Duodenoscope-associated infections: a review

Bălan, Gheorghe G.; Sfarti, Cătălin; Chiriac, Ştefan; Stanciu, C; Trifan, Anca

doi:10.1007/s10096-019-03671-3

Cited by 41 publications

(44 citation statements)

References 67 publications

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“…It is widely known that biofilm formation contributes not only to the viability and pathogenicity of bacteria in infected hosts, but also to the ability of bacteria to survive in poor environments such as those depleted of nutrient sources (Tolker-Nielsen, 2015). Further, there are many cases in which nosocomial infections are caused as a result of bacteria contaminating medical devices and forming biofilms (Donlan, 2001;Ribeiro et al, 2012;McConoughey et al, 2014;Balan et al, 2019). Thus, it is considered that the formation of bacterial biofilms is deeply involved in the adaptation to environmental changes and the exertion of pathogenicity.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, research on bacterial biofilms has been widely developed in various fields. Numerous studies have reported that bacterial biofilms attached to improperly stored medical devices can promote nosocomial infections in medical practice (Donlan, 2001;Ribeiro et al, 2012;McConoughey et al, 2014;Balan et al, 2019). With respect to Aeromonas, several reports have shown that some Aeromonas strains form biofilms on medical devices by strongly adhering to non-living surfaces such as plastic materials, leading to infectious disease in patients (Andreoli-Pinto and Graziano, 1999;Tang et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

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Outer Membrane Vesicles Released From Aeromonas Strains Are Involved in the Biofilm Formation

et al. 2021

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Aeromonas spp. are Gram-negative rod-shaped bacteria ubiquitously distributed in diverse water sources. Several Aeromonas spp. are known as human and fish pathogens. Recently, attention has been focused on the relationship between bacterial biofilm formation and pathogenicity or drug resistance. However, there have been few reports on biofilm formation by Aeromonas. This study is the first to examine the in vitro formation and components of the biofilm of several Aeromonas clinical and environmental strains. A biofilm formation assay using 1% crystal violet on a polystyrene plate revealed that most Aeromonas strains used in this study formed biofilms but one strain did not. Analysis of the basic components contained in the biofilms formed by Aeromonas strains confirmed that they contained polysaccharides containing GlcNAc, extracellular nucleic acids, and proteins, as previously reported for the biofilms of other bacterial species. Among these components, we focused on several proteins fractionated by SDS-PAGE and determined their amino acid sequences. The results showed that some proteins existing in the Aeromonas biofilms have amino acid sequences homologous to functional proteins present in the outer membrane of Gram-negative bacteria. This result suggests that outer membrane components may affect the biofilm formation of Aeromonas strains. It is known that Gram-negative bacteria often release extracellular membrane vesicles from the outer membrane, so we think that the outer membrane-derived proteins found in the Aeromonas biofilms may be derived from such membrane vesicles. To examine this idea, we next investigated the ability of Aeromonas strains to form outer membrane vesicles (OMVs). Electron microscopic analysis revealed that most Aeromonas strains released OMVs outside the cells. Finally, we purified OMVs from several Aeromonas strains and examined their effect on the biofilm formation. We found that the addition of OMVs dose-dependently promoted biofilm formation, except for one strain that did not form biofilms. These results suggest that the OMVs released from the bacterial cells are closely related to the biofilm formation of Aeromonas strains.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outer Membrane Vesicles Released From Aeromonas Strains Are Involved in the Biofilm Formation

et al. 2021

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“…While many new devices are being developed to attempt to address the shortfalls of conventional endoscopy (Table 1), COVID-19 has further highlighted the need for innovation in the field of flexible endoscopy. One such improvement is the use of disposable endoscopes that have already gained popularity due to concerns around duodenoscope related infection and infected biofilm in endoscope channels (Rauwers et al, 2018;Balan et al, 2019). There is also a considerable argument for a single use endoscope in reducing the running costs of departments by preventing the need for costly decontamination facilities and supplies (Larsen et al, 2020).…”

