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UEL-led study finds that rise of antibiotic resistance in public places poses a potential risk

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Dr Hermine Mkrtchyan leads says study finding increased levels of antibiotic resistance in public places is worrisome 

Increased levels of antibiotic resistance (AMR) have been found in public settings such as train stations and shopping centres and areas in hospitals where the general public has easy access, posing a potential risk to public health, according to a new report just published in Nature Research.

The study in London, led by Dr Hermine Mkrtchyan, a senior lecturer in biomedical sciences at the University of East London, concluded that the findings were ‘disturbing’ and ‘worrisome’.

Dr Mkrtchyan said, “Our research highlights that general public areas, which are part of our everyday life, can be reservoirs for multidrug resistant bacteria. Increased levels of  such bacteria  in public areas provides further evidence that infection control measures, both in the hospitals and in public places, fail to limit the spread of such resistant bacteria and emphasises the importance of good hygiene in these environments.’’

The study recovered a total of 600 staphylococci isolates from general public settings and hospital public areas in East and West London. These 600 isolates belonged to 11 species. Of the 600 isolates, 281 were multi-drug resistant.

A higher proportion of these bacteria were detected in East London (56.7%) compared to West London (49.6%). Some of the areas sampled in public places included items such as poles on washroom door handles, taps, toilet seats, ATM machines, soap dispensers, escalator rails and pedestrian crossing buttons.

The higher incidence in East London may be due to that area having a higher population density (9.7 thousand per square km) compared to West London (8.9 thousand per square km; 2017 estimate), Dr Mkrtchyan said.

Dr Mkrtchyan said, “The rise of antibiotic resistance is one of the most important public health threats worldwide. Today, increasing attention is being paid to multidrug resistant staphylococci isolated from healthcare and non-healthcare environments, as the treatment of these bacteria has become increasingly difficult, which consequently is increasing healthcare costs.”

Several species of staphylococci are major opportunistic pathogens that cause mild to life threatening infections in humans. Most of the isolates Dr Mkrtchyan’s team found were coagulase-negative staphylococci, which lives on a person’s skin and is generally considered harmless as long as it remains outside the body, are less virulent than Staphylococcus aureus. These bacteria are an important reservoir of antimicrobial resistance genes and mobile genetic elements that can be transferred between staphylococcal species.

Dr Mkrtchyan said her team carried out the study as they wanted to find out the antibiotic resistance pollution in general public settings and decipher genetic characteristics of these and isolates recovered from general public areas in hospitals.

She said, “We know that the AMR in the healthcare settings is a result of human activities such as use/misuse of antibiotics, and high levels are expected. However, finding such high levels of antibiotic resistant bacteria in the general public settings is a worrisome finding.”

Dr Mkrtchyan said, “Resistance genes and elements present in these bacteria can spread to human pathogens and result in the emergence of new clones. Although these bacteria generally are non-pathogenic, the finding of increased levels of antibiotic resistance in general public settings in the community and in hospitals is disturbing.

“We are currently undertaking additional comparative genomics analyses to decipher the genetic features of multidrug resistant staphylococci recovered from general public settings and to further our understanding of the origin and evaluation of these isolates."

The most common antibiotic that the staphylococci isolates were resistant to was penicillin 206 (80.42%); followed by fusidic acid 204 (72.4%), erythromycin 153 (54.45%), amoxicillin 78 (27.76%); tetracycline 74 (26.33%); oxacillin 70 (24.91%); cefoxitin 63 (22.42%); mupirocin 41 (14.59%); gentamycin 27 (9.61%); cefepime 20 (7.12%), and chloramphenicol 14 (4.98%).