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JAMA. 2014 Oct 8;312(14):1447-55. doi: 10.1001/jama.2014.12720.

New Delhi metallo-β-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes.

Author information

1
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia2Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georg.
2
Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia3Illinois Department of Public Health, Chicago, Illinois.
3
Illinois Department of Public Health, Chicago, Illinois.
4
Advocate Lutheran General Hospital, Park Ridge, Illinois.
5
Cook County Department of Public Health, Oak Forest, Illinois.
6
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
7
Chicago Department of Public Health, Chicago, Illinois.

Abstract

IMPORTANCE:

Carbapenem-resistant Enterobacteriaceae (CRE) producing the New Delhi metallo-β-lactamase (NDM) are rare in the United States, but have the potential to add to the increasing CRE burden. Previous NDM-producing CRE clusters have been attributed to person-to-person transmission in health care facilities.

OBJECTIVE:

To identify a source for, and interrupt transmission of, NDM-producing CRE in a northeastern Illinois hospital.

DESIGN, SETTING, AND PARTICIPANTS:

Outbreak investigation among 39 case patients at a tertiary care hospital in northeastern Illinois, including a case-control study, infection control assessment, and collection of environmental and device cultures; patient and environmental isolate relatedness was evaluated with pulsed-field gel electrophoresis (PFGE). Following identification of a likely source, targeted patient notification and CRE screening cultures were performed.

MAIN OUTCOMES AND MEASURES:

Association between exposure and acquisition of NDM-producing CRE; results of environmental cultures and organism typing.

RESULTS:

In total, 39 case patients were identified from January 2013 through December 2013, 35 with duodenoscope exposure in 1 hospital. No lapses in duodenoscope reprocessing were identified; however, NDM-producing Escherichia coli was recovered from a reprocessed duodenoscope and shared more than 92% similarity to all case patient isolates by PFGE. Based on the case-control study, case patients had significantly higher odds of being exposed to a duodenoscope (odds ratio [OR], 78 [95% CI, 6.0-1008], P < .001). After the hospital changed its reprocessing procedure from automated high-level disinfection with ortho-phthalaldehyde to gas sterilization with ethylene oxide, no additional case patients were identified.

CONCLUSIONS AND RELEVANCE:

In this investigation, exposure to duodenoscopes with bacterial contamination was associated with apparent transmission of NDM-producing E coli among patients at 1 hospital. Bacterial contamination of duodenoscopes appeared to persist despite the absence of recognized reprocessing lapses. Facilities should be aware of the potential for transmission of bacteria including antimicrobial-resistant organisms via this route and should conduct regular reviews of their duodenoscope reprocessing procedures to ensure optimal manual cleaning and disinfection.

PMID:
25291580
DOI:
10.1001/jama.2014.12720
[Indexed for MEDLINE]

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