surveillance of mucorales resistance to azoles in … · 2020. 3. 31. · azoles such as...

1,E+00 1,E+01 1,E+02 1,E+03 1,E+04 1,E+05 1,E+06 1,E+07 Log CFU.m -2 Gloves 1,E+00 1,E+01 1,E+02 1,E+03 1,E+04 1,E+05 1,E+06 1,E+07 Log CFU.m -2 FRPD Interior layer 1,E+00 1,E+01 1,E+02 1,E+03 1,E+04 1,E+05 1,E+06 Log CFU.m -2 FRPD Exhalation valves Mucorales from FRPD and gloves grew in azole-supplemented media. Mucor sp. and Rhizopus sp. presented reduced susceptibility to itraconazole and posaconazole at tested conditions, besides expected resistance to voriconazole. Liliana A. Caetano 1,2 , Marta Dias 1 , Beatriz Almeida 1 , Carla Viegas 1,3,4 1 H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa. 2 Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal 3 NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa. 4 Comprehensive Health Research Center (CHRC), 1150-090 Lisbon, Portugal. SURVEILLANCE OF MUCORALES RESISTANCE TO AZOLES IN THE WASTE SORTING INDUSTRY: Assessment of Filtering Respiratory Protective Devices and Gloves The use of Filtering Respiratory Protective Devices (FRPD) and Gloves is mandatory in waste-sorting industry in Portugal as preventive of workers' exposure to bioaerosols, including fungi. The emergence of resistance to azoles among fungal species, including Mucorales, in the environment challenges the management of severe fungal infections. The aims of the study were to evaluate: 1. Mucorales burden in Filtering Respiratory Protective Devices (FRPD) and in Gloves used in one Portuguese waste sorting industry. 2. If azole-resistant Mucorales is present in this occupational environment. [email protected] Purpose 1 Methods 2 Passive sampling in one sorting Portuguese waste sorting industry in different workstations from Jan to Feb, 2019. FRPD (interior layer and exhalation valve) and Gloves extracted with 0.1% Tween™ 80 saline solution (NaCl 0.9%) and inoculated on MEA, DG18 and azole-supplemented SDA media plates and incubated at 27 ºC for 5 to 7 days. Mucorales densities (CFU/m2) calculated and genera identified through macro and microscopic characteristics in MEA and DG18. Screening of azole resistance in 4 mg/L itraconazole (ITRA), 1 mg/L voriconazole (VORI), and 0.5 mg/L posaconazole (POSA) supplemented SDA media (EUCAST). Results 3 Mucorales was detected in FRPD interior layers (12.35% MEA; 0.03% DG18) and exhalation valves (0.21% DG18), and in gloves (39.00% MEA; 4.03% DG18). 1,E+00 1,E+01 1,E+02 1,E+03 1,E+04 1,E+05 1,E+06 1,E+07 Log CFU.m-2 FRPD Interior layer 1,E+00 1,E+01 1,E+02 1,E+03 1,E+04 1,E+05 1,E+06 1,E+07 Log CFU.m-2 FRPD Exhalation valves 1,E+00 1,E+01 1,E+02 1,E+03 1,E+04 1,E+05 1,E+06 1,E+07 1,E+08 Log CFU.m-2 Gloves Conclusion 4 • Contamination of FRPD and gloves with Mucorales is present at the waste sorting industry • Reduced susceptibility to clinical azoles such as posaconazole, one of the few effective azole drugs against mucormycosis, can be a risk factor in the waste sorting industry Station Task FRPD Gloves A Feeding machines with waste 33 9 B Sorting waste 54 39 C Machines inspection 12 10 D Machines and special vehicles operator 13 8 Not specified 8 1 Total 120 67 Acknowledgments 5 This work was supported by FCT – Fundação para Ciência e Tecnologia, project EXPOsE (02/SAICT/2016/Project nº 23222), and Instituto Politécnico de Lisboa, Lisbon, Portugal, Project "Waste FRPD” (IPL/2018/WasteFRPD/ESTeSL).

