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Hervé RC. Endoscopy in the twenty-first century: minimally invasive state-of-the-art medical technology or a future main vector of hospital-acquired infections? J Hosp Infect 2017; 97:329-330. [PMID: 28760633 DOI: 10.1016/j.jhin.2017.07.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 12/11/2022]
Affiliation(s)
- R C Hervé
- University of Southampton, Southampton General Hospital, Southampton, UK.
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Usawachintachit M, Isaacson DS, Taguchi K, Tzou DT, Hsi RS, Sherer BA, Stoller ML, Chi T. A Prospective Case-Control Study Comparing LithoVue, a Single-Use, Flexible Disposable Ureteroscope, with Flexible, Reusable Fiber-Optic Ureteroscopes. J Endourol 2017; 31:468-475. [PMID: 28287823 PMCID: PMC5439446 DOI: 10.1089/end.2017.0027] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE LithoVue™ is a novel, single-use, digital flexible ureteroscope that was released to the US market in January 2016. There are scant data regarding its performance in humans. Procedural outcomes comparing LithoVue with reusable ureteroscopes are presented in patients undergoing ureteroscopy for upper urinary tract pathology. PATIENTS AND METHODS Clinical outcomes between two groups of patients undergoing flexible ureteroscopy for upper urinary tract pathology were analyzed. The first group underwent surgery utilizing LithoVue, and the second group used reusable fiber-optic flexible ureteroscopes. Differences in procedural outcomes, operative times, and time spent in hospital were analyzed using two-tailed t-tests and chi-squared and Fisher's exact tests. RESULTS One hundred fifteen cases utilizing LithoVue and 65 cases utilizing reusable ureteroscopes were included in this study. Demographics, surgical indications, stone size, location, total stone burden, composition, procedural outcomes, and complications were comparable between groups. For all cases, LithoVue procedures lasted 54.1 ± 25.7 minutes compared with 64.5 ± 37.0 minutes for reusable scope procedures (p < 0.05) and for stone removal cases, 57.3 ± 25.1 vs 70.3 ± 36.9 minutes, respectively (p < 0.05). Scope failure occurred in 4.4% of LithoVue cases and 7.7% of reusable cases (p = 0.27). CONCLUSIONS LithoVue represents a feasible alternative to reusable ureteroscopes with a low rate of scope failure comparable with reusable ureteroscopes. Its use shortens procedure duration, a finding that warrants further investigation.
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Affiliation(s)
- Manint Usawachintachit
- Department of Urology, University of California, San Francisco, San Francisco, California
- Division of Urology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Dylan S. Isaacson
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Kazumi Taguchi
- Department of Urology, University of California, San Francisco, San Francisco, California
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - David T. Tzou
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Ryan S. Hsi
- Department of Urology, University of California, San Francisco, San Francisco, California
- Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Benjamin A. Sherer
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Marshall L. Stoller
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Thomas Chi
- Department of Urology, University of California, San Francisco, San Francisco, California
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Clinical Issues- March 2017. AORN J 2017; 105:322-331. [PMID: 28241955 DOI: 10.1016/j.aorn.2017.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/11/2017] [Indexed: 11/24/2022]
Abstract
Using one flexible endoscope for an upper and lower gastrointestinal (GI) endoscopy procedure Key words: flexible endoscope, esophagogastroduodenoscopy, colonoscopy, enteroscope, risk assessment. Enhanced methods for processing flexible duodenoscopes Key words: flexible duodenoscopes, liquid chemical sterilization, ethylene oxide sterilization, low-temperature sterilization, risk assessment. Modification of the Spaulding classification Key words: Spaulding classification, critical items, semicritical items, mucous membranes, risk assessment. Flushing flexible endoscope lumens with alcohol Key words: flexible endoscopes, isopropyl alcohol, ethyl alcohol, fixative, risk assessment. Using chlorine dioxide wipes for nonchanneled flexible endoscopes Key words: nonchanneled flexible endoscopes, high-level disinfectant, chlorine dioxide, risk assessment.
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Doizi S, Traxer O. Re: Evaluation of a Novel Single-use Flexible Ureteroscope. Eur Urol 2017; 72:152-153. [PMID: 28236501 DOI: 10.1016/j.eururo.2017.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 02/09/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Steeve Doizi
- Department of Urology, Tenon Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France; Pierre et Marie Curie University, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, AP-HP, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France
| | - Olivier Traxer
- Department of Urology, Tenon Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France; Pierre et Marie Curie University, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, AP-HP, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.
