Eliminating Duodenoscope-Associated Transmission of Carbapenem-Resistant Enterobacteriaceae (CRE): In Search of an Optimal Strategy

Excerpt

A much feared and increasingly commonplace complication of gastrointestinal endoscopic procedures is endoscope-to-patient transmission of bacterial pathogens resistant to multiple antibiotics, known as multi-drug-resistant organisms (MDRO). Multiple outbreaks of duodenoscope-associated infections with MDRO, including carbapenem-resistant Enterobacteriaceae (CRE), have been reported in the USA and in Europe [1, 2]. The presence of an elevator mechanism in duodenoscopes used in endoscopic retrograde cholangiopancreatography (ERCP) impedes effective decontamination and has been implicated in the risk of persistent bacterial contamination [3]. Several strategies have been proposed to mitigate the risk of transmission, including strict adherence to manufacturer-recommended high-level disinfection (HLD), universal ethylene oxide (EtO) sterilization, the culturing and sequestering of endoscopes, and patient screening with polymerase chain reaction (PCR)-based tests. Nevertheless, there is substantial variability in the strategies being utilized across institutions, and outcomes data for these approaches are limited. …