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1,E+001,E+011,E+021,E+031,E+041,E+051,E+061,E+07

Log

CFU

.m-2

Gloves

1,E+001,E+011,E+021,E+031,E+041,E+051,E+061,E+07

Log

CFU

.m-2

FRPD Interior layer

1,E+001,E+011,E+021,E+031,E+041,E+051,E+06

Log

CFU

.m-2

FRPD Exhalation valves

Mucorales from FRPD and gloves grew in azole-supplemented media. Mucor sp. and Rhizopus sp. presented reduced susceptibility to itraconazole and posaconazole at tested conditions, besides expected resistance to voriconazole.

Liliana A. Caetano1,2, Marta Dias1, Beatriz Almeida1, Carla Viegas1,3,4

1 H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa.

2 Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal

3 NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa.4 Comprehensive Health Research Center (CHRC), 1150-090 Lisbon, Portugal.

SURVEILLANCE OF MUCORALES RESISTANCE TO AZOLES IN THE WASTE SORTING INDUSTRY:

Assessment of Filtering Respiratory Protective Devices and Gloves

The use of Filtering RespiratoryProtective Devices (FRPD) and Gloves ismandatory in waste-sorting industry inPortugal as preventive of workers'exposure to bioaerosols, including fungi.

The emergence of resistance to azolesamong fungal species, includingMucorales, in the environmentchallenges the management of severefungal infections.

The aims of the study were to evaluate:

1. Mucorales burden in FilteringRespiratory Protective Devices (FRPD)and in Gloves used in one Portuguesewaste sorting industry.

2. If azole-resistant Mucorales is presentin this occupational environment.

[email protected]

Purpose1 Methods2

Passive sampling in one sorting Portuguese wastesorting industry in different workstations from Jan toFeb, 2019.

FRPD (interior layer and exhalation valve)and Gloves extracted with 0.1% Tween™ 80saline solution (NaCl 0.9%) and inoculatedon MEA, DG18 and azole-supplementedSDA media plates and incubated at 27 ºCfor 5 to 7 days.

Mucorales densities (CFU/m2)calculated and genera identifiedthrough macro and microscopiccharacteristics in MEA andDG18.

Screening of azoleresistance in 4 mg/Litraconazole (ITRA), 1 mg/Lvoriconazole (VORI), and0.5 mg/L posaconazole(POSA) supplemented SDAmedia (EUCAST).

Results3

Mucorales was detected in FRPD interior layers (12.35% MEA; 0.03% DG18) and exhalation valves (0.21% DG18), and in gloves (39.00% MEA; 4.03% DG18).

1,E+001,E+011,E+021,E+031,E+041,E+051,E+061,E+07

Log

CFU

.m-2

FRPD Interior layer

1,E+001,E+011,E+021,E+031,E+041,E+051,E+061,E+07

Log

CFU

.m-2

FRPD Exhalation valves

1,E+001,E+011,E+021,E+031,E+041,E+051,E+061,E+071,E+08

Log

CFU

.m-2

Gloves

Conclusion4

• Contamination of FRPD and gloves with Mucorales is present at the waste sorting industry

• Reduced susceptibility to clinical azoles such as posaconazole, one of the few effective azole drugs against mucormycosis, can be a risk factor in the waste sorting industry

Station Task FRPD Gloves

AFeeding

machines with waste

33 9

B Sorting waste 54 39

CMachines inspection

12 10

DMachines and

special vehicles operator

13 8

Not specified 8 1

Total 120 67

Acknowledgments5

This work was supported by FCT – Fundaçãopara Ciência e Tecnologia, project EXPOsE(02/SAICT/2016/Project nº 23222), and Instituto Politécnico de Lisboa, Lisbon, Portugal, Project "Waste FRPD” (IPL/2018/WasteFRPD/ESTeSL).