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Ofstead CL, Wetzler HP, Heymann OL, Johnson EA, Eiland JE, Shaw MJ. Longitudinal assessment of reprocessing effectiveness for colonoscopes and gastroscopes: Results of visual inspections, biochemical markers, and microbial cultures. Am J Infect Control 2017; 45:e26-e33. [PMID: 28159069 DOI: 10.1016/j.ajic.2016.10.017] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Flexible endoscopes are currently reused following cleaning and high-level disinfection. Contamination has been found on endoscopes, and infections have been linked to gastrointestinal, respiratory, and urologic endoscopes. METHODS This longitudinal study involved visual inspections with a borescope, microbial cultures, and biochemical tests for protein and adenosine triphosphate to identify endoscopes in need of further cleaning or maintenance. Three assessments were conducted over a 7-month period. Control group endoscopes reprocessed using customary practices were compared with intervention group endoscopes subjected to more rigorous reprocessing. RESULTS At final assessment, all endoscopes (N = 20) had visible irregularities. Researchers observed fluid (95%), discoloration, and debris in channels. Of 12 (60%) endoscopes with microbial growth, 4 had no growth until after 48 hours. There were no significant differences in culture results by study group, assessment period, or endoscope type. Similar proportions of control and intervention endoscopes (~20%) exceeded postcleaning biochemical test benchmarks. Adenosine triphosphate levels were higher for gastroscopes than colonoscopes (P = .014). Eighty-five percent of endoscopes required repair due to findings. CONCLUSIONS More rigorous reprocessing was not consistently effective. Seven-day incubation allowed identification of slow-growing microbes. These findings bolster the need for routine visual inspection and cleaning verification tests recommended in new reprocessing guidelines.
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Affiliation(s)
| | | | | | | | | | - Michael J Shaw
- Division of Gastroenterology, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
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Harris PNA, Peri AM, Pelecanos AM, Hughes CM, Paterson DL, Ferguson JK. Risk factors for relapse or persistence of bacteraemia caused by Enterobacter spp.: a case-control study. Antimicrob Resist Infect Control 2017; 6:14. [PMID: 28127422 PMCID: PMC5251334 DOI: 10.1186/s13756-017-0177-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 01/18/2017] [Indexed: 12/02/2022] Open
Abstract
Background Enterobacter spp. possess chromosomal AmpC beta-lactamases that may be expressed at high levels. Previous studies have demonstrated a risk of relapsed bacteraemia following therapy with third generation cephalosporins (3GCs). What additional factors predict microbiological failure in Enterobacter bacteraemia is unclear. We aimed to determine factors associated with microbiological failure in Enterobacter bacteraemia. Methods We retrospectively identified cases of bacteraemia caused by Enterobacter spp. occurring in four hospitals. Using a case–control design, we determined clinical risk factors for persistence or relapse defined as repeated positive blood cultures collected between 72 hours and up to 28 days post initial positive blood culture. Results During the study period a total of 922 bacteraemia events caused by Enterobacter spp. in adults were identified. The overall risk of relapsed or persisting bacteraemia at 28 days was low (31 of 922, 3.4%), with only 2 patients experiencing emergent resistance to 3GCs. A total of 159 patients were included in the case–control study. Using multivariate logistic regression, independent predictors for relapse were a line-associated source of infection (OR 3.87; 95% CI 1.56-9.60, p = 0.004) and the presence of immunosuppression (OR 2.70; 95% CI 1.14-6.44, p = 0.02). On univariate analysis definitive therapy with a broad-spectrum beta-lactam-beta-lactamase inhibitor (BLBLI, e.g. piperacillin-tazobactam) was not associated with relapse (OR 1.83; 95% CI 0.64-5.21, p = 0.26) although the proportion of patients receiving a BLBLI as definitive therapy was relatively small (21/159, 13.2%). Conclusions The risk of relapsed or persistent Enterobacter bacteraemia appears to be low in Australia. A line-associated source of infection and immunocompromise were significant independent predictors for relapse. Larger, preferably randomized, studies are needed to address whether BLBLIs represent an effective carbapenem-sparing option for Enterobacter bacteraemia. Electronic supplementary material The online version of this article (doi:10.1186/s13756-017-0177-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patrick N A Harris
