Extended-spectrum β-lactamase–producing Enterobacteriaceae in cell phones of health care workers from Peruvian pediatric and neonatal intensive care units

Published:April 07, 2016DOI:


      • Phones may serve as mechanical vectors to transmit bacteria within and across wards.
      • Phones can be an important source of multidrug-resistant or extended-spectrum β-lactamase bacteria.
      • Phones keep pathogens randomly circulating in intensive care units, representing an infection risk.


      Health care workers (HCWs) use their mobile phones during working hours or medical care. There is evidence that the instruments are colonized with pathogenic microorganisms. Here, we describe levels of Enterobacteriaceae contamination (EC) in cell phones and the risk factors associated with EC in Peruvian intensive care units (ICUs).


      This was a 5-month cohort study among 114 HCWs of 3 pediatric and 2 neonatology ICUs from 3 Peruvian hospitals. A baseline survey collected data on risk factors associated with EC. Swabs were collected from HCWs' phones every other week.


      Three-quarters of HCWs never decontaminated their phones, and 47% reported using the phones in the ICU >5 times while working. EC was frequent across samplings and sites and was substantially higher in subjects with longer follow-up. Potential risk factors identified did not have strong associations with positive samples (relative risk, 0.7-1.5), regardless of significance. Half of the phones were colonized with an Enterobacteriaceae at least once during the 4 samplings attained on average during the study period. Half of the isolates were multidrug resistant (MDR), and 33% were extended-spectrum β-lactamase producers.


      EC on HCWs' phones was frequent and apparently randomly distributed through the hospitals without clear clustering or strongly associated risk factors for having a positive sample. Based on the level of EC, phones may be considered as potential bacterial reservoirs of MDR and ESBL bacteria.

