Carbapenem-resistant Enterobacteriaceae and endoscopy: An evolving threat

Background Several clusters of Carbapenem-resistant Enterobacteriaceae (CRE) infections associated with contaminated endoscopes have recently been reported. Interim guidelines for mitigating endoscope-associated transmission have been proposed, but there has not been a systematic appraisal of CRE pr...

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Bibliographic Details
Published in:American journal of infection control 2016-09, Vol.44 (9), p.1032-1036
Main Authors: O'Horo, John C., MD, MPH, Farrell, Ann, MLS, Sohail, M. Rizwan, MD, Safdar, Nasia, MD, PhD
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - pharmacology
Bacterial infections
beta-Lactam Resistance
carbapenem-resistant Enterobacteriaceae
Carbapenems - pharmacology
Contamination
CRE
Disease transmission
Disease Transmission, Infectious
duodenoscope
endoscopy
Endoscopy - adverse effects
Enterobacteriaceae - drug effects
Enterobacteriaceae - isolation & purification
Enterobacteriaceae Infections - epidemiology
Enterobacteriaceae Infections - microbiology
Enterobacteriaceae Infections - transmission
Epidemics
ERCP
Humans
Infection Control
Infectious Disease
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Summary:Background Several clusters of Carbapenem-resistant Enterobacteriaceae (CRE) infections associated with contaminated endoscopes have recently been reported. Interim guidelines for mitigating endoscope-associated transmission have been proposed, but there has not been a systematic appraisal of CRE prevention practices. Methods We conducted a systematic review of endoscope-associated CRE infection episodes, abstracting information on outbreak detection, mitigation, outcomes, and corrective steps taken to prevent recurrence. Results Seven distinct outbreaks were identified in the published literature, and 5 of these were associated with duodenal endoscopy, with the remaining 2 associated with cystoscopy and ureteroscopy. Several investigators noted difficulties in cleaning protocols surrounding difficult to access components, such as the elevator on duodenoscopes. The published investigations did not report any failures of sterilization. It is unclear if routine reprocessing was ineffective, or difficult to execute properly. Conclusions Meticulous cleaning protocols and increased surveillance are necessary to prevent and detect future outbreaks of CRE and to determine whether more stringent measures, such as sterilization, are needed for duodenoscopes.
ISSN:0196-6553
1527-3296
DOI:10.1016/j.ajic.2016.03.029