Abstract
Antimicrobial resistant pathogens and associated infections represent major public health threats affecting healthcare facilities, with sink drain biofilms serving as reservoirs for many of these bacteria. Despite attempts at sink drain biofilm disinfection and removal, drain biofilms inevitably regrow, and disinfection may shape the returning microbial communities and their resistance profiles. We applied culture-based and metagenomic approaches to study these drain disinfection effects on microbial community abundance, taxonomy, and antimicrobial resistance in operational hospital sinks. Drain biofilms regrew to baseline densities in approximately four days. Regrown biofilms contained more viable carbapenem-resistant bacteria and were dominated by Pseudomonadota, including Cupriavidus and Pseudomonas. Long-read sequencing revealed an increase in multidrug efflux pump genes after disinfection, which confer broad resistance to antibiotics and disinfectants. This work provides mechanistic insights into how disinfection influences sink drain biofilm ecology and the enrichment of antimicrobial resistance, with implications for infection prevention strategies in healthcare environments.
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Acknowledgements
We thank the YNHH nursing staff and patients on the study floor for accommodating our sampling campaign. We are grateful to the HIPSTER consortia, especially helpful discussions with and support from Lucien Dieter, Trini Mathew, Jamie Trumpler, David Peaper, and Windy Tanner.
Funding
This publication was supported by the Centers for Disease Control and Prevention (CDC) of the US Department of Health and Human Services (HHS) as part of a financial assistance award totaling $3,014,045.50 with 100% funded by the CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by the CDC/HHS or the US Government. Research reported in this publication was also supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number 1S10OD030363-01A1. The Yale Center for Genome Analysis and Keck Microarray Shared Resource at Yale University provided the PacBio sequencing services and is funded in part by the National Institutes of Health instrument grant 1S10OD028669-01. This work was also supported by the Yale Institute for Biospheric Studies Gaylord Donnelley Postdoctoral Environmental Fellowship (H.G.H.). and the National Library of Medicine (NLM) training grant T15LM [T15LM007056], which supports the Biomedical Informatics and Data Science training program at Yale University (K.R.B.).
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Bowie, K.R., Luhung, I., Burke, T.R. et al. Disinfection of hospital sink drains enriches pseudomonadota and efflux pump-mediated antibiotic resistance in reestablished biofilms. Nat Commun (2026). https://doi.org/10.1038/s41467-026-73533-y
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DOI: https://doi.org/10.1038/s41467-026-73533-y