- University of Queensland, UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, Building 71/918 Royal Brisbane & Women's Hospital Campus, 4029 Herston, QLD Australia
| | - Anna M Peri
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | | | - Carly M Hughes
- Pathology North - Hunter, John Hunter Hospital, Newcastle, NSW Australia
| | - David L Paterson
- UQ Centre for Clinical Research, Royal Brisbane and Women's Hospital, QLD, Australia & Wesley Medical Research, University of Queensland, Toowong, QLD Australia
| | - John K Ferguson
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW Australia.,School of Rural Medicine, University of New England, Armidale, NSW Australia.,Pathology North - Hunter, John Hunter Hospital, Newcastle, NSW Australia
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Cabral AB, Maciel MAV, Barros JF, Antunes MM, Barbosa de Castro CMM, Lopes ACS. Clonal spread and accumulation of β-lactam resistance determinants in Enterobacter aerogenes and Enterobacter cloacae complex isolates from infection and colonization in patients at a public hospital in Recife, Pernambuco, Brazil. J Med Microbiol 2017; 66:70-77. [DOI: 10.1099/jmm.0.000398] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Adriane Borges Cabral
- Universidade Estadual de Ciências da Saúde de Alagoas-UNCISAL, Maceió, Alagoas 57010-300, Brazil
- Universidade Federal de Pernambuco-UFPE, Recife, Pernambuco 50732-970, Brazil
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First clinical evaluation of a new single-use flexible cystoscope dedicated to double-J stent removal (Isiris™): a European prospective multicenter study. World J Urol 2016; 35:1269-1275. [DOI: 10.1007/s00345-016-1986-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022] Open
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Ofstead CL, Wetzler HP, Eiland JE, Heymann OL, Held SB, Shaw MJ. Assessing residual contamination and damage inside flexible endoscopes over time. Am J Infect Control 2016; 44:1675-1677. [PMID: 27614710 DOI: 10.1016/j.ajic.2016.06.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/13/2016] [Accepted: 06/20/2016] [Indexed: 10/21/2022]
Abstract
Researchers evaluated flexible endoscope damage and contamination levels at baseline and 2 months later. Postcleaning test results exceeded benchmarks for all gastroscopes and no colonoscopes. Microbial growth was found in samples from 47% of fully reprocessed endoscopes at baseline and 60% at follow-up. Borescope examinations identified scratches, discoloration, debris, and fluid inside endoscopes. Irregularities changed over time. Study evaluations allowed damaged and contaminated endoscopes to be identified and re-reprocessed or sent for repairs.
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First clinical evaluation of a new single-use flexible ureteroscope (LithoVue™): a European prospective multicentric feasibility study. World J Urol 2016; 35:809-818. [PMID: 27671898 DOI: 10.1007/s00345-016-1936-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/08/2016] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION We evaluated a new digital single-use flexible ureteroscope, LithoVue™ with respect to deflection, image quality and maneuverability. METHODS A prospective cohort study was conducted in eight tertiary reference centers in Europe in December 2015 and January 2016. All consecutive patients included underwent flexible ureteroscopy and were 18 years or older. Deflection and image quality pre- and post-use and maneuverability were rated with a Likert scale. RESULTS A total of 40 procedures were performed (five per institution). The indication for FURS was treatment of renal stones in 92.5 % of the cases. Before LithoVue™ usage, the median measured upward and downward deflections were both 270°. Image quality was rated as "very good" in 65 % of cases and "good" in 30 %. Maneuverability was "very good" in 77.5 % and "good" in 17.5 %. At the final evaluation, median upward and downward deflections were both 270°. Image quality was still "very good" in 65 % of cases and "good" in 30 % with no significant difference compared with preoperative data (p = 1). Maneuverability was "very good" in 72.5 % and "good" in 17.5 %, with no significant difference compared with preoperative data (p = 0.92). Two LithoVue™ broke during surgery (5 %): one occurring in extreme deflection with acute infundibulopelvic angle and spontaneous loss of vision for the second one. CONCLUSION The LithoVue™ displayed good image quality, active deflection and maneuverability. Further evaluation of surgical outcomes and cost analysis will help to present the best utility of this single-use FURS in current practice.
