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Klebsiella pneumoniae survival and regrowth in endoscope channel biofilm exposed to glutaraldehyde and desiccation

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Abstract

Biofilm in endoscopes is a major problem that can result in failure of disinfection. We studied the survival of K. pneumoniae in a biofilm formed on endoscope tubes subjected to combined chemical and physical stresses. We monitored bacterial survival in the biofilm after the action of 1% and 2% GTA either immediately or after 15 days of desiccation and described the ability of surviving bacteria to recolonize endoscope tubing in a dynamic model. There were surviving bacteria after 5-min exposure to 2% and 1% GTA. The percentage of survivors after 2% and 1% GTA was greater when the GTA treatment was performed after 15 days of prior desiccation of the biofilm. The survivors were able to recolonize and reform biofilm on abiotic surfaces probably because of the survival of persisters in a viable but non-culturable state in the biofilm. Our findings emphasize that the current guidelines on endoscope reprocessing should be strictly followed but that once constituted the biofilm in endoscope tubing will be very difficult to eradicate with present practices.

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References

  1. Costerton JW, Lewandowski Z, Caldwell DE, Korber DR, Lappin-Scott HM (1995) Microbial biofilms. Annu Rev Microbiol 49:711–745

    Article  CAS  Google Scholar 

  2. Donlan RM, Costerton JW (2002) Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev 15:167–193

    Article  CAS  Google Scholar 

  3. Lewis K (2010) Persister cells. Annu Rev Microbiol 64:357–372

    Article  CAS  Google Scholar 

  4. Li L, Mendis N, Trigui H, Oliver JD, Faucher SP (2014) The importance of the viable but non-culturable state in human bacterial pathogens. Front Microbiol 5:258

    PubMed  PubMed Central  Google Scholar 

  5. Høiby N, Bjarnsholt T, Givskov M, Molin S, Ciofu O (2010) Antibiotic resistance of bacterial biofilms. Int J Antimicrob Agents 35(4):322–332

    Article  Google Scholar 

  6. Kovaleva J, Peters FT, van der Mei HC, Degener JE (2013) Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev 26(2):231–254

    Article  CAS  Google Scholar 

  7. Rahman MR, Perisetti A, Coman R, Bansal P, Chhabra R, Goyal H (2019) Duodenoscope-associated infections: update on an emerging problem. Dig Dis Sci 64(6):1409–1418

    Article  Google Scholar 

  8. Hennequin C, Aumeran C, Robin F, Traore O, Forestier C (2012) Antibiotic resistance and plasmid transfer capacity in biofilm formed with a CTX-M-15-producing Klebsiella pneumoniae isolate. J Antimicrob Chemother 67(9):2123–2130

    Article  CAS  Google Scholar 

  9. Aumeran C, Poincloux L, Souweine B, Robin F, Laurichesse H, Baud O, Bommelaer G, Traoré O (2010) Multidrug-resistant Klebsiella pneumoniae outbreak after endoscopic retrograde cholangiopancreatography. Endoscopy 42(11):895–899

    Article  CAS  Google Scholar 

  10. Pajkos A, Vickery K, Cossart Y (2004) Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and decontamination? J Hosp Infect 58(3):224–229

    Article  CAS  Google Scholar 

  11. Kovaleva J (2017) Endoscope drying and its pitfalls. J Hosp Infect 97(4):319–328

    Article  CAS  Google Scholar 

  12. Vickery K, Pajkos A, Cossart Y (2004) Removal of biofilm from endoscopes: evaluation of detergent efficiency. Am J Infect Control 32(3):170–176

    Article  Google Scholar 

  13. Russell AD (1994) Glutaraldehyde: current status and uses. Infect Control Hosp Epidemiol 15(11):724–733

    Article  CAS  Google Scholar 

  14. Beilenhoff U, Biering H, Blum R, Brljak J, Cimbro M, Dumonceau J-M, Hassan C, Jung M, Kampf B, Neumann C, Pietsch M, Pineau L, Ponchon T, Rejchrt S, Rey JF, Schmidt V, Tillett J, van Hooft JE (2018) Reprocessing of flexible endoscopes and endoscopic accessories used in gastrointestinal endoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA) – update 2018. Endoscopy 50(12):1205–1234

    Article  Google Scholar 

  15. Alfa MJ, Howie R (2009) Modeling microbial survival in buildup biofilm for complex medical devices. BMC Infect Dis 9:56

    Article  Google Scholar 

  16. Ofstead CL, Wetzler HP, Heymann OL, Johnson EA, Eiland JE, Shaw MJ (2017) Longitudinal assessment of reprocessing effectiveness for colonoscopes and gastroscopes: results of visual inspections, biochemical markers, and microbial cultures. Am J Infect Control 45(2):26–33

