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.

中文翻译：

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与医院废水环境中产碳青霉烯酶肠杆菌 (CPE) 阳性相关的危险因素。

医院废水是越来越多的公认的耐药革兰氏阴性微生物的储存库。肺炎克雷伯菌的建立和持续存在的相关因素医院废水管道中产生碳青霉烯酶的微生物 (KPCO) 尚不清楚。这项研究是在一家医院进行的，该医院的地方性 KPCO 与废水水库相关联，并对无声 KPCO 携带的患者进行了强有力的直肠周围筛查。在 5 个月内，在每个房间内的三个废水站点（水槽排水管、水槽 P-trap 和厕所或料斗）对 KPCO 阳性患者占用的房间和未占用的房间进行采样。使用逻辑回归评估 KPCO 阳性的危险因素。全基因组测序 (WGS) 确定了 KPCO 阳性患者的环境播种。在至少一个污水处理场中，总共有 219/475 (46%) 个房间采样事件是 KPCO 阳性。KPCO 阳性患者暴露与房间和厕所/漏斗的环境阳性风险增加有关。既往阳性和重症监护病房房间类型始终与风险增加相关。管饲与引流风险增加有关，而暴露于患有艰难梭菌与风险降低有关。导尿管暴露与 P-trap 阳性风险增加有关。P-trap 加热器降低了 P-trap 和水槽排水阳性的风险。WGS 在 40 名 KPCO 阳性患者的 99 个房间占用中的 6 个中确定了与基因组相关的环境播种。总之，KPCO 阳性患者在至少 6% 的机会中播种环境；一旦 KPCO 呈阳性，废水处理场随后出现阳性的风险就更大。增加的营养暴露，例如，由于管道食物在水槽中的处理，可能会增加风险；频繁冲洗可能具有保护作用。