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Original article
High prevalence rate of digestive tract bacteria in duodenoscopes: a nationwide study
  1. Arjan W Rauwers1,
  2. Anne F Voor in ’t holt2,
  3. Jolanda G Buijs3,
  4. Woutrinus de Groot2,
  5. Bettina E Hansen1,
  6. Marco J Bruno1,
  7. Margreet C Vos2
  1. 1 Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
  2. 2 Department of Medical Microbiology and Infectious diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
  3. 3 Staff Office Medical Devices, Erasmus MC University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Dr Margreet C Vos, Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, CA 3000, The Netherlands; m.vos{at}erasmusmc.nl

Abstract

Objective Increasing numbers of outbreaks caused by contaminated duodenoscopes used for Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures have been reported, some with fatal outcomes. We conducted a nationwide cross-sectional study to determine the prevalence of bacterial contamination of reprocessed duodenoscopes in The Netherlands.

Design All 73 Dutch ERCP centres were invited to sample ≥2 duodenoscopes using centrally distributed kits according to uniform sampling methods, explained by video instructions. Depending on duodenoscope type, four to six sites were sampled and centrally cultured. Contamination was defined as (1) any microorganism with ≥20 colony forming units (CFU)/20 mL (AM20) and (2) presence of microorganisms with gastrointestinal or oral origin, independent of CFU count (MGO).

Results Sixty-seven out of 73 centres (92%) sampled 745 sites of 155 duodenoscopes. Ten different duodenoscope types from three distinct manufacturers were sampled including 69 (46%) Olympus TJF-Q180V, 43 (29%) Olympus TJF-160VR, 11 (7%) Pentax ED34-i10T, 8 (5%) Pentax ED-3490TK and 5 (3%) Fujifilm ED-530XT8. Thirty-three (22%) duodenoscopes from 26 (39%) centres were contaminated (AM20). On 23 (15%) duodenoscopes MGO were detected, including Enterobacter cloacae, Escherichia coli, Klebsiella pneumonia and yeasts. For both definitions, contamination was not duodenoscope type dependent (p values: 0.20 and higher).

Conclusion In 39% of all Dutch ERCP centres, at least one AM20-contaminated patient-ready duodenoscope was identified. Fifteen per cent of the duodenoscopes harboured MGO, indicating residual organic material of previous patients, that is, failing of disinfection. These results suggest that the present reprocessing and process control procedures are not adequate and safe.

  • endoscopic retrograde pancreatography
  • endoscopy

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Footnotes

  • MJB and MCV contributed equally.

  • Contributors AWR: acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis. AFV in ‘t holt: analysis and interpretation of data; critical revision of the manuscript for important intellectual content; statistical analysis. JGB: study concept and design; critical revision of the manuscript for important intellectual content. RDG: study concept and design; acquisition of data; critical revision of the manuscript for important intellectual content. BEH: analysis and interpretation of data; critical revision of the manuscript for important intellectual content; statistical analysis. MJB: study concept and design; analysis and interpretation of data; critical revision of the manuscript for important intellectual content; study supervision. MCV: study concept and design; analysis and interpretation of data; critical revision of the manuscript for important intellectual content; obtained funding; study supervision.

  • Funding This study was supported by grant 324841 from the Dutch Ministry of Health, Wellbeing and Sports (Professor Dr MCV).

  • Disclaimer The funder of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report.

  • Competing interests AWR, AFV in ‘t holt, JGB and RDG reported no relevant financial activities. BEH has had the following relevant financial activities outside the submitted work: Consultant for Intercept Pharmaceuticals Inc.; Consultant for Novartis; Consultant for Albiero; Received grants from Intercept Pharmaceuticals Inc.; Received grants from Roche International. MJB has had the following relevant financial activities outside the submitted work: Consultant for 3M; Grant from 3M for an investigator initiated study for the benefit of the Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Consultant and lecturer for Boston Scientific; Grants from Boston Scientific for investigator initiated studies and industry initiated studies for the benefit of the Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Consultant and lecturer for Cook Medical; Grants from Cook Medical for investigator initiated studies and industry initiated studies for the benefit of the Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Grant of Pentax Medical for the benefit of the Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. MCV has had the following relevant financial activities outside the submitted work: Grant from 3M for an investigator initiated study.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at Spring meeting Dutch Society of Gastroenterology. Veldhoven, The Netherlands, 17–18 March 2016. Title: Bacterial contamination of reprocessed ERCP duodenoscopes in The Netherlands is widespread (abstract number: 4317) Oral presentation. Session Title: President Select 26th ECCMID Congress, the European Congress of Clinical Microbiology and Infectious Diseases. Amsterdam, The Netherlands, 9–12 April 2016. Title: ERCP duodenoscopes in Dutch ERCP centres: high prevalence of bacterial contamination despite reprocessing (abstract number: O384) Oral presentation. Session Title: New insights in the control of multi-resistant Gram-negatives Digestive Disease Week. San Diego, USA, 21–24 May 2016. Title: ERCP Duodenoscopes in Dutch ERCP Centres: High Prevalence of Bacterial Contamination Despite Reprocessing (abstract number: 2442341) Oral presentation. Session Title: Bugs on Duodenoscope: Pressing Need for Pest Control (ASGE) 8th Steering Group Flexible Endoscopes Cleaning and Disinfection (SFERD) Symposium, Veenendaal, the Netherlands, 14 September 2016. Title: Contamination of duodenoscopes, where are we now? Oral presentation.

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