Risk factors associated with the transmission of carbapenem-resistant Enterobacteriaceae via contaminated duodenoscopes

Autor: Peera Hemarajata, Rabindra R. Watson, Zachary Rubin, Shangxin Yang, Dana Russell, Romney M. Humphries, Alireza Sedarat, V. Raman Muthusamy, Stephen Kim, Mehdi Mohamadnejad, Jitin Makker
Rok vydání: 2015
Předmět:
0301 basic medicine
Male
Carbapenem-resistant enterobacteriaceae
Cholangiocarcinoma
0302 clinical medicine
Risk Factors
Odds Ratio
Duodenoscopes
Child
Aged
80 and over
Cholangiopancreatography
Endoscopic Retrograde
Univariate analysis
Gastroenterology
Enterobacteriaceae Infections
Middle Aged
Anti-Bacterial Agents
Hospitalization
Klebsiella pneumoniae
Carrier State
030211 gastroenterology & hepatology
Female
Stents
Adult
medicine.medical_specialty
Adolescent
030106 microbiology
03 medical and health sciences
Young Adult
Enterobacteriaceae
Internal medicine
Drug Resistance
Bacterial
medicine
Humans
Radiology
Nuclear Medicine and imaging
Risk factor
Aged
Retrospective Studies
business.industry
Case-control study
Retrospective cohort study
Odds ratio
Confidence interval
Surgery
Klebsiella Infections
Bile Duct Neoplasms
Carbapenems
Case-Control Studies
Equipment Contamination
business
Zdroj: Gastrointestinal endoscopy. 83(6)
ISSN: 1097-6779
Popis: Background and Aims The duodenoscopes used to perform ERCP have been implicated in several outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) infection. The risk factors for CRE transmission via contaminated duodenoscopes remain unclear. Methods In this retrospective, single-center, case-control study, all patients who underwent ERCP with either 1 of 2 contaminated duodenoscopes were evaluated. We compared the patients who acquired CRE (active infection or colonization) with those who did not. Results Between October 3, 2014, and January 28, 2015, a total of 125 procedures were performed on 115 patients by using either of the contaminated duodenoscopes. Culture data were available for 104 of the 115 exposed patients (90.4%). Among these patients, 15 (14.4%) became actively infected (n = 8, 7.7%) or colonized (n = 7, 6.7%) with CRE. On univariate analysis, recent antibiotic exposure (66.7% vs 37.1%; P = .046), active inpatient status (60.0% vs 28.1%; P = .034), and a history of cholangiocarcinoma (26.7% vs 3.4%; P = .008) were patient characteristics associated with an increased risk of CRE infection. Biliary stent placement (53.3% vs 22.5%; P = .024) during ERCP was a significant procedure-related risk factor. After adjusting for cholangiocarcinoma, biliary stent placement (odds ratio 3.62; 95% confidence interval, 1.12-11.67), and active inpatient status (odds ratio 3.74; 95% confidence interval, 1.15-12.12) remained independent risk factors for CRE transmission. Conclusions In patients undergoing ERCP with a contaminated duodenoscope, biliary stent placement, a diagnosis of cholangiocarcinoma, and active inpatient status are associated with an increased risk of CRE transmission.
Databáze: OpenAIRE
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