Gastrointestinal Endoscopy-Associated Infections: Update on an Emerging Issue

Area of Science:

• Gastroenterology
• Infectious Diseases
• Medical Device Reprocessing

Background:

• Gastrointestinal (GI) endoscopic procedures are common, with over 17.7 million performed annually in the US.
• While generally low-risk, adverse events including infections can occur, often stemming from endogenous gut flora.
• The incidence, causative organisms, and trends of post-endoscopy infections, particularly endoscope-associated infections (EAI), require updated understanding.

Purpose of the Study:

• To systematically review and summarize data on endoscope-associated infections (EAI) following GI endoscopic procedures.
• To estimate the incidence rate of post-endoscopy infections and identify prevalent causative organisms.
• To discuss prevention strategies and explore novel solutions like disposable endoscopes.

Main Methods:

• A systematic review of 117 articles reporting on demographical, clinical, and management data of EAI events.
• Analysis of infection rates across different types of GI endoscopic procedures.
• Identification of common microbial culprits associated with EAIs.

Main Results:

• The composite infection rate following GI endoscopic procedures was 0.2%.
• Specific rates included 0.8% for ERCP, 0.123% for non-ERCP upper GI, and 0.073% for lower GI procedures.
• Pseudomonas aeruginosa was the most frequent causative organism, followed by Enterobacteriaceae and Gram-positive cocci.

Conclusions:

• Endoscope-associated infections (EAI) following GI endoscopy have a low overall incidence, but specific procedures like ERCP carry higher risks.
• Effective prevention relies on antimicrobial prophylaxis, robust endoscope reprocessing and sterilization, and ongoing surveillance.
• Disposable endoscopes present a potential future alternative to mitigate reprocessing-related infection risks, though environmental and financial impacts need consideration.