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Clin Infect Dis. 2018 Sep 11. doi: 10.1093/cid/ciy683. [Epub ahead of print]

Transmission of Mobile Colistin Resistance (mcr-1) by Duodenoscope.

Author information

1
Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA.
2
Infection Control Unit, Massachusetts General Hospital, Boston, MA.
3
Department of Medicine, Harvard Medical School, Boston, MA.
4
Microbiology Laboratory, Pathology Service, Massachusetts General Hospital, Boston, MA.
5
Pediatric Infectious Disease Unit, MassGeneral Hospital for Children, Boston, MA.
6
Department of Pathology, Harvard Medical School, Boston, MA.
7
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
8
Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA.
9
Bureau of Health Care Safety and Quality, Massachusetts Department of Public Health, Boston, MA.

Abstract

Background:

Clinicians increasingly utilize polymyxins for treatment of serious infections caused by multidrug-resistant gram-negative bacteria. Emergence of plasmid-mediated, mobile colistin resistance genes creates potential for rapid spread of polymyxin resistance. We investigated the possible transmission of Klebsiella pneumoniae carrying mcr-1 via duodenoscope and report the first documented healthcare transmission of mcr-1-harboring bacteria in the United States.

Methods:

A field investigation, including screening targeted high-risk groups, evaluation of the duodenoscope, and genome sequencing of isolated organisms, was conducted. The study site included a tertiary care academic health center in Boston, Massachusetts, and extended to community locations in New England.

Results:

Two patients had highly related mcr-1-positive K. pneumoniae isolated from clinical cultures; a duodenoscope was the only identified epidemiological link. Screening tests for mcr-1 in 20 healthcare contacts and 2 household contacts were negative. K. pneumoniae and E. coli were recovered from the duodenoscope; neither carried mcr-1. Evaluation of the duodenoscope identified intrusion of biomaterial under the sealed distal cap; devices were recalled to repair this defect.

Conclusions:

We identified transmission of mcr-1 in a United States acute care hospital that likely occurred via duodenoscope despite no identifiable breaches in reprocessing or infection control practices. Duodenoscope design flaws leading to transmission of multidrug-resistant organsisms persist despite recent initiatives to improve device safety. Reliable detection of colistin resistance is currently challenging for clinical laboratories, particularly given the absence of an FDA-cleared test; improved clinical laboratory capacity for colistin susceptibility testing is needed to prevent the spread of mcr-carrying bacteria in healthcare settings.

PMID:
30204838
DOI:
10.1093/cid/ciy683

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