An update on gastrointestinal endoscopy-associated infections and their contributing factors

Charles Eugenio McCafferty, Marra Jai Aghajani, David Abi-Hanna, Iain Bruce Gosbell, Slade Owen Jensen, Charles Eugenio McCafferty, Marra Jai Aghajani, David Abi-Hanna, Iain Bruce Gosbell, Slade Owen Jensen

Abstract

Introduction: During clinical use, gastrointestinal endoscopes are grossly contaminated with patient's native flora. These endoscopes undergo reprocessing to prevent infectious transmission upon future use. Endoscopy-associated infections and outbreaks have been reported, with a recent focus on the transmission of multi-drug resistant organisms. This review aims to provide an update on endoscopy-associated infections, and the factors contributing to their occurrence.

Methods: PubMed, ScienceDirect, and CINAHL were searched for articles describing gastrointestinal endoscopy-associated infections and outbreaks published from 2008 to 2018. Factors contributing to their occurrence, and the outcomes of each outbreak were also examined.

Results: This review found 18 articles, 16 of which described duodenoscope-associated infections, and the remaining two described colonoscope- and gastroscope-associated infection respectively. Outbreaks were reported from the United States, France, China, Germany, the Netherlands and the United Kingdom. The causative organisms reported were Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli and Salmonella enteritidis.

Conclusions: A number of factors, including lapses in reprocessing, biofilm formation, endoscope design issues and endoscope damage, contribute to gastrointestinal endoscopy associated infection. Methods of improving endoscope reprocessing, screening for contamination and evaluating endoscope damage may be vital to preventing future infections and outbreaks.

Figures

Fig. 1
Fig. 1
Search strategy and study selection flow chart. This is a flow chart illustrating which databases were searched and the number of articles found from each database. This flow chart also documents the screening process and reasons for the exclusion of articles from the review, as well as the number of articles removed at each screening step

