Increasing tolerance of hospital Enterococcus faecium to handwash alcohols

Sacha J Pidot; Wei Gao; Andrew H Buultjens; Ian R Monk; Romain Guerillot; Glen P Carter; Jean Y H Lee; Margaret M C Lam; M Lindsay Grayson; Susan A Ballard; Andrew A Mahony; Elizabeth A Grabsch; Despina Kotsanas; Tony M Korman; Geoffrey W Coombs; J Owen Robinson; Anders Gonçalves da Silva; Torsten Seemann; Benjamin P Howden; Paul D R Johnson; Timothy P Stinear

doi:10.1126/scitranslmed.aar6115

Increasing tolerance of hospital Enterococcus faecium to handwash alcohols

Sci Transl Med. 2018 Aug 1;10(452):eaar6115. doi: 10.1126/scitranslmed.aar6115.

Authors

Sacha J Pidot¹, Wei Gao¹, Andrew H Buultjens¹, Ian R Monk¹, Romain Guerillot¹, Glen P Carter¹, Jean Y H Lee¹, Margaret M C Lam¹, M Lindsay Grayson^{2

3

4}, Susan A Ballard⁵, Andrew A Mahony², Elizabeth A Grabsch², Despina Kotsanas⁶, Tony M Korman⁶, Geoffrey W Coombs^{7

8}, J Owen Robinson^{7

8}, Anders Gonçalves da Silva⁵, Torsten Seemann⁹, Benjamin P Howden^{1

2

3

5}, Paul D R Johnson^{10

2

3}, Timothy P Stinear¹⁰

Affiliations

¹ Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Victoria 3010, Australia.
² Infectious Diseases Department, Austin Health, Heidelberg, Victoria 3084, Australia.
³ Department of Medicine, University of Melbourne, Heidelberg, Victoria 3084, Australia.
⁴ Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3800, Australia.
⁵ Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Victoria 3010, Australia.
⁶ Monash Infectious Diseases, Monash Health, Clayton, Victoria 3168, Australia.
⁷ Antimicrobial Resistance and Infectious Diseases Research Laboratory, School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia 6150, Australia.
⁸ Department of Microbiology, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Murdoch, Western Australia 6150, Australia.
⁹ Melbourne Bioinformatics, University of Melbourne, Carlton, Victoria 3053, Australia.
¹⁰ Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Victoria 3010, Australia. tstinear@unimelb.edu.au paul.johnson@austin.org.au.

PMID: 30068573
DOI: 10.1126/scitranslmed.aar6115

Abstract

Alcohol-based disinfectants and particularly hand rubs are a key way to control hospital infections worldwide. Such disinfectants restrict transmission of pathogens, such as multidrug-resistant Staphylococcus aureus and Enterococcus faecium Despite this success, health care infections caused by E. faecium are increasing. We tested alcohol tolerance of 139 hospital isolates of E. faecium obtained between 1997 and 2015 and found that E. faecium isolates after 2010 were 10-fold more tolerant to killing by alcohol than were older isolates. Using a mouse gut colonization model of E. faecium transmission, we showed that alcohol-tolerant E. faecium resisted standard 70% isopropanol surface disinfection, resulting in greater mouse gut colonization compared to alcohol-sensitive E. faecium We next looked for bacterial genomic signatures of adaptation. Alcohol-tolerant E. faecium accumulated mutations in genes involved in carbohydrate uptake and metabolism. Mutagenesis confirmed the roles of these genes in the tolerance of E. faecium to isopropanol. These findings suggest that bacterial adaptation is complicating infection control recommendations, necessitating additional procedures to prevent E. faecium from spreading in hospital settings.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

2-Propanol / toxicity
Adaptation, Physiological / drug effects*
Alcohols / toxicity*
Animals
Cross Infection / microbiology
Enterococcus faecium / drug effects*
Enterococcus faecium / genetics
Enterococcus faecium / isolation & purification
Female
Hand Disinfection*
Humans
Mice, Inbred BALB C
Reproducibility of Results
Time Factors

Substances

Alcohols
2-Propanol