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Pseudomonas aeruginosa cross-infection following endoscopic retrograde cholangiopancreatography
Abstract:
In a 6 week period, three of 50 patients developed Pseudomonas aeruginosa septicaemia following Endoscopic Retrograde Cholangiopancreatography (ERCP). Pseudomonas aeruginosa serotype 10 was isolated from each of the patients and from the endoscope. The outbreak was related to inadequate disinfection of the air and water channel of the endoscope. Following the introduction of a modified decontamination technique, which involved rinsing the air and water channel with glutaraldehyde, no further cases of pseudomonas infection occurred, and the organism could not be isolated from the instrument. Obstruction of the biliary tract was a predisposing factor in the development of infection; and administration of antibiotics immediately following the procedure failed to prