2Department of Life Sciences, Biochemistry and Molecular Biology, Central China Normal University, Wuhan, Hubei, P. R. China
Keywords: MDR; Mobile phones; MRSA; VISA
Mobile phones may harbor different pathogenic bacteria because they are commonly handled regardless of the sanitation of hands and hardly disinfected [5]. The use of such mobile phone serves as a potential vehicle for the spread of nosocomial pathogens including multidrug-resistant pathogens such as MRSA [6].
In recent years, community-acquired MRSA (CA-MRSA) strains, the rapidly becoming dominant pathogens in the community, have emerged [3]. Vancomycin is the antibiotic for the treatment of MRSA cases but several reports have shown that MRSA intermediate and resistant patterns against vancomycin and treatment of MRSA cases with vancomycin is extremely problematic [7,8]. Presence of such pathogenic bacteria like MRSA, VISA and MDR S. aureus in mobile phones can indicate the immediate medical attention to abate this issue.
Although the contamination of mobile phones of health workers has been studied, little information regarding the contamination of personal mobile phones of people in the community exists. Bacterial flora on cell phones may vary in composition, number and antibiotic sensitivity from person to person. This is probably the first study in Nepal that attempts to explore the bacterial flora present on the mobile phones in community samples and their antimicrobial susceptibility patterns.
In this study, we have identified MRSA, VISA and MDR S. aureus from mobile phones used by the students and the staffs and also have drawn a significant association between various attributes of users and mobile phones with the isolation rate of S. aureus.
S No |
Antibiotics |
Antibiotic Susceptibility Test |
MDR |
% |
Isolates |
|||||
Sensitive |
% |
Intermediate |
% |
Resistant |
% |
|||||
1 |
Amikacin |
95 |
84.8 |
7 |
6.3 |
10 |
8.9 |
24 |
21.4
|
112
|
2 |
Cefoxitin |
42 |
37.5 |
40 |
35.7 |
30 |
26.8 |
|||
3 |
Ceftriazone |
65 |
58 |
29 |
25.9 |
18 |
16.1 |
|||
4 |
Ciprofloxacin |
91 |
81.3 |
5 |
4.5 |
16 |
14.3 |
|||
5 |
Cloxacillin |
61 |
54.5 |
38 |
33.9 |
13 |
11.6 |
|||
6 |
Cotrimoxazole |
90 |
80.4 |
16 |
14.3 |
6 |
5.4 |
|||
7 |
Erythromycin |
61 |
54.5 |
25 |
22.3 |
26 |
23.2 |
|||
8 |
Gentamicin |
101 |
90.2 |
7 |
6.3 |
4 |
3.6 |
|||
9 |
Tetracycline |
90 |
80.4 |
10 |
8.9 |
12 |
10.7 |
|||
10 |
Vancomycin |
54 |
48.2 |
58 |
51.8 |
- |
- |
The number of MRSA isolates was quite higher in the mobile phones carried in pockets than those carried in mobile-bags (P-value < 0.01) (Table 3). A significant association was observed between the presence of MDR isolates and the gender of the users. A large number of MDR S. aureus 16 (66.7%) was detected from the mobile phones used by females compared to those used by males 8 (33.3%) (P-value < 0.01) (Table 4).
