Risk factors associated with the transmission of carbapenem-resistant Enterobacteriaceae via contaminated duodenoscopes

Gastrointest Endosc. 2016 Jun;83(6):1121-9. doi: 10.1016/j.gie.2016.03.790. Epub 2016 Mar 16.

Abstract

Background and aims: 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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Bile Duct Neoplasms / epidemiology
  • Carbapenems*
  • Carrier State / epidemiology*
  • Case-Control Studies
  • Child
  • Cholangiocarcinoma / epidemiology
  • Cholangiopancreatography, Endoscopic Retrograde / adverse effects*
  • Drug Resistance, Bacterial / genetics
  • Duodenoscopes / microbiology*
  • Enterobacteriaceae / genetics
  • Enterobacteriaceae / isolation & purification
  • Enterobacteriaceae Infections / epidemiology
  • Enterobacteriaceae Infections / etiology
  • Equipment Contamination*
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Klebsiella Infections / epidemiology*
  • Klebsiella Infections / etiology
  • Klebsiella pneumoniae / genetics
  • Klebsiella pneumoniae / isolation & purification*
  • Male
  • Middle Aged
  • Odds Ratio
  • Retrospective Studies
  • Risk Factors
  • Stents / statistics & numerical data
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Carbapenems