References

    1. Nelson DB, Muscarella LF. Current issues in endoscope reprocessing and infection control during gastrointestinal endoscopy. World J Gastroenterol. 2006;12(25):3953–3964. doi: 10.3748/wjg.v12.i25.3953.
    1. Ribeiro MM, de Oliveira AC. Analysis of the air/water channels of gastrointestinal endoscopies as a risk factor for the transmission of microorganisms among patients. Am J Infect Control. 2012;40(10):913–916. doi: 10.1016/j.ajic.2012.02.005.
    1. Bisset L, Cossart YE, Selby W, West R, Catterson D, O’Hara K, et al. A prospective study of the efficacy of routine decontamination for gastrointestinal endoscopes and the risk factors for failure. Am J Infect Control. 2006;34(5):274–280. doi: 10.1016/j.ajic.2005.08.007.
    1. Committee AQAIE. Petersen BT, Chennat J, Cohen J, Cotton PB, Greenwald DA, et al. Multisociety guideline on reprocessing flexible gastrointestinal endoscopes: 2011. Gastrointestinal endoscopy. 2011;73(6):1075–1084. doi: 10.1016/j.gie.2011.03.1183.
    1. Gastroenterological Society of Australia (GESA). Infection control in endoscopy consenus statements. In: Australian gastroenterology week (AGW) 2017, Queensland, Australia; 2017.
    1. Choi HH, Cho YS. Endoscope reprocessing: update on controversial issues. Clin Endosc. 2015;48(5):356–360. doi: 10.5946/ce.2015.48.5.356.
    1. Epstein L, Hunter JC, Arwady MA, Tsai V, Stein L, Gribogiannis M, et al. New Delhi metallo-beta-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes. JAMA. 2014;312(14):1447–1455. doi: 10.1001/jama.2014.12720.
    1. Naryzhny I, Silas D, Chi K. Impact of ethylene oxide gas sterilization of duodenoscopes after a carbapenem-resistant Enterobacteriaceae outbreak. Gastrointest Endosc. 2016;84(2):259–262. doi: 10.1016/j.gie.2016.01.055.
    1. Smith ZL, Oh YS, Saeian K, Edmiston CE, Jr, Khan AH, Massey BT, et al. Transmission of carbapenem-resistant Enterobacteriaceae during ERCP: time to revisit the current reprocessing guidelines. Gastrointest Endosc. 2015;81(4):1041–1045. doi: 10.1016/j.gie.2014.11.006.
    1. Rutala WA, Weber DJ. Disinfection and sterilization: an overview. Am J Infect Control. 2013;41(5 Suppl):S2–S5. doi: 10.1016/j.ajic.2012.11.005.
    1. Dirlam Langlay AM, Ofstead CL, Mueller NJ, Tosh PK, Baron TH, Wetzler HP. Reported gastrointestinal endoscope reprocessing lapses: the tip of the iceberg. Am J Infect Control. 2013;41(12):1188–1194. doi: 10.1016/j.ajic.2013.04.022.
    1. Herve RC. Endoscopy in the twenty-first century: minimally invasive state-of-the-art medical technology or a future main vector of hospital-acquired infections? J Hosp Infect. 2017;97(4):329–330. doi: 10.1016/j.jhin.2017.07.030.
    1. Kimmery MBBD, Carr-Locke DL, DiMarino AJ, Jensen DM, Katon R, et al. ASGE technology assessment position paper: transmission of infection by gastrointestinal endoscopy. Gastrointest Endosc. 1993;36:885–888. doi: 10.1016/S0016-5107(93)70316-8.
    1. Ofstead CL, Dirlam Langlay AM, Mueller NJ, Tosh PK, Wetzler HP. Re-evaluating endoscopy-associated infection risk estimates and their implications. Am J Infect Control. 2013;41(8):734–736. doi: 10.1016/j.ajic.2012.10.008.
    1. O’Horo JC, Farrell A, Sohail MR, Safdar N. Carbapenem-resistant Enterobacteriaceae and endoscopy: an evolving threat. Am J Infect Control. 2016;44(9):1032–1036. doi: 10.1016/j.ajic.2016.03.029.
    1. Rubin ZA, Murthy RK. Outbreaks associated with duodenoscopes: new challenges and controversies. Curr Opin Infect Dis. 2016;29(4):407–414. doi: 10.1097/QCO.0000000000000290.
    1. Gastroenterological Society of Australia (GESA), Gastroenterological Nurses College of Australia (GENCA). Infection control in endoscopy, 3rd ed. Mulgrave; 2010.
    1. Carbonne A, Thiolet JM, Fournier S, Fortineau N, Kassis-Chikhani N, Boytchev I, et al. Control of a multi-hospital outbreak of KPC-producing Klebsiella pneumoniae type 2 in France, September to October 2009. Euro surveill Bull Europeen sur les maladies transmissibles = European communicable disease bulletin. 2010;15(48):19734.
    1. Alrabaa SF, Nguyen P, Sanderson R, Baluch A, Sandin RL, Kelker D, et al. Early identification and control of carbapenemase-producing Klebsiella pneumoniae, originating from contaminated endoscopic equipment. Am J Infect Control. 2013;41(6):562–564. doi: 10.1016/j.ajic.2012.07.008.
    1. Naas T, Cuzon G, Babics A, Fortineau N, Boytchev I, Gayral F, et al. Endoscopy-associated transmission of carbapenem-resistant Klebsiella pneumoniae producing KPC-2 beta-lactamase. J Antimicrob Chemother. 2010;65(6):1305–1306. doi: 10.1093/jac/dkq117.
    1. Bajolet O, Ciocan D, Vallet C, de Champs C, Vernet-Garnier V, Guillard T, et al. Gastroscopy-associated transmission of extended-spectrum beta-lactamase-producing Pseudomonas aeruginosa. J Hosp Infect. 2013;83(4):341–343. doi: 10.1016/j.jhin.2012.10.016.
    1. Aumeran C, Poincloux L, Souweine B, Robin F, Laurichesse H, Baud O, et al. Multidrug-resistant Klebsiella pneumoniae outbreak after endoscopic retrograde cholangiopancreatography. Endoscopy. 2010;42(11):895–899. doi: 10.1055/s-0030-1255647.
    1. Robertson P, Smith A, Anderson M, Stewart J, Hamilton K, McNamee S, et al. Transmission of Salmonella enteritidis after endoscopic retrograde cholangiopancreatography because of inadequate endoscope decontamination. Am J Infect Control. 2017;45(4):440–442. doi: 10.1016/j.ajic.2016.11.024.
