Airport door handles and the spread of drug-resistant bacteria

Researchers from the University Hospital Münster have suggested that drug-resistant bacteria from international travellers could be transferred to inanimate surfaces in airports and then picked up by others, who may go on to spread these bacteria in their home countries. Their study was led by Frieder Schaumburg and has been published in the journal Clinical Microbiology and Infection.

In order to test their theory, members of the research group each undertook international travel, swabbing the surface of an internal airport toilet door along the way and preserving the swab for culture when they returned to the lab. During the course of the study, 400 toilet door handles in 136 airports in 59 countries were sampled in this way.

Bacteria of interest found in the samples included Staphylococcus aureus (found in 5.5% of the samples), Staphylococcus maltophilia (2%) and bacteria of the Acinetobacter baumannii complex (1.3%). Upon further study, it was found that two out of eight of the S. maltophilia isolates were resistant to trimethoprim and sulfamethoxazole. Additionally, two out of five of the A. baumannii complex isolates were resistant to trimethoprim and sulfamethoxazole, but all were susceptible to quinolones and gentamicin.

The scientists made particular note of one isolate of S. aureus, isolated from a toilet door in a Paris airport. This was found to be resistant to aminoglycosides, quinolones, macrolides, clindamycin and trimethoprim/sulfamethoxazole, though it was susceptible to glycopeptides, linezolid and rifampicin. It was thus classed as MRSA (mecA-positive, ST672, t1451, SCCmec type V, PVL-negative) — an emerging MRSA clone from the Indian subcontinent that has “very rarely” been reported elsewhere, according to Schaumburg.

“Although our finding suggests that the MRSA was imported to France from the Indian subcontinent, scientists, politicians, stakeholders and opinion leaders should not play the blame game,” said Schaumburg. “Almost every geographic region has its problems with antimicrobial resistance, which are not limited to MRSA but also includes vancomycin-resistant enterococci, carbapenem-resistant Acinetobacter or Enterobacteriaceae or so-called extended-spectrum beta-lactamase producers.

“A joint strategy that brings together low-, middle- and high-income countries is probably the most important aspect in the fight against antimicrobial resistance.”

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