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Bactericidal Effect of Antimicrobial-Treated Textiles on
Multi-drug Resistant Gram Negatives
Amy Mathers MD, Gerald R. Donowitz, MD
Division of Infectious Diseases and International Health, Department of Medicine
University of Virginia Health System, Charlottesville, VA
In vitro Exposure to Textile
Abstract
Number of carbapenem resistant K. pneumoniae
after one hour exposure to VTTOO3 fabric compared
to control fabric
•Method
1 One gram of treated or control fabric were placed in
flasks containing 25 mL 0.3 mM potassium phosphate (KH2PO4)
solution containing 0.01% surfactant (Q2-5211 Dow Corning) along
with bacteria for a final concentration of 1-5 X 106 colony forming
unit (CFU)/mL and allowed to shake 120 RPM for one hour.
Bacteria from fabric containing solutions were plated in triplicate.
Background: Nosocomial transmission of drug resistant gram
negative bacteria is a current public health threat and clothing of
health-care professionals has been implicated in spread of these
organisms. VTTOO3 is an antimicrobial-based textile using an
acrylic copolymer dispersion technology to repel contaminating
fluids in combination with a quaternary ammonium based
microbicide. We evaluated this material’s effect on drug-resistant
bacteria.
1.00E+08
1.00E+07
1.00E+07
1.00E+06
1.00E+06
• Method
1.00E+05
1.00E+05
CFU/mL
1.00E+04
1.00E+04
• Method 3 Fabric was swiped over dried culture of 107 organisms
1.00E+03
placed into buffer, and evaluated for number of viable organisms
recovered by plating in triplicate.
1.00E+02
1.00E+03
CFU
2 100 μL of liquid culture containing 107 organisms
applied to treated and untreated fabric placed in buffer and
immediately evaluated recovery of organisms from fabric by plating
in triplicate.
Methods: A carbapenemase producing K. pneumoniae and a panresistant A. baumanni were obtained. One gram of treated or
control fabric was added to a flask containing buffer solution,
surfactant, and 1-5 X 106 colony forming units (CFU)/mL of
bacteria. Incubation with shaking occurred for one hour. Bacteria
from fabric containing solutions were plated in triplicate. In other
studies, 100 μL of liquid culture containing 107 organisms was
applied to treated and untreated fabric, placed in buffer, and
immediately plated. Finally, fabric was swiped over dried culture of
107 organisms, placed into buffer, and evaluated for number of
viable organisms. All experiments were performed in triplicate.
•All experiments were performed in triplicate
Results
1.00E+00
1.00E+00
Control
Control
Initial
* On average 1 CFU recovered
Method 3: Transmission of bacteria from surface
•Experiment failed, unable to transmit more than five organisms from any
Method 2: In vitro Transmission from Broth Culture
Reduction in number of KPC producing K. pneumoniae
CFU after 1 hour exposure to VTTOO3 fabric
Qualitative Analysis
100 µL of bacterial culture on control fabric and
VTTOO3 fabric
group
•There was no difference between treated and control fabrics but not
meaningful since model failed to work
Conclusion
•Exposure to VTTOO3, an antibacterial textile, in broth resulted in more than a
six log reduction of multidrug resistant gram negative organisms in vitro
Background
infection with multidrug resistant gram negative rods was recently
cited as the number one issue facing Hospital Epidemiology. (1)
•Exposure of the VTTOO3 fabric to saturated culture had greater than a 2 log
Positive
Exposure to
untreated fabric
•The epidemiology, pathogenesis, treatment, and prevention of
reduction in recovery of KPC producing K. pneumoniae and pan-resistant A.
baumannii when compared to control fabric
Exposure to
VTTOO3 treated fabric
•Multi-drug resistant gram negative bacteria could not be consistently
recovered with fabric after drying on a surface
Quantitative Analysis
•Transmission of multi-drug resistant A. baumannii on clothing to
•Almost exclusively due to nosocomial transmission, infection with
carbapenem resistant A. baumannii and K. pneumoniae results in
increased length of stay, additional cost and worse clinical
outcome.(3-5)
VTTOO3
Control
Pan-resistant A. baumannii after one hour
exposure to VTTOO3 fabric compared to control
fabric
skin has been demonstrated in vitro. (2)
Pan-resistant A. baumannii transmitted by
VTTOO3 fabric in vitro
1.00E+07
1.00E+08
1.00E+06
K. pneumoniae remain high and are increasing within the United
States(6)
CFU
CFU/mL
1.00E+05
1.00E+04
1.00E+03
Bacteria
1.00E+03
1.00E+02
1.00E+02
*
1.00E+01
1.00E+01
1.00E+00
*
tested including carbapenems, colistin, and tigecycline was utilized.
