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DOI: 10.1055/s-0040-1704233
DUODENOSCOPE-RELATED INFECTIONS: AN ITALIAN PICK IN 2019
Publication History
Publication Date:
23 April 2020 (online)
Aims ERCP is performed with reusable duodenoscopes after manual and automated reprocessing. Recently, multidrug-resistant infection outbreaks associated with infected duodenoscopes have been reported. Our aim was to investigate the current Italian experience with duodenoscope-related infections and assess the criticality of the risk.
Methods Sixty-one Italian centers who perform ERCP were invited to complete a questionnaire about various aspects of duodenoscope-associated infection over the past 3 years.
Results Most centers (52, 85.2%) responded, 39 from Northern Italy (75.0%), 19 (36.6%) academic. Median number of duodenoscopes in use was 3.7/center with 39 (75.0%) using Olympus, 11 (21.2%) Pentax, 10 (19.2%) Fujifilm and 1 Storz (1.9%). Twenty-four (24, 46.2%) centers affirmed adopting reusable accessories, mainly Dormia baskets. Median number of ERCP/year was 300, with 38 (73.1%) reporting< 5% rate of ERCP-related complications, mostly pancreatitis. Thirty-six (69.2%) centers reported at least one episode of duodenoscope-related infection, with up to 25 patients/center contaminated. Isolated pathogens were Klebsiella pneumoniae (KP) (18, 50%), Pseudomonas aeruginosa (10, 27.7%) and Escherichia coli (8, 22.3%). Six cases of KP infection were due to carbapenemase-producing strain, while only one patient was infected with ESBL E. coli. In all cases but six the infective episode prolonged hospitalization. Only 1 center reported 1 death. Major problems reported by centers in reviewing duodenoscopes and local policies after the evidence of ERCP-related infections were damaged working channel and non-compliance with reprocessing procedures according to local and international guidelines. Forty-one (41, 78.9%) participants responded that duodenoscope-related infections are relevant for their daily practice and 49 (94.2%) stated that their center would agree to participate in a study on duodenoscope-related infections.
Conclusions These data represent the first Italian report pertaining to duodenoscope-associated infection with majority of Italian centers having experienced at least one case of ERCP-related infection. The rising number of cases reported worldwide makes it urgent to find a solution.