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Multidrug-Resistant Pseudomonas aeruginosa Cholangitis After Endoscopic Retrograde Cholangiopancreatography: Failure of Routine Endoscope Cultures to Prevent an Outbreak

Published online by Cambridge University Press:  02 January 2015

Thomas G. Fraser ,
Sandra Reiner ,
Michael Malczynski ,
Paul R. Yarnold ,
John Warren  and
Gary A. Noskin
Thomas G. Fraser*
Affiliation:
Department of Infectious Diseases, The Cleveland Clinic Foundation, Cleveland, Ohio
Sandra Reiner
Affiliation:
Department of Infection Control and Prevention, Northwestern Memorial Hospital, Chicago, Illinois
Michael Malczynski
Affiliation:
Molecular Epidemiology Laboratory, Northwestern Memorial Hospital, Chicago, Illinois
Paul R. Yarnold
Affiliation:
Department of Medicine, Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
John Warren
Affiliation:
Department of Pathology, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois Molecular Epidemiology Laboratory, Northwestern Memorial Hospital, Chicago, Illinois
Gary A. Noskin
Affiliation:
Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois Department of Infection Control and Prevention, Northwestern Memorial Hospital, Chicago, Illinois
*
Department of Infectious Diseases/S32, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195
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Abstract

Background:

Nosocomial infections due to medical devices are of increasing concern to infection control practitioners. Attempts to prevent such infections have included surveillance cultures of endoscopes and bronchoscopes. In July 2002, the infectious disease consultation service was asked to see three patients with sepsis due to multidrug-resistant Pseudomonas aeruginosa after endoscopic retrograde cholangiopancreatography (ERCP).

Objective:

To describe an outbreak of multidrug-resistant P. aeruginosa sepsis after ERCP at an institution that performs routine surveillance cultures of endoscopes.

Design:

A traditional outbreak investigation supplemented by pulsed-field gel electrophoresis (PFGE) was undertaken, including a case-control analysis based on the hypothesis that all infected individuals had their ERCP performed with the same endoscope.

Setting:

A tertiary-care academic medical center.

Results:

The case-control analysis confirmed the hypothesis that undergoing ERCP with the implicated endoscope was associated with a culture positive for Pseudomonas (P = .01). The available strains were identical by PFGE. This outbreak occurred despite a negative surveillance culture of the implicated endoscope 1 month earlier.

Conclusions:

Infectious morbidity can occur after endoscopy despite negative surveillance cultures. The practice of routine endoscope cultures does not prevent device-related infectious morbidity.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 10 , October 2004 , pp. 856 - 859
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004 

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