title: Outbreaks of carbapenem-resistant Enterobacteriaceae infections associated with duodenoscopes: What can we do to prevent infections?
abstract: Recent outbreaks with carbapenem-resistant Enterobacteriaceae (CRE) in patients who have undergone endoscopic retrograde cholangiopancreatography (ERCP) have raised concerns of whether current endoscope reprocessing guidelines are adequate to ensure a patient-safe endoscope. Unlike previous outbreaks, these CRE outbreaks occurred even though manufacturer's instructions and professional guidelines were followed correctly. This article reviews why outbreaks associated with endoscopes continue to occur; what alternatives exist that might improve the margin of safety associated with duodenoscope reprocessing; and how to prevent future outbreaks associated with ERCP procedures. The advantages and disadvantages for the proposed enhancements for reprocessing duodenoscopes are reviewed as well as future strategies to prevent GI endoscope-related outbreaks.
authors.affiliation: Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC. Electronic address: brutala@unch.unc.edu.
authors.forename: William A
authors.initials: WA
authors.lastname: Rutala
authors.affiliation: Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
authors.forename: David J
authors.initials: DJ
authors.lastname: Weber
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D004196:Disease Outbreaks; D020698:Duodenoscopes / Q000382:microbiology; D004384:Duodenoscopy / Q000009:adverse effects*; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D006801:Humans; D017053:Infection Control / Q000379:methods; D061214:Patient Safety; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: Endoscopes; disinfection; duodenoscopes; endoscopic retrograde cholangiopancreatography; outbreaks; sterilization