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Duodenoscope-Associated Infections: Update on an Emerging Problem

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Abstract

The duodenoscope is among the most complex medical instruments that undergo disinfection between patients. Transmission of infection by contaminated scopes has remained a challenge since its inception. Notable risk factors for pathogen transmission include non-adherence to disinfection guidelines, encouragement of biofilm deposition due to complex design and surface defects and contaminated automated endoscope reprocessors. The most common infections following endoscopy are endogenous infections involving the patient’s own gut flora. Exogenous infections, on the other hand, are associated with contaminated scopes and can theoretically be prevented by effective reprocessing. Pseudomonas aeruginosa is currently the most common organism isolated from contaminated endoscopes. Of note, reports of multidrug-resistant duodenoscopy-associated outbreaks have surfaced recently, many of which occurred despite adequate reprocessing. The FDA and CDC currently recommend comprehensive cleaning followed with at least high-level disinfection for reprocessing of flexible GI endoscopes. Reports of duodenoscope-related outbreaks despite compliance with established guidelines have prompted professional and government bodies to revisit existing guidelines and offer supplementary recommendations for duodenoscope processing. For the purposes of this review, we identified reports of duodenoscope-associated infections from 2000 till date. For each outbreak, we noted the organisms isolated, the number of cases reported, any possible explanations of contamination, and the measures undertaken to end each outbreak. We have also attempted to present an overview of recent developments in this rapidly evolving field.

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Authors and Affiliations

  1. Texas Tech University, Lubbock, USA

    M. Rubayat Rahman

  2. Department of Gastroenterology and Hepatology, University of Arkansas For Medical Sciences, Little Rock, AR, USA

    Abhilash Perisetti

  3. Gastroenterology Division, The Medical Center Navicent Health, 777 Hemlock St., Macon, GA, 31201, USA

    Roxana Coman

  4. GI Fellowship Program, The Wright Center of Graduate Medical Education, Scranton, USA

    Pardeep Bansal

  5. Department of Gastroenterology, Regional Hospital and Mosses Taylor Hospital, 743 Jefferson Ave, Ste 104, Scranton, PA, 18510, USA

    Pardeep Bansal

  6. Department of Gastroenterology, University of Missouri Kansas City (UMKC) School of Medicine, Saint Luke’s Hospital, 4321 Washington Street, Suite 5100, Kansas City, MO, 64111, USA

    Rajiv Chhabra

  7. Mercer University School of Medicine, 707 Pine St, Macon, GA, 31201, USA

    Hemant Goyal

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Rahman, M.R., Perisetti, A., Coman, R. et al. Duodenoscope-Associated Infections: Update on an Emerging Problem. Dig Dis Sci 64, 1409–1418 (2019). https://doi.org/10.1007/s10620-018-5431-7

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