Duodenoscope-Associated Bacterial Infections: A Review and Update

Abstract

Physicians depend on the use of flexible endoscopes for delivery of vital care that is morbidity sparing compared to surgical alternatives. Iatrogenic infection is a well-documented complication of therapeutic endoscopy. Recent emergence of unique antimicrobial resistance patterns and molecular "fingerprinting" of bacteria harken a new era in duodenoscope-related infections which occur in spite of compliance with device manufacturer-recommended protocols for high-level disinfection (HLD). Further studies suggest that these protocols are likely inadequate. Endoscopic retrograde cholangiopancreatography (ERCP) remains critical in the provision of minimally invasive diagnostic, therapeutic, and palliative care for patients with pancreaticobiliary disease. This manuscript reviews the history of duodenoscope-related infections, current challenges to scope reprocessing, and recommendations from regulatory agencies.

Keywords: CRE; Duodenoscope; ERCP; Infection; MDRO; Reprocessing.