Abstract：
In Pakistan, antimicrobial resistance (AMR) is expected to greatly increase the already high mortality and morbidity rates attributed to infections, making AMR surveillance and prevention a priority in the country. The aims of the project were to characterize the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in healthcare facility sink drains in Pakistan and to characterize how physical characteristics of sinks and healthcare facility rooms were associated with CRE in those sinks. The study took place in 40 healthcare facilities in Jamshoro Pakistan. Swabs were collected from sink drains in each facility that had a sink, and structured observations of sinks and facilities were performed at each facility. Swabs were plated on CHROMagar KPC to screen for carbapenem-resistant Enterobacteriaceae, which were then isolated on Mueller-Hinton agar plates. Antibiotic susceptibility was determined using the disk diffusion method to assess resistance to carbapenems, cephalosporins, and fluoroquinolones. Thirty-seven of the healthcare facilities had at least one sink, and thirty-nine total sinks were present and sampled from those healthcare facilities. Sinks in these facilities varied in quality; at the time of sampling 68% had water available, 51% had soap/alcohol cleanser at the sink, 28% appeared clean, and 64% drained completely. Twenty-five (64%) of the sink samples grew Enterobacteriaceae on CHROMagar KPC, sixteen (41%) of which were clinically non-susceptible to ertapenem. Seven of the 39 sampled sinks (18%) produced Enterobacteriaceae that were resistant to all three antibiotic classes tested. Several facilities and sink characteristics were associated with CRE. Sinks and drains can serve as undetected reservoirs for carbapenem-resistant Enterobacteriaceae. Control and remediation of such environments will require both systemic strategies and physical improvements to clinical environments.
摘要：
在巴基斯坦,抗菌素耐药性（AMR）预计将大大增加已经很高的死亡率和发病率归因于感染，将AMR监测和预防作为国家的优先事项。该项目的目的是描述巴基斯坦医疗机构水槽排水沟中耐碳青霉烯类肠杆菌科（CRE）的流行情况，并描述水槽和医疗机构房间的物理特性与这些水槽中的CRE的关联。该研究在巴基斯坦Jamshoro的40个医疗机构中进行。从每个有水槽的设施的水槽排水管中收集拭子，并对每个设施的汇和设施进行了结构化观察。将拭子铺在CHROMagarKPC上，以筛选耐碳青霉烯的肠杆菌科细菌，然后在Mueller-Hinton琼脂平板上分离。使用圆盘扩散法测定抗生素敏感性，以评估对碳青霉烯类抗生素的耐药性。头孢菌素,和氟喹诺酮类药物.37个医疗机构至少有一个水槽，总共有39个水槽，并从这些医疗保健设施中取样。这些设施中的水槽质量各不相同；在取样时，68%的水可用，51%的人在水槽里有肥皂/酒精清洁剂，28%的人看起来很干净，64%的人完全排干了。25个（64％）的水槽样本在CHROMagarKPC上生长肠杆菌科，其中16例（41%）临床上对厄他培南不敏感。在39个采样的水槽中，有7个（18％）产生了肠杆菌科，对所测试的所有三种抗生素都具有抗性。一些设施和水槽特征与CRE相关。水槽和排水沟可以作为耐碳青霉烯的肠杆菌科细菌的未发现的储层。这种环境的控制和补救将需要对临床环境的系统策略和物理改进。
