Passenger Pathogens on Physicians

Published:October 25, 2022DOI:

      Key Points

      • 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.


      Background: Hospital acquired infections pose a significant risk for patients undergoing hematopoietic stem cell transplantation. Horizontal transfer of antimicrobial resistance genes contributes to prevalence of multi-drug resistant infections in this patient population.
      Methods: 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 six physicians. Data were analyzed to determine antimicrobial resistance and virulence factor genes.
      Results: 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 & 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 (e.g. 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.


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