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

Details

• Alternative Title:
  Clin Infect Dis
• Personal Author:
  Shenoy, Erica S. ; Pierce, Virginia M. ; Walters, Maroya Spalding ; Moulton-Meissner, Heather ; Lawsin, Adrian ; Lonsway, David ; Shugart, Alicia ; McAllister, Gillian ; Halpin, Alison Laufer ; Zambrano-Gonzalez, Alejandra ; Ryan, Erin E. ; Suslak, Dolores ; DeJesus, Alexandra ; Barton, Kerri ; Madoff, Lawrence C. ; McHale, Eileen ; DeMaria, Alfred ; Hooper, David C.
• Description:
  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. Klebsiella pneumoniae and Escherichia 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 a US Food and Drug Administration–cleared test; improved clinical laboratory capacity for colistin susceptibility testing is needed to prevent the spread of mcr-carrying bacteria in healthcare settings.
  
  
• Keywords:
  Colistin Drug Resistance, Multiple, Bacterial Duodenoscope Duodenoscopes Equipment Contamination Humans Infection Control Klebsiella Pneumoniae Medical Device Safety Microbial Sensitivity Tests Mobile Colistin Resistance United States

  More +
• Source:
  Clin Infect Dis. 68(8):1327-1334
• Pubmed ID:
  30204838
• Pubmed Central ID:
  PMC10849062
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  68
• Issue:
  8
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:f97347e780eca60c0c214678d5df91aa91dfae38944e2083e6374ccc9f22d41b
• Download URL:
  https://stacks.cdc.gov/view/cdc/148990/cdc_148990_DS1.pdf
• File Type:
  [PDF - 599.77 KB ]