Pseudomonas-Septikämie nach endoskopischen Eingriffen am Gallengangsystem

Abstract

In the first half of 1982 there was an increase in septicaemia cases, especially among patients with biliary-tract drainage. The septicaemia incidence rose from 1.25% to 4.4%. The proportion of Pseudomonas septicaemias was especially high: of 20 patients (21 episodes of septicaemia) nine had infections with Pseudomonas aeruginosa alone, three a mixed septicaemia. In ten of these twelve patients there was impaired drainage by a malignant tumour. Three patients with a tumour stenosis died, mainly of the septicaemia. The cause of this increased incidence of Pseudomonas septicaemias lay in contamination of the instruments; it was in part sustained by the Endo-Washer. The connection between the septicaemia after endoscopic-retrograde cholangiography and recontamination of the endoscope was discovered after sero- and pyocin-typing of the Pseudomonas strains. By changing the methods of disinfection the Pseudomonas incidence among endoscopies fell. However, in individual samplings Pseudomonas can still be demonstrated on instruments as well as on the Endo-Washer.

Endowashers: an overlooked risk for possible post-endoscopic infections

“…The particular infection control emphasis of water for irrigation is based on a report on a severe septicaemia associated with contaminated EWs published by Helm et al [1]. Septicaemia is clearly a severe complication in ERCP, associated with high morbidity and mortality.…”

“…In recent years, endowashers have become more and more popular as a useful tool and are nowadays used for a broad range of indications. However, the increasing use of endowashers could make them critical for nosocomial transmission or cross infection [1], but in nine recommendations published by professional societies and official bodies they are not specifically mentioned – including those by the APIC (Association for Professionals in Infection Control and Epidemiology, USA) [2], FDA (Food and Drug Administration, USA) [3], RKI (Robert Koch Institute, Germany) [4], [5], ESGE (European Society of Gastrointestinal Endoscopy) [6], [7], SHEA (Society for Healthcare Epidemiology of America) [8], BSG (British Society of Gastroenterology) [9], Austrian guidelines (Arbeitsgruppe Krankenhaushygiene Wien und Magistratsabteilung 15 der Stadt Wien) [10], SGNA Guidelines (Society of Gastroenterology Nurses and Associates, USA) [11], and ASGE (American Society for Gastrointestinal Endoscopy, USA) [12]. …”