Bacterial colonization and succession in a newly opened hospital | Science Translational Medicine

Bacterial colonization and succession in a newly opened hospital | Science Translational Medicine

Bacterial colonization and succession in a newly opened hospital

1. Simon Lax¹,², 
2. Naseer Sangwan²,³, 
3. Daniel Smith⁴, 
4. Peter Larsen², 
5. Kim M. Handley¹,*, 
6. Miles Richardson¹, 
7. Kristina Guyton³, 
8. Monika Krezalek³, 
9. Benjamin D. Shogan³,†, 
10. Jennifer Defazio³, 
11. Irma Flemming³,‡, 
12. Baddr Shakhsheer³, 
13. Stephen Weber⁵, 
14. Emily Landon⁵, 
15. Sylvia Garcia-Houchins⁵, 
16. Jeffrey Siegel⁶,⁷, 
17. John Alverdy³, 
18. Rob Knight⁸,⁹, 
19. Brent Stephens¹⁰ and 
20. Jack A. Gilbert¹,²,³,§

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Science Translational Medicine  24 May 2017:
Vol. 9, Issue 391, eaah6500
DOI: 10.1126/scitranslmed.aah6500

A new hospital teems with life

Lax et al. conducted a yearlong survey of the bacterial diversity associated with the patients, staff, and built surfaces in a newly opened hospital. They found that the bacterial communities on patient skin strongly resembled those found in their rooms. The authors demonstrated that the patient skin microbial communities were shaped by a diversity of clinical and environmental factors during hospitalization. They found little effect of intravenous or oral antibiotic treatment on the skin microbiota of patients.

Abstract

The microorganisms that inhabit hospitals may influence patient recovery and outcome, although the complexity and diversity of these bacterial communities can confound our ability to focus on potential pathogens in isolation. To develop a community-level understanding of how microorganisms colonize and move through the hospital environment, we characterized the bacterial dynamics among hospital surfaces, patients, and staff over the course of 1 year as a new hospital became operational. The bacteria in patient rooms, particularly on bedrails, consistently resembled the skin microbiota of the patient occupying the room. Bacterial communities on patients and room surfaces became increasingly similar over the course of a patient’s stay. Temporal correlations in community structure demonstrated that patients initially acquired room-associated taxa that predated their stay but that their own microbial signatures began to influence the room community structure over time. The α- and β-diversity of patient skin samples were only weakly or nonsignificantly associated with clinical factors such as chemotherapy, antibiotic usage, and surgical recovery, and no factor except for ambulatory status affected microbial similarity between the microbiotas of a patient and their room. Metagenomic analyses revealed that genes conferring antimicrobial resistance were consistently more abundant on room surfaces than on the skin of the patients inhabiting those rooms. In addition, persistent unique genotypes of Staphylococcus and Propionibacterium were identified. Dynamic Bayesian network analysis suggested that hospital staff were more likely to be a source of bacteria on the skin of patients than the reverse but that there were no universal patterns of transmission across patient rooms.