Prevalence of Carbapenemase-producing organisms (CPO) colonization before and after endoscopic retrograde cholangiopancreatography (ERCP): A prospective observational study

Abstract

Introduction: Risk of transmission of carbapenemase-producing organisms (CPO) from duodenoscopes has been widely described and is now considered a well-known threat. Data on infection rates are limited to case series and confined to the setting of infection outbreaks. To date, data on universal screening for multidrug-resistant microorganisms of patients referring to the Endoscopy service are extremely scant.

Aim: to evaluate the overall incidence of CPO colonization after endoscopic retrograde cholangiopancreatography (ERCP).

Methods: All consecutive patients undergoing ERCP at our Service were evaluated. All enrolled patients underwent rapid rectal swab for KPC genes 2-24 h before the endoscopic procedure, with Xpert Carba-R rapid detection swabs. 72 h after ERCP, patients underwent a second rapid rectal swab for CPO.

Results: from July 2022 to 15th November 2023 539 patients referring to the Endoscopy Unit for ERCP were evaluated. Of these, 16 had already a known colonization for MDR. The other 523 patients were screened: 10 resulted positive for CPO. Of the remaining 513 patients, 355 underwent post-procedural swab, and 9 (2,5 %) had a rectal colonization from CPO.

Conclusions: duodenoscope-related infections are an open issue. Routine screening with anal swabs could provide early recognition of infection outbreaks and identification of high-risk cases to drive proper resource allocation.

Keywords: Colonization; Duodenoscopes; ERCP; Infections; Multidrug-resistant organisms.