醫療院所水龍頭及大眾游泳池水中細菌之抗藥性及抗氯性採樣評估

Sampling Evaluation of Antibiotic and Chlorine-resistant Bacteria in Hospital Tap Water and Public Swimming Pool Water

余權真(Chuan-Chen Yu)

指導教授 ： 賴全裕

中山醫學大學/健康管理學院/公共衛生學系/碩士(2017年)

摘要

本研究於某醫療場所周遭之洗手台採集自來水及其管道生物膜（biofilm)，並與加氯前後不同時段之大眾游泳池池水與池壁生物膜比較，針對樣本中培養出的細菌進行微生物菌種鑑定及抗藥性分析，以瞭解自來水中細菌之種類及其抗藥型態。研究使用紙錠擴散(disk-diffusion)及肉湯稀釋(broth dilution)方法針對多重抗藥性細菌進行抗次氯酸鈉（sodium hypochlorite）水溶液試驗，並探討多重抗藥性細菌(multiple drug-resistant bacteria, MDRB)與抗氯性之間的關係。

研究結果顯示，自來水直接抹盤培養出的細菌總菌落數顯著低於自來水生物膜與泳池水(P<0.05)，總菌落數濃度平均值為1.2I102 CFU/mL及5.9I103 CFU/mL。自來水生物膜中革蘭氏陽性及陰性菌比例為64%、36%，分別以Brevibacterium species及Stenotrophomonas spp.為主要菌屬。泳池水在下午時段平均總菌落數高達2.4I104 CFU/mL，以Moraxella spp.為主要菌屬。針對藥敏性試驗之結果，採集到35株多重抗藥性細菌(MDRB)且大多從醫院水龍頭生物膜中蒐集(23/35)。對於多重抗藥性菌株進行抗氯測試，在紙錠擴散實驗中，11%標準次氯酸鈉溶液有30（86%）株細菌的抑制圈直徑 ≤ 20 mm，具有抗氯性。在次氯酸鈉溶液之肉湯稀釋測試後可以發現，有23株（66%）的MDRB判讀結果為R，顯示具有抗氯性。且8株對7種以上抗生素有抗性的MDRB在懸浮液測試後，判讀皆為R，顯示與紙錠擴散方法相似的結果。

綜合以上實驗數據，得知多重抗藥性細菌對自來水中加氯有抗性。另外，自來水生物膜如同細菌的溫床，在管線老舊的供水系統尤其嚴重，建議定期清潔水龍頭管壁內，減少生物膜的堆積。

關鍵字

多重抗藥性細菌 ； 生物膜 ； 抗氯性

並列摘要

This study collected tap water and tubing biofilm from sinks located in a hospital and compare with the pool water and wall biofilm. The pool samples were collected from various periods before and after adding chlorine in a public swimming pool. The research conducted microorganism identification and antimicrobial resistance analysis for the bacteria cultured from samples in tap water or pool. Disk-diffusion and broth dilution were used to carry out the chlorine-resistant test for multiple drug-resistant bacteria (MDRB), and to investigate the relationship between MDRB and sodium hypochlorite resistance.

Study result indicated that total bacterial concentration counts of the bacteria cultured by direct smear of tap water (DSTW) are significantly lower than biofilm in tap water (BFTW) and pool water from swimming pool(PWSP) (P<0.05) which average concentration for total bacterial counts was 1.2IE2 CFU/mL and 5.9IE3 CFU/mL. Ratio for G (+) and G (-) of BFTW is 64% over 36% with Brevibacterium species and Stenotrophomonas spp. as the dominate genus, respectively. Average total bacterial count in PWSP during the afternoon reached up to 2.4IE4 CFU/mL with Moraxella species as the dominate genus. As for result from antimicrobial susceptibility testing, 35 MDRBs were collected and mostly from BFTW (23/35). For MDRBs of sodium hypochlorite-resistant test, disk diffusion method, 11% sodium hypochlorite solution has 30 (86%) strains of bacteria inhibition circle diameter ≤ 20 mm, interpreted as chlorine resistance. After the broth dilution test, 23 (66%) MDRBs interpretation results were R, showing resistance to chlorine. Moreover, 8 MDRBs resistant to more than 7 antibiotics were tested in the broth dilution and were all R, showing similar results to the disk-diffusion method.

To conclude based on experimental data, it was found that MDRB had resistance to sodium hypochlorite aqueous. Furthermore, tap water biofilms were especially serious in water-supply systems with outmoded piping, regularly cleaning inside of faucet and piping is recommended to reduce piling up biofilms.

並列關鍵字

biofilm ； multiple drug-resistant bacteria ； sodium hypochlorite -resistant

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