Global Carriage of Antimicrobial Resistance Genes and Virulence Factors Among Physicians in Cirrhosis Care

Abstract Cirrhosis patients are at high risk for drug-resistant infections, which may be transmitted between patients and healthcare providers. In this study, we used shotgun metagenomics to characterize the fecal microbiome of physicians in cirrhosis care (n = 55) across 9 countries. Our results indicate physicians from low- or middle-income countries carry greater antimicrobial resistance gene (ARG) diversity corresponding to increased taxonomic richness. Physicians carried a low prevalence of clinically relevant ARGs or virulence factors (VFs), regardless of country of practice or patient exposure. Further comparison of fecal microbiomes between a subset of cirrhosis patients and physicians’ fecal samples collected from the same medical facility in the United States indicated that cirrhosis patients carried a far greater burden of high-risk VFs and ARGs. Collectively, this study provides evidence that most physicians in cirrhosis care are unlikely to be a primary reservoir of drug-resistant pathogens, although further surveillance of healthcare workers is warranted.