Risk of transmission of carbapenem-resistant Enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy

To evaluate the risk of transmission of carbapenem-resistant Enterobacteriaceae(CRE) and their related superbugs during gastrointestinal(GI) endoscopy. Reports of outbreaks linked to GI endoscopes contami-nated with different types of infectious agents, includ-ing CRE and their related superbugs, were reviewed. Published during the past 30 years, both prior to and since CRE's emergence, these reports were obtained by searching the peer-reviewed medical literature(via the United States National Library of Medicine's "MEDLINE" database); the Food and Drug Administration's Manu-facturer and User Facility Device Experience database, or "MAUDE"; and the Internet(via Google's search engine). This review focused on an outbreak of CRE in 2013 following the GI endoscopic procedure known as endoscopic retrograde cholangiopancreatography, or ERCP, performed at "Hospital X" located in the sub-urbs of Chicago(IL; United States). Part of the largest outbreak of CRE in United States history, the infection and colonization of 10 and 28 of this hospital's patients, respectively, received considerable media attention and was also investigated by the Centers for Disease Con-trol and Prevention(CDC), which published a report about this outbreak in Morbidity and Mortality WeeklyReport(MMWR), in 2014. This report, along with the results of an independent inspection of Hospital X's in-fection control practices following this CRE outbreak, were also reviewed. While this article focuses primar-ily on the prevention of transmissions of CRE and their related superbugs in the GI endoscopic setting, some of its discussion and recommendations may also apply to other healthcare settings, to other types of flexible endoscopes, and to other types of transmissible infec-tious agents. This review found that GI endoscopy is an important risk factor for the transmission of CRE and their related superbugs, having been recently as-sociated with patient morbidity and mortality following ERCP. The CDC reported in MMWR that the type of GI endoscope, known as an ERCP endoscope, that Hospi-tal X used to perform ERCP in 2013 on the 38 patients who became infected or colonized with CRE might be particularly challenging to clean and disinfect, because of the complexity of its physical design. If performed in strict accordance with the endoscope manufacturer's labeling, supplemented as needed with professional organizations' published guidelines, however, current practices for reprocessing GI endoscopes, which include high-level disinfection, are reportedly adequate for the prevention of transmission of CRE and their related superbugs. Several recommendations are provided to prevent CRE transmissions in the healthcare setting. CRE transmissions are not limited to contaminated GI endoscopes and also have been linked to other reusable flexible endoscopic instrumentation, including broncho-scopes and cystoscopes. In conclusion, contaminated GI endoscopes, particularly those used during ERCP, have been causally linked to outbreaks of CRE and their related superbugs, with associated patient morbidity and mortality. Thorough reprocessing of these complex reusable instruments is necessary to prevent disease transmission and ensure patient safety during GI endos-copy. Enhanced training and monitoring of reprocessing staffers to verify the proper cleaning and brushing of GI endoscopes, especially the area around, behind andnear the forceps elevator located at the distal end othe ERCP endoscope, are recommended. If the ERCPendoscope features a narrow and exposed channel thathouses a wire connecting the GI endoscope's controhead to this forceps elevator, then this channel's com-plete reprocessing, including its flushing with a deter-gent using a procedure validated for effectiveness, is also emphasized.

A surveillance study on penicillin-resistant streptococcus pneumoniae in China

Objectives To find out whether there are also penicillinresistant str eptococcus pneumoniae and the resistant rate in China Methods A surveillance study which is a part of the international surve illance on pneumococci resistance to penicillin and other antimicrobial agents w as conducted in Beijing, China More than 900 pediatric patients with respirato r y tract infections aged from six months to three years selected from two pediatr ic units were enrolled in the study Perthroat swabs were immediately streaked o nto blood agar plates Isolates were identified as pneumococci by their typical appearance, gram stain, confirmation tests Antibiotic susceptibility was asses s ed by the disk diffusion method and minimal inhibition concentration (MIC) deter mination according to Protocol and National Committee for Clinical Laboratory St andards (NCCLS). Results Of the 51 streptococcus pneumoniae isolates, 5 strains had zone s of inhibition indicative of penicillin resistance, of which two had penicillin MICs01?mg/L and were considered to be relatively or fully resistant to pen i cillin The MICs of two penicillin resistant strains were 2?mg/L and 4?mg/L R esistant rates to ceftriaxone and cefotaxime were 0% and 10% respectively For the othe r ten antimicrobial agents, the resistant rates were as follows: ampicillin 12% , piperacillin 26%, furbenicillin 14%, cefuroxime 6%, erythromycin 54%, clarithr omycin 52%, meleumycin 64%, roxithromycin 52%, chloramphenicol 35%, tetracycline 100% Conclusions The study suggested that penicillin resistant streptococcus pneumoniae strains existed in China and were also resistant to ampicillin, pipe racillin, furbenicillin and cefuroxime Moreover, the resistant rates of penici llin resistant streptococcus pneumoniae to macrolides and tetracycline were high