Passenger pathogens on physicians

Published:October 25, 2022DOI:


      • Whole genome DNA sequencing (WGS) was performed on bone marrow transplantation physician items.
      • WGS identified thousands of unique bacteria, DNA viruses, fungi, and bacteriophages.
      • Antimicrobial resistance elements were identified on all items tested.
      • Stethoscopes contained the greatest frequency of antibiotic resistance genes.



      Hospital acquired infections pose a significant risk for patients undergoing hematopoietic stem cell transplantation. Horizontal transfer of antimicrobial resistance genes contributes to prevalence of multidrug-resistant infections in this patient population.


      At an academic bone marrow transplantation center, we performed whole genome DNA sequencing (WGS) on commonly used physician items, including badges, stethoscopes, soles of shoes, and smart phones from 6 physicians. Data were analyzed to determine antimicrobial resistance and virulence factor genes.


      A total of 1,126 unique bacterial species, 495 distinct bacteriophages, 91 unique DNA viruses, and 175 fungal species were observed. Every item contained bacteria with antibiotic and/or antiseptic resistance genes. Stethoscopes contained greatest frequency of antibiotic resistance and more plasmid-carriage of antibiotic resistance.

      Discussion and Conclusions

      These data indicate that physician examination tools and personal items possess potentially pathogenic microbes. Infection prevention policies must consider availability of resources to clean physical examination tools as well as provider awareness when enacting hospital policies. Additionally, the prevalence of antimicrobial resistance genes (eg, encoding resistance to aminoglycosides, β-lactams, and quinolones) reinforces need for antimicrobial stewardship, including for immunocompromised patients. Further research is needed to assess whether minute quantities of microbes on physician objects detectable by WGS represents clinically significant inoculums for immunocompromised patients.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Miles SH.
        The Hippocratic Oath and the Ethics of Medicine.
        Oxford University Press, 2004
        • Tomblyn M
        • Chiller T
        • Einsele H
        • et al.
        Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective.
        Biol Blood Marrow Transplant. 2009; 15: 1143-1238
        • Cave R
        • Misra R
        • Chen J
        • et al.
        Whole genome sequencing revealed new molecular characteristics in multidrug resistant staphylococci recovered from high frequency touched surfaces in London.
        Sci Rep. 2019; 9: 9637
        • Carbon S
        • Ireland A
        • Mungall CJ
        • Shu S
        • Marshall B
        • Lewis S.
        AmiGO: online access to ontology and annotation data.
        Bioinformatics. 2009; 25: 288-289
        • Caspi R
        • Foerster H
        • Fulcher CA
        • et al.
        The MetaCyc Database of metabolic pathways and enzymes and the BioCyc collection of Pathway/Genome Databases.
        Nucleic Acids Res. 2008; 36: D623-D631
        • Franzosa EA
        • McIver LJ
        • Rahnavard G
        • et al.
        Species-level functional profiling of metagenomes and metatranscriptomes.
        Nat Methods. 2018; 15: 962-968
        • The UniProt Consortium
        UniProt: the universal protein knowledgebase.
        Nucleic Acids Res. 2016; 45: D158-D169
        • The UniProt Consortium
        UniProt: the universal protein knowledgebase.
        Nucleic Acids Res. 2017; 45: D158-D169
        • DeCrescenzo AJ
        • Philips RC
        • Wilkerson MG.
        Trichodysplasia spinulosa: a rare complication of immunosuppression.
        JAAD Case Rep. 2016; 2: 307-309
        • Haun N
        • Hooper-Lane C
        • Safdar N.
        Healthcare personnel attire and devices as fomites: a systematic review.
        Infect Control Hosp Epidemiol. 2016; 37: 1367-1373
        • Dashtbani-Roozbehani A
        • Brown MH.
        Efflux pump mediated antimicrobial resistance by staphylococci in health-related environments: challenges and the quest for inhibition.
        Antibiotics (Basel). 2021; 10: 1502
        • Gjoerup O
        • Chang Y.
        Chapter 1 - Update on human polyomaviruses and cancer.
        in: Vande Woude GF Klein G Advances in Cancer Research. 106. Academic Press, 2010: 1-51
        • Batinovic S
        • Wassef F
        • Knowler SA
        • et al.
        Bacteriophages in natural and artificial environments.
        Pathogens. 2019; 8: 100