Outbreak of ertapenem-resistant Enterobacter cloacae urinary tract infections due to a contaminated ureteroscope

Chang, Chin-Lu; Su, Lin‐Hui; Lu, Chunmei; Tai, Fang-Ting; Huang, Yhu-Chering; Chang, Kuo‐Kuan

doi:10.1016/j.jhin.2013.06.010

Cited by 82 publications

(56 citation statements)

References 19 publications

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“…11 In light of growing concerns over severe infections transmitted with reusable duodenoscopes, 15 utilizing a single-use ureteroscope may help allay fears of both patients and providers that a reusable ureteroscope might one day be discovered to be a source of an infection. 16 Single-use products may be easier for facilities, reducing the system stressors placed on the hospital and central processing by the needs of scope reprocessing and maintenance. In line with these potential advantages, understanding the clinical performance of LithoVue bears exploration.…”

Section: Discussionmentioning

confidence: 99%

“…With regard to the difference in complication rates, the fact that the complications occurring in the control reusable scope group were not related to infection indicates that these differences were possibly reflective of the study design rather than a factor intrinsically related to the ureteroscopes themselves. If there were differences in infection rates between the two groups, one might consider the reprocessing of reusable scopes as a reason to account for these differences 16 ; however, this was not the case.…”

Section: Discussionmentioning

confidence: 99%

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A Prospective Case–Control Study Comparing LithoVue, a Single-Use, Flexible Disposable Ureteroscope, with Flexible, Reusable Fiber-Optic Ureteroscopes

Usawachintachit

Isaacson

Taguchi

et al. 2017

Journal of Endourology

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Objective: LithoVueÔ is a novel, single-use, digital flexible ureteroscope that was released to the US market in January 2016. There are scant data regarding its performance in humans. Procedural outcomes comparing LithoVue with reusable ureteroscopes are presented in patients undergoing ureteroscopy for upper urinary tract pathology. Patients and Methods: Clinical outcomes between two groups of patients undergoing flexible ureteroscopy for upper urinary tract pathology were analyzed. The first group underwent surgery utilizing LithoVue, and the second group used reusable fiber-optic flexible ureteroscopes. Differences in procedural outcomes, operative times, and time spent in hospital were analyzed using two-tailed t-tests and chi-squared and Fisher's exact tests. Results: One hundred fifteen cases utilizing LithoVue and 65 cases utilizing reusable ureteroscopes were included in this study. Demographics, surgical indications, stone size, location, total stone burden, composition, procedural outcomes, and complications were comparable between groups. For all cases, LithoVue procedures lasted 54.1 -25.7 minutes compared with 64.5 -37.0 minutes for reusable scope procedures ( p < 0.05) and for stone removal cases, 57.3 -25.1 vs 70.3 -36.9 minutes, respectively ( p < 0.05). Scope failure occurred in 4.4% of LithoVue cases and 7.7% of reusable cases ( p = 0.27). Conclusions: LithoVue represents a feasible alternative to reusable ureteroscopes with a low rate of scope failure comparable with reusable ureteroscopes. Its use shortens procedure duration, a finding that warrants further investigation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Prospective Case–Control Study Comparing LithoVue, a Single-Use, Flexible Disposable Ureteroscope, with Flexible, Reusable Fiber-Optic Ureteroscopes

Usawachintachit

Isaacson

Taguchi

et al. 2017

Journal of Endourology

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“…Other types of flexible endoscopic procedures, including bronchoscopy and cystoscopy (as well as other types of medical procedures unrelated to flexible endoscopy), are also identified risk factors for infections (and predictors for colonizations) with CRE and related superbugs [23,44,45] . Indeed, some infection-control measures designed to prevent CRE transmission during GI endoscopy may also be employed during these other flexible endoscopic procedures for the successful prevention of infection.…”

Section: Transmission Of Cre and Related Superbugs During Other Typesmentioning

confidence: 99%

“…For example, Koo et al [23] (2012) discuss an outbreak of NDM-1 K. pneumoniae linked to contamination of the video camera head of urological instrumentation. Chang et al [44] (2013) similarly report a CRE outbreak at a regional teaching hospital in southern Taiwan, finding an ureteroscope contaminated with ertapen-…”

Section: Transmission Of Cre and Related Superbugs During Other Typesmentioning

confidence: 99%

“…em-resistant E. cloacae (a type of CRE) to be responsible for several UTIs. Chang et al [44] 's (2013) findings are not entirely surprising, since UTIs are the most common types of HAIs caused by CRE. Like Hospital X's CRE outbreak, this outbreak in Taiwan was reportedly terminated only once the hospital used EtO sterilization to process the implicated ureteroscope [9,25,44] .…”

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confidence: 96%

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

Muscarella¹

2014

WJGE

119

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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A Systematic Review of Disposable Sheath Use During Flexible Endoscopy

Ofstead¹,

Hopkins²,

Quick³

et al. 2019

AORN Journal

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Flexible endoscopes are exposed to blood, mucus, and other secretions during procedures. Single-use sheaths are designed to prevent contact between contaminants and reusable endoscope components. This systematic review examined findings from 22 studies that assessed endoscopic sheath use during urologic, gastrointestinal, or respiratory procedures. The evidence showed that sheaths were durable and yielded faster endoscope turnover times because their reusable components did not require high-level disinfection or sterilization. After a brief learning period, health care providers successfully assembled and maneuvered sheathed endoscopes. Patients generally did not experience greater discomfort during procedures in which sheaths were used. Microbial cultures of sheathed endoscopes were negative or similar to unsheathed endoscopes. More research is needed to evaluate the potential effect of disposable sheaths on infection risks. The evidence suggests that sheaths are a viable option for reliably providing a barrier between endoscopes and patients without affecting the quality of endoscopic procedures.

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Outbreak of ertapenem-resistant Enterobacter cloacae urinary tract infections due to a contaminated ureteroscope

Cited by 82 publications

References 19 publications

A Prospective Case–Control Study Comparing LithoVue, a Single-Use, Flexible Disposable Ureteroscope, with Flexible, Reusable Fiber-Optic Ureteroscopes

A Prospective Case–Control Study Comparing LithoVue, a Single-Use, Flexible Disposable Ureteroscope, with Flexible, Reusable Fiber-Optic Ureteroscopes

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

A Systematic Review of Disposable Sheath Use During Flexible Endoscopy

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