Proteeae Groin Skin Carriage Among Nursing Home Resident—Resistance to Antiseptics

Abstract

Proteeae carriage was evaluated in groin skin carriers following vigorous antiseptic application. Three Proteus mirabilis carriers were treated with 60% isopropyl alcohol or 4% chlorhexidine, observed to prevent skin contact, and then recultured; at four and eight hours P mirabilis numbers remained undiminished. Ten Proteeae carriers received a series of nine body baths with soap, chlorhexidine, and 0.75% povidone-iodine plus three cefazolin injections over 16 to 34 days; cumulative treatments failed to clear seven carriers. Within three months, all were again carriers. Proteeae carriers also had affinity for groin carriage of various aerobic gram-negative bacilli (AGNB) including cefazolin-resistant strains. In seven subjects, more than one AGNB species were recovered shortly after applying an antiseptic. Proteeae groin skin carriage appears to reflect a major change in the nature of resident bacteria on intact groin skin.

Failure of Bland Soap Handwash to Prevent Hand Transfer of Patient Bacteria to Urethral Catheters

“…Two (3%) residents, yielding gram-negative bacteria at levels slO"/ml cup scrub fluid, met the definition of high-burden Proteeae carriers as previously described. 5 In this hand contamination model, despite intervening bland soap handwash, contact with intact groin skin of high-burden carriers routinely permitted gram-negative bacteria transfer to a catheter. Follow- ing soap handwash, healthcare workers transferred gram-negative bacteria to a catheter in 11 of 1.2 (92%) single contact source experiments.…”