Contributing factors to an outbreak of multidrug-resistant K pneumoniae

Post written by Arjan W. Rauwers, MD, from the Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. Rauwer_headshot

Worldwide, an increasing number of duodenoscope-associated outbreaks are reported. The contributing factors to an outbreak are not well understood. We report on an investigation after the outbreak of a multidrug-resistant Klebsiella pneumoniae (MRKP) related to 2Olympus TJF-Q180V duodenoscopes. We screened contact patients and conducted a microbiologic laboratory database search. To identify all contributing factors to the outbreak we audited our reprocessing procedures, and both duodenoscopes were fully dismantled. All outcomes were reviewed by an experienced independent expert.

During 8 months, 2 duodenoscopes were persistently contaminated with identical MRKP isolates and infected ≥29% of all patients who underwent an ERCP procedure with 1 of the 2 duodenoscopes. In total, 27 patients were MRKP infected or colonized, including 10 patients who developed an MRKP-related active infection.

Identical MRKP isolates were cultured from channel flushes of both duodenoscopes. The review revealed 4 major abnormalities: miscommunication about reprocessing, undetected damaged parts, inadequate repair of duodenoscope damage, and duodenoscope design abnormalities, including the forceps elevator, elevator lever, and instrumentation port sealing. These investigations indicated a multifactorial etiology of the outbreak.

The number of duodenoscope-associated outbreaks could be reduced by a reliable servicing market, direct implementation of critical reprocessing measures, review of current monitoring methods, and introduction of surveillance measures. Eventually, new duodenoscope designs and reprocessing procedures with a larger margin of safety are required.


Read the full article online.

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