Eine systematische Analyse nosokomialer Ausbrüche von Infektionskrankheiten in der gastrointestinalen Endoskopie

Zusammenfassung

Die Ösophagogastroduodenoskopie (ÖGD), die endoskopische retrograde Cholangiopankreatikografie (ERCP) sowie die Koloskopie (KOLO) bergen stets das Risiko einer Transmission von Erregern. Leider gibt es bislang nur wenige Daten zu den Ursachen und Erregerspektren für diese Ereignisse.

In einer systematischen Literaturrecherche der Worldwide Outbreak Database, der PubMed und der Embase wurden entsprechende Ausbrüche hinsichtlich der Ausbruchsursache, des Erregerspektrums, der Attack Rate und Letalität sowie der daraufhin eingeleiteten Hygienemaßnahmen evaluiert.

Es wurden insgesamt 73 Ausbrüche (ÖDG: 24; ERCP: 42; KOLO: 7) eingeschlossen mit Attack Rates in Höhe von 3,5%, 7,1% und 12,8%. Die zugehörigen Letalitäten betrugen 6,3%, 12,7% und 10,0%. Im Rahmen der ÖGD ereigneten sich vor allem Transmissionen von Enterobakterien mit einem großen Anteil multiresistenter Isolate. Via ERCP wurden überwiegend Nonfermenter übertragen. Die häufigste Ursache für die akzidentelle Verwendung kontaminierter Endoskope war menschliches Versagen während der Endoskopaufbereitung.

Dem Anwender sollte das Risiko einer Übertragung stets bewusst sein, um diese frühestmöglich erkennen und fortan unterbinden zu können. Darüber hinaus müssen Mitarbeiter regelmäßig in der Aufbereitung von Medizinprodukten geschult werden. Die Verwendung von Einmalendoskopen senkt zwar das Übertragungsrisiko von Erregern, erhöht jedoch andererseits die Abfallmenge und ggf. auch die Kosten.

Abstract

Esophagogastroduodenoscopy (EGD), endoscopic retrograde cholangiopancreatography (ERCP) and colonoscopy (CLN) come with a potential risk of pathogen transmission. Unfortunately, up to now data on the causes and the distribution of pathogens is rather sparse.

We performed a systematic review of the medical literature using the Worldwide Outbreak Database, the PubMed, and Embase. We then checked so-retrieved articles for potential sources of the outbreak, the spectrum of pathogens, the attack rates, mortality and infection control measures.

In total 73 outbreaks (EGD: 24, ERCP: 42; CLN: 7) got included. The corresponding attack rates were 3.5%, 7.1% and 12.8% and mortality rates were 6.3%, 12.7% and 10.0% respectively. EGD was highly associated with transmission of enterobacteria including a large proportion of multi-drug resistant strains. ERCP led primarily to transmission of non-fermenting gram-negative rods. The most frequent cause was human failure during reprocessing regardless of the type of endoscope.

Staff working in the field of endoscopy should always be aware of the possibility of pathogen transmission in order to detect and terminate those events at the early most time point. Furthermore, proper ongoing education of staff involved in the reprocessing and maintenance of endoscopes is crucial. Single-use devices may be an alternative option and lower the risk of pathogen transmission, but on the downside may also increase costs and waste.

Schlüsselwörter

Ausbruch - Endoskopie - Transmission - Infektion - Hygiene - Prävention

Keywords

Outbreak - Endoscopy - Transmission - Infection - Hygiene - Prevention

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