Walker J T, Bradshaw D J, Finney M, Fulford M R, Frandsen E, ØStergaard E, Ten Cate J M, Moorer W R, Schel A J, Mavridou A, Kamma J J, Mandilara G, Stösser L, Kneist S, Araujo R, Contreras N, Goroncy-Bermes P, O'Mullane D, Burke F, Forde A, O'Sullivan M, Marsh P D
Health Protection Agency, Porton Down, Salisbury, UK.
Eur J Oral Sci. 2004 Oct;112(5):412-8. doi: 10.1111/j.1600-0722.2004.00151.x.
A range of opportunistic pathogens have been associated with dental unit water systems (DUWS), particularly in the biofilms that can line the tubing. This study therefore aimed to assess the microbiology of DUWS and biofilms in general dental practices across seven European countries, including the United Kingdom (UK), Ireland (IRL), Greece (GR), Spain (ES), Germany (D), Denmark (DK) and the Netherlands (NL). Water supplied by 51% of 237 dental unit water lines exceeded current American Dental Association recommendations of < or = 200 colony-forming units (CFU) ml(-1). Microbiological loading of the source waters was between 0 (Denmark, the Netherlands and Spain) and 4.67 (IRL) log CFU ml(-1); water line samples from the DUWS ranged from 1.52 (ES) to 2.79 (GR) log CFU ml(-1); and biofilm counts ranged from 1.49 (GR) to 3.22 (DK) log CFU.cm(-2). Opportunistic pathogens such as legionellae (DK and ES), including Legionella pneumophila SG1 (DK and GR), and Mycobacterium spp. (DK, NL, GR, D and ES) were recovered occasionally. Presumptive oral streptococci (ES and NL), oral anaerobes (GR), Candida spp. (UK, NL and ES) and blood (GR and IRL) were detected at relatively low frequencies, but their presence indicated a failure of the 3-in-1 antiretraction valve, leading to back siphonage of oral fluids into the water and biofilm phase. These findings confirm that a substantial proportion of DUWS have high levels of microbial contamination, irrespective of country, type of equipment and source water. The study emphasizes the need for effective mechanisms to reduce the microbial burden within DUWS, and highlights the risk of occupational exposure and cross-infection in general dental practice.
一系列机会性病原体与牙科设备水系统（DUWS）有关，尤其是在可能附着于管道内壁的生物膜中。因此，本研究旨在评估包括英国（UK）、爱尔兰（IRL）、希腊（GR）、西班牙（ES）、德国（D）、丹麦（DK）和荷兰（NL）在内的七个欧洲国家普通牙科诊所中DUWS和生物膜的微生物情况。237条牙科设备水线中有51%所供应的水超过了美国牙科协会目前推荐的≤200菌落形成单位（CFU）/毫升的标准。原水的微生物负荷在0（丹麦、荷兰和西班牙）至4.67（爱尔兰）log CFU/毫升之间；DUWS水线样本的范围为1.52（西班牙）至2.79（希腊）log CFU/毫升；生物膜计数范围为1.49（希腊）至3.22（丹麦）log CFU/平方厘米。偶尔会检测到诸如军团菌（丹麦和西班牙）等机会性病原体，包括嗜肺军团菌1型菌株（丹麦和希腊），以及分枝杆菌属（丹麦、荷兰、希腊、德国和西班牙）。推定的口腔链球菌（西班牙和荷兰）、口腔厌氧菌（希腊）、念珠菌属（英国、荷兰和西班牙）以及血液（希腊和爱尔兰）的检出频率相对较低，但它们的存在表明三合一防回流阀出现故障，导致口腔液体倒吸进入水和生物膜阶段。这些发现证实，无论国家、设备类型和原水如何，很大一部分DUWS都存在高水平的微生物污染。该研究强调需要有有效的机制来减少DUWS中的微生物负荷，并突出了普通牙科诊所中职业暴露和交叉感染的风险。
