Costs of purchase, maintenance, microbiological control, and reprocessing of a reusable duodenoscope

Auxetic solution for enhanced esophageal brachytherapy applicator

Purpose

In this study, a novel auxetic applicator equipped with four-channel catheters for esophageal brachytherapy was presented.

Material and methods

The applicator, made of a new biocompatible material, has an auxetic helical structure with four channels. Details of applicator modeling, construction, commissioning, and insertion were provided. Initial ex vivo trial conducted on a porcine model was outlined.

Results

Simulations and dose calculations closely matched experimental measurements, validating the modeling approach. This applicator achieved highly asymmetric dose distributions. Its unique auxetic helical design allowed smooth insertion, while mitigating sequential inter-fraction hot spot formation.

Conclusions

Ex vivo implementation of the applicator demonstrated feasibility, resulting in consistent and reproducible dose distributions. Initial outcomes showed promise for the applicator's efficacy and versatility in intra-luminal or intra-cavitary applications.

Evidence of transmission of New Delhi metallo-β-lactamase-producing Klebsiella pneumoniae through a gastrointestinal endoscope without an elevator channel

OBJECTIVE

To investigate the source and transmission dynamics of an endoscope-associated New Delhi metallo-β-lactamase-producing Klebsiella pneumonia (NDM-KP) outbreak.

DESIGN

Epidemiological and genomic investigation.

SETTING

Academic acute care hospital in New Jersey.

PATIENTS

Five patients with active NDM-KP infection identified on clinical isolates, and four NDM-KP colonized patients identified via rectal swab screening.

RESULTS

Over a twelve-month period, nine patients were identified with NDM-KP infection or colonization. Whole-genome sequencing (WGS) revealed that all of the identified cases were related by 25 mutational events or less. Seven of the cases were linked to gastrointestinal endoscopic procedures (four clinical cases and three positive screens among patients exposed to endoscopes suspected of transmission). Two cases demonstrated delayed transmission that occurred five months after the initial outbreak, likely through shared usage of a non-therapeutic gastroscope without an elevator channel.

CONCLUSIONS

Although all endoscope cultures in our investigation were negative, the epidemiological link to gastrointestinal endoscopes, the high degree of relatedness via WGS, and the identification of asymptomatic NDM-KP colonization among patients exposed to shared endoscopes make the endoscopic mode of transmission most likely. This investigation highlights the probable transmission of NDM-KP via a gastroscope without an elevator channel, observed several months after an initial outbreak. We hypothesize that persistent mechanical defects may have contributed to the delayed device-related transmission of NDM-KP.