Hospital Premises as a Potential Reservoir of Antimicrobial Resistance
Soil in hospital premises can be a potential reservoir of organisms with Antimicrobial Resistance (AMR) due to their spread from hospital environment including pre-treated hospital waste. Thus, studying AMR in the soil samples from hospital premises at periodic interval could be helpful in monitoring the trend of its load and spectrum in hospital environment. Prevalence of Extended-Spectrum Beta-Lactamase (ESBL), carbapenemase and New Delhi Metallo-Beta-Lactamase (NDM) varieties of AMR were estimated in Escherichia coli and Klebsiella pneumoniae as indicator organisms in surface soil samples from hospital premises viz. hospital grounds and pedestrian tracks in relation to the pre-monsoon and post-monsoon seasons at an interval of four years between 2014 and 2018. There was significant increase in the prevalence of ESBL (mainly CTX-M variety), carbapenemase and NDM varieties of AMR in isolates from soil samples collected from hospital premises during post-monsoon season compared to pre-monsoon isolates regardless of the year of sampling although monsoon season did not affect the prevalence of AMR in clinical samples processed during the same period. There was gradual rise in resistance to other antibiotics viz. co-trimoxazole, tetracycline, fluoroquinolones and amoxyclav in soil samples collected from hospital premises during the four years interval. Prevalence of various categories of AMR were higher in samples collected during the post-monsoon season compared to prevalence in clinical isolates from hospital attending population during the corresponding period regardless of the year of sampling. Increasing prevalence of various categories of AMR recorded in hospital premises could indicate inadequate containment measures towards prevention of their spread from hospital environment warranting adaption of requisite measures for prevention.
How to cite this article:
Chattopadhya D, Devi LS, Rautela RS, Grover SS, Broor S. Hospital Premises as a Potential Reservoir of Antimicrobial Resistance. J Commun Dis 2021; 53(1): 15-22.
Modi G, Mishra SK, Modi BS et al. Production and characterization of multiple drug resistant cultures
isolated from hospital premises. Indian J Life Sci 2013; 3: 7-14.
Lamba M, Graham DW, Ahammad SZ. Hospital waste water releases carbapenem resistance pathogens and
genes in urban India. Environ Sci Technol 2017; 51: 13906-12.
Taneja N, Sharma M. Antimicrobial resistance in the environment: The Indian scenario. Indian J Med Res
; 149: 119-28.
Nicolle LW. Infection control programmes to contain antimicrobial resistance. WHO/CDS/CSR/DRS/2001.7,
World Health Organisation, 2001.
Kumaraswamy KK, Toleman MA, Walsh TR et al. Emergence of a new antibiotic resistance mechanism
in India, Pakistan,and the UK: a molecular, biological and epidemiological study. Lancet Infect Dis 2010;
Kumar SG, Adithan C, Harish BN, et al. Antimicrobial resistance in India: A review. J Nat Sci Biol Med 2013;
Jarvis WR, Munn VP, Highsmith AK et al. The epidemiology of nosocomial infections caused by Klebsiella pneumoniae. Infect Cont 1985; 6: 68-74.
Podschun R, Ullmann U. Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods
and pathogenicity factors. Clin Microbiol Rev 1998; 11: 589-603.
Haberacht HB, Nealon NJ, Gilliand JR et al. Antimicrobialresistant Escherichia coli from environmental waters
in northern Colorado. J Environ Public Health 2019. 10. India Meteorological Department, Ministry of Earth
Sciences, Government of India. Available from: https://mausam.imd.gov.in/imd_latest/contents/monsoon.
Freeman JC, Nimmo J, Gregory E et al. Predictors of hospital surface contamination with ESBL-producing
Escherichia coli and Klebsiella pneumoniae: patient and organism factors. Antimicrob Resist Infect Cont
; 3: 5.
Devi LS, Broor S, Rautela RS et al. Increasing prevalence of Escherichia coli and Klebsiella pneumoniae producing CTX-M type extended-spectrum beta-lactamase (CTXM-ESBL), carbapenemase and NDM-1 in patients from a rural community with community acquired infections: A three years study. Int J Appl Basic Med Res 2020;
Devi LS, Broor S, Chakravarti A et al. Livestock manure as potential reservoir of CTX-M type extendedspectrum β-lactamase producing Escherichia coli and Klebsiella pneumoniae associated with carbapenemase production. J Pure Appl Microbiol 2020; 14: 171-181.
Clinical Laboratory Standard Institute. Performance Standards for Antimicrobial Susceptibility Testing,
th Informational Supplement. M100-S27, 2019. Pennsylvania, Wayne, USA.
Sidjabat HE, Paterson DL, Adams-Haduch JM et al. Molecular Epidemiology of CTX-M-Producing
Escherichia coli Isolates at a Tertiary Medical Centre in Western Pennsylvania. Antimicrob Agents Chemother
; 53: 4733-9.
Prado T, Pereira WC, Silva DM et al. Detection of extended spectrum beta-lactamase producing
Klebsiella pneumoniae in effluents and sludge of a hospital sewage treatment plant. Lett Appl Microbiol
; 46: 136-41.
Bengtsson-Palme J, Larsson DJ. Concentrations of antibiotics predicted to select for resistant bacteria:
proposed limits for environmental regulation. Environ Int 2016; 86: 140-149.
Kazemian H, Heideri H, Ghanavati R et al. Phenotypic and genotypic characterisation of ESBL, Amp-C and
carbapenamase producing Klebsiella pneumoniae and Escherichia coli isolates. Med Princ Pract 2019; 28:
Zhang C, Qiu S, Wang Y et al. Higher isolation of NDM-1 producing Acinetobacter baumannii from the sewage
of the hospitals in Beijing. PLoS ONE 2013; 8: e64857.
Tanner WD, Atkinson RM, Goel RK et al. Horizontal transfer of the blaNDM-1 gene to Pseudomonas
aeruginosa and Acinetobacter baumannii in biofilms. FEMS Microb Lett 2017; 364: fnx048.
Sharma MK, Bhatnagar T, Goel NK et al. Operationalization of surveillance of communicable
diseases in Chandigarh. J Commun Dis 2005; 37: 197-202.
Kumari R, Nath B, Midha T et al. Morbidity profile and seasonal variation of diseases in a primary health
center in Kanpur district: a tool for the health planners. J Family Med Prim Care 2012; 1: 86-91.
Ahmad A, Patel I, Mohanta G et al. Evaluation of Selfmedication practices in rural area of town Sahaswan
at Northern India. Ann Med Health Sci Res 2014; 4 (Suppl 2): S73-8.
Nafade V, Huddart S, Sulis G et al. Over-the-counter antibiotic dispensing by pharmacies: a standardized
patient study in Udupi district, India. BMJ Glob Health 2019; 4: e001869.
Alvarez-Uria G, Zacharia S, Thomas D. High prescription of antimicrobials in a rural district hospital in India.
Pharm Pract 2014; 12: 384.
Lutgring JD, Limbago BM. The problem of carbapenamase-producing carbapenem-resistant
Enterobacteriaceae detection. J Clin Microbiol 2016; 54: 529-34.
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