Colonisation of extended spectrum β-lactamase- and carbapenemase-producing bacteria on hospital surfaces from low-/middle-income countries

Abstract Inanimate surfaces in hospital settings can harbour bacterial pathogens, which can disseminate and cause nosocomial infections, resulting in unacceptable mortality in low- and middle-income countries (LMICs). As part of the BARNARDS study, this hospital swabs study determined which hospital surfaces were colonised by Gram-negative bacteria (GNB) carrying antibiotic resistance genes (ARGs). PCR screening for the presence of extended-spectrum β-lactamases ( bla CTX-M-15 ) and carbapenemases ( bla NDM , bla OXA-48 -like and bla KPC ) showed higher prevalence of bla NDM , and bla OXA-48 -like in Pakistan, Bangladesh, and Ethiopia, compared to other LMICs. Identification of GNB carrying ARGs by MALDI-TOF MS confirmed dominance of Klebsiella pneumoniae , Enterobacter hormaechei , Acinetobacter baumannii , Serratia marcescens and Leclercia adecarboxylata , mostly found in sinks and water system. The isolates were further analysed by whole genome sequencing, and the presence of consistently dominant clones and their relatedness to strains causing neonatal sepsis was determined. The same strain was identified from the same ward on multiple occasions suggesting clonal persistence, and ST15 K. pneumoniae was shown to be responsible for transmission events in Pakistan and identical to isolates causing neonatal sepsis over similar time periods. Our data suggests persistence of dominant clones across multiple time points, highlighting the need for assessment of Infection Prevention and Control guidelines.