital built-environment microbiome on patient microbial composition, and particularly those data regarding the influence of environmental cleaning regimens on patient microbiota [ 41 , 42 , 43 ].…”

Section: Discussionsupporting

confidence: 92%

Microbial Sharing between Pediatric Patients and Therapy Dogs during Hospital Animal-Assisted Intervention Programs

et al. 2021

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Microbial sharing between humans and animals has been demonstrated in a variety of settings. However, the extent of microbial sharing that occurs within the healthcare setting during animal-assisted intervention programs is unknown. Understanding microbial transmission between patients and therapy dogs can provide important insights into potential health benefits for patients, in addition to addressing concerns regarding potential pathogen transmission that limits program utilization. This study evaluated for potential microbial sharing between pediatric patients and therapy dogs and tested whether patient–dog contact level and a dog decolonization protocol modified this sharing. Patients, therapy dogs, and the hospital environment were sampled before and after every group therapy session and samples underwent 16S rRNA sequencing to characterize microbial communities. Both patients and dogs experienced changes in the relative abundance and overall diversity of their nasal microbiome, suggesting that the exchange of microorganisms had occurred. Increased contact was associated with greater sharing between patients and therapy dogs, as well as between patients. A topical chlorhexidine-based dog decolonization was associated with decreased microbial sharing between therapy dogs and patients but did not significantly affect sharing between patients. These data suggest that the therapy dog is both a potential source of and a vehicle for the transfer of microorganisms to patients but not necessarily the only source. The relative contribution of other potential sources (e.g., other patients, the hospital environment) should be further explored to determine their relative importance.

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Section: Discussionsupporting

confidence: 92%

Microbial Sharing between Pediatric Patients and Therapy Dogs during Hospital Animal-Assisted Intervention Programs

et al. 2021

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“…Infection prevention and control strategies may be classified in environments focused (such as cleaning and disinfection procedures, use of antimicrobial materials for inanimate surfaces, use air filters and negative pressure rooms), and human-focused (antimicrobial stewardship, hand hygiene, patient decolonization, and educational actions) [ 39 , 40 ]. Hand hygiene, chlorhexidine bathing, environmental cleaning protocols, and antimicrobial stewardship have been identified as the main components for prevention and control of VRE in hospital settings [ 34 ], whereas prevention of human colonization, patient decolonization and the use of a “One Health” approach has been proposed as the most promising novel strategies for an integrated hospital and community control effort of these opportunists [ 39 , 40 ].…”

Section: The Public Health Impact Of Vrementioning

confidence: 99%

Enterococci, from Harmless Bacteria to a Pathogen

et al. 2020

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Enterococci are gastrointestinal commensals whose hardiness allowed them to colonize very diverse environments, including soils, water, food, and feed. This ability to overcome adverse conditions makes enterococci problematic once they colonize hospital niches. Together with the malleability of their genomes, the capacity to acquire and disseminate determinants of antibiotic resistance has contributed to converting what was once just another opportunistic pathogen into a first-class clinical problem. This review discusses the dimension of the emergence of enterococcal resistance to key antimicrobial agents, the dissemination of this resistance, and its significance in terms of public health, with the aim of raising awareness of the need to devise and implement surveillance programs and more effective antibiotic stewardship.

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“…Following successful colonization and systemic spreading, K. pneumoniae can induce a wide range of pathologies such as pneumonia, liver abscesses and urinary infections [ 2 ]. This pathogen has shown a remarkable ability to develop resistance to several antibiotics and is currently responsible for several nosocomial infection cases, related mortality and morbidity and associated economic burden [ 2 , 3 , 4 ]. K. pneumoniae resistance to last resort antibiotic class carbapenems has been widely reported.…”

Section: Introductionmentioning

confidence: 99%

Klebsiella pneumoniae Lipopolysaccharides Serotype O2afg Induce Poor Inflammatory Immune Responses Ex Vivo

et al. 2021

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Currently, Klebsiella pneumoniae is a pathogen of clinical relevance due to its plastic ability of acquiring resistance genes to multiple antibiotics. During K. pneumoniae infections, lipopolysaccharides (LPS) play an ambiguous role as they both activate immune responses but can also play a role in immune evasion. The LPS O2a and LPS O2afg serotypes are prevalent in most multidrug resistant K. pneumoniae strains. Thus, we sought to understand if those two particular LPS serotypes were involved in a mechanism of immune evasion. We have extracted LPS (serotypes O1, O2a and O2afg) from K. pneumoniae strains and, using human monocytes ex vivo, we assessed the ability of those LPS antigens to induce the production of pro-inflammatory cytokines and chemokines. We observed that, when human monocytes are incubated with LPS serotypes O1, O2a or O2afg strains, O2afg and, to a lesser extent, O2a but not O1 failed to elicit the production of pro-inflammatory cytokines and chemokines, which suggests a role in immune evasion. Our preliminary data also shows that nuclear translocation of NF-κB, a process which regulates an immune response against infections, occurs in monocytes incubated with LPS O1 and, to a smaller extent, with LPS O2a, but not with the LPS serotype O2afg. Our results indicate that multidrug resistant K. pneumoniae expressing LPS O2afg serotypes avoid an initial inflammatory immune response and, consequently, are able to systematically spread inside the host unharmed, which results in the several pathologies associated with this bacterium.

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One Health in hospitals: how understanding the dynamics of people, animals, and the hospital built-environment can be used to better inform interventions for antimicrobial-resistant gram-positive infections

Cited by 49 publications

References 167 publications

Microbial Sharing between Pediatric Patients and Therapy Dogs during Hospital Animal-Assisted Intervention Programs

Microbial Sharing between Pediatric Patients and Therapy Dogs during Hospital Animal-Assisted Intervention Programs

Enterococci, from Harmless Bacteria to a Pathogen

Klebsiella pneumoniae Lipopolysaccharides Serotype O2afg Induce Poor Inflammatory Immune Responses Ex Vivo

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