Basic Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Exp Med. Dec 20, 2023; 13(5): 134-141
Published online Dec 20, 2023. doi: 10.5493/wjem.v13.i5.134
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
Pavlina Lena, Mpn Unilab Clinical Laboratory, Nicosia 1066, Cyprus
Pavlina Lena, Maria Liatsou, Demetris Lamnisos, Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia 2404, Cyprus
Spyridon Karageorgos, First Department of Pediatrics, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, Athens 11527, Greece
Aris P Agouridis, Constantinos Tsioutis, School of Medicine, European University Cyprus, Nicosia 2404, Cyprus
Aris P Agouridis, Nikolaos Spernovasilis, Infectious Diseases, German Oncology Center, Limassol 4108, Cyprus
Panagiotis Papageorgis, Department of Life Sciences, School of Sciences, European University Cyprus, Nicosia 2404, Cyprus
Author contributions: Lena P contributed to the conceptualization of this study; Lena P, Liatsou M, Lamnisos D, Papageorgis P, and Tsioutis C involved in the methodology of the manuscript; Lena P, Karageorgos S, Agouridis AP, Spernovasilis N, Lamnisos D, Papageorgis P, and Tsioutis C participated in the formal analysis and investigation of this manuscript; Lena P, Karageorgos S, and Tsioutis C drafted the manuscript; Lena P, Karageorgos S, Agouridis AP, Spernovasilis N, and Tsioutis C contributed to the review and editing of this manuscript; Lena P, Papageorgis P, and Tsioutis C involved in the supervision of this study; and all authors approved final article version published.
Institutional review board statement: Approval was not required it did not involve human subjects or animals.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data to those presented in the study are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nikolaos Spernovasilis, BSc, MD, MSc, PhD, Director, Infectious Diseases, German Oncology Center, Nikis 1, Limassol 4108, Cyprus. nikolaos.spernovasilis@goc.com.cy
Received: July 15, 2023
Peer-review started: July 15, 2023
First decision: September 19, 2023
Revised: September 22, 2023
Accepted: October 23, 2023
Article in press: October 23, 2023
Published online: December 20, 2023
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: Textiles, Attire, Multidrug-resistant bacteria, Methicillin-resistant Staphylococcus aureus, Vancomycin-resistant Enterococcus faecium, Extended-spectrum b-lactamase, Pig skin, Skin, Transmission

Core Tip: The current study aimed to evaluate the transmission of multidrug-resistant bacteria (MDRB) from attire (scrubs, white coats) onto skin. Three MDRB types [methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium, carbapenem-resistant Klebsiella pneumoniae] were inoculated on textiles over various time intervals for up to 6 h and then imprinted onto pig skin. All MDRB were able to be sustained and transferred to skin, but at different concentrations and time. MRSA had the longest presence on textile and highest transmission potential even at lower concentrations. Evidence suggests that textiles can be implicated as vectors of MDRB spread in the healthcare setting.