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Irene Soffritti,1,2 Maria D’Accolti,1,2 Carolina Cason,3 Luca Lanzoni,2 Matteo Bisi,2 Antonella Volta,2 Giuseppina Campisciano,3 Sante Mazzacane,2 Francesca Bini,1,2 Eleonora Mazziga,1 Paola Toscani,4 Elisabetta Caselli,1,2,* Manola Comar3,5,* 1Section of Microbiology, Department of Chemical, Pharmaceutical and Agricultural Sciences, and LTTA, University of Ferrara, Ferrara, 44121, Italy; 2CIAS Research Center, University of Ferrara, Ferrara, 44122, Italy; 3Department of Advanced Translational Microbiology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, Trieste, 34137, Italy; 4Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, Trieste, 34137, Italy; 5Department of Medical Sciences, University of Trieste, Trieste, 34149, Italy*These authors contributed equally to this workCorrespondence: Elisabetta Caselli, Section of Microbiology, Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, via Luigi Borsari 46, Ferrara, 44121, Italy, Tel +39 0532 455387, Fax +39 0532 974470, Email csb@unife.itBackground: Antimicrobial resistance (AMR) represents a major threat to public health, especially in the hospital environment, and the massive use of disinfectants to prevent COVID-19 transmission might intensify this risk, possibly leading to future AMR pandemics. However, the control of microbial contamination is crucial in hospitals, since hospital microbiomes can cause healthcare-associated infections (HAIs), which are particularly frequent and severe in pediatric wards due to children having high susceptibility.Aim: We have previously reported that probiotic-based sanitation (PCHS) could stably decrease pathogens and their AMR in the hospital environment, reduce associated HAIs in adult hospitals, and inactivate enveloped viruses. Here, we aimed to test the effect of PCHS in the emergency room (ER) of a children’s hospital during the COVID-19 pandemic.Methods: Conventional chemic

Elisabetta Caselli,1,2 Luca Arnoldo,3 Carla Rognoni,4 Maria D’Accolti,1,2 Irene Soffritti,1,2 Luca Lanzoni,2 Matteo Bisi,2 Antonella Volta,2 Rosanna Tarricone,4 Silvio Brusaferro,3 Sante Mazzacane2 1Section of Microbiology and Medical Genetics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy; 2CIAS Research Interdepartmental Centre, Departments of Architecture and Medical Sciences, University of Ferrara, Ferrara, Italy; 3Department of Medicine, University of Udine, Udine, Italy; 4Centre for Research on Health and Social Care Management (CERGAS), Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy Purpose: Antimicrobial resistance (AMR) is one of the major threats to human health, and the high frequency of resistant pathogens in the hospital environment can contribute to the transmission of difficult-to-treat health care-associated infections (HAIs). We recently reported that, compared with conventional chemical cleaning, the use of a microbial-based sanitation strategy (Probiotic Cleaning Hygiene System [PCHS]) was associated with remodulation of hospital microbiota and reduction of HAI incidence. Here, we aimed to analyze the impact of PCHS on AMR and related effects, such as HAI-associated antimicrobial drug consumption and costs. Patients and methods: Five Italian hospitals, enrolled in a multicenter study where conventional sanitation methods were replaced with PCHS, were included in the analysis. The study period included a 6-month observation for each sanitation type. Surface microbiota AMR was analyzed using microarray, nested PCR, antibiogram, and microdilution tests. Drug consumption data and related costs were obtained from the medical records of all hospitalized patients affected by HAIs. Results: PCHS use was associated with up to 99% decrease of the AMR genes harbored by surface hospital microbiota, independently of the resistance types originally present in each individual setting (Pc&am