Download PDF
Endoscopy 2022; 54(02): 148-155
DOI: 10.1055/a-1467-6294
Systematic review

Risk evaluation of duodenoscope-associated infections in the Netherlands calls for a heightened awareness of device-related infections: a systematic review

Judith A. Kwakman 
1   Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, the Netherlands
2   Department of Microbiology, Erasmus Medical Center, Rotterdam, the Netherlands
,
Nicole S. Erler 
3   Department of Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands
,
Margreet C. Vos   *
2   Department of Microbiology, Erasmus Medical Center, Rotterdam, the Netherlands
,
Marco J. Bruno   *
1   Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, the Netherlands
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Referred to by:

Author commentary on Judith A. Kwakman et al.Endoscopy 2022; 54(02): v6-v6
DOI: 10.1055/a-1476-4580

Abstract

Background The risk of exogenous infections from endoscopic procedures is often cited as almost negligible (1 infection in 1.8 million procedures); however, this risk is based on older literature and does not seem to match the number of infectious outbreaks due to contaminated duodenoscopes reported after endoscopic retrograde cholangiopancreatography (ERCP). Using Dutch data, we aimed to estimate the minimum risk of duodenoscope-associated infection (DAI) and colonization (DAC) in patients undergoing ERCP.

Methods A systematic literature search identified all DAI outbreaks in the Netherlands reported between 2008 and 2019. Included cases were confirmed by molecular matching of patient and duodenoscope cultures. Risk ratios were calculated based on the total number of ERCPs performed during the study period.

Results Three outbreaks were reported and published between 2008 and 2018, including 21 confirmed DAI cases and 52 confirmed DAC cases. The estimated number of ERCPs performed during the same period was 181 209–227 006. The calculated minimum estimated DAI risk was approximately 0.01 % and the minimum estimated DAC risk was 0.023 %–0.029 %.

Conclusions The estimated risk of DAI in Dutch ERCP practice was at least 180 times higher than previously published risk estimates. The actual risk is likely to be (much) higher due to underreporting of infections caused by multidrug-resistant organisms and sensitive bacteria. Greater awareness by healthcare personnel involved in endoscopy and endoscope cleaning is required, as well as innovative technical solutions to contain and ultimately eliminate DAIs.

* Co-last authors.


Appendices 1 s, 2 s



Publication History

Received: 22 May 2020

Accepted: 08 March 2021

Article published online:
29 April 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Refers to:

Duodenoscope-associated infections: risks and countermeasuresEndoscopy 2022; 54(02): 156-157
DOI: 10.1055/a-1507-5196

 