Section: Potential For Innovationmentioning

confidence: 99%

“…Despite concerns around patient exposure to the virus due to contaminated endoscopes, evidence suggests that reprocessing agents with viricidal activity will remove the SARS-CoV-2 virus (Kampf et al, 2020;Rai, 2020). In the past, certain bacteria were not successfully removed from duodenoscopes (Rauwers et al, 2018;Balan et al, 2019), starting a push for disposable endoscopes. There is some evidence of bronchoscope contamination (Ofstead et al, 2020), and therefore single-use endoscopes are considered safer, with potential cost savings in the long run from not having large-scale cleaning facilities on premises.…”

Section: No Available Clinical Studiesmentioning

confidence: 99%

Guidelines for Robotic Flexible Endoscopy at the Time of COVID-19

et al. 2021

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Flexible endoscopy involves the insertion of a long narrow flexible tube into the body for diagnostic and therapeutic procedures. In the gastrointestinal (GI) tract, flexible endoscopy plays a major role in cancer screening, surveillance, and treatment programs. As a result of gas insufflation during the procedure, both upper and lower GI endoscopy procedures have been classified as aerosol generating by the guidelines issued by the respective societies during the COVID-19 pandemic—although no quantifiable data on aerosol generation currently exists. Due to the risk of COVID-19 transmission to healthcare workers, most societies halted non-emergency and diagnostic procedures during the lockdown. The long-term implications of stoppage in cancer diagnoses and treatment is predicted to lead to a large increase in preventable deaths. Robotics may play a major role in this field by allowing healthcare operators to control the flexible endoscope from a safe distance and pave a path for protecting healthcare workers through minimizing the risk of virus transmission without reducing diagnostic and therapeutic capacities. This review focuses on the needs and challenges associated with the design of robotic flexible endoscopes for use during a pandemic. The authors propose that a few minor changes to existing platforms or considerations for platforms in development could lead to significant benefits for use during infection control scenarios.

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“…Gastrointestinal (GI) endoscopy procedures are performed each year worldwide. Gastroenterologists and surgeons use flexible endoscopes for providing minimally invasive diagnostic, therapeutic, and palliative care, and the overall low rates of associated adverse events have offered such procedures optimal risk-benefit ratio [1]. The duodenoscope, a complex endoscopic instrument, is frequently utilized to accomplish the increasing demand for minimally invasive treatments of pancreatic and biliary diseases.…”

Section: Introductionmentioning

confidence: 99%

Does double high-level disinfection for duodenoscopes add any value? A mini-systematic review and meta-analysis

Elbahr

Saleh

Aziz

et al. 2020

Egypt Liver Journal

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Background: Duodenoscope-emerging infection especially drug-resistant bacteria is considered a major concern nowadays. Different approaches were attempted to overcome this problem, like double high-level disinfection procedure. We performed a systematic review and meta-analysis to evaluate risk difference for positive cultures from duodenoscopes between double high-level disinfection (dHLD) and single (standard) high-level disinfection (sHLD). Main body: A thorough literature search (in October and November 2019) for studies comparing dHLD and sHLD for duodenoscopes was performed by 3 researchers in the Web of Science, Scopus, PubMed, and Cochran databases. The search terms were "duodenoscope," "ERCP endoscope," "disinfection," "sterilization," and "reprocessing," and only randomized clinical trials with the English language were accepted. Four trials were identified studying dHLD, and only 2 clinical trials comparing dHLD with standard sHLD were found reporting 6193 duodenoscope cultures. Overall sHLD cultures were 2972, and dHLD cultures were 3221; overall positive cultures were 140 in sHLD and 161 in dHLD. The results of a meta-analysis using the random-effect model showed no significant risk difference (RD) between the 2 procedures for duodenoscope positive cultures (p = 0.53, RD 0.003, 95% CI "− 0.007-0.013"). Conclusions: Double HLD offered no significant difference over single HLD for duodenoscope disinfection. An alternative strategy to overcome duodenoscope-transmitted infection is a big issue to be resolved.

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Duodenoscope-associated infections: a review

Cited by 41 publications

References 67 publications

Outer Membrane Vesicles Released From Aeromonas Strains Are Involved in the Biofilm Formation

Outer Membrane Vesicles Released From Aeromonas Strains Are Involved in the Biofilm Formation

Guidelines for Robotic Flexible Endoscopy at the Time of COVID-19

Does double high-level disinfection for duodenoscopes add any value? A mini-systematic review and meta-analysis

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