Treated
Control
Initial
* On average 1 CFU recovered
transmission of multi-drug resistant gram negative bacteria in a health care
setting
1. Sinaii N. Charting the course for the future of science in healthcare epidemiology: results of a survey of the
membership of the Society of Healthcare Epidemiology of America. Infect Control Hosp Epidemiol. 2010;31(7):669-75.
2. Butler DL, Major Y, Bearman G, Edmond MB. Transmission of nosocomial pathogens by white coats: an in-vitro
model. J Hosp Infect. 2010;75(2):137-8.
3. Perez F, Hujer AM, Hulten EA, Fishbain J, Hujer KM, Aron D, et al. Antibiotic resistance determinants in Acinetobacter
spp and clinical outcomes in patients from a major military treatment facility. Am J Infect Control. 2010;38(1):63-5.
PMCID: 19783325.
4. Sheng WH, Liao CH, Lauderdale TL, Ko WC, Chen YS, Liu JW, et al. A multicenter study of risk factors and outcome
of hospitalized patients with infections due to carbapenem-resistant Acinetobacter baumannii. Int J Infect Dis.
2010;14(9):e764-9.
5. Patel G, Huprikar S, Factor SH, Jenkins SG, Calfee DP. Outcomes of carbapenem-resistant Klebsiella pneumoniae
infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol. 2008;29(12):1099106. PMCID: 18973455.
6. Kallen AJ, Hidron AI, Patel J, Srinivasan A. Multidrug resistance among gram-negative pathogens that caused
healthcare-associated infections reported to the National Healthcare Safety Network, 2006-2008. Infect Control Hosp
Epidemiol. 2010;31(5):528-31. PMCID: 20334552.
1.00E+06
1.00E+04
•Future study will be needed to determine the impact this may have on
Selected References
1.00E+07
1.00E+05
•There is in vitro evidence that VTTOO3 treated fabric has antimicrobial
activity against important nosocomial gram negative bacteria
Quantitative Analysis
•Rates of infection with carbapenem resistant A. baumannii and
•A clinical strain of A. baumanni resistant to all antimicrobial agents
Recovered
Recovered
Qualitative Analysis
Negative
clinical strain of K. pneumoniae confirmed to have Klebsiella
pneumoniae carbapenemase (KPC), susceptible to only tigecycline,
colistin and amikacin was utilized.
Initial
*
Method 1: Antibacterial Effect of Textile
Treated
Treated
Conclusions: Antimicrobial- treated fabric demonstrated in vitro
bactericidal activity against pan-resistant A. baumannii and
multidrug resistant K. pneumoniae. This could be of potential use
in decreasing transmission of multi-drug resistant gram negatives in
the healthcare setting.
•A
1.00E+02
1.00E+01
1.00E+01
Results: For the shaking flask method, control fabric final bacterial
concentration averages were 1.8 X 106 for K. pneumoniae and 5.6
X 105 cfu/mL for A. baumannii compared to treated fabric final
concentration of 1.0 X 101 cfu/mL for both strains. The method of
dropping liquid culture directly onto fabric recovered 6.6 X107CFU
of Klebsiella pneumoniae from controls versus 3.8 X 105 CFU from
treated fabric and 1.3X107 CFU of A. baumannii from control versus
1.2X105 CFU from treated fabric. The technique of swiping material
over dried culture was not able to demonstrate consistent growth of
bacteria on control or treated fabric.
Methods
Number of carbapenem resistant
K. pneumoniae transmitted by VTTOO3
treated fabric in vitro
1.00E+00
Control
Treated
Recovered
Initial
Recovered