Abstract

Objective: Door handles of cars harbor bacteria common on skin surfaces and the environment. Some of these bacteria are pathogenic and others have the ability to developed or acquire antibiotic-resistant genes. The purpose of this study was to describe the bacterial profile and the antibiotic sensitivity patterns of door handles of cars entering CHUY, Cameroon.

Method: This cross-sectional hospital-based study was carried out between February and March 2021 with a total of 100 car door handles collected for analysis. After inoculation in four agar media (Brain Heart infusion, nutrient agar, Mannitol salt agar, MacConkey agar) and incubated inappropriate conditions, seven biochemical tests were done and finally, the Kirby-Bauer disk-diffusion method was used for antibiotic susceptibility testing.

Results: The prevalence of positive specimens was as follows; (98%%) with bacterial culture with 176 isolates (86 (48.6%) Gram-positive and 90 (51.45%) Gram-negative isolates. The most isolated bacteria were S. aureus, Enterobacter spp. Klebsiella spp., and CoNS. The bacteria isolates were tested each one to 18 antibiotics. There was a high level of resistance to Vancomycin, Oxacillin, and Tetracyclin. The overall prevalence of MDRB was 51.13%% (90/176). CRSA was mostly detected 29.54 % (52/176), followed by VISA 10.23% (18/176).MRSA had a 1.114% (2/176) with ESBL having a 9.09% (16/176).

Conclusion:  There was a high prevalence of bacterial contamination of these car door handles and a significant prevalence of AMR and occurrence of MDRB

CHAPTER ONE

INTRODUCTION

1.1 Background

The hands are the most used organ for handling and manipulating objects. They come in contact with many surfaces daily most of which are commonly carrying microbes one of which are car door handles [1].

The hands are never bacteria-free as they have their normal flora (Resident and Transient) like any other body organ. Most of these bacteria are not pathogenic and as such harmless with both having the propensity to acquire resistance such as; S. epidermidis, S. hominis due to resistant genes acquired from other bacteria notably from other surfaces and the environment.

These surfaces and our hands, therefore, play a vital role in microbe transmission and as an extension of infection transmission. Scientific studies have proven the existence of potentially pathogenic bacteria on these common surfaces [2].

Antibiotic resistance is not a new phenomenon and other than naturally it may originate from the misuse and overuse of antibiotics since their creation. [3].

This is common in our society today due to the availability of and easy access to information. The existence of these various resistance thwarts the treatment of infectious diseases worldwide.

These bacteria can cause many diseases and physiologic complications some of which may be difficult to treat due to the development of resistance to drugs, mostly common antibacterial drugs e.g Staphylococci can colonize commonly touched inanimate objects, it is feasible that the car door handles can serve as reservoirs for pathogenic staphylococci and may play an important role in human colonization and infection [1] and about 80% of infections are spread through hand contact with hands or other objects [11].

There are many bacterial species on the contaminated solid surfaces, which are frequently used such as handles of car and house doors. The most important of these bacterial species belonging to the genus of Staphylococcus, representing one of the most important sources of infection due to its ability to be pathogenic even as a commensal [8].

Naturally, as a commensal Staphylococcus spp. has increased the possibility of colonizing surface and as such causing disease because of the arrival of these bacterial contaminants to places other than their natural places in addition to certain members of the Enterobacteriaceae family [9].

Pathogens that may be present on the hand include Escherichia coli other potentially pathogenic bacteria Include Salmonella typhi, Shigella spp Clostridium perfringes, Giardia lamblia, Norwalk virus, and Hepatitis A virus; Pseudomonas aeruginosa, S. aureus, Proteus mirabilis, Citrobacter freundii, Enterobacter spp; Streptococcus spp, Klebsiella spp [10].

Cars entering the hospital may play an important role in disease transmission as health care professionals, carers and patients come in contact with them especially during hand-to-door handle contact. These cars are from an environment out of the hospital and will return to be used by the general public out of the hospitals which may provide a platform for disease transmission from hospitals to the public and vice-versa.

This can lead to the acquisition of nosocomial pathogens by a patient and the resultant development of infection depends on a multifaceted interplay between the environment, a pathogen, and a susceptible host [12]. These nosocomial pathogens are responsible for nosocomial infections or Hospital Acquired infections (HAIs) which are infections acquired after a stay of at least 24 hours in the hospital environment.

Nosocomial infections are the fifth leading cause of death in critical-care hospitals. A systemic review has estimated the prevalence of HAIs to be 7.6% in high-income countries and 10.1% in low and middle-income countries [14].

Studies have reported that HAIs caused by multidrug-resistant gram-positive organisms such as Staphylococcus aureus and Extended beta-lactamase resistant Enterobacteriaceae (ESBLs) are increasing as one of the problems in healthcare institutions as a result, antibiotic resistance is one of the greatest public health challenges of our time this is particularly dangerous as the incidence of nosocomial infections is directly linked to antimicrobial-resistant strains [13].

1.2 Problem Statement

Similar previous studies have been carried out in other communities on cars, other studies investigated the bacterial contamination of hand touched surfaces in buses, trains, stations, and other public areas [4], toilets and wards, and public car door handle [5]. Knowledge of the bacterial profile of these car handles can provide a platform for the testing and establishment of common antibiotics in cases of transient diseases which will contribute to slowing the unregulated use of antibiotics-a major cause of antibiotic resistance.

This work may then help to inform the public health sector and transport sector for better and revised government policies on car hygiene and personnel hand decontamination due to the existence of multi-resistant-strain bacteria and the devastating effect of these potentially pathogenic bacteria in the immuno-compromised.

1.3 Hypothesis

Car door handles harbor and acts as a transport of potentially pathogenic bacteria and multi-drug resistant (MDR) strains of bacteria between and within the hospital environment and community.

1.4 Objectives

1.4.1 Main;

To characterize the bacterial profile and antibiotic sensitivity patterns of car door handles entering the Yaoundé 1 university teaching hospital.

1.4.2 Specific;

1. To characterized the bacterial profile of car door handles, highlighting potentially pathogenic bacteria.
2. To determine the bacterial profile resistant strains.