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

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. JohnsonTimothy P. Stinear

Epidemiology and Preventive Medicine Alfred Hospital

Research output: Contribution to journal › Article › Research › peer-review

159 Citations (Scopus)

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.

Original language	English
Article number	eaar6115
Number of pages	11
Journal	Science Translational Medicine
Volume	10
Issue number	452
DOIs	https://doi.org/10.1126/scitranslmed.aar6115
Publication status	Published - 1 Aug 2018

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Pidot, S. J., Gao, W., Buultjens, A. H., Monk, I. R., Guerillot, R., Carter, G. P., Lee, J. Y. H., Lam, M. M. C., Grayson, M. L., Ballard, S. A., Mahony, A. A., Grabsch, E. A., Kotsanas, D., Korman, T. M., Coombs, G. W., Robinson, J. O., Da Silva, A. G., Seemann, T., Howden, B. P., ... Stinear, T. P. (2018). Increasing tolerance of hospital Enterococcus faecium to handwash alcohols. Science Translational Medicine, 10(452), Article eaar6115. https://doi.org/10.1126/scitranslmed.aar6115

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title = "Increasing tolerance of hospital Enterococcus faecium to handwash alcohols",

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.",

author = "Pidot, {Sacha J.} and Wei Gao and Buultjens, {Andrew H.} and Monk, {Ian R.} and Romain Guerillot and Carter, {Glen P.} and Lee, {Jean Y.H.} and Lam, {Margaret M.C.} and Grayson, {M. Lindsay} and Ballard, {Susan A.} and Mahony, {Andrew A.} and Grabsch, {Elizabeth A.} and Despina Kotsanas and Korman, {Tony M.} and Coombs, {Geoffrey W.} and Robinson, {J. Owen} and {Da Silva}, {Anders Gon{\c c}alves} and Torsten Seemann and Howden, {Benjamin P.} and Johnson, {Paul D.R.} and Stinear, {Timothy P.}",

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Pidot, SJ, Gao, W, Buultjens, AH, Monk, IR, Guerillot, R, Carter, GP, Lee, JYH, Lam, MMC, Grayson, ML, Ballard, SA, Mahony, AA, Grabsch, EA, Kotsanas, D, Korman, TM, Coombs, GW, Robinson, JO, Da Silva, AG, Seemann, T, Howden, BP, Johnson, PDR & Stinear, TP 2018, 'Increasing tolerance of hospital Enterococcus faecium to handwash alcohols', Science Translational Medicine, vol. 10, no. 452, eaar6115. https://doi.org/10.1126/scitranslmed.aar6115

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AU - Pidot, Sacha J.

AU - Gao, Wei

AU - Buultjens, Andrew H.

AU - Monk, Ian R.

AU - Guerillot, Romain

AU - Carter, Glen P.

AU - Lee, Jean Y.H.

AU - Lam, Margaret M.C.

AU - Grayson, M. Lindsay

AU - Ballard, Susan A.

AU - Mahony, Andrew A.

AU - Grabsch, Elizabeth A.

AU - Kotsanas, Despina

AU - Korman, Tony M.

AU - Coombs, Geoffrey W.

AU - Robinson, J. Owen

AU - Da Silva, Anders Gonçalves

AU - Seemann, Torsten

AU - Howden, Benjamin P.

AU - Johnson, Paul D.R.

AU - Stinear, Timothy P.

PY - 2018/8/1

Y1 - 2018/8/1

N2 - 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.

AB - 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.

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DO - 10.1126/scitranslmed.aar6115

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SN - 1946-6234

VL - 10

JO - Science Translational Medicine

JF - Science Translational Medicine

IS - 452

M1 - eaar6115

ER -

Increasing tolerance of hospital Enterococcus faecium to handwash alcohols

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Increasing tolerance of hospital Enterococcus faecium to handwash alcohols

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Why is VRE (a resistant hospital infection) becoming more common in Australia?

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