a quarantine process for the resolution of duodenoscope-associated transmission of multidrug-resistant escherichia coli：对多重耐药大肠埃希菌十二指肠镜相关的传输分辨率检疫过程.pdfVIP

ORIGINAL ARTICLE: Clinical Endoscopy A quarantine process for the resolution of duodenoscope-associated transmission of multidrug-resistant Escherichia coli Andrew S. Ross, MD, 1 Christopher Baliga, MD,1 Punam Verma, PhD,1 Jeffrey Duchin, MD, 2 Michael Gluck, MD1 Seattle, Washington, USA Background: Because of their complex design, duodenoscopes have been long recognized to be difficult to fully disinfect and may play a role in transmission of bacteria between patients. Recent reports of duodenoscope- associated carbapenem-resistant enterobacteriaceae transmission have confirmed these suspicions. An outbreak of a multidrug resistant strain of Escherichia coli was recently reported at our institution. Herein we report the results of our investigation and the process improvements that we deployed in an effort to contain the outbreak. Methods: A full investigation into the environment, endoscopists, infection control practices, high-level disinfec- tion process as well as endoscopes was undertaken in conjunction with the local county health authority and the Centers for Disease Control and Prevention. Duodenoscopes were cultured and quarantined for 48 hours until negative cultures were obtained. Ergonomic changes were made to the endoscope reprocessing area, duodeno- scopes were returned for routine maintenance, and surveillance cultures were obtained from all patients under- going ERCP. Results: Between November 2012 and August 2013, 32 patients were found to harbor 1 of 2 clonal strains of multidrug-resistant E coli , all of whom had undergone ERCP or duodenoscopy. A total of 1149 ERCPs were per- formed during this time period. Seven patients died within 31 days of the organism being identified in culture, 16 patients died overall by March 2015. The exact contribution of E coli to death is unclear be