Modeling the Transmission of Highly Drug-Resistant Pathogens in Healthcare Settings

**Krista Ternus, PhD**
*Genomics Specialist*

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The prevalence of healthcare-acquired infections (HAI) and rising levels of antimicrobial resistance places significant economic and public health burdens on modern healthcare systems. A group of highly drug resistant pathogens known as the ESKAPE pathogens, along with C. difficile, are the leading causes of HAIs. Interactions between patients, healthcare workers, and environmental conditions impact disease transmission.

With the goal of contributing to improvements in pathogen transmission modeling in healthcare settings, Signature Science conducted research supported by the Centers of Disease Control and Prevention’s investments to combat antibiotic resistance under award number (200-2018-75D30118C02922). Study objectives were to evaluate how healthcare-associated pathogen transfer rates change under a variety of simulated conditions, compare traditional culturing methods with the culture-independent methods of shotgun metagenomics and metatranscriptomics for pathogen detection and characterization, assess how pathogen abundance impacts detection of virulence and antimicrobial resistance genes, and identify potential signatures of pathogen viability.

Experimental Design

Evaluating Pathogen Transfer Rates Under Various Conditions

**Direct Contact Scenario:** The primary VITRO-SKIN coupon is inoculated with a mix of pathogen and background bacteria, representing a contaminated patient hand (step 1). The inoculated VITRO-SKIN is either washed (step 2a) or not washed (step 2b) and then touched to a new, secondary VITRO-SKIN with only background microorganisms (step 3), simulating the touch transfer of bacteria from a sick patient to a clean healthcare worker. The secondary VITRO-SKIN with any transferred bacteria (step 4), representing the contaminated healthcare worker, is then harvested for downstream analysis (step 5).

**Indirect Contact Scenario:** The primary VITRO-SKIN coupon is inoculated with a mix of pathogen and background bacteria, representing a contaminated patient hand. The inoculated VITRO-SKIN is touched to a surface (nitrile, stainless steel, or cotton), simulating bacterial transfer to the fomite (step 1). The fomite then either undergoes a surface-appropriate wash (step 2a) or does not (2b). A new, secondary VITRO-SKIN with only background microorganisms, representing a clean health worker hand, touches the fomite (step 3) where bacteria on the surface may transfer to the secondary VITRO-SKIN (step 4). The secondary VITRO-SKIN with any transferred bacteria is then harvested for downstream analysis (step 5).

Publications

Simulating transmission of ESKAPE pathogens plus C. difficile in relevant clinical scenarios

Detection of ESKAPE pathogens and Clostridioides difficile in Simulated Skin Transmission Events with Metagenomic and Metatranscriptomic Sequencing

Data and Analysis

For this project’s sequencing data, visit:

NCBI BioProject: ESKAPE pathogens and Clostridioides difficile isolates, metagenomes, and metatranscriptomes

For intermediate analyses and results from tools, visit:

OSF Project: Analysis of ESKAPE+C Pathogens

Want more information about this project?

Contact Krista Ternus