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        • Martinez-Aguilar G.
        • Alpuche-Aranda C.
        • Anaya C.
        • Alcantar-Curiel D.
        • Gayosso C.
        • Daza C.
        • et al.
        Outbreak of nosocomial sepsis and pneumonia in a newborn intensive care unit by multiresistant extended-spectrum beta-lactamase-producing Klebsiella pneumoniae: high impact on mortality.
        Infect Control Hosp Epidemiol. 2001; 22: 725-728
        • Stone P.
        • Gupta A.
        • Loughrey M.
        • Della-Latta P.
        • Cimiotti J.
        • Larson E.
        • et al.
        Attributable costs and lenght of stay of an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae outbreak in a neonatal intensive care unit.
        Infect Control Hosp Epidemiol. 2003; 24: 601-606
        • Benner K.W.
        • Prabhakaran P.
        • Lowros A.S.
        Epidemiology of infections due to extended-spectrum Beta-lactamase-producing bacteria in a pediatric intensive care unit.
        J Pediatr Pharmacol Ther. 2014; 19: 83-90
        • Morgan D.J.
        • Lomotan L.L.
        • Agnes K.
        • McGrail L.
        • Roghmann M.C.
        Characteristics of healthcare-associated infections contributing to unexpected in-hospital deaths.
        Infect Control Hosp Epidemiol. 2010; 31: 864-866
        • Lee C.C.
        • Lee N.Y.
        • Yan J.J.
        • Lee H.C.
        • Chen P.L.
        • Chang C.M.
        • et al.
        Bacteremia due to extended-spectrum-beta-lactamase-producing Enterobacter cloacae: role of carbapenem therapy.
        Antimicrob Agents Chemother. 2010; 54: 3551-3556
        • Chopra T.
        • Marchaim D.
        • Veltman J.
        • Johnson P.
        • Zhao J.J.
        • Tansek R.
        • et al.
        Impact of cefepime therapy on mortality among patients with bloodstream infections caused by extended-spectrum-β-lactamase-producing Klebsiella pneumoniae and Escherichia coli.
        Antimicrob Agents Chemother. 2012; 56: 3936-3942
        • Burdette S.D.
        • Herchline T.E.
        • Oehler R.
        Surfing the web: practicing medicine in a technological age: using smartphones in clinical practice.
        Clin Infect Dis. 2008; 47: 117-122
        • Ramesh J.
        • Carter A.O.
        • Campbell M.H.
        • Gibbons N.
        • Powlett C.
        • Moseley H.
        • et al.
        Use of mobile phones by medical staff at Queen Elizabeth Hospital, Barbados: evidence for both benefit and harm.
        J Hosp Infect. 2008; 70: 160-165
        • Nwankwo E.O.
        • Ekwunife N.
        • Mofolorunsho K.C.
        Nosocomial pathogens associated with the mobile phones of healthcare workers in a hospital in Anyigba, Kogi state, Nigeria.
        J Epidemiol Glob Health. 2014; 4: 135-140
        • Brady R.R.
        • Wasson A.
        • Stirling I.
        • McAllister C.
        • Damani N.N.
        Is your phone bugged? The incidence of bacteria known to cause nosocomial infection on healthcare workers' mobile phones.
        J Hosp Infect. 2006; 62: 123-125
        • Ulger F.
        • Esen S.
        • Dilek A.
        • Yanik K.
        • Gunaydin M.
        • Leblebicioglu H.
        Are we aware how contaminated our mobile phones with nosocomial pathogens?.
        Ann Clin Microbiol Antimicrob. 2009; 8: 1-4
        • Ustun C.
        • Cihangiroglu M.
        Health care workers' mobile phones: a potential cause of microbial cross-contamination between hospitals and community.
        J Occup Environ Hyg. 2012; 9: 538-542
        • Clinical and Laboratory Standards Institute
        Performance standards for antimicrobial susceptibility testing: twenty-third informational supplement M100-S23.
        Clinical Laboratory Standards Institute, Wayne (PA)2013
        • Yong D.
        • Lee K.
        • Yum J.H.
        • Shin H.B.
        • Rossolini G.M.
        • Chong Y.
        Imipenem-EDTA disk method for differentiation of metallo-beta-lactamase-producing clinical isolates of Pseudomonas spp. and Acinetobacter spp.
        J Clin Microbiol. 2002; 40: 3798-3801
        • Pasteran F.
        • Mendez T.
        • Guerriero L.
        • Rapoport M.
        • Corso A.
        Sensitive screening tests for suspected class A carbapenemase production in species of Enterobacteriaceae.
        J Clin Microbiol. 2009; 47: 1631-1639
        • Tan T.Y.
        • Ng L.S.
        • He J.
        • Koh T.H.
        • Hsu L.Y.
        Evaluation of screening methods to detect plasmid-mediated AmpC in Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis.
        Antimicrob Agents Chemother. 2009; 53: 146-149
        • Arlet G.
        • Philippon A.
        Construction by polymerase chain reaction and use of intragenic DNA probes for three main types of transferable beta-lactamases (TEM, SHV, CARB) [corrected].
        FEMS Microbiol Lett. 1991; 66: 19-25
        • Babini G.S.
        • Livermore D.M.
        Are SHV beta-lactamases universal in Klebsiella pneumoniae?.
        Antimicrob Agents Chemother. 2000; 44: 2230
        • Edelstein M.
        • Pimkin M.
        • Palagin I.
        • Edelstein I.
        • Stratchounski L.
        Prevalence and molecular epidemiology of CTX-M extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Russian hospitals.
        Antimicrob Agents Chemother. 2003; 47: 3724-3732
        • Lee Y.J.
        • Yoo C.G.
        • Lee C.T.
        • Chung H.S.
        • Kim Y.W.
        • Han S.K.
        • et al.
        Contamination rates between smart cell phones and non-smart cell phones of healthcare workers.
        J Hosp Med. 2013; 8: 144-147
        • Mammina C.
        • Di Carlo P.
        • Cipolla D.
        • Giuffrè M.
        • Casuccio A.
        • Di Gaetano V.
        • et al.
        Surveillance of multidrug-resistant gram-negative bacilli in a neonatal intensive care unit: prominent role of cross transmission.
        Am J Infect Control. 2007; 35: 222-230
        • Bradford P.A.
        Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat.
        Clin Microbiol Rev. 2001; 14: 933-951