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Molecules. 2019 Jun 25;24(12). pii: E2343. doi: 10.3390/molecules24122343.

Duodenoscope-Associated Infections beyond the Elevator Channel: Alternative Causes for Difficult Reprocessing.

Author information

1
Department of Gastroenterology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 University Street, 700115 Iași, Romania. balan.gheo@me.com.
2
Centre of Advanced Research in Bionanoconjugates and Biopolymers (IntelCentru), ''Petru Poni'' Institute of Macromolecular Chemistry, 41A Grigore Ghica Vodă Alley, 700487 Iași, Romania. rosca.irina@icmpp.ro.
3
Centre of Advanced Research in Bionanoconjugates and Biopolymers (IntelCentru), ''Petru Poni'' Institute of Macromolecular Chemistry, 41A Grigore Ghica Vodă Alley, 700487 Iași, Romania. ursu.laura@icmpp.ro.
4
Centre of Advanced Research in Bionanoconjugates and Biopolymers (IntelCentru), ''Petru Poni'' Institute of Macromolecular Chemistry, 41A Grigore Ghica Vodă Alley, 700487 Iași, Romania. fifere@icmpp.ro.
5
Centre of Advanced Research in Bionanoconjugates and Biopolymers (IntelCentru), ''Petru Poni'' Institute of Macromolecular Chemistry, 41A Grigore Ghica Vodă Alley, 700487 Iași, Romania. varganici.cristian@icmpp.ro.
6
Centre of Advanced Research in Bionanoconjugates and Biopolymers (IntelCentru), ''Petru Poni'' Institute of Macromolecular Chemistry, 41A Grigore Ghica Vodă Alley, 700487 Iași, Romania. florica.doroftei@icmpp.ro.
7
Centre of Advanced Research in Bionanoconjugates and Biopolymers (IntelCentru), ''Petru Poni'' Institute of Macromolecular Chemistry, 41A Grigore Ghica Vodă Alley, 700487 Iași, Romania. moleavin.ioana@icmpp.ro.
8
Department of Gastroenterology Research, Clinical Emergency Hospital of Bucharest, 8 Calea Floreasca, 014461 Bucharest, Romania. drsandruvasile@gmail.com.
9
Department of Gastroenterology Research, Clinical Emergency Hospital of Bucharest, 8 Calea Floreasca, 014461 Bucharest, Romania. gabrielconstantinescu63@gmail.com.
10
Internal Medicine Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 030167 Bucharest, Romania. gabrielconstantinescu63@gmail.com.
11
Department of Gastroenterology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 University Street, 700115 Iași, Romania. dantimofte@yahoo.com.
12
Department of Gastroenterology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 University Street, 700115 Iași, Romania. gabriela.stefanescu@gmail.com.
13
Department of Gastroenterology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 University Street, 700115 Iași, Romania. ancatrifan@yahoo.com.
14
Department of Gastroenterology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 University Street, 700115 Iași, Romania. cvsfarti@gmail.com.

Abstract

OBJECTIVES:

Duodenoscopes have been widely used for both diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) procedures, but recently, numerous outbreaks of multidrug-resistant organisms (MDRO) infections have been reported which has led to extensive research for their possible causes. Consequently, the aim of this study is to search for possible duodenoscope surface damages that could provide an alternative and plausible source of infections.

MATERIALS AND METHODS:

In order to assess both outer and inner surfaces, a duodenoscope was dismantled and samples were taken from the outer resin polymer and from the air/water, elevator, and working (biopsy) channels that were characterized by FTIR, DSC, TGA, AFM, SEM techniques and the antimicrobial activity were tested.

RESULTS:

Alterations were noticed on both the coating and working channel polymers, with external alterations increasing progressively from the proximal sample to the distal sample near the tip of the scope. However, the results showed that the coating surface was still efficient against bacterial adhesion. Changes in surface texture and also morphological changes were shown.

CONCLUSIONS:

The study describes the impact of routine procedural use and reprocessing cycles on the duodenoscope, showing that these may possibly make it susceptible to bacterial contamination and MDRO biofilm formation due to difficult reprocessing of the altered surfaces.

KEYWORDS:

carbapenem-resistant enterobacteriaceae; endoscopic retrograde cholangiopancreatography; nosocomial infections; reprocessing

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