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Duodenoscope-Associated Infections: Update on an Emerging Problem

  • M. Rubayat Rahman
  • Abhilash Perisetti
  • Roxana Coman
  • Pardeep Bansal
  • Rajiv Chhabra
  • Hemant GoyalEmail author
Review
  • 96 Downloads

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.

Keywords

Duodenoscopes Endoscopic retrograde cholangiopancreatography Infection Contamination 

Notes

Compliance with ethical standards

Conflict of interest

The authors declared that they have no conflict of interest.

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Authors and Affiliations

  1. 1.Texas Tech UniversityLubbockUSA
  2. 2.Department of Gastroenterology and HepatologyUniversity of Arkansas For Medical SciencesLittle RockUSA
  3. 3.Gastroenterology DivisionThe Medical Center Navicent HealthMaconUSA
  4. 4.GI Fellowship ProgramThe Wright Center of Graduate Medical EducationScrantonUSA
  5. 5.Department of GastroenterologyRegional Hospital and Mosses Taylor HospitalScrantonUSA
  6. 6.Department of GastroenterologyUniversity of Missouri Kansas City (UMKC) School of Medicine, Saint Luke’s HospitalKansas CityUSA
  7. 7.Mercer University School of MedicineMaconUSA

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