SN |
Attributes |
Growth |
% |
P-value |
|
1 |
Gender |
Male |
59 |
52.7 |
0.085 |
Female |
53 |
47.3 |
|||
2 |
Age |
11-20 |
20 |
17.1 |
0.49 |
21-30 |
64 |
57.9 |
|||
31-40 |
28 |
25 |
|||
3 |
Status |
Student |
61 |
54.5 |
0.191 |
Staff |
51 |
45.5 |
|||
4 |
Mobile phones types |
Screen-touch |
97 |
86.6 |
0.085 |
Keypad |
15 |
13.4 |
|||
5 |
Used in toilet |
Yes |
67 |
59.8 |
<0.01 |
No |
45 |
40.2 |
|||
6 |
Disinfectant used |
Yes |
55 |
49.1 |
<0.01 |
No |
57 |
50.9 |
|||
7 |
Storage of mobile phones |
Clothes |
72 |
64.3 |
0.163 |
Bag |
40 |
35.7 |
|||
8 |
Age of mobile phones (Months) |
01-12 |
23 |
20.5 |
<0.01 |
13-24 |
44 |
39.3 |
|||
More than 24 |
45 |
40.2 |
SN |
Attributes |
MRSA |
% |
P-value |
|
1 |
Gender |
Male |
13 |
43.3 |
0.398 |
Female |
17 |
56.7 |
|||
2 |
Age |
11-20 |
4 |
13.3 |
0.352 |
21-30 |
19 |
63.3 |
|||
31-40 |
7 |
23.4 |
|||
3 |
Status |
Student |
19 |
63.3 |
0.284 |
Staff |
11 |
36.7 |
|||
4 |
Mobile phones types |
Screen-touch |
28 |
93.3 |
0.439 |
Keypad |
2 |
6.7 |
|||
5 |
Used in toilet |
Yes |
25 |
83.3 |
<0.01 |
No |
5 |
16.7 |
|||
6 |
Disinfectant used |
Yes |
6 |
20 |
<0.01 |
No |
24 |
80 |
|||
7 |
Storage of mobile phones |
Clothes |
25 |
83.3 |
0.036 |
Bag |
5 |
16.7 |
|||
8 |
Age of mobile phones (Months) |
01-12 |
3 |
10 |
<0.01 |
13-24 |
6 |
20 |
|||
More than 24 |
21 |
70 |
SN |
Attributes |
MDR |
% |
P-value |
|
1 |
Gender |
Male |
8 |
33.3 |
<0.01 |
Female |
16 |
66.7 |
|||
2 |
Age |
11-20 |
3 |
12.5 |
0.282 |
21-30 |
17 |
70.8 |
|||
31-40 |
4 |
16.7 |
|||
3 |
Status |
Student |
17 |
70.8 |
0.191 |
Staff |
7 |
29.2 |
|||
4 |
Mobile phones types |
Screen-touch |
22 |
91.7 |
0.208 |
Keypad |
2 |
8.3 |
|||
5 |
Used in toilet |
Yes |
22 |
91.7 |
<0.01 |
No |
2 |
8.3 |
|||
6 |
Disinfectant used |
Yes |
2 |
8.3 |
<0.01 |
No |
22 |
91.7 |
|||
7 |
Storage of mobile phones |
Clothes |
12 |
50 |
0.19 |
Bag |
12 |
50 |
|||
8 |
Age of mobile phones (Months) |
01-12 |
- |
- |
<0.01 |
13-24 |
5 |
20.8 |
|||
More than 24 |
19 |
79.2 |
Elkholy et al reported 31.0% S. aureus isolated from mobile phones were methicillin resistant [4]. A report by Heyba et al showed that MRSA was identified in 3 (1.4 %) mobile phones among which none was resistant to vancomycin [17]. In our work, 26.8% of S. aureus were found to be resistant against cefoxitin which is nearly similar to a study conducted by Kuhu Pal et al, who showed almost 21.0% of S. aureus isolated from mobile phones were resistant to cefoxitin [18]. None of the S. aureus isolates was noted to be resistant against vancomycin in Kuhu Pal’s work which is consistent with our study. Similarly, Chawla et al also reported the presence of 20.0% of MRSA on the mobile phones used by health care workers in teaching institution, Manipal, Karnataka, India. But no MRSA was detected from non-health workers’ mobile phones in their study [12]. Similarly, in India, Bhat et al identified 40.0% MRSA and 58.6% MSSA from mobile phones of medical personnels [19]. In health care settings, MRSA can cause terrible consequences. It can cause bloodstream infections, if not treated properly it can also result sepsis and even deaths [https://www. cdc. gov/mrsa/healthcare/index. html]. In another study, Kuhu Pal revealed that conventional keypad phones (94.4%) were greatly contaminated than touch-screen phones (67.8%) by S. aureus and other microorganisms as well [18]. In contrast, in our study, 86.6% of touch-screen phones and 13.4% of keypad phones were found to be contaminated by S. aureus.
