Department of Infection Prevention and Control, Tokyo Medical University Hospital, Tokyo, Japan.
Department of Microbiology and Infectious Diseases, Faculty of Medicine, Toho University, Tokyo, Japan.
J Hosp Infect. 2021 Dec;118:1-6. doi: 10.1016/j.jhin.2021.08.013. Epub 2021 Aug 24.
Although sink- and drain-related carbapenemase-producing Enterobacterales transmission has been reported previously, there is limited research regarding the transmission of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales.
To investigate nosocomial ESBL-producing Klebsiella pneumoniae transmission via patient sinks and drains on a general surgical hospital ward.
ESBL-producing K. pneumoniae transmission on a surgical ward at Tokyo Medical University Hospital (built in July 2019) from July 2019 to February 2020 was investigated. Information regarding the relatedness of the isolates from the patients and the environment was provided by whole-genome sequence analysis.
Four clinical isolates of K. pneumoniae (TUM19831, TUM19832, TUM19833 and TUM19834) were detected during the study. TUM19831 was identified prior to moving to the new building and was detected again in the new building. TUM19832 and TUM19833 were detected in July 2019, and TUM19834 was detected in December 2019. TUM19835 and TUM19836 were detected in two different sinks and drains in July 2019, while a further two sinks and drains tested positive for TUM19837 and TUM19838 in February 2020. Whole-genome analysis revealed that all strains were ST307 and CTXM15 sequence types, and the isolates were indistinguishable by genetic analysis. Due to inadequate removal of the slime biofilm coating, the sinks needed to be cleaned again before TUM19837 and TUM19838 could be detected.
This study demonstrated the transmission of indistinguishable ESBL-producing K. pneumoniae strains from sinks and drains in the patient area of a general surgical hospital ward. There is a need to recognize this risk and develop optimal management strategies for plumbing systems in hospitals and other healthcare settings.
虽然已有关于产碳青霉烯酶肠杆菌科的水槽和排水相关传播的报道，但对于产超广谱β-内酰胺酶（ESBL）的肠杆菌科的传播，相关研究有限。
调查东京医科大学医院（2019 年 7 月建成）普通外科病房患者水槽和排水系统中产 ESBL 的肺炎克雷伯菌的传播情况。
对 2019 年 7 月至 2020 年 2 月期间该医院普通外科病房产 ESBL 的肺炎克雷伯菌的传播情况进行了调查。通过全基因组序列分析提供了患者和环境中分离株的相关性信息。
研究期间共检测到 4 株肺炎克雷伯菌（TUM19831、TUM19832、TUM19833 和 TUM19834）临床分离株。TUM19831 在搬入新楼前被鉴定出来，随后在新楼中再次被检测到。TUM19832 和 TUM19833 于 2019 年 7 月被检测到，TUM19834 于 2019 年 12 月被检测到。2019 年 7 月，TUM19835 和 TUM19836 在两个不同的水槽和排水中被检测到，而 2020 年 2 月，另外两个水槽和排水中又检测到 TUM19837 和 TUM19838。全基因组分析显示，所有菌株均为 ST307 和 CTXM15 序列类型，通过遗传分析，这些分离株无法区分。由于粘液生物膜涂层的去除不充分，在检测到 TUM19837 和 TUM19838 之前，水槽需要再次清洗。
本研究表明，普通外科病房患者区水槽和排水中的产 ESBL 的肺炎克雷伯菌菌株可以进行不可区分的传播。有必要认识到这种风险，并为医院和其他医疗机构的管道系统制定最佳管理策略。
