Response:

Abstract

We appreciate the interest of Dr Saliou and colleagues in our study, and we congratulate them on their work that searches for the improvement of microbial quality surveillance of gastrointestinal endoscopes and automatic endoscope reprocessors. Endoscope surveillance through bacterial cultures can assess the sufficiency of reprocessing to prevent infectious outbreaks. Methodologic details vary among the published articles and guidelines, and certainly some adaptation of culturing procedures may yield better results. The main guideline recently published by the Centers for Diseases Control and Prevention 1 has suggested qualitative and quantitative protocols with 48 hours as the incubation time for recovering the usual pathogens. Although the same incubation time has been recommended by recently established protocols for reprocessing endoscopes, 2,3 evidence of outbreaks of infection has been reported despite microbiologic surveillance. 4,5 Many limitations have been associated with endoscope culturing protocols, including the lack of standardized sampling techniques, culture methods, and interpretation of results. 6 Hence, in our study, we focused on evaluating the procedures routinely used in the setting of an endoscopy unit. 3,7 Conversely, we agree that incubating the samples for more than 48 hours could result in better rates of bacterial recovery, especially those obtained from biofilms, as described by Saliou et al. 8 It is intriguing to notice, however, that some studies have described increased biofilm growth rates in comparison with planktonic (free-floating microorganisms) growth rates, whereas others have reported exactly the opposite. 9,10 Finally, we understand that the data from Sailou and colleagues are relevant, and they also appear to be complementary to our study. Together, both studies strongly reinforce the need for continuous adaptation of the guidelines and protocols regarding endoscope surveillance, particularly in the context of biofilm-forming instruments.