Airborne ESKAPE pathogens at inner-city clinic resist advanced antibiotics

In a South African inner-city clinic, researchers have discovered airborne ESKAPE bacteria that have developed resistance to most antibiotics. Located in a densely populated area, the clinic was studied by researchers from the University of Johannesburg (UJ). They collected air samples from the clinic and identified ESKAPE bacteria present in the air.

The team then tested how well these bacteria resist various antibiotics, finding that a wide range of dangerous ESKAPE bacteria can withstand first-line drugs and some are highly resistant to multiple first-line drugs. Some bacteria are even resistant to drugs typically reserved for use when all other options have failed.

South Africa's high HIV and TB infection rates amplify the risk of lower respiratory tract infections (LRIs) caused by these bacteria, including bronchitis, bronchiolitis, and pneumonia. These infections can lead to community-acquired, hospital-acquired, and ventilator-associated pneumonia, which are potentially fatal. The ESKAPE bacteria found in the clinic's air are typically multidrug-resistant or extensively drug-resistant, posing a significant threat to patients, particularly those already immunocompromised. Exposure to these bacteria can result in sepsis, a life-threatening condition.

Among the gram-negative ESKAPE bacteria tested, a concerning level of resistance to first-line and last-resort drugs was found. Eighty-five percent of the gram-negative bacteria survived exposure to colistin, a toxic last defense drug. Additionally, 31.2% of gram-negative bacteria survived exposure to the carbapenems ertapenem and meropenem.

All gram-negative bacteria showed resistance to at least one drug in three or more antibiotic categories, with some classified as multi-drug-resistant (MDR) or extensively drug-resistant (XDR) bacterial infections. This resistance leaves doctors with limited treatment options, as XDR infections offer few treatment alternatives.

The study's findings on methicillin-resistant Staphylococcus aureus (MRSA) were particularly concerning, as MRSA can rapidly infect intact skin and spread easily from person to person. Worldwide, 10% of people carry S. aureus in their nasal passages or armpits. Health care workers who are carriers must be treated with appropriate antibiotics before resuming patient contact.

The clinic and NICU in this study serve as examples of medical facilities worldwide struggling to reduce the incidence of LRIs among patients during treatment. This issue is further complicated by South Africa's high rates of TB and HIV co-infection, as well as unreliable water supplies, which impact infection control at clinics and hospitals. Antimicrobial resistance (AMR) continues to rise both in South Africa and globally.