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Microplastics enhance the risk of cross-genus dissemination of carbapenemase resistance plasmids in ICU patients
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Researchers demonstrated that hospital-derived microplastics significantly increase the conjugation rate of carbapenemase resistance plasmids between drug-resistant bacteria by stimulating biofilm formation, with the effect amplified more than 3.9-fold under conditions simulating diabetic patient urine — identifying medical plastics as a potential environmental driver of untreatable ICU infections.
Background The emergence of carbapenem-resistant Enterobacterales (CRE) in intensive care units (ICUs) poses a critical global health threat. Environmental factors within hospitals, including microplastic (MP) pollution derived from degraded medical plastics, are potential yet underexplored contributors to the dissemination of antibiotic resistance. This study aimed to investigate whether MPs can accelerate the horizontal transfer of clinically relevant carbapenemase plasmids among CRE pathogens prevalent in ICUs. Methods Representative CRE isolates and epidemic carbapenemase-producing plasmids were co-incubated with environmentally relevant concentrations of characterized MPs. Conjugation frequencies were quantified under simulated ICU conditions, including standard and hyperglycemic media. The influence of MPs on recipient biofilm formation—a key facilitator for genetic exchange—was assessed using crystal violet assays and confocal microscopy. Plastic-free conditions were set as controls. Results MPs significantly enhanced the conjugation rates of carbapenemase plasmids between CRE strains ( p < 0.001). Importantly, the elevated conjugation efficiencies were correlated with potent MP-induced stimulation of biofilm formation in recipient bacteria. Additionally, MPs synergized with the simulated diabetic ICU urine environment, increasing plasmid transfer efficiency by more than 3.96-fold. MPs acted as abiotic surfaces that promoted bacterial aggregation and plasmid exchange. Conclusion Our findings reveal that medical plastic-derived MPs serve as novel environmental catalysts for the rapid dissemination of carbapenem resistance within ICUs. By significantly enhancing biofilm-associated plasmid conjugation—especially in the context of patient comorbidity (hyperglycemia)—MPs constitute an emerging environmental driver that exacerbates the spread of untreatable CRE infections, highlighting the need for urgent mitigation strategies.
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