In vitro study on the transmission of multidrug-resistant bacteria from textiles to pig skin

Pavlina Lena; Spyridon Karageorgos; Maria Liatsou; Aris P Agouridis; Nikolaos Spernovasilis; Demetris Lamnisos; Panagiotis Papageorgis; Constantinos Tsioutis

doi:10.5493/wjem.v13.i5.134

In vitro study on the transmission of multidrug-resistant bacteria from textiles to pig skin

World J Exp Med. 2023 Dec 20;13(5):134-141. doi: 10.5493/wjem.v13.i5.134.

Authors

Pavlina Lena^{1

2}, Spyridon Karageorgos³, Maria Liatsou², Aris P Agouridis^{4

5}, Nikolaos Spernovasilis⁶, Demetris Lamnisos², Panagiotis Papageorgis⁷, Constantinos Tsioutis⁴

Affiliations

¹ Mpn Unilab Clinical Laboratory, Nicosia 1066, Cyprus.
² Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia 2404, Cyprus.
³ First Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens 11527, Greece.
⁴ School of Medicine, European University Cyprus, Nicosia 2404, Cyprus.
⁵ Infectious Diseases, German Oncology Center, Limassol 4108, Cyprus.
⁶ Infectious Diseases, German Oncology Center, Limassol 4108, Cyprus. nikolaos.spernovasilis@goc.com.cy.
⁷ Department of Life Sciences, School of Sciences, European University Cyprus, Nicosia 2404, Cyprus.

Abstract

Background: The survival of microorganisms on textiles and specifically on healthcare professionals' (HCP) attire has been demonstrated in several studies. The ability of microorganisms to adhere and remain on textiles for up to hours or days raises questions as to their possible role in transmission from textile to skin via HCP to patients.

Aim: To evaluate the presence, survival and transmission of different multidrug-resistant bacteria (MDRB) from HCP attire onto skin.

Methods: Three MDRB [methicillin-resistant Staphylococcus aureus (MRSA); vancomycin-resistant Enterococcus faecium (VRE); carbapenem-resistant Klebsiella pneumoniae, CRKP)] were inoculated on textiles from scrubs (60% cotton-40% polyester) and white coat (100% cotton) at concentrations of 10⁸ colony-forming units (CFU), 10⁵ CFU, and 10³ CFU per mL. The inoculation of swatches was divided in time intervals of 1 min, 5 min, 15 min, 30 min, 1 h, 2 h, 3 h, 4 h, 5 h, and 6 h. At the end of each period, textiles were imprinted onto pig skins and each skin square was inverted onto three different selective chromogenic media. Growth from the pig skin squares was recorded for the 3 MDRB at the three above concentrations, for the whole length of the 6-h experiment.

Results: MRSA was recovered from pig skins at all concentrations for the whole duration of the 6-h study. VRE was recovered from the concentration of 10⁸ CFU/mL for 6 h and from 10⁵ CFU/mL for up to 3 h, while showing no growth at 10³ CFU/mL. CRKP was recovered from 10⁸ CFU/mL for 6 h, up to 30 min from 10⁵ CFU/mL and for 1 min from the concentration of 10³ CFU/mL.

Conclusion: Evidence from the current study shows that MRSA can persist on textiles and transmit to skin for 6 h even at low concentrations. The fact that all MDRB can be sustained and transferred to skin even at lower concentrations, supports that textiles are implicated as vectors of bacterial spread.

Keywords: Attire; Extended-spectrum b-lactamase; Methicillin-resistant Staphylococcus aureus; Multidrug-resistant bacteria; Pig skin; Skin; Textiles; Transmission; Vancomycin-resistant Enterococcus faecium.