Control of a multi-hospital outbreak of KPC-producing Klebsiella pneumoniae type 2 in France, September to October 2009

Carbonne, A.; Thiolet, J M; Fournier, Sandra; Fortineau, Nicolas; Kassis-Chikhani, Najiby; Boytchev, Isabelle; Aggoune, M; Seguier, J.-C.; Sénéchal, H.; Tavolacci, Marie‐Pierre; Coignard, B.; Astagneau, Pascal; Jarlier, Vincent

doi:10.2807/ese.15.48.19734-en

Cited by 146 publications

(129 citation statements)

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“…Indeed, patient morbidity and mortality due to GI endoscopes contaminated with these antibiotic-resistant bacteria have been documented [13,[20][21][22]24,[26][27][28][29][30][31][32][33] . Reports of GI endoscopes transmitting other types of bacteria, too, as well as viruses and other infectious agents, also have been published during the past 30 years.…”

Section: Findings and Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Risk of transmission of carbapenem-resistantEnterobacteriaceaeand related “superbugs” during gastrointestinal endoscopy

Muscarella¹

2014

WJGE

115

112

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To evaluate the risk of transmission of carbapenemresistant Enterobacteriaceae (CRE) and their related superbugs during gastrointestinal (GI) endoscopy. Reports of outbreaks linked to GI endoscopes contaminated with different types of infectious agents, including CRE and their related superbugs, were reviewed. Published during the past 30 years, both prior to and since CRE's emergence, these reports were obtained by searching the peer-reviewed medical literature (via the United States National Library of Medicine's "MEDLINE" database); the Food and Drug Administration's Manufacturer and User Facility Device Experience database, or "MAUDE"; and the Internet (via Google's search engine). This review focused on an outbreak of CRE in 2013 following the GI endoscopic procedure known as endoscopic retrograde cholangiopancreatography, or ERCP, performed at "Hospital X" located in the suburbs of Chicago (IL; United States). Part of the largest outbreak of CRE in United States history, the infection and colonization of 10 and 28 of this hospital's patients, respectively, received considerable media attention and was also investigated by the Centers for Disease Control and Prevention (CDC), which published a report about this outbreak in Morbidity and Mortality Weekly Report (MMWR), in 2014. This report, along with the results of an independent inspection of Hospital X's infection control practices following this CRE outbreak, were also reviewed. While this article focuses primarily on the prevention of transmissions of CRE and their related superbugs in the GI endoscopic setting, some of its discussion and recommendations may also apply to other healthcare settings, to other types of flexible endoscopes, and to other types of transmissible infectious agents. This review found that GI endoscopy is an important risk factor for the transmission of CRE and their related superbugs, having been recently associated with patient morbidity and mortality following ERCP. The CDC reported in MMWR that the type of GI endoscope, known as an ERCP endoscope, that Hospital X used to perform ERCP in 2013 on the 38 patients who became infected or colonized with CRE might be particularly challenging to clean and disinfect, because of the complexity of its physical design. If performed in strict accordance with the endoscope manufacturer's labeling, supplemented as needed with professional organizations' published guidelines, however, current practices for reprocessing GI endoscopes, which include high-level disinfection, are reportedly adequate for the prevention of transmission of CRE and their related superbugs. Several recommendations are provided to prevent CRE transmissions in the healthcare setting. CRE transmissions are not limited to contaminated GI endoscopes and also have been linked to other reusable flexible endoscopic instrumentation, including bronchoscopes and cystoscopes. In conclusion, contaminated GI endoscopes, particularly those used during ERCP, have been causally linked to outbreaks of CRE and their related su...

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Section: Findings and Resultsmentioning

confidence: 99%

“…And, with the recent emergence of the "superbug" known as carbapenem-resistant Enterobacteriaceae, or "CRE", infection control in this setting has taken on even more urgency and closer examination [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] .…”

Section: Introductionmentioning

confidence: 99%

Risk of transmission of carbapenem-resistantEnterobacteriaceaeand related “superbugs” during gastrointestinal endoscopy

Muscarella¹

2014

WJGE

115

112

View full text Add to dashboard Cite

show abstract

“…Even if infection does ensue, it may not be immediately apparent after exposure to the endoscope because of silent transmission and colonization. [4][5][6] In 1 recent endoscopy-associated, multidrug-resistant organism (MDRO) outbreak, investigators found that several patients were asymptomatic carriers of an extended-spectrum b-lactamase-producing Klebsiella pneumoniae for more than 10 months after exposure to contaminated endoscopes. Others presented with symptomatic bloodstream infections or biliary tract infections.…”

Section: Reply To Petersenmentioning

confidence: 99%

Reply to Petersen

Visrodia

Ofstead

Yellin

et al. 2014

Infect. Control Hosp. Epidemiol.

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“…1,2 Several recent publications, including the paper in this issue of ICHE by Wendorf et al, 3 have associated multidrug-resistant (MDR) bacterial infections, especially carbapenemase-resistant Enterobacteriaceae (CRE), in patients who have undergone ERCP with reprocessed duodenoscopes. [3][4][5] Unlike other endoscope-associated outbreaks, these recent outbreaks occurred even when the manufacturer's instructions and professional guidelines were followed correctly. 3,4 The purpose of this commentary is 3-fold: (1) to briefly discuss the outbreak described by Wendorf et al; (2) to discuss what alternatives exist today that might improve the safety margin associated with duodenoscope reprocessing; and (3) to discuss how to prevent future outbreaks associated with ERCP endoscopes and other gastrointestinal (GI) endoscopes.…”

mentioning

confidence: 99%

“…If endoscopes are found to be contaminated with potential pathogens (eg, enteric Gramnegative bacilli), the clinical impact of such contamination needs to be quantified. In addition, based on the studies by Wendorf et al and others, [3][4][5] it would be reasonable to consider periodic microbiologic surveillance of duodenoscopes to assess microbial contamination as one component of a prevention strategy. However, culture results are delayed 2-3 days, and many questions related to microbiologic surveillance remain: What cutoff should be used to define proper disinfection (eg, 0 pathogens or a higher number [eg, <10 CFU] of enteric pathogens per channel)?…”

mentioning

confidence: 99%