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Multicenter Study
. 2018 Sep;67(9):1637-1645.
doi: 10.1136/gutjnl-2017-315082. Epub 2018 Apr 10.

High prevalence rate of digestive tract bacteria in duodenoscopes: a nationwide study

Arjan W Rauwers  1 , Anne F Voor In 't Holt  2 , Jolanda G Buijs  3 , Woutrinus de Groot  2 , Bettina E Hansen  1 , Marco J Bruno #  1 , Margreet C Vos #  2
Affiliations
Multicenter Study

High prevalence rate of digestive tract bacteria in duodenoscopes: a nationwide study

Arjan W Rauwers et al. Gut. 2018 Sep.

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.

Keywords: endoscopic retrograde pancreatography; endoscopy.

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Conflict of interest statement

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.

Figures

Figure 1
Figure 1
Flow diagram. ERCP, Endoscopic Retrograde Cholangiopancreatography.
Figure 2
Figure 2
OR for each duodenoscope type on contamination. AM20, microbial growth with ≥20 CFU/20 mL of any type of microorganism; CFU, colony forming units; MGO, presence of any microbial growth of gastrointestinal or oral microorganisms.
Figure 3
Figure 3
OR for each sample site on contamination. AM20, microbial growth with ≥20 CFU/20 mL of any type of microorganism; CFU, colony forming units; MGO, presence of any microbial growth of gastrointestinal or oral microorganisms.
See this image and copyright information in PMC

References

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