Transmission of Mobile Colistin Resistance (mcr-1) by Duodenoscope

Abstract

We identified transmission of mcr-1 in a United States acute care hospital that likely occurred via duodenoscope despite no identifiable breaches in reprocessing or infection control practices. Duodenoscope design flaws leading to transmission of multidrug-resistant organsisms persist despite recent initiatives to improve device safety. Reliable detection of colistin resistance is currently challenging for clinical laboratories, particularly given the absence of an FDA-cleared test; improved clinical laboratory capacity for colistin susceptibility testing is needed to prevent the spread of mcr-carrying bacteria in healthcare settings.

Escherichia coli Harboring mcr-1 in a Cluster of Liver Transplant Recipients: Detection through Active Surveillance and Whole-Genome Sequencing

“…The detection of this cluster demonstrates the potential for silent dissemination of mcr-1 in a U.S. hospital setting through asymptomatic colonization and suggests a possible role for same-day endoscopy-related transmission, independent of using the same endoscope. This represents the earliest documented health care-associated cluster of mcr-1 in the United States and predates a recent report from 2017 (7). Both reports implicate endoscopy as a potential route for transmission.…”

Sepsis Attributed to Bacterial Contamination of Platelets Associated with a Potential Common Source — Multiple States, 2018

“…CDC performed whole genome sequencing on collected ACBC and S. saprophyticus isolates (Table) using standard methods ( 1 ). ACBC organisms were isolated by culture from posttransfusion blood samples from patients A, B, C, and D; all four associated transfused platelet bag residuals; and environmental samples from hospital B and the platelet supplier in Utah.…”

Nationwide risk analysis of duodenoscope and linear echoendoscope contamination

“…Worldwide, an increasing number of reports describe outbreaks of multidrug-resistant organisms caused by contaminated duodenoscopes. [1][2][3][4][5][6] Duodenoscopes are used for ERCP procedures, of which approximately 650,000 are performed in the United States annually. 7 Contaminated duodenoscopes and the subsequent outbreaks are commonly detected by transmission of multidrug-resistant organisms bearing distinct features that enable retrospective tracing.…”