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首页> 外文期刊>Applied Microbiology >Risk Factors Associated with Carbapenemase-Producing Enterobacterales (CPE) Positivity in the Hospital Wastewater Environment
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Risk Factors Associated with Carbapenemase-Producing Enterobacterales (CPE) Positivity in the Hospital Wastewater Environment

机译：与碳碱酶活性的肠杆菌（CPE）阳性相关的危险因素在医院废水环境中

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Hospital wastewater is an increasingly recognized reservoir for resistant Gram-negative organisms. Factors involved in establishment and persistence of Klebsiella pneumoniae carbapenemase-producing organisms (KPCOs) in hospital wastewater plumbing are unclear. This study was conducted at a hospital with endemic KPCOs linked to wastewater reservoirs and robust patient perirectal screening for silent KPCO carriage. Over 5 months, both rooms occupied and rooms not occupied by KPCO-positive patients were sampled at three wastewater sites within each room (sink drain, sink P-trap, and toilet or hopper). Risk factors for KPCO positivity were assessed using logistic regression. Whole-genome sequencing (WGS) identified environmental seeding by KPCO-positive patients. A total of 219/475 (46%) room sampling events were KPCO positive in at least one wastewater site. KPCO-positive patient exposure was associated with increased risk of environmental positivity for the room and toilet/hopper. Previous positivity and intensive care unit room type were consistently associated with increased risk. Tube feeds were associated with increased risk for the drain, while exposure to patients with Clostridioides difficile was associated with decreased risk. Urinary catheter exposure was associated with increased risk of P-trap positivity. P-trap heaters reduced risk of P-trap and sink drain positivity. WGS identified genomically linked environmental seeding in 6 of 99 room occupations by 40 KPCO-positive patients. In conclusion, KPCO-positive patients seed the environment in at least 6% of opportunities; once positive for KPCOs, wastewater sites are at greater risk of being positive subsequently. Increased nutrient exposure, e.g., due to tube food disposal down sinks, may increase risk; frequent flushing may be protective.IMPORTANCE Klebsiella pneumoniae carbapenemase-producing organisms (KPCOs) are bacteria that are resistant to most antibiotics and thus are challenging to treat when they cause infections in patients. These organisms can be acquired by patients who are hospitalized for other reasons, complicating their hospital stay and even leading to death. Hospital wastewater sites, such as sink drains and toilets, have played a role in many reported outbreaks over the past decade. The significance of our research is in identifying risk factors for environmental positivity for KPCOs, which will facilitate further work to prevent transmission of these organisms to patients from the hospital environment.
机译：医院废水是一种越来越识别的抗革兰阴性生物的储层。在医院废水管道中涉及肺癌肺炎肺癌肺活结碳酸盐酶生物（KPCOS）的成立和持续存在的因素尚不清楚。本研究在具有特有的KPCOS的医院进行，与废水储层和静音KPCO托运有稳健的患者北方展示。超过5个月，在每个房间的三个废水场所（水槽排水管，水槽P-Trap和厕所或料斗）上，占用的房间占据了3个占用的房间和未被KPCO阳性患者占用的房间。使用Logistic回归评估KPCO积极性的危险因素。全基因组测序（WGS）通过KPCO阳性患者鉴定了环境播种。共有219/475（46％）房间采样事件在至少一个废水场所是KPCO阳性。 KPCO阳性患者暴露与房间和厕所/料斗环境阳性的风险增加有关。以前的积​​极性和重症监护室房型始终与风险增加有关。管饲料与流失的风险增加有关，同时暴露于梭氏梭菌差异的患者与风险降低有关。尿导管暴露与p-trap积极性的风险增加有关。 P-Trap加热器降低了p-trap和水槽漏极积极性的风险。 WGs在99个室职业中鉴定了统计组织的环境播种，得到40 kpco阳性患者。总之，KPCO阳性患者将环境占据了至少6％的机会;一旦KPCOS阳性，随后阳性的污水网站处于阳性的风险。增加营养暴露，例如，由于管食物处理下沉，可能会增加风险;频繁冲洗可能是保护性的。重量分析克雷布氏菌肺活结的碳结素酶产生的生物（KPCO）是对大多数抗生素的细菌，因此在患者引起感染时挑战治疗。这些生物可以被其他因素住院的患者获得，使他们的住院保持持续并导致死亡。水槽和厕所等医院的废水场地在过去十年中在许多报告的爆发中发挥了作用。我们的研究的重要性是识别KPCO的环境积极性的危险因素，这将有助于进一步的工作，以防止这些生物传播来自医院环境的患者。

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