    Article  Google Scholar 

  17. da Costa LC, Olson N, Tipple AF, Alfa M (2016) Evaluation of the ability of different detergents and disinfectants to remove and kill organisms in traditional biofilm. Am J Infect Control 44(11):243–249

    Article  Google Scholar 

  18. Alfa MJ, Ribeiro MM, da Costa LC, Franca R, Olson N, DeGagne P, Singh H (2017) A novel polytetrafluoroethylene-channel model, which simulates low levels of culturable bacteria in buildup biofilm after repeated endoscope reprocessing. Gastrointest Endosc 86(3):442–451

    Article  Google Scholar 

  19. Aumeran C, Thibert E, Chapelle FA, Hennequin C, Lesens O, Traoré O (2012) Assessment on experimental bacterial biofilms and in clinical practice of the efficacy of sampling solutions for microbiological testing of endoscopes. J Clin Microbiol 50(3):938–942

    Article  CAS  Google Scholar 

  20. Tolker-Nielsen T, Sternberg C. 2011. Growing and analyzing biofilms in flow chambers. Curr Protoc Microbiol. Chapter 1:unit 1B.2

  21. Stewart PS, Costerton JW (2001) Antibiotic resistance of bacteria in biofilms. Lancet 358(9276):135–138

    Article  CAS  Google Scholar 

  22. Tuomanen E, Cozens R, Tosch W, Zak O, Tomasz A (1986) The rate of killing of Escherichia coli by beta-lactam antibiotics is strictly proportional to the rate of bacterial growth. J Gen Microbiol 132(5):1297–1304

    CAS  PubMed  Google Scholar 

  23. Martin DJ, Denyer SP, McDonnell G, Maillard JY (2008) Resistance and cross-resistance to oxidising agents of bacterial isolates from endoscope washer disinfectors. J Hosp Infect 69(4):377–383

    Article  CAS  Google Scholar 

  24. Tschudin-Sutter S, Frei R, Kampf G, Tamm M, Pflimlin E, Battegay M, Widmer AF (2011) Emergence of glutaraldehyde-resistant Pseudomonas aeruginosa. Infect Control Hosp Epidemiol 32(12):1173–1178

    Article  Google Scholar 

  25. Ofstead CL, Hopkins KM, Buro BL, Eiland JE, Wetzler HP (2019) Challenges in achieving effective high-level disinfection in endoscope reprocessing. Am J Infect Control S0196-6553(19):30849–30841

    Google Scholar 

  26. Greenwald DA (2015) Endoscopic hang time: can we get some clarity? Gastrointest Endosc 81(5):1155–1157

    Article  Google Scholar 

  27. Perumpail RB, Marya NB, McGinty BL, Muthusamy VR (2019) Endoscope reprocessing: comparison of drying effectiveness and microbial levels with an automated drying and storage cabinet with forced filtered air and a standard storage cabinet. Am J Infect Control 47(9):1083–1089

    Article  Google Scholar 

  28. Ren-Pei W, Hui-Jun X, Ke Q, Dong W, Xing N, Zhao-Shen L (2014) Correlation between the growth of bacterial biofilm in flexible endoscopes and endoscope reprocessing methods. Am J Infect Control 42(11):1203–1206

    Article  Google Scholar 

  29. Vickery K, Ngo Q-D, Zou J, Cossart YE (2009) The effect of multiple cycles of contamination, detergent washing, and disinfection on the development of biofilm in endoscope tubing. Am J Infect Control 37(6):470–475

    Article  Google Scholar 

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Acknowledgments

We thank Jeffrey Watts for his help in preparing the manuscript.

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Authors and Affiliations

  1. Université Clermont Auvergne, CNRS, Laboratoire “Microorganismes : Génome et Environnement”, F-63000, Clermont-Ferrand, France

    A. C. Cholley, O. Traoré, C. Hennequin & C. Aumeran

  2. Service d’hygiène hospitalière, CHU de Clermont-Ferrand, Clermont-Ferrand, France

    A. C. Cholley, O. Traoré & C. Aumeran

  3. Laboratoire de Bactériologie clinique, CHU de Clermont-Ferrand, Clermont-Ferrand, France

    C. Hennequin

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  1. A. C. Cholley
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  2. O. Traoré
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  3. C. Hennequin
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  4. C. Aumeran
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Correspondence to O. Traoré.

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Cholley, A.C., Traoré, O., Hennequin, C. et al. Klebsiella pneumoniae survival and regrowth in endoscope channel biofilm exposed to glutaraldehyde and desiccation. Eur J Clin Microbiol Infect Dis 39, 1129–1136 (2020). https://doi.org/10.1007/s10096-020-03818-7

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  • DOI: https://doi.org/10.1007/s10096-020-03818-7

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