Assessment of door handles as potential reservoirs of drug-resistant enterococci

Abstract

Abstract Background Fomites have long been known to play a key role in the spread of disease causing agents. Hospital-associated fomites in particular have been linked with transmission of members of the Enterococci sp which are key human pathogens. Few studies have explored the role non-hospital door handles might play as potential sources of these isolates. This study therefore set out to explore this role. Results A total of hundred toilet and office door handles in a tertiary institution in Rivers State, Nigeria, were sampled using the swab and rinse method. The presence and drug susceptibility of Enterococcus was determined using the selective bile esculin agar (BEA) and standard microbiological methods. Growth on BEA was observed in 71% of cases, with more growth (38/50, 76%) observed from toilet door handles. Only 35% of samples produced the characteristic black pigmentation associated with Enterococcus sp. Six different bacterial groups were identified from this subset with Enterococcus sp. making up only 14% (5/35) of the isolates. All (100%) Enterococci were isolated from toilet door handles. Antibiotic susceptibility testing revealed very high levels of resistance (80–100%) against 75% of the test antibiotics. An analysis of the antibiotic resistance pattern of each isolate revealed 11 unique antibiogram patterns. Only 2 of these patterns were associated with the enterococci, with majority (4/5) exhibiting resistance to Augmentin (AUG), Ceftazidime (CAZ), Ceftriaxone (CTR), Cefuroxime (CRX), Cloxacillin (CXC), Erythromycin (ERY), Gentamicin (GEN), Ofloxacin (OFL) (antibiogram of AUG–CAZ–CRX–CTR–CXC–ERY). None of the enterococci, however, was resistant to vancomycin. Conclusion This study reports low level contamination of door handles by enterococci. Identical antibiogram patterns linked with majority of the enterococci could however point at the occurrence of a single clone perhaps indicating single source contamination. Reports of high levels of ampicillin resistance among these isolates are problematic as ampicillin–gentamicin combination is the treatment of choice for nosocomial enterococci pathogens.