关键词: carbapenem-resistant carbapenemase healthcare-associated infections outbreak water.

Mesh : Anti-Bacterial Agents / therapeutic use Bacterial Proteins / biosynthesis Carbapenem-Resistant Enterobacteriaceae / drug effects enzymology genetics Carbapenems / pharmacology Cross Infection / epidemiology microbiology Disease Outbreaks / prevention & control Disease Reservoirs / microbiology Disinfection Drug Resistance, Bacterial Electrophoresis, Gel, Pulsed-Field Equipment and Supplies, Hospital / microbiology Hospitals Humans Klebsiella Infections / drug therapy epidemiology microbiology Klebsiella pneumoniae / drug effects enzymology genetics Microbial Sensitivity Tests Molecular Typing Pseudomonas Infections / drug therapy epidemiology microbiology Pseudomonas aeruginosa / drug effects enzymology genetics Water Microbiology Water Supply beta-Lactamases / biosynthesis

来  源:   DOI:10.1093/cid/cix132

Abstract:
Over the last 20 years there have been 32 reports of carbapenem-resistant organisms in the hospital water environment, with half of these occurring since 2010. The majority of these reports have described associated clinical outbreaks in the intensive care setting, affecting the critically ill and the immunocompromised. Drains, sinks, and faucets were most frequently colonized, and Pseudomonas aeruginosa the predominant organism. Imipenemase (IMP), Klebsiella pneumoniae carbapenemase (KPC), and Verona integron-encoded metallo-β-lactamase (VIM) were the most common carbapenemases found. Molecular typing was performed in almost all studies, with pulse field gel electrophoresis being most commonly used. Seventy-two percent of studies reported controlling outbreaks, of which just more than one-third eliminated the organism from the water environment. A combination of interventions seems to be most successful, including reinforcement of general infection control measures, alongside chemical disinfection. The most appropriate disinfection method remains unclear, however, and it is likely that replacement of colonized water reservoirs may be required for long-term clearance.
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