To screen or not to screen medical students for carriage of multidrug-resistant pathogens?

• Published in: The Journal of hospital infection Vol. 140; pp. 15 - 23
• Main Authors: Smelikova, E., Drevinek, P., Nyc, O., Brajerova, M., Tkadlec, J., Krutova, M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2023
• Subjects: Bioinformatics; Chromosomally encoded; Prevalence; Resistance; Surveillance; Whole-genome sequencing; Resistance; Prevalence; Surveillance; Whole-genome sequencing; Bioinformatics; Chromosomally encoded; chromosomally-encoded; tigecycline; VRE; carbapenems; resistance; whole genome sequencing; prevalence; MRSA; bioinformatics; ESBL; vancomycin; surveillance; mcr; colistin
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2023.06.028

The carriage of multidrug-resistant (MDR) pathogens in medical students has not been studied extensively, despite the fact that they are in contact with patients and exposed to a hospital environment. To investigate the intestinal and nasal carriage of MDR pathogens among medical students and its association with their lifestyle and demographic data. In 2021, first- and final-year medical students were invited to the study. Two rectal swabs were used for detection of extended-spectrum β-lactamase (ESBL)-producing, colistin-, tigecycline- or carbapenem-resistant Gram-negative bacteria and vancomycin-resistant enterococci. Nasal swab was used for Staphylococcus aureus culture. S. aureus isolates were characterized by spa typing; Gram-negative resistant isolates and meticillin-resistant S. aureus (MRSA) were subjected to whole-genome short and/or long sequencing. From 178 students, 80 (44.9%) showed nasal carriage of S. aureus; two isolates were MRSA. In rectal swabs, seven ESBL-producing strains were detected. Sixteen students were colonized by colistin-resistant bacteria, three isolates carried the mcr-1 gene (1.7%). The mcr-9 (10.7%, 19/178) and mcr-10 (2.2%, 4/178) genes were detected by quantitative polymerase chain reaction, but only two colistin-susceptible mcr-10-positive isolates were cultured. The S. aureus nasal carriage was negatively associated with antibiotic and probiotic consumption. S. aureus and colistin-resistant bacteria were detected more frequently among students in contact with livestock. Medical students can be colonized by (multi)drug-resistant bacteria with no difference between first- and final-year students. The participation of students in self-screening increases their awareness of possible colonization by resistant strains and their potential transmission due to poor hand hygiene. [Display omitted]