RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0042-116490
A novel adjunctive cleansing method to reduce colony-forming units on duodenoscopes
Publikationsverlauf
submitted22. April 2016
accepted after revision22. August 2016
Publikationsdatum:
20. Oktober 2016 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00025476/201611/lookinside/thumbnails/601_10-1055-s-0042-116490-1.jpg)
Background and study aims: Endoscopic retrograde cholangiopancreatography-related infections are of increasing global concern due to the emergence of multidrug-resistant bacteria such as carbapenem-resistant enterobacteriaceae (CRE), with bacterial biofilm production postulated as one cause of persistent infection from such virulent organisms. Because N-acetylcysteine (NAC) has been shown to possess antibacterial and biofilm-disruption properties, we aimed to evaluate if NAC would demonstrate clinical utility in reducing the colony forming units (CFU) at the elevator end of a duodenoscope, one of the hardest areas to clean.
Patients and methods: This was a pilot study of 16 procedures involving the use of a duodenoscope. After use, the elevator tip of a duodenoscope was cultured and submerged for 30 minutes, either in 20 % NAC (200 mg/mL, intervention) or in sterile water (control). After 30 minutes, the elevator tip was re-cultured.
Results: Submersion of the distal end of a duodenoscope in 20 % NAC (200 mg/mL) for 30 minutes resulted in a statistically significant reduction in bacterial colony forming units compared to control (average reduction 41.6 % vs 8.8 %, P = 0.001). There was no visible damage and no optical distortion to the duodenoscope after submersion in NAC.
Conclusions: In summary, NAC may be a safe, simple, and useful adjunct to currently available methods of duodenoscope reprocessing. Further research may better define NAC’s role in duodenoscope reprocessing, either broadly or specifically after procedures suspected to produce a high risk of bacterial contamination (e. g. choledocholithiasis).
-
References
- 1 Yigit HQA, Anderson GJ, Domenech-Sanchez A et al. Novel carbapenem-hydrolyzing B-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrob Agents Chemother 2001; 45: 1151-1161
- 2 Muscarella LF. Risk of transmission of carbapenem-resistant enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy. World J Gastrointest Endosc 2014; 6: 457-474
- 3 Verfaillie CJ, Bruno MJ, Voor In’t holt AF et al. Withdrawal of a novel-design duodenoscope ends outbreak of a VIM-2-producing Pseudomonas aeruginosa. Endoscopy 2015; 47: 493-502
- 4 Falagas ME, Tansarli GS, Karageorgopoulos DE et al. Deaths attributable to carbapenem-resistant enterobacteriaceae infections. Emerging Infect Dis 2014; 20: 1170-1175
- 5 Almario CV, May FP, Shaheen NJ et al. Cost utility of competing strategies to prevent endoscopic transmission of carbapenem-resistant enterobacteriaceae. Am J Gastroenterol 2015; 110: 1666-1674
- 6 Aslam S, Darouiche R. Role of antibiofilm-antimicrobial agents in control of device-related infections. Int J Artif Organs 2011; 34: 752-758
- 7 Quah SY, Wu S, Lui JN et al. N-acetylcysteine inhibits growth and eradicates biofilm of Enterococcus faecalis. J Endod 2012; 38: 81-85
- 8 Dinicola S, De Grazia S, Carlomagno G et al. N-acetylcysteine as powerful molecule to destroy bacterial biofilms. A systematic review. Eur Rev Med Pharmacol Sci 2014; 18: 2942-2948
- 9 Cryan EM, Falkiner FR, Mulvihill TE et al. Pseudomonas aeruginosa cross-infection following endoscopic retrograde cholangiopancreatography. J Hosp Infect 1984; 5: 371-376
- 10 Bass DH, Oliver S, Bornman PC. Pseudomonas septicaemia after endoscopic retrograde cholangiopancreatography – an unresolved problem. South African Med J 1990; 77: 509-511
- 11 Struelens MJ, Rost F, Deplano A et al. Pseudomonas aeruginosa and enterobacteriaceae after biliary endoscopy: An outbreak investigation using DNA macrorestriction analysis. Am J Med 1993; 95: 489-498
- 12 Kovaleva J, Peters FTM, van der Mei HC et al. Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microb Rev 2013; 26: 231-254
- 13 Pajkos A, Vickery K, Cossart Y. Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and decontamination?. J Hosp Infect 2004; 58: 224-229
- 14 Alfa MJ, DeGagne P, Olson N et al. Comparison of ion plasma, vaporised hydrogen peroxide, and 100 % ethylene oxide sterilisers to the 12/88 ethylene oxide gas steriliser. Infect Control Hosp Epidem 1996; 17: 92-100
- 15 Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev 2002; 15: 167-193
- 16 Vlamakis H, Chai Y, Beauregard P et al. Sticking together: building a biofilm the Bacillus subtilis way. Nat Rev Microbiol 2013; 11: 157-168
- 17 Wendorf KA, Kay M, Baliga C et al. Endoscopic retrograde cholangiopancreatography-associated AmpC Escherichia coli outbreak. Infect Control Hosp Epidemiol 2015;
- 18 Olofsson AC, Hermansson M, Elwing H. N-acetyl-L-cysteine affects growth, extracellular polysaccharide production, and biofilm formation on solid surfaces. Applied Environ Microbiol 2003; 69: 4814-4822
- 19 Zhao T, Liu Y. N-acetylcysteine inhibit biofilms produced by Pseudomonas aeruginosa. BMC Microbiol 2010; 10: 140-148
- 20 El-Feky MA, El-Rehewe MS, Hassan MA et al. Effect of ciprofloxacin and N-acetylcysteine on bacterial adherence and biofilm formation on ureteral stent surfaces. Polish J Microbiol 2009; 58: 261-267