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Defective bronchoscope blamed for cluster of multidrug-resistant infections

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November 30, 2018

Researchers determined that a defective bronchoscope was likely the source of a cluster of multidrug-resistant infections among patients in a medical ICU in Pittsburgh.

They launched an investigation for a common source after multidrug-resistant Pseudomonas aeruginosa and carbapenem-resistant Klebisella pneumoniae was recovered from several patients.

Writing in Infection Control & Hospital Epidemiology, the researchers said evidence “strongly linked” the infections to a single defective bronchoscope and said efforts should be made beyond standard reprocessing guidelines to prevent such transmission in the future.

“Millions of endoscopic procedures are performed in U.S. hospitals every year. Over the last decade, reports have implicated endoscopes as a source of infectious disease outbreaks and pseudo-outbreaks,” Alison L. Galdys, MD, assistant professor of infectious diseases and international medicine and infection preventionist and hospital epidemiologist at the University of Minnesota Medical School, and colleagues wrote. “Recently, an increasing number of U.S. hospitals have reported multidrug-resistant (MDR) organism clusters linked to endoscopes.”

According to the study, in November 2014, a cluster of patients with clinical cultures taken via bronchoscopy that tested positive for carbapenem-resistant K. pneumoniae (CR-KP) and gentamicin-resistant MDR P. aeruginosa (MDR-PA) was identified in the ICU at the University of Pittsburgh Medical Center-Presbyterian Hospital.

Galdys and colleagues said the investigation was prompted by the “unexpected” identification of CR-KP and MDR-PA isolates in a bronchoalveolar lavage specimen from an ICU patient without recent health care and nine more positive tests from other patients involving samples taken during or after bronchoscopy procedures over the ensuing 3 weeks.

In all, 33 patients with cultures positive for CR-KP and or MDR-PA from respiratory sources were identified between July and December 2014, according to the study. Of these patients, tests showed that 23 were exposed to the implicated bronchoscope, including 19 who had cultures positive for MDR-PA and 11 for CR-KP, Galdys and colleagues reported. They said MDR-PA and CR-KP was recovered from the bronchoscope’s lumen, which they reported was “physically defective,” allowing “proteinaceous debris” to accumulate despite appropriate cleaning.

“In conclusion, we report an outbreak and pseudo-outbreak of MDR-PA and CR-KP that were strongly linked to the contamination of a single, physically defective bronchoscope, and we provide genomic data to support our epidemiologic investigation,” the authors wrote.

“In addition to adhering to endoscope reprocessing guidelines, hospital epidemiology programs should prioritize thorough periodic maintenance of endoscopic devices and emphasize scrutiny of endoscope-derived culture data as an important intervention to hasten recognition of endoscope-associated outbreaks.” – by Caitlyn Stulpin

Disclosures: Galdys reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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