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Jones-Dias D, Manageiro V, Ferreira E, Barreiro P, Vieira L, Moura IB, Caniça M. Architecture of Class 1, 2, and 3 Integrons from Gram Negative Bacteria Recovered among Fruits and Vegetables. Front Microbiol 2016; 7:1400. [PMID: 27679611 PMCID: PMC5020092 DOI: 10.3389/fmicb.2016.01400] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/24/2016] [Indexed: 02/03/2023] Open
Abstract
The spread of antibiotic resistant bacteria throughout the food chain constitutes a public health concern. To understand the contribution of fresh produce in shaping antibiotic resistance bacteria and integron prevalence in the food chain, 333 antibiotic resistance Gram negative isolates were collected from organic and conventionally produced fruits (pears, apples, and strawberries) and vegetables (lettuces, tomatoes, and carrots). Although low levels of resistance have been detected, the bacterial genera identified in the assessed fresh produce are often described not only as environmental, but mostly as commensals and opportunistic pathogens. The genomic characterization of integron-harboring isolates revealed a high number of mobile genetic elements and clinically relevant antibiotic resistance genes, of which we highlight the presence of as mcr-1, qnrA1, blaGES−11, mphA, and oqxAB. The study of class 1 (n = 8), class 2 (n = 3) and class 3 (n = 1) integrons, harbored by species such as Morganella morganii, Escherichia coli, Klebsiella pneumoniae, led to the identification of different integron promoters (PcW, PcH1, PcS, and PcWTNG−10) and cassette arrays (containing drfA, aadA, cmlA, estX, sat, and blaGES). In fact, the diverse integron backbones were associated with transposable elements (e.g., Tn402, Tn7, ISCR1, Tn2*, IS26, IS1326, and IS3) that conferred greater mobility. This is also the first appearance of In1258, In1259, and In3-13, which should be monitored to prevent their establishment as successfully dispersed mobile resistance integrons. These results underscore the growing concern about the dissemination of acquired resistance genes by mobile elements in the food chain.
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Affiliation(s)
- Daniela Jones-Dias
- National Reference Laboratory of Antibiotic Resistances and Healthcare Associated Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo JorgeLisbon, Portugal; Centre for the Studies of Animal Science, Institute of Agrarian and Agri-Food Sciences and Technologies, Oporto UniversityOporto, Portugal
| | - Vera Manageiro
- National Reference Laboratory of Antibiotic Resistances and Healthcare Associated Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo JorgeLisbon, Portugal; Centre for the Studies of Animal Science, Institute of Agrarian and Agri-Food Sciences and Technologies, Oporto UniversityOporto, Portugal
| | - Eugénia Ferreira
- National Reference Laboratory of Antibiotic Resistances and Healthcare Associated Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge Lisbon, Portugal
| | - Paula Barreiro
- Innovation and Technology Unit, Human Genetics Department, National Institute of Health Doutor Ricardo Jorge Lisbon, Portugal
| | - Luís Vieira
- Innovation and Technology Unit, Human Genetics Department, National Institute of Health Doutor Ricardo Jorge Lisbon, Portugal
| | - Inês B Moura
- National Reference Laboratory of Antibiotic Resistances and Healthcare Associated Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo JorgeLisbon, Portugal; Centre for the Studies of Animal Science, Institute of Agrarian and Agri-Food Sciences and Technologies, Oporto UniversityOporto, Portugal
| | - Manuela Caniça
- National Reference Laboratory of Antibiotic Resistances and Healthcare Associated Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge Lisbon, Portugal
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O'Horo JC, Farrell A, Sohail MR, Safdar N. Carbapenem-resistant Enterobacteriaceae and endoscopy: An evolving threat. Am J Infect Control 2016; 44:1032-6. [PMID: 27179395 DOI: 10.1016/j.ajic.2016.03.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 03/02/2016] [Accepted: 03/02/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several clusters of Carbapenem-resistant Enterobacteriaceae (CRE) infections associated with contaminated endoscopes have recently been reported. Interim guidelines for mitigating endoscope-associated transmission have been proposed, but there has not been a systematic appraisal of CRE prevention practices. METHODS We conducted a systematic review of endoscope-associated CRE infection episodes, abstracting information on outbreak detection, mitigation, outcomes, and corrective steps taken to prevent recurrence. RESULTS Seven distinct outbreaks were identified in the published literature, and 5 of these were associated with duodenal endoscopy, with the remaining 2 associated with cystoscopy and ureteroscopy. Several investigators noted difficulties in cleaning protocols surrounding difficult to access components, such as the elevator on duodenoscopes. The published investigations did not report any failures of sterilization. It is unclear if routine reprocessing was ineffective, or difficult to execute properly. CONCLUSIONS Meticulous cleaning protocols and increased surveillance are necessary to prevent and detect future outbreaks of CRE and to determine whether more stringent measures, such as sterilization, are needed for duodenoscopes.
