New Delhi Metallo-β-Lactamase–Producing Carbapenem-Resistant Escherichia coli Associated With Exposure to Duodenoscopes

Details

• Alternative Title:
  JAMA
• Personal Author:
  Epstein, Lauren ; Hunter, Jennifer C. ; Arwady, M. Allison ; Tsai, Victoria ; Stein, Linda ; Gribogiannis, Marguerite ; Frias, Mabel ; Guh, Alice Y. ; Laufer, Alison S. ; Black, Stephanie ; Pacilli, Massimo ; Moulton-Meissner, Heather ; Rasheed, J. Kamile ; Avillan, Johannetsy J. ; Kitchel, Brandon ; Limbago, Brandi M. ; MacCannell, Duncan ; Lonsway, David ; Noble-Wang, Judith ; Conway, Judith ; Conover, Craig ; Vernon, Michael ; Kallen, Alexander J.
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• Description:
  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.
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• Keywords:
  • Adult
  • Aged
  • Aged, 80 and over
  • Carbapenems
  • Case-Control Studies
  • Cohort Studies
  • Cross Infection
  • Disease Outbreaks
  • Disinfection
  • Drug Resistance, Bacterial
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• Source:
  JAMA. 312(14):1447-1455
• Pubmed ID:
  25291580
• Pubmed Central ID:
  PMC10877559
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  312
• Issue:
  14
• Download URL:
  https://stacks.cdc.gov/view/cdc/150276/cdc_150276_DS1.pdf
• File Type:
  [PDF - 775.81 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:38a24f18ad0d019ae51289035e8d0e253fb6b18128c0ab8a6cffd220a68e0032