Preoptimized phage cocktail for use in aerosols against nosocomial transmission of carbapenem-resistant Acinetobacter baumannii: A 3-year prospective intervention study

Ecotoxicology and Environmental Safety

Jui-Chih Chang¹  Lih-Shinn Wang²  Yi-Ting Chen³  Chin-Cheng Chang⁴  Soon-Hian Teh⁵  Hui-Li Jiang⁶  Chun-Chieh Tseng⁶  Hsiu-Tzu Chu⁷  Yu-Zhong Li⁸  Dar-Sen Chen⁸  Li-Kuang Chen⁹  Debangana Sankhla^1,10  Hui-Hua Yang^1,11 

[1] Branch of Clinical Pathology, Department of Laboratory Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan;Department and Graduate Institute of Public Health, Tzu Chi University, Hualien, Taiwan;Department of Surgery, School of Medicine, Tzu Chi University, No. 701, Section 3, Zhongyang Rd., Hualien, Taiwan;Bioinnovation Center, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan;Department and Graduate Institute of Public Health, Tzu Chi University, Hualien, Taiwan;Department of Laboratory Medicine, Clinical Pathology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan;Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Section 3, Zhongyang Rd., Hualien, Taiwan;Division of Infectious Diseases, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan;Institute of Medical Sciences, Department of Laboratory Diagnostic, College of Medicine, Tzu Chi University, Hualien, Taiwan;School of Pharmacy, China Medical University, Taiwan;Unit of Infection Control and Management, Buddhist Tzu Chi General Hospital, Hualien, Taiwan;

关键词: Acinetobacter baumannii;    Phage;    Carbapenem resistant;    Nosocomial infection;   

DOI  :  

来源: DOAJ

【 摘 要 】

Using bacteriophages (phages) as environmental sanitizers has been recognized as a potential alternative method to remove bacterial contamination in vitro; however, very few studies are available on the application of phages for infection control in hospitals. Here, we performed a 3-year prospective intervention study using aerosolized phage cocktails as biocontrol agents against carbapenem-resistant Acinetobacter baumannii (CRAB) infection in the hospital. When a CRAB-infected patient was identified in an intensive care unit (ICU), their surrounding environment was chosen for phage aerosol decontamination. Before decontamination, 501 clinical specimens from the patients were subjected to antibiotic resistance analysis and phage typing. The optimal phage cocktails were a combination of different phage families or were constructed by next-evolutionary phage typing with the highest score for the host lysis zone to prevent the development of environmental CRAB phage resistance. The phage infection percentage of the antibiotic-resistant A. baumannii strains was 97.1%, whereas the infection percentage in the antibiotic-susceptible strains was 79.3%. During the phage decontamination periods from 2017 to 2019, the percentage of carbapenem-resistant A. baumannii in test ICUs decreased significantly from 65.3% to 55%. The rate of new acquisitions of CRAB infection over the three years was 4.4 per 1000 patient-days, which was significantly lower than that in the control wards (8.9 per 1000 patient-days) where phage decontamination had never been performed. In conclusion, our results support the potential of phage cocktails to decrease CRAB infection rates, and the aerosol generation process may make this approach more comprehensive and time-saving.

【 授权许可】

Unknown