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Affiliation(s)
- John C O'Horo
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN; Multidisciplinary Epidemiology and Translational Research in Intensive Care Research Group, Mayo Clinic, Rochester, MN.
| | - Ann Farrell
- Library Services, Plummer Library, Mayo Clinic, Rochester, MN
| | - M Rizwan Sohail
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN
| | - Nasia Safdar
- William S. Middleton Memorial Veterans Affairs Hospital, Madison, WI; Division of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Madison, WI; Department of Infection Control, University of Wisconsin Hospital and Clinics, Madison, WI
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Chapuis A, Amoureux L, Bador J, Gavalas A, Siebor E, Chrétien ML, Caillot D, Janin M, de Curraize C, Neuwirth C. Outbreak of Extended-Spectrum Beta-Lactamase Producing Enterobacter cloacae with High MICs of Quaternary Ammonium Compounds in a Hematology Ward Associated with Contaminated Sinks. Front Microbiol 2016; 7:1070. [PMID: 27462306 PMCID: PMC4940370 DOI: 10.3389/fmicb.2016.01070] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/27/2016] [Indexed: 11/21/2022] Open
Abstract
Objective: To investigate an outbreak of extended-spectrum beta-lactamase (ESBL) producing Enterobacter cloacae that occurred in the Hematology ward (24-bed unit) of the François Mitterrand University Hospital (Dijon, France) between January 2011 and December 2013. The outbreak involved 43 patients (10 infected and 33 colonized). Design: We performed environmental analysis to detect multiresistant E. cloacae for comparison with clinical isolates (genotyping by pulsed-field gel electrophoresis and MLST as well as ESBL-typing) and determined the MICs of the quaternary ammonium compounds (QACs) alkyldimethylbenzylammonium chloride (ADBAC) and didecyldimethylammonium chloride (DDAC). A bleach-based cleaning-disinfection program was implemented in December 2012 after mechanical removal of the biofilm in all sinks. Results: We have detected 17 ESBL-producing E. cloacae in patients sink drains, shower drains and medical sink drains. Sequencing of the bla genes performed on 60 strains recovered from patients and environment (n = 43 clinical and n = 17 environmental) revealed that blaCTX−M15 was predominant (37 isolates) followed by blaCTX−M9 plus blaSHV−12 (20 isolates). We observed a great diversity among the isolates: 14 pulsotypes (11 STs) in clinical isolates and 9 pulsotypes (7 STs) in environmental isolates. Six pulsotypes were identical between clinical and environmental isolates. MICs of the quaternary ammonium compounds widely used for disinfection were very high in clinical and environmental isolates. Immediately after the implementation of the disinfection program we noticed a substantial fall in cases number. Our findings demonstrate the role of drains as important reservoir of ESBL-producing E. cloacae and highlight the necessity to settle drains accessible to achieve correct cleaning as well as to use disinfectant with proved activity against nosocomial pathogens.
