Multidrug-resistant <i>Klebsiella pneumoniae</i> outbreak after endoscopic retrograde cholangiopancreatography

Auméran, C.; Poincloux, Laurent; Souweine, Bertrand; Robin, Frédéric; Laurichesse, H.; Baud., Olivier; Bommelaer, Gilles; Traoré, Ousmane

doi:10.1055/s-0030-1255647

Cited by 175 publications

(186 citation statements)

References 14 publications

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“…And, with the recent emergence of the "superbug" known as carbapenem-resistant Enterobacteriaceae, or "CRE", infection control in this setting has taken on even more urgency and closer examination [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] .…”

Section: Introductionmentioning

confidence: 99%

Risk of transmission of carbapenem-resistantEnterobacteriaceaeand related “superbugs” during gastrointestinal endoscopy

Muscarella¹

2014

WJGE

120

112

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To evaluate the risk of transmission of carbapenemresistant Enterobacteriaceae (CRE) and their related superbugs during gastrointestinal (GI) endoscopy. Reports of outbreaks linked to GI endoscopes contaminated with different types of infectious agents, including CRE and their related superbugs, were reviewed. Published during the past 30 years, both prior to and since CRE's emergence, these reports were obtained by searching the peer-reviewed medical literature (via the United States National Library of Medicine's "MEDLINE" database); the Food and Drug Administration's Manufacturer and User Facility Device Experience database, or "MAUDE"; and the Internet (via Google's search engine). This review focused on an outbreak of CRE in 2013 following the GI endoscopic procedure known as endoscopic retrograde cholangiopancreatography, or ERCP, performed at "Hospital X" located in the suburbs of Chicago (IL; United States). Part of the largest outbreak of CRE in United States history, the infection and colonization of 10 and 28 of this hospital's patients, respectively, received considerable media attention and was also investigated by the Centers for Disease Control and Prevention (CDC), which published a report about this outbreak in Morbidity and Mortality Weekly Report (MMWR), in 2014. This report, along with the results of an independent inspection of Hospital X's infection control practices following this CRE outbreak, were also reviewed. While this article focuses primarily on the prevention of transmissions of CRE and their related superbugs in the GI endoscopic setting, some of its discussion and recommendations may also apply to other healthcare settings, to other types of flexible endoscopes, and to other types of transmissible infectious agents. This review found that GI endoscopy is an important risk factor for the transmission of CRE and their related superbugs, having been recently associated with patient morbidity and mortality following ERCP. The CDC reported in MMWR that the type of GI endoscope, known as an ERCP endoscope, that Hospital X used to perform ERCP in 2013 on the 38 patients who became infected or colonized with CRE might be particularly challenging to clean and disinfect, because of the complexity of its physical design. If performed in strict accordance with the endoscope manufacturer's labeling, supplemented as needed with professional organizations' published guidelines, however, current practices for reprocessing GI endoscopes, which include high-level disinfection, are reportedly adequate for the prevention of transmission of CRE and their related superbugs. Several recommendations are provided to prevent CRE transmissions in the healthcare setting. CRE transmissions are not limited to contaminated GI endoscopes and also have been linked to other reusable flexible endoscopic instrumentation, including bronchoscopes and cystoscopes. In conclusion, contaminated GI endoscopes, particularly those used during ERCP, have been causally linked to outbreaks of CRE and their related su...

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Section: Introductionmentioning

confidence: 99%

Risk of transmission of carbapenem-resistantEnterobacteriaceaeand related “superbugs” during gastrointestinal endoscopy

Muscarella¹

2014

WJGE

120

112

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“…Even if infection does ensue, it may not be immediately apparent after exposure to the endoscope because of silent transmission and colonization. [4][5][6] In 1 recent endoscopy-associated, multidrug-resistant organism (MDRO) outbreak, investigators found that several patients were asymptomatic carriers of an extended-spectrum b-lactamase-producing Klebsiella pneumoniae for more than 10 months after exposure to contaminated endoscopes. Others presented with symptomatic bloodstream infections or biliary tract infections.…”

Section: Reply To Petersenmentioning

confidence: 99%

“…More cases continued to occur, and investigators were able to harvest the epidemic strain and other MDROs (Morganella morganii and Pseudomonas aeruginosa) on several duodenoscopes, following a change in sampling and culturing protocols. 4 This emphasizes the importance of microbial cultures but also highlights the potential disadvantages of relying solely on cultures, because they are difficult to perform and may not be a reliable indicator of the absence of viable organisms. In the outbreak previously mentioned, 4 253 patients were exposed to multiple MDROs over a period of 9 months, with 16 verified cases of transmission, because cultures failed to identify contaminated endoscopes.…”

Section: Reply To Petersenmentioning

confidence: 99%

“…4 This emphasizes the importance of microbial cultures but also highlights the potential disadvantages of relying solely on cultures, because they are difficult to perform and may not be a reliable indicator of the absence of viable organisms. In the outbreak previously mentioned, 4 253 patients were exposed to multiple MDROs over a period of 9 months, with 16 verified cases of transmission, because cultures failed to identify contaminated endoscopes. 4 The lack of standardization in sampling and culturing techniques alluded to by Petersen 1 may have played a role in the duration and severity of this outbreak.…”

Section: Reply To Petersenmentioning

confidence: 99%

“…In the outbreak previously mentioned, 4 253 patients were exposed to multiple MDROs over a period of 9 months, with 16 verified cases of transmission, because cultures failed to identify contaminated endoscopes. 4 The lack of standardization in sampling and culturing techniques alluded to by Petersen 1 may have played a role in the duration and severity of this outbreak.…”

Section: Reply To Petersenmentioning

confidence: 99%

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Reply to Petersen

Visrodia

Ofstead

Yellin

et al. 2014

Infect. Control Hosp. Epidemiol.

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New Delhi Metallo-β-Lactamase–Producing Carbapenem-ResistantEscherichia coliAssociated With Exposure to Duodenoscopes

Epstein

Hunter

Arwady

et al. 2014

JAMA

380

318

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In this investigation, exposure to duodenoscopes with bacterial contamination was associated with apparent transmission of NDM-producing E coli among patients at 1 hospital. Bacterial contamination of duodenoscopes appeared to persist despite the absence of recognized reprocessing lapses. Facilities should be aware of the potential for transmission of bacteria including antimicrobial-resistant organisms via this route and should conduct regular reviews of their duodenoscope reprocessing procedures to ensure optimal manual cleaning and disinfection.

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Multidrug-resistant Klebsiella pneumoniae outbreak after endoscopic retrograde cholangiopancreatography

Abstract: The endoscopes used for ERCP can act as a reservoir for the emerging ESBL-producing K. PNEUMONIAE. Regular audits to ensure rigorous application of cleaning, high-level disinfection, and drying steps are crucial to avoid contamination.

Cited by 175 publications

References 14 publications

Risk of transmission of carbapenem-resistantEnterobacteriaceaeand related “superbugs” during gastrointestinal endoscopy

Risk of transmission of carbapenem-resistantEnterobacteriaceaeand related “superbugs” during gastrointestinal endoscopy

Reply to Petersen

New Delhi Metallo-β-Lactamase–Producing Carbapenem-ResistantEscherichia coliAssociated With Exposure to Duodenoscopes

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