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Serious pseudomonas infections associated with endoscopic retrograde cholangiopancreatography

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      Abstract

      After observing a single case of Pseudomonas aeruginosa bacteremia following endoscopic retrograde cholangiopancreatography (ERCP), six other P. aeruginosa infections that were temporally related to ERCP were retrospectively found over one year (August 1985 through July 1986) at LDS Hospital. In all seven patients, infection developed within five days after an ERCP. Five patients had bacteremia and two had cholangitis. All five of the Pseudomonas isolates available for testing were serotype 010. Cultures from the ERCP endoscope and several other endoscopes also yielded P. aeruginosa serotype 10, as did environmental cultures from equipment used to clean endoscopes. Among 167 ERCPs performed during the outbreak period, no other patient acquired P. aeruginosa infection. Each of the patients in the outbreak received the first scheduled ERCP of the day. The mean duration between the cleaning of the ERCP endoscope and its subsequent use was significantly longer in cases than in matched controls, a factor that may have permitted contaminating organisms to achieve high inocula in the inadequately cleaned endoscope. Epidemic control measures included improved disinfection of endoscopes, ongoing surveillance, and appropriate antimicrobial prophylaxis. This experience suggests that exogenous infection with Pseudomonas is associated with ERCP, that protracted and insidious outbreaks may occur, and that the occurrence of even a single case of Pseudomonas infection after ERCP should stimulate an epidemiologic investigation.
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      References

        • Colcher H
        Current concepts: gastrointestinal endoscopy.
        N Engl J Med. 1975; 293: 1129-1131
        • Katen RM
        • Smith FW
        Pandendoscopy in early diagnosis of acute upper gastrointestinal bleeding.
        Gastroenterology. 1973; 65: 728-734
        • Gibb SP
        • Tarshis A
        Diagnostic endoscopy of the upper gastrointestinal tract.
        Current Concepts of Gastroenterology. 1982; 7: 3-7
        • Forrest JA
        • Finlayson NDC
        • Shearman DJC
        Endoscopy in gastrointestinal bleeding.
        Lancet. 1974; II: 394-397
        • Silver SE
        • Nebel O
        • Rogers G
        • Sugawa L
        • Mendeston P
        Endoscopic complications: results of a 1974 American Society for Gastrointestinal Endoscopy survey.
        JAMA. 1976; 235: 928-930
        • Shorum PJ
        • Eykyn SJ
        • Cotton PB
        Gastrointestinal instrumentation, bacteremia and endocarditis.
        Gut. 1983; 24: 1078-1093
        • Colin-Jones DG
        • Cockel R
        • Schiller KFR
        Current endoscopic practice in the United Kingdom.
        Clin Gastroenterol. 1986; 7: 775-786
        • Vennes JA
        Infectious complications of gastrointestinal endoscopy.
        Dig Dis Sci. 1981; 26 (July suppl): 60S-64S
        • Kasugai T
        • Kino N
        • Kobashis H
        Endoscopic pancreatography 1&11.
        Gastroenterology. 1972; 63: 217-234
        • Ingelfinger FJ
        Endoscopic pancreatocholangiography: progress and problem.
        N Engl J Med. 1972; 287: 879-880
        • Bilbao MK
        • Dotter CT
        • Lee TG
        • Katon RM
        Complications of endoscopic retrograde cholangiopancreatography (ERCP): a study of 10,000 cases.
        Gastroenterology. 1976; 70: 314-320
        • Low DE
        • Micflikier AB
        • Kennedy JK
        • Striver HG
        Infectious complications of endoscopic retrograde cholangiopancreatography: a prospective assessment.
        Arch Intern Med. 1980; 140: 1076-1077
        • Dutta SK
        • Cox M
        • Williams RB
        • Eisenstat TE
        • Standiform HC
        Prospective evaluation of the risk of bacteremia and the role of antibiotics in ERCP.
        J Clin Gastroenterol. 1983; 5: 325-329
        • Doherty DE
        • Falko JM
        • Lefkovitz N
        • Rogers J
        • Fromkes J
        Pseudomonas aeruginosa sepsis following retrograde cholangiopancreatography.
        Dig Dis Sciences. 1982; 27: 169-170
        • Cryan EM
        • Falkiner FR
        • Mulvihill TE
        • Keane CT
        • Keeling PWN
        Pseudomonas aeruginosa cross infection following endoscopic retrograde cholangiopancreatography.
        J Hosp Infect. 1984; 5: 371-376
        • Earnshaw JJ
        • Clark AW
        • Thon BT
        Outbreak of Pseudomonas aeruginosa following endoscopic retrograde cholangiopancreatography.
        J Hosp Infect. 1985; 6: 95-97
        • Simmons BP
        • Hooton TM
        • Mallison GF
        • et al.
        Cleaning, disinfection, and sterilization of hospital equipment: guidelines for the prevention and control of nosocomial infections.
        Centers for Disease Control, July 1982
        • Ad Hoc Committee on Infection Control in the Handling of Endoscopic
        • Equipment
        Guidelines for cleaning and disinfection of flexible fiberoptic endoscopes used in gastrointestinal endoscopy.
        AORN J. 1978; 28: 907-910
        • Hawkey PM
        • Davies AJ
        • Viant AC
        • Lush CJ
        • Mortensen NJ
        Contamination of endoscopes by Salmonella species.
        J Hosp Infect. 1981; 2: 373-376
        • Bond WW
        • Moncada RE
        Viral hepatitis B infection risk in flexible fiberoptic endoscopy.
        Gastrointest Endosc. 1978; 24: 225-230
        • Webb SF
        • Vall-Spinosa A
        Outbreak of Serratia marcescens associated with flexible fiberoptic bronchoscope.
        Chest. 1974; 68: 703-708
        • Libermann TR
        Bacteremia and fiberoptic endoscopy.
        Gastrointest Endosc. 1976; 23: 36-37
        • Everett ED
        • Hirschmann JV
        Transient bacteremia and endocarditis prophylaxis.
        in: A review. 4th ed. Medicine (Baltimore). 56. 1977: 61-77
        • Claesson BE
        Microflora of the gallbladder related to duration of acute cholecystitis.
        Surg Gynecol Obstet. 1986; 102: 531-535
        • Evans RS
        • Larsen RA
        • Burke JP
        • et al.
        Computer surveillance of hospital-acquired infections and antibiotic use.
        JAMA. 1986; 256: 1007-1011
        • Allen JI
        • Allen MO
        • Olson MM
        • et al.
        Pseudomonas infection of the biliary system resulting from use of a contaminated endoscope.
        Gastroenterology. 1987; 92: 759-763
        • Vasil ML
        Pseudomonas aeruginosa: biology, mechanisms of virulence, epidemiology.
        J Pediatr. 1986; 108: 800-805
        • Matteucci DJ
        • Organ CH
        • Dykstra M
        • Zalasney B
        • Jenkens H
        Efficacy of a simplified lower gastrointestinal flexible endoscope cleaning method.
        Dis Colon Rectum. 1985; 28: 653-657
        • Favero MS
        Sterilization, disinfection and antisepsis in the hospital.
        in: 4th ed. Manual of clinical microbiology. American Society of Microbiology, Washington1985: 129-138