  • References

  • 1 Balan GG, Sfarti CV, Chiriac SA. et al. Duodenoscope-associated infections: a review. Eur J Clin Microbiol Infect Dis 2019; 38: 2205-2213
    CrossrefPubMedGoogle Scholar
  • 2 Dirlam Langlay AM, Ofstead CL, Mueller NJ. et al. Reported gastrointestinal endoscope reprocessing lapses: the tip of the iceberg. Am J Infect Control 2013; 41: 1188-1194
    CrossrefPubMedGoogle Scholar
  • 3 Rauwers AW, Voor In’t Holt AF, Buijs JG. et al. High prevalence rate of digestive tract bacteria in duodenoscopes: a nationwide study. Gut 2018; 67: 1637-1645
    CrossrefPubMedGoogle Scholar
  • 4 Kimmey MB, Burnett DA, Carr-Locke DL. et al. ASGE Technology Assessment Position Paper: Transmission of infection by gastrointestinal endoscopy. Gastrointest Endosc 1993; 39: 885-888 DOI: 10.1016/S0016-5107(93)70316-8.
    CrossrefPubMedGoogle Scholar
  • 5 Ofstead CL, Dirlam Langlay AM, Mueller NJ. et al. Re-evaluating endoscopy-associated infection risk estimates and their implications. Am J Infect Control 2013; 41: 734-736
    CrossrefPubMedGoogle Scholar
  • 6 Kovaleva J. Infectious complications in gastrointestinal endoscopy and their prevention. Best Pract Res Clin Gastroenterol 2016; 30: 689-704
    CrossrefPubMedGoogle Scholar
  • 7 Nelson DB. Infectious disease complications of GI endoscopy: part II, exogenous infections. Gastrointest Endosc 2003; 57: 695-711
    CrossrefPubMedGoogle Scholar
  • 8 Nelson DB. Infectious disease complications of GI endoscopy: Part I, endogenous infections. Gastrointest Endosc 2003; 57: 546-556
    CrossrefPubMedGoogle Scholar
  • 9 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535
    CrossrefPubMedGoogle Scholar
  • 10 Rauwers AW, Troelstra A, Fluit AC. et al. Independent root-cause analysis of contributing factors, including dismantling of 2 duodenoscopes, to investigate an outbreak of multidrug-resistant Klebsiella pneumoniae. Gastrointest Endosc 2019; 90: 793-804
    CrossrefPubMedGoogle Scholar
  • 11 Kovaleva J, Meessen NE, Peters FT. et al. Is bacteriologic surveillance in endoscope reprocessing stringent enough?. Endoscopy 2009; 41: 913-916
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Verfaillie CJ, Bruno MJ, Voor in't Holt AF. et al. Withdrawal of a novel-design duodenoscope ends outbreak of a VIM-2-producing Pseudomonas aeruginosa. Endoscopy 2015; 47: 493-502
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Ekkelenkamp VE, de Man RA, Ter Borg F. et al. Prospective evaluation of ERCP performance: results of a nationwide quality registry. Endoscopy 2015; 47: 503-507
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Kovaleva J, Peters FT, van der Mei HC. et al. Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev 2013; 26: 231-254
    CrossrefPubMedGoogle Scholar
  • 15 Smith ZL, Oh YS, Saeian K. et al. Transmission of carbapenem-resistant Enterobacteriaceae during ERCP: time to revisit the current reprocessing guidelines. Gastrointest Endosc 2015; 81: 1041-1045
    CrossrefPubMedGoogle Scholar
  • 16 Carbonne A, Thiolet JM, Fournier S. et al. Control of a multi-hospital outbreak of KPC-producing Klebsiella pneumoniae type 2 in France, September to October 2009. Euro Surveill 2010; 15: 19734
    CrossrefPubMedGoogle Scholar
  • 17 Seoane-Vazquez E, Rodriguez-Monguio R, Visaria J. et al. Exogenous endoscopy-related infections, pseudo-infections, and toxic reactions: clinical and economic burden. Curr Med Res Opin 2006; 22: 2007-2021
    CrossrefPubMedGoogle Scholar
  • 18 Spach DH, Silverstein FE, Stamm WE. Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med 1993; 118: 117-128
    CrossrefPubMedGoogle Scholar
  • 19 Gorse GJ, Messner RL. Infection control practices in gastrointestinal endoscopy in the United States: a national survey. Gastroenterol Nurs 1991; 14: 72-79
    CrossrefPubMedGoogle Scholar
  • 20 Bajolet O, Ciocan D, Vallet C. et al. Gastroscopy-associated transmission of extended-spectrum beta-lactamase-producing Pseudomonas aeruginosa. J Hosp Infect 2013; 83: 341-343
    CrossrefPubMedGoogle Scholar
  • 21 Reddick E. Investigation of salmonellosis outbreak following a hospital endoscopy: a public health case study. Can J Infect Control 2017; 32: 156-159
    PubMedGoogle Scholar
  • 22 Rutala WA, Kanamori H, Sickbert-Bennett EE. et al. What’s new in reprocessing endoscopes: are we going to ensure “the needs of the patient come first” by shifting from disinfection to sterilization?. Am J Infect Control 2019; 47S: A62-A66
    CrossrefPubMedGoogle Scholar
  • 23 Bartles RL, Leggett JE, Hove S. et al. A randomized trial of single versus double high-level disinfection of duodenoscopes and linear echoendoscopes using standard automated reprocessing. Gastrointest Endosc 2018; 88: 306-313
    CrossrefPubMedGoogle Scholar
  • 24 Ren-Pei W, Hui-Jun X, Ke Q. et al. Correlation between the growth of bacterial biofilm in flexible endoscopes and endoscope reprocessing methods. Am J Infect Control 2014; 42: 1203-1206
    CrossrefPubMedGoogle Scholar
  • 25 Roberts CG. The role of biofilms in reprocessing medical devices. Am J Infect Control 2013; 41: S77-S80
    CrossrefPubMedGoogle Scholar
  • 26 Rauwers AW, Voor Inʼt Holt AF, Buijs JG. et al. Nationwide risk analysis of duodenoscope and linear echoendoscope contamination. Gastrointest Endosc 2020; 92: 681-691
    CrossrefPubMedGoogle Scholar
  • 27 Shenoy ES, Pierce VM, Walters MS. et al. Transmission of mobile colistin resistance (mcr-1) by duodenoscope. Clin Infect Dis 2019; 68: 1327-1334
    CrossrefPubMedGoogle Scholar
  • 28 Robertson P, Smith A, Anderson M. et al. Transmission of Salmonella enteritidis after endoscopic retrograde cholangiopancreatography because of inadequate endoscope decontamination. Am J Infect Control 2017; 45: 440-442
    CrossrefPubMedGoogle Scholar
  • 29 Muthusamy VR, Bruno MJ, Kozarek RA. et al. Clinical evaluation of a single-use duodenoscope for endoscopic retrograde cholangiopancreatography. Clin Gastroenterol Hepatol 2019; 18: 2108-2117
    CrossrefPubMedGoogle Scholar
  • 30 Ross AS, Bruno MJ, Kozarek RA. et al. Novel single-use duodenoscope compared with 3 models of reusable duodenoscopes for ERCP: a randomized bench-model comparison. Gastrointest Endosc 2020; 91: 396-403
    CrossrefPubMedGoogle Scholar
  • 31 Cassini A, Hogberg LD, Plachouras D. et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis 2019; 19: 56-66
    CrossrefPubMedGoogle Scholar