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Affiliation(s)
- Angélique Chapuis
- Laboratoire de Bactériologie Médicale et de Surveillance Environnementale, Hôpital Universitaire de Dijon Dijon, France
| | - Lucie Amoureux
- Laboratoire de Bactériologie Médicale et de Surveillance Environnementale, Hôpital Universitaire de Dijon Dijon, France
| | - Julien Bador
- Laboratoire de Bactériologie Médicale et de Surveillance Environnementale, Hôpital Universitaire de Dijon Dijon, France
| | - Arthur Gavalas
- Laboratoire de Bactériologie Médicale et de Surveillance Environnementale, Hôpital Universitaire de Dijon Dijon, France
| | - Eliane Siebor
- Laboratoire de Bactériologie Médicale et de Surveillance Environnementale, Hôpital Universitaire de Dijon Dijon, France
| | | | - Denis Caillot
- Service d'Hématologie Clinique, Hôpital Universitaire de Dijon Dijon, France
| | - Marion Janin
- Laboratoire de Bactériologie Médicale et de Surveillance Environnementale, Hôpital Universitaire de Dijon Dijon, France
| | - Claire de Curraize
- Laboratoire de Bactériologie Médicale et de Surveillance Environnementale, Hôpital Universitaire de Dijon Dijon, France
| | - Catherine Neuwirth
- Laboratoire de Bactériologie Médicale et de Surveillance Environnementale, Hôpital Universitaire de Dijon Dijon, France
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Guérin F. Infections à Enterobacter cloacae complex : résistance aux antibiotiques et traitement. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.antinf.2015.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Kenters N, Huijskens EGW, Meier C, Voss A. Infectious diseases linked to cross-contamination of flexible endoscopes. Endosc Int Open 2015; 3:E259-65. [PMID: 26355428 PMCID: PMC4554517 DOI: 10.1055/s-0034-1392099] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Flexible endoscopes are widely used to examine, diagnose, and treat medical disorders. While the risk of endoscopy-related transmission of infection is estimated to be very low, more health care-associated infections are related to contaminated endoscopes than to any other medical device. Flexible endoscopes can get highly contaminated with microorganisms, secretions and blood during use. The narrow lumens and multiple internal channels make the cleaning of flexible endoscopes a complex and difficult task. Despite the availability of international, national and local endoscope reprocessing guidelines, contamination and transmission of microorganisms continue to occur. These transmissions are mostly related to the use of defective equipment, endoscope reprocessing failures, and noncompliance with recommended guidelines. This article presents an overview of publications about case reports and outbreaks related to contamination of flexible endoscopes.
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Affiliation(s)
- Nikki Kenters
- Albert Schweitzer Hospital, Department of Infection Prevention and Control, Dordrecht, Netherlands
| | | | - Corianne Meier
- Rivierenland Hospital, Department of Infection Prevention and Control, Tiel, Netherlands
| | - Andreas Voss
- Canisius-Wilhelmina Hospital, Department of Medical Microbiology, Nijmegen, Netherlands,Radboud University Medical Centre, Nijmegen, NL,Corresponding author: Prof. Andreas Voss Canisius-Wilhelmina Hospital, Department of Medical MicrobiologyP.O. Box 9015NijmegenNetherlands+31243657516
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Muggeo E, Boissel A, Martin L, Sgro C, Michiels C. Comparaison de coûts de deux modalités de retraitement des urétéroscopes souples au CHU de Dijon. Prog Urol 2015; 25:318-24. [DOI: 10.1016/j.purol.2015.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 01/09/2015] [Accepted: 01/23/2015] [Indexed: 10/23/2022]
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Haque A, Yoshizumi A, Saga T, Ishii Y, Tateda K. ESBL-producing Enterobacteriaceae in environmental water in Dhaka, Bangladesh. J Infect Chemother 2014; 20:735-7. [PMID: 25103169 DOI: 10.1016/j.jiac.2014.07.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/08/2014] [Accepted: 07/08/2014] [Indexed: 12/14/2022]
Abstract
Pathogens encoding extended-spectrum β-lactamase (ESBL) genes represent a threat for failure of empirical antibiotic therapy and are associated with high mortality, morbidity and expenses. We examined surface water in Dhaka, capital of Bangladesh and isolated ESBL-producing Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae, suggesting the potential role of water for the dissemination and transmission of resistant genes among microorganisms. E. coli found most prevalent among isolated Enterobacteriaceae from environmental water. Molecular and genetic analysis revealed CTX-M-type and SHV-type ESBL genes in isolates that may influence the spread of multidrug resistant pathogenic bacteria causing human and animal infections in Bangladesh.
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Affiliation(s)
- Anwarul Haque
- Department of Microbiology and Infectious Disease, Toho University School of Medicine, 5-21-16 Omori-Nishi, Ota-ku, Tokyo 143-8540, Japan
| | - Ayumi Yoshizumi
- Department of Microbiology and Infectious Disease, Toho University School of Medicine, 5-21-16 Omori-Nishi, Ota-ku, Tokyo 143-8540, Japan
| | - Tomoo Saga
- Department of Microbiology and Infectious Disease, Toho University School of Medicine, 5-21-16 Omori-Nishi, Ota-ku, Tokyo 143-8540, Japan
| | - Yoshikazu Ishii
- Department of Microbiology and Infectious Disease, Toho University School of Medicine, 5-21-16 Omori-Nishi, Ota-ku, Tokyo 143-8540, Japan.
| | - Kazuhiro Tateda
- Department of Microbiology and Infectious Disease, Toho University School of Medicine, 5-21-16 Omori-Nishi, Ota-ku, Tokyo 143-8540, Japan
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