Digestive tract bacteria highly prevalent in duodenoscopes
The prevalence rates of duodenoscope contamination appear to be high in Endoscopic Retrograde Cholangiopancreatography (ERCP) centres in the Netherlands, a study has shown. Specifically, a substantial proportion of the cultured duodenoscopes are contaminated with microorganisms of gastrointestinal or oral origin.
A total of 73 Dutch ERCP centres were asked to sample ≥2 duodenoscopes using centrally distributed kits according to uniform sampling methods, as described by video instructions. Four to six sites, depending on duodenoscope type, were centrally cultured and assessed for contamination, which was defined as the presence of any microorganism with ≥20 colony forming units (CFU)/20 mL (AM20) or the presence of microorganisms with gastrointestinal or oral origin, independent of CFU count (MGO).
The final data included 745 sites of 155 duodenoscopes sampled from 67 centres. Duodenoscope types included Olympus TJF-Q180V (n=69), Olympus TJF-160VR (n=43), Pentax ED34-i10T (n=11), Pentax ED-3490TK (n=8) and Fujifilm ED-530XT8 (n=5).
Contamination as per the AM20 definition was found in 33 duodenoscopes (22 percent) from 26 centres (39 percent). On the other hand, MGO contamination was detected in 23 duodenoscopes (15 percent). Common microorganisms that were cultured included Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae and yeasts.
For both AM20 and MGO definitions, contamination was not dependent on duodenoscope type (p≥0.20).
The findings suggest that the current combination of reprocessing and process control are not adequate and safe, and patients undergoing ERCP procedures remain at risk of being exposed to contaminated equipment.
Researchers called for efficient surveillance strategies and reprocessing control measures to reduce the number of contaminated duodenoscopes and minimize, in turn, the odds of interpatient transmission of microorganisms.