The sink as a potential source of transmission of carbapenemase-producing Enterobacteriaceae in the intensive care unit.
The sink as a potential source of transmission of carbapenemase-producing Enterobacteriaceae in the intensive care unit.
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DOI：
10.1186/s13756-017-0182-3
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发表时间：
2017
影响因子：
5.5
通讯作者：
Wybo I
中科院分区：
文献类型：
--
作者：
De Geyter D;Blommaert L;Verbraeken N;Sevenois M;Huyghens L;Martini H;Covens L;Piérard D;Wybo I
产碳青霉烯酶肠杆菌科（CPE）是一种新兴的病原体，代表了一个主要的公共卫生威胁。在布鲁塞尔大学医院，CPE新发患者的发病率从2010年的1例上升到2015年的35例。2015年1月至8月期间，5名患者在重症监护室（ICU）的同一房间内感染/定植CPE。由于这些患者之间的时间相对较短，菌株属于不同的物种，具有不同的细菌谱和耐药机制，因此假设环境可能是传播来源。环境样本表明，受污染的水槽是爆发的源头。除其他菌株外，弗氏柠檬酸杆菌OXA-48型也经常从患者和水槽中分离出来。为了研究这些菌株之间的系统发育关系，进行了脉冲场凝胶电泳。从患者和受牵连房间的水槽中分离的菌株高度相关，并指向水槽到患者的传播。在ICU隔离室的8个水槽中，共有7个被发现受到CPE污染。为了控制疫情，水槽及其管道被具有另一种结构的新水槽及其管道所取代，每天早上用葡萄糖蛋白溶液冲洗水槽，并改进了水槽实践的常规，从而停止了疫情的爆发。这次爆发突出表明，医院水槽排水沟可以积累具有耐药基因的菌株，并成为CPE的潜在来源。
Carbapenemase-producing Enterobacteriaceae (CPE) are emerging pathogens that represent a major public health threat. In the University Hospital of Brussels, the incidence of new patients with CPE rose from 1 case in 2010 to 35 cases in 2015. Between January and August 2015, five patients became infected/colonized with CPE during their stay in the same room in the intensive care unit (ICU). Since the time period between those patients was relatively short and the strains belonged to different species with different antibiograms and mechanisms of resistance, the hypothesis was that the environment could be a possible source of transmission. Environmental samples suggested that a contaminated sink was the source of the outbreak. Besides other strains, Citrobacter freundii type OXA-48 was frequently isolated from patients and sinks. To investigate the phylogenetic relationschip between those strains, pulsed-field gel electrophoresis was performed. The strains isolated from patients and the sink in the implicated room were highly related and pointed to sink-to-patient transmission. In total, 7 of 8 sinks in the isolation rooms of the ICU were found to be CPE contaminated. To control the outbreak, the sinks and their plumbings were replaced by new ones with another structure, they were flushed every morning with a glucoprotamin solution and routines regarding sink practices were improved leading to discontinuation of the outbreak. This outbreak highlights that hospital sink drains can accumulate strains with resistance genes and become a potential source of CPE.