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Increasing tolerance of hospital Enterococcus faecium to hand-wash 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, View ORCID ProfileTimothy P. Stinear
doi: https://doi.org/10.1101/053728
Sacha J. Pidot
1Department of Microbiology and Immunology, The Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, 3010, Australia.
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Wei Gao
1Department of Microbiology and Immunology, The Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, 3010, Australia.
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Andrew H. Buultjens
1Department of Microbiology and Immunology, The Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, 3010, Australia.
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Ian R. Monk
1Department of Microbiology and Immunology, The Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, 3010, Australia.
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Romain Guerillot
1Department of Microbiology and Immunology, The Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, 3010, Australia.
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Glen P. Carter
1Department of Microbiology and Immunology, The Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, 3010, Australia.
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Jean Y.H. Lee
1Department of Microbiology and Immunology, The Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, 3010, Australia.
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Margaret M. C. Lam
1Department of Microbiology and Immunology, The Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, 3010, Australia.
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M. Lindsay Grayson
2Infectious Diseases Department, Austin Health, Heidelberg, Victoria, 3084, Australia.
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Susan A. Ballard
3Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, 3010, Australia.
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Andrew A. Mahony
2Infectious Diseases Department, Austin Health, Heidelberg, Victoria, 3084, Australia.
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Elizabeth A. Grabsch
2Infectious Diseases Department, Austin Health, Heidelberg, Victoria, 3084, Australia.
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Despina Kotsanas
4Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia, Victoria, 3168, Australia
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Tony M. Korman
4Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia, Victoria, 3168, Australia
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Geoffrey W. Coombs
5Antimicrobial Resistance and Infectious Diseases (AMRID) Research Laboratory, School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, 6150, Australia.
6Department of Microbiology, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia, 6150, Australia.
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J. Owen Robinson
5Antimicrobial Resistance and Infectious Diseases (AMRID) Research Laboratory, School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, 6150, Australia.
6Department of Microbiology, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia, 6150, Australia.
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Anders Gonçalves da Silva
5Antimicrobial Resistance and Infectious Diseases (AMRID) Research Laboratory, School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, 6150, Australia.
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Torsten Seemann
7Melbourne Bioinformatics, University of Melbourne, Carlton, Victoria, 3053, Australia.
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Benjamin P. Howden
1Department of Microbiology and Immunology, The Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, 3010, Australia.
2Infectious Diseases Department, Austin Health, Heidelberg, Victoria, 3084, Australia.
3Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, 3010, Australia.
8Department of Medicine, University of Melbourne, Heidelberg, Victoria, 3084, Australia.
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Paul D. R. Johnson
1Department of Microbiology and Immunology, The Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, 3010, Australia.
2Infectious Diseases Department, Austin Health, Heidelberg, Victoria, 3084, Australia.
8Department of Medicine, University of Melbourne, Heidelberg, Victoria, 3084, Australia.
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  • For correspondence: tstinear@unimelb.edu.au paul.johnson@austin.org.au
Timothy P. Stinear
1Department of Microbiology and Immunology, The Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, 3010, Australia.
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  • ORCID record for Timothy P. Stinear
  • For correspondence: tstinear@unimelb.edu.au paul.johnson@austin.org.au
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Abstract

Alcohol-based hand rubs are international pillars of hospital infection control, restricting transmission of pathogens such as Staphylococcus aureus. Despite this success, health care infections caused by Enterococcus faecium (Efm) - another multidrug resistant pathogen - are increasing. We tested alcohol tolerance of 139 hospital Efm isolates, obtained between 1997 and 2015 and found Efm post-2010 were 10-fold more tolerant to alcohol killing than older isolates. Using a mouse infection control model, we then showed that alcohol tolerant Efm resisted standard 70% isopropanol surface disinfection and led to gastrointestinal colonization significantly more often than alcohol sensitive Efm. We next looked for bacterial genomic signatures of adaptation. Tolerant Efm have independently accumulated mutations modifying genes involved in carbohydrate uptake and metabolism. Mutagenesis confirmed their roles in isopropanol tolerance. These findings suggest bacterial adaptation and complicate infection control recommendations. Additional policies and procedures to prevent Efm spread are required.

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Posted January 29, 2018.
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Increasing tolerance of hospital Enterococcus faecium to hand-wash 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
bioRxiv 053728; doi: https://doi.org/10.1101/053728
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Increasing tolerance of hospital Enterococcus faecium to hand-wash 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
bioRxiv 053728; doi: https://doi.org/10.1101/053728

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