Impact of a probiotic-based hospital sanitation on antimicrobial resistance and HAI-associated antimicrobial consumption and costs: a multicenter study

Figures & data

Table 1 Variations in individual pathogens’ load on hospital surfaces during pre-PCHS and PCHS (CFU/m²)

Pathogen type	Pre-PCHSa	PCHSa	Decrease (%)
Aspergillus spp.	181±307	12±6	93.3
Candida spp.	2,597±1,798	1,108±559	57.3
Clostridium difficile	334±290	132±219	60.5
Pseudomonas aeruginosa	970±982	415±350	57.2
Acinetobacter baumannii	2,844±841	520±726	81.7
Enterobacteriaceae spp.	1,774±901	189±135	89.3
Staphylococcus spp.	26,947±17,293	4,674±3,799	82.7

Note:

a Results are expressed as mean value of CFU/m² ± SD detected in the five enrolled hospitals.

Abbreviations: PCHS, Probiotic Cleaning Hygiene System; CFU, colony forming units.

Figure 1 Resistome analysis of the hospital surface microbiota.

Notes: The resistome of the surface contaminant population was analyzed as described in the “Patients and methods” section. The results of the pre-intervention (pre-PCHS, left panels) and intervention (PCHS, right panels) phases are shown for each setting (hospitals 1, 2, 3, 4, and 5). The results of the pre-PCHS phase are expressed as the log₁₀ fold change of each detected R gene compared with the negative controls (NTC), and the results of the PCHS phase are expressed as the log₁₀ fold change of each detected R gene compared with the pre-PCHS phase. The plotted data are the mean values obtained in monthly environmental sampling campaigns (12 sampling campaigns) for all of the sampled points (18 sampled points per hospital per sampling campaign).

Abbreviation: PCHS, Probiotic Cleaning Hygiene System.

Figure 2 Resistome analysis of the hospital surface microbiota during the pre-PCHS phase.

Notes: The resistome of the surface contaminant population was analyzed as described in the “Patients and methods” section. The results of the pre-intervention (pre-PCHS) phase are plotted according to the prevalence of R genes. The results are the mean values for all five enrolled hospitals obtained in monthly environmental sampling campaigns (six sampling campaigns) for all of the sampled points (18 sampled points per hospital per sampling campaign).

Abbreviations: PCHS, Probiotic Cleaning Hygiene System; CTR, control.

Table 2 Antibiotic resistance in Staphylococcus aureus isolates of pre-PCHS and PCHS phases of the study

Study period	Isolates (n)	Resistant isolates
		Penicillin G	Ampicillin	Vancomycin	Oxacillin	Cefotaxime	Imipenem	MDRa
Pre-PCHS	81	53 (65.4%)	58 (71.6%)	31 (38.2%)	50 (61.7%)	61 (75.3%)	42 (51.8%)	58 (71.6%)
<g>PCHS	<g>30	<g>18 (60.0%)	<g>20 (66.6%)	<g>2 (6.6%)	<g>18 (60.0%)	<g>22 (73.3%)	<g>13 (43.3%)	<g>16 (53.3%)
% Decrease (strain number)		–66.0	–65.5	–93.5	–64.0	–63.9	–69.0	–72.4

Notes:

a MDR was defined as those strains resistant to three or more antibiotics. Penicillin G (10 IU), ampicillin (10 µg), vancomycin (30 µg), oxacillin (1 µg), cefotaxime (30 µg), imipenem (10 µg).

Abbreviation: PCHS, Probiotic Cleaning Hygiene System.

Table 3 Drug consumption and therapy days during pre-PCHS and PCHS phases of the survey

Drug types	Molecules (n)		Therapy days (n)
	Pre-PCHS	PCHS	Pre-PCHS	PCHS
β-Lactamsa	126	75 (−40.5%)	1,140	711 (−37.6%)
Fluoroquinolones	111	20 (−82%)	723	102 (−85.9%)
Glycopeptides	43	18 (−58.1%)	442	178 (−59.7%)
Cephalosporins	43	22 (−48.8%)	354	136 (−61.6%)
Antifungals	31	6 (−80.6%)	287	41 (−85.7%)
Acid antibiotics	11	1 (−90.9%)	68	2 (−97.1%)
Polymixins	7	3 (−57.1%)	85	56 (−34.1%)
Sulfamides	6	1 (−83.3%)	43	9 (−79.1%)
Aminoglycosides	5	2 (−60.0%)	39	27 (−30.8%)
Others	16	9 (−43.7%)	112	98 (−12.5%)
Total	403	160 (−60.3%)	3,339	1,382 (−58.6%)

Note:

a With or without β-lactamase inhibitors.

Abbreviation: PCHS, Probiotic Cleaning Hygiene System.

Table S1 Demographic characteristics of patients

Patients	Pre-PCHS	PCHS	Differences
	No. (%)	No. (%)	P-value
Total	274	124
Gender (male)	118 (43.1%)	55 (44.4%)	n.s.
Age (years ± SD)	76.0±12.3	78.7±11.3	0.025

Abbreviations: n.s., nonsignificant; PCHS, Probiotic Cleaning Hygiene System.