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Risk factors identified for CRE infection with contaminated duodenoscopes
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For patients undergoing endoscopic retrograde cholangiopancreatography, the risk for carbapenem-resistant Enterobacteriaceae infection from a contaminated duodenoscope increased when the patient had biliary stent placement, a history of cholangiocarcinoma or active inpatient status, according to the results of a retrospective study.
“Our study reveals that biliary stent placement, a history of cholangiocarcinoma, and active inpatient status are independent risk factors for CRE transmission during ERCP using a contaminated duodenoscope,” V. Raman Muthusamy, MD, director of interventional endoscopy, division of digestive diseases, UCLA Health System, and colleagues wrote. “In circumstances where a concern for CRE transmission via contaminated duodenoscopes were to arise, patients with these high-risk clinical risk factors and the duodenoscopes used in these patients should be monitored closely to aid in early recognition and prevention of future outbreaks of ERCP-related CRE infection.”
V. Raman Muthusamy
In a retrospective, single-center, case-control study, Muthusamy and colleagues examined 115 patients who underwent ERCP between October 3, 2014, and January 28, 2015. An outbreak of CRE infection occurred at the center that implicated two duodenoscopes used in procedures during this time. The duodenoscopes were immediately removed from service and were evaluated as sources of the contamination. The patients assessed in this study underwent a total of 125 procedures with one of the two implicated duodenoscopes. A comparison was then completed between patients who acquired CRE (active infection or colonization) and patients who did not acquire an infection.
Culture data were available for 104 of the 115 exposed patients, of whom eight became actively infected with CRE and seven became colonized with CRE.
Univariate analysis showed several patient characteristics were associated with an increased risk for infection: recent antibiotic exposure (P = .046), active inpatient status (P = .034) and a history of cholangiocarcinoma (P = .008). Biliary stent placement was significant risk factor (P = .024).
After adjusting for cholangiocarcioma, the researchers found that biliary stent placement (OR = 3.62; 95% CI, 1.12-11.67) and active inpatient status (OR = 3.74; 95% CI, 1.15-12.12) were still independently associated with CRE transmission.
“In conclusion, it has become increasingly apparent that duodenoscope exposure has been associated with outbreaks of multidrug-resistant bacterial infections,” the researchers wrote. “These outbreaks have highlighted the difficulty in adequately disinfecting these complicated devices and bacterial contamination can persist, despite strict adherence to reprocessing guidelines. Until more definitive processes for scope cleaning are developed, physicians must rely on enhanced high level disinfection techniques and their clinical judgment regarding specific patients and procedures that may be at increased risk for CRE transmission.” – by Suzanne Reist
Disclosures: The researchers report no relevant financial disclosures.
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