In our study, 37.0% users were found to have never used any disinfectants in their mobile phones. This figure is quite lesser than a research carried out by Sadat-Ali in Saudi Arabia who reported that 76.0% of the clinicians had never disinfected their mobile phones [20]. Similarly, a work done at one of the hospitals in Kuwait by Heyba et al pointed out that 66. 5% of the participants had never disinfected their mobile phones [17]. Microbial contaminations are the risks related with the irregular cleaning of phones [21]. Our study shows a significant association between the disinfection process and the rate of contamination by S. aureus (P-value < 0.01), MRSA (P-value < 0.01) and MDR S. aureus (P-value < 0.01).
The rate of incidence of contamination of mobile phones held by females in IUG (Islamic University of Gaza) (52.0%) was lower than that of male counterparts (79.0%) [13]. Auhim’s findings in Iraq were consistent with this, which showed that the rate of bacterial contamination of personal mobile phones of males was 85.0% compared with 80.0% of females [22]. Similarly, in the present study, we observed a higher rate of incidence of bacterial contamination in the mobile phones carried by males (52.7%) than those carried by the females (47.3%). We also noted a significant association between the isolation rate of MDR S. aureus and gender of the users (P-value < 0.01). Female users had their mobile phones more contaminated with MDR S. aureus than the males. In a research work performed by Salha H. M and Al-Zahrani in 2012, it was found that fingernails can also harbor MDR S. aureus [23]. Females usually keep longer nails which can directly transmit MDR S. aureus to the mobile phones while using. In a study presented in a meeting of the Infectious Disease Society of America in San Francisco, researchers showed that artificial and natural nails longer than 3 millimeters beyond the tip of the finger, or the length of a pencil tip, transport more harmful bacteria and yeast under them as compared to the short nails (http://abcnews. go. com/Health/story?id=117161).
Akinyemi et al concluded that S. aureus was the most encountered bacterial agent, probably because this type of bacteria proliferates in optimum temperatures, as phones are kept warm in pockets, handbags and brief cases [24]. Our study reveals that 83.3% MRSA were isolated from the mobile phones carried in the pants and shirts and only 5 (16.7%) bacteria were isolated from mobile phones carried in bags. A study conducted by Kuhu Pal illustrated that a large number of users carry their phones in clothes than in bags but in his study the rate of contamination was found to be higher in mobile phones stored in bags (95.4%) than those carried in clothes (84.6%) [18]. Converesly, in our study, 64.3 % of S. aureus were isolated from the mobile phones stored in the pocket which was 28.6 % higher than those isolated from mobile phones stored in the bags. This may be because users frequently put their hands inside the pockets than inside the bags which can increase the chances of transmission of S. aureus through their hands on the mobile phones kept inside the pockets. There was no significant association between the rates of isolation of MDR S. aureus and the storage of mobile phones (P-value> 0.01) in our study. Similarly, no significant association was noted in the study conducted by Kuhu Pal regarding the rate of isolation S. aureus and storage of mobile phones (P-value>0.01) [19].
A study conducted by Zakai et al revealed that 59.0% medical students used their mobile phones in the toilets [25]. This finding is comparatively higher than our study in which 40.2% of the respondents used their mobile phones in toilets. Mobile phones can act as fomites as they are contaminated by users from areas such as toilets, hospitals and kitchens, which are burdened with microorganisms [26]. Furthermore, Giannini et al reported that hospital’s toilets are the source for MRSA [27]. The MRSA are very difficult to kill and are significantly dangerous as stated by San Diego County Health and Human Services Agency which also reported that MRSA is spread by person-to-person contact and is frequently harbored in toilet bowls and dirty environment [https://healthyliving. azcentral. com/bacteriafound- in-toilet-bowls12320100. html]. Using mobile phones in such environments can be one of the reasons for presence of MRSA on the mobile phone surface. It is also revealed in our study that the mobile phones used in the toilets were tremendously contaminated with S aureus (P-value < 0.01) and also a significant number of MRSA (P-value < 0.01) and MDR S. aureus (P-value < 0.01) were found in the mobile phones used in toilets.
Furthermore, in our study, mobile phones used for more than 24 months were found to be highly contaminated with MRSA, VISA and MDR S. aureus. This may be due to the fact that older phones are more hospitable to S. aureus for proliferation as they may contain more layers of dusts and sweats compared to the newer phones.
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