    1. Sanderson R, Braithwaite L, Ball L, Ragan P, Eisenstein L. An outbreak of carbapenem-resistant Klebsiella pneumoniae infections associated with endoscopic retrograde cholangiopancreatography (ERCP) procedures at a hospital. Am J Infect Control. 2010;38(5):e141. doi: 10.1016/j.ajic.2010.04.191.
    1. Reiner S. Investigation of a cluster of genomically identical Pseudomonas aeruginosa blood isolates following endoscopic retrograde cholangiopancreatography in a gastroenterology laboratory. Am J Infect Control. 2008;36(5):E198.
    1. Reddick E. Investigation of salmonellosis outbreak following a hospital endoscopy: a public health case study. Can J Infect Control. 2017;32(3):156–159.
    1. Kim S, Russell D, Mohamadnejad M, Makker J, Sedarat A, Watson RR, et al. Risk factors associated with the transmission of carbapenem-resistant Enterobacteriaceae via contaminated duodenoscopes. Gastrointest Endosc. 2016;83(6):1121–1129. doi: 10.1016/j.gie.2016.03.790.
    1. Kola A, Piening B, Pape UF, Veltzke-Schlieker W, Kaase M, Geffers C, et al. An outbreak of carbapenem-resistant OXA-48—producing Klebsiella pneumonia associated to duodenoscopy. Antimicrob Resist Infect Control. 2015;4:8. doi: 10.1186/s13756-015-0049-4.
    1. Qiu L, Zhou Z, Liu Q, Ni Y, Zhao F, Cheng H. Investigating the failure of repeated standard cleaning and disinfection of a Pseudomonas aeruginosa-infected pancreatic and biliary endoscope. Am J Infect Control. 2015;43(8):e43–e46. doi: 10.1016/j.ajic.2015.04.204.
    1. Humphries RM, Yang S, Kim S, Muthusamy VR, Russell D, Trout AM, et al. Duodenoscope-related outbreak of a carbapenem-resistant Klebsiella pneumoniae identified using advanced molecular diagnostics. Clin Infect Dis. 2017;65(7):1159–1166. doi: 10.1093/cid/cix527.
    1. Kovaleva J, Meessen NE, Peters FT, Been MH, Arends JP, Borgers RP, et al. Is bacteriologic surveillance in endoscope reprocessing stringent enough? Endoscopy. 2009;41(10):913–916. doi: 10.1055/s-0029-1215086.
    1. Verfaillie CJ, Bruno MJ, Voor in ‘t Holt AF, Buijs JG, Poley JW, Loeve AJ, et al. Withdrawal of a novel-design duodenoscope ends outbreak of a VIM-2-producing Pseudomonas aeruginosa. Endoscopy. 2015;47(6):493–502. doi: 10.1055/s-0034-1391886.
    1. Wendorf KA, Kay M, Baliga C, Weissman SJ, Gluck M, Verma P, et al. Endoscopic retrograde cholangiopancreatography-associated AmpC Escherichia coli outbreak. Infect Control Hosp Epidemiol. 2015;36(6):634–642. doi: 10.1017/ice.2015.66.
    1. Humphries RM, McDonnell G. Superbugs on duodenoscopes: the challenge of cleaning and disinfection of reusable devices. J Clin Microbiol. 2015;53(10):3118–3125. doi: 10.1128/JCM.01394-15.
    1. Medical P. Video Duodenoscopes ED34-i10T. Japan: PENTAX Medical; 2018. . Accessed Mar 2018.
    1. Asge Standards Of Practice C. Banerjee S, Shen B, Nelson DB, Lichtenstein DR, Baron TH, et al. Infection control during GI endoscopy. Gastrointest Endosc. 2008;67(6):781–790. doi: 10.1016/j.gie.2008.01.027.
    1. Ren-Pei W, Hui-Jun X, Ke Q, Dong W, Xing N, Zhao-Shen L. Correlation between the growth of bacterial biofilm in flexible endoscopes and endoscope reprocessing methods. Am J Infect Control. 2014;42(11):1203–1206. doi: 10.1016/j.ajic.2014.07.029.
    1. Kovaleva J. Infectious complications in gastrointestinal endoscopy and their prevention. Best Pract Res Clin Gastroenterol. 2016;30(5):689–704. doi: 10.1016/j.bpg.2016.09.008.
    1. Alfa MJ. Current issues result in a paradigm shift in reprocessing medical and surgical instruments. Am J Infect Control. 2016;44(5 Suppl):e41–e45. doi: 10.1016/j.ajic.2016.01.020.
    1. Pineau L, Villard E, Duc DL, Marchetti B. Endoscope drying/storage cabinet: interest and efficacy. J Hosp Infect. 2008;68(1):59–65. doi: 10.1016/j.jhin.2007.10.012.
    1. Grandval P, Hautefeuille G, Marchetti B, Pineau L, Laugier R. Evaluation of a storage cabinet for heat-sensitive endoscopes in a clinical setting. J Hosp Infect. 2013;84(1):71–76. doi: 10.1016/j.jhin.2013.01.013.
    1. Ofstead CL, Wetzler HP, Eiland JE, Heymann OL, Held SB, Shaw MJ. Assessing residual contamination and damage inside flexible endoscopes over time. Am J Infect Control. 2016;44(12):1675–1677. doi: 10.1016/j.ajic.2016.06.029.
    1. Ross AS, Baliga C, Verma P, Duchin J, Gluck M. A quarantine process for the resolution of duodenoscope-associated transmission of multidrug-resistant Escherichia coli. Gastrointest Endosc. 2015;82(3):477–483. doi: 10.1016/j.gie.2015.04.036.
    1. Higa JT, Gluck M, Ross AS. Duodenoscope-associated bacterial infections: a review and update. Curr Treat Options Gastroenterol. 2016;14(2):185–193. doi: 10.1007/s11938-016-0088-9.
    1. Gastmeier P, Vonberg RP. Klebsiella spp. in endoscopy-associated infections: we may only be seeing the tip of the iceberg. Infection. 2014;42(1):15–21. doi: 10.1007/s15010-013-0544-6.
    1. McCafferty CE, Abi-Hanna D, Aghajani MJ, Micali GT, Lockart I, Vickery K, et al. The validity of adenosine triphosphate (ATP) measurement in detecting endoscope contamination. J Hosp Infect. 2018 doi: 10.1016/j.jhin.2018.08.004.

Source: PubMed

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