Department of Microbiology, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium.
Department of Intensive Care, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium.
J Hosp Infect. 2019 May;102(1):82-88. doi: 10.1016/j.jhin.2018.12.009. Epub 2018 Dec 21.
Carbapenemase-producing Enterobacteriaceae (CPE) are emerging pathogens representing a major concern for public health. In Belgium, the OXA-48 carbapenemase resistance gene is identified most frequently. Sink drains in intensive care units (ICUs) are known to be colonized by Gram-negative bacilli. A correlation between environmental contamination and CPE infections in ICUs has been established. A long-term CPE epidemic in a local ICU proved difficult to control.
A variety of CPE strains, all carrying the OXA-48 resistance gene, were isolated from almost all sinks in patient rooms in the ICU. Decontamination of the sinks with 250 mL 25% acetic acid three times weekly was implemented. Sink drain colonization was followed up for six months thereafter. Both the number of CPE-colonized sinks and the number of patients colonized or infected with CPE decreased drastically, to the extent that the epidemic was considered to be eradicated. In-vitro growth of all isolates was inhibited by a concentration of acetic acid equal to or smaller than that used for decontamination. Epidemiological analysis demonstrated a positive and significant relationship between contaminated sinks and CPE acquisition of patients admitted to ICU rooms, indicating the importance of contaminated sinks as the environmental reservoir of the epidemic.
Decontamination of sink drains with acetic acid is a valuable alternative to other methods, such as heated sinks and water-free care, especially when other options are not feasible in the short term. Acetic acid is cheap, widely available, effective and manageable from a safety and technical point of view.
产碳青霉烯酶肠杆菌科（CPE）是新兴的病原体，对公共卫生构成重大威胁。在比利时，最常发现的是 OXA-48 碳青霉烯酶耐药基因。重症监护病房（ICU）的水槽排水口已知会被革兰氏阴性杆菌定植。环境污染与 ICU 中的 CPE 感染之间存在相关性。当地 ICU 中 CPE 的长期流行难以控制。
从 ICU 病房中几乎所有患者房间水槽中分离出了多种携带 OXA-48 耐药基因的 CPE 菌株。每周三次用 250 毫升 25%的醋酸对水槽进行消毒。此后，对水槽排水口进行了六个月的定植情况监测。CPE 定植的水槽数量和 CPE 定植或感染的患者数量均急剧减少，以至于该流行被认为已被根除。所有分离株的体外生长均被等于或小于用于消毒的醋酸浓度所抑制。流行病学分析表明，污染的水槽与 ICU 病房患者获得 CPE 之间存在正相关且具有统计学意义，这表明污染水槽是该流行的环境储库的重要性。
用醋酸消毒水槽排水口是替代其他方法（如加热水槽和无水护理）的有效方法，尤其是在短期内无法采用其他方法时。醋酸价格低廉、广泛可用、有效且从安全和技术角度来看易于管理。
