title: Risk factors associated with the transmission of carbapenem-resistant Enterobacteriaceae via contaminated duodenoscopes.
abstract: OBJECTIVE
  The duodenoscopes used to perform ERCP have been implicated in several outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) infection. The risk factors for CRE transmission via contaminated duodenoscopes remain unclear.
  
  
  METHODS
  In this retrospective, single-center, case-control study, all patients who underwent ERCP with either 1 of 2 contaminated duodenoscopes were evaluated. We compared the patients who acquired CRE (active infection or colonization) with those who did not.
  
  
  RESULTS
  Between October 3, 2014, and January 28, 2015, a total of 125 procedures were performed on 115 patients by using either of the contaminated duodenoscopes. Culture data were available for 104 of the 115 exposed patients (90.4%). Among these patients, 15 (14.4%) became actively infected (n = 8, 7.7%) or colonized (n = 7, 6.7%) with CRE. On univariate analysis, recent antibiotic exposure (66.7% vs 37.1%; P = .046), active inpatient status (60.0% vs 28.1%; P = .034), and a history of cholangiocarcinoma (26.7% vs 3.4%; P = .008) were patient characteristics associated with an increased risk of CRE infection. Biliary stent placement (53.3% vs 22.5%; P = .024) during ERCP was a significant procedure-related risk factor. After adjusting for cholangiocarcinoma, biliary stent placement (odds ratio 3.62; 95% confidence interval, 1.12-11.67), and active inpatient status (odds ratio 3.74; 95% confidence interval, 1.15-12.12) remained independent risk factors for CRE transmission.
  
  
  CONCLUSIONS
  In patients undergoing ERCP with a contaminated duodenoscope, biliary stent placement, a diagnosis of cholangiocarcinoma, and active inpatient status are associated with an increased risk of CRE transmission.
authors.affiliation: Division of Digestive Diseases, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kim
authors.affiliation: Clinical Epidemiology and Infection Prevention, University of California, Los Angeles Health, Los Angeles, California, USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Russell
authors.affiliation: Division of Digestive Diseases, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Mohamadnejad
authors.affiliation: Division of Digestive Diseases, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Jitin
authors.initials: J
authors.lastname: Makker
authors.affiliation: Division of Digestive Diseases, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Alireza
authors.initials: A
authors.lastname: Sedarat
authors.affiliation: Division of Digestive Diseases, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Rabindra R
authors.initials: RR
authors.lastname: Watson
authors.affiliation: Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Shangxin
authors.initials: S
authors.lastname: Yang
authors.affiliation: Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Peera
authors.initials: P
authors.lastname: Hemarajata
authors.affiliation: Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Romney
authors.initials: R
authors.lastname: Humphries
authors.affiliation: Infectious Diseases, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Rubin
authors.affiliation: Division of Digestive Diseases, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: V Raman
authors.initials: VR
authors.lastname: Muthusamy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001650:Bile Duct Neoplasms / Q000453:epidemiology; D015780:Carbapenems; D002353:Carrier State / Q000453:epidemiology*; D016022:Case-Control Studies; D002648:Child; D018281:Cholangiocarcinoma / Q000453:epidemiology; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D024881:Drug Resistance, Bacterial / Q000235:genetics; D020698:Duodenoscopes / Q000382:microbiology*; D004755:Enterobacteriaceae / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000209:etiology; D004866:Equipment Contamination; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000209:etiology; D007711:Klebsiella pneumoniae / Q000235:genetics / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems