A study of hospital surfaces in six low- and middle-income countries (LMICs) indicates colonization with multidrug-resistant bacteria is common, researchers reported late last week in Nature Communications.

The researchers also found evidence that the observed colonization of hospital surfaces by multidrug-resistant bacteria may be linked to cases of neonatal sepsis.

Focusing on countries that were involved in the BARNARDS (Burden of Antibiotic Resistance in Neonates from Developing Societies) study, which assessed common sepsis-causing pathogens in newborns in LMICs, a team led by researchers at Cardiff University collected and analyzed hospital surface swabs from 10 hospitals in Bangladesh, Ethiopia, Nigeria, Pakistan, Rwanda, and South Africa. Their aim to was determine the prevalence and diversity of extended-spectrum beta-lactamase (ESBL)- and carbapenemase-carrying bacterial species colonizing neonatal wards.

Widespread bacterial colonization

Of the 6,290 surface swabs collected, 60.7% were positive for gram-negative bacteria and 13.3% were positive for ESBL and carbapenemase genes. A higher prevalence of carbapenemase genes was observed in hospitals in Pakistan, Bangladesh, and Ethiopia, and the most common surfaces for bacterial colonization were those near sink drains. Contamination of medical equipment and ward furniture was also common.

Further analysis of 175 isolates using MALDI-TOF mass spectrometry showed that Klebsiella pneumoniae was the most frequent carbapenemase-producing bacteria, followed by Eneterobacter hormaechei. Analysis of whole-genome sequencing (WGS) data revealed that, in one hospital in Pakistan where cases of neonatal sepsis had been reported in the BARNARDS study, isolates of K pneumoniae sequence type (ST)15—which carries two carbapenemase genes—were identified on surfaces from the same ward on multiple occasions and were nearly identical to those from neonatal blood cultures.

WGS also showed evidence of similarity between plasmids carrying antibiotic resistance genes (ARGs) detected within Enterobacterales from multiple hospital surfaces, indicating possible horizontal transmission.

"This data highlights the widespread bacterial colonisation and the transmission of bacteria carrying multiple ARG upon hospital surfaces, which could be useful to guide realistic approaches and support action plans for countries where IPC [infection prevention and control] practices are limited," the study authors wrote.

Only 16% of US adults aged 27 to 45 have received the human papillomavirus (HPV) vaccine, with men, Hispanic respondents, and people with less education at even lower levels, according to a large survey study published last week in Human Vaccines & Immunotherapeutics.

Although routine HPV vaccination was initially recommended for children aged 11 to 12 years, with catch-up vaccination through age 26, the Food and Drug Administration (FDA) expanded the age range in 2018 to adults 27 to 45 years, as well.

Women 3 times as likely to be vaccinated

For the study, Duke University researchers analyzed data from the 2019 National Health Interview Survey, a nationally representative sample of the US population. They write that this is the first study since the FDA age expansion to examine HPV vaccine uptake in a diverse sample of 27- to 45-year-olds from across the United States.

The investigators found that 84.5% of the 9,440 participants had not yet been vaccinated against HPV. Women were more than three times more likely to have gotten the vaccine than men (adjusted odds ratio, 3.58). And, compared to White respondents, Black adults were 36% more likely and Hispanics 27% less likely to receive the vaccine. Compared to those with a college degree, adults with a high school education were 38% less likely to be immunized.

The overall low uptake of the HPV vaccine in this age group raises concerns regarding cancer prevention efforts.

"The overall low uptake of the HPV vaccine in this age group raises concerns regarding cancer prevention efforts," senior author Nosayaba Osazuwa-Peters, BDS, PhD, MPH, a head and neck cancer epidemiologist at Duke, said in a press release from Taylor & Francis, which publishes the journal. "Given the importance of the HPV vaccine in cancer prevention, it is critical that these disparities are addressed and mitigated."

He adds, "For oropharyngeal cancer, about 75% of new cases are in males. As oral HPV is the primary cause of HPV-associated oropharyngeal cancer; providing the HPV vaccine to middle-aged individuals is undoubtedly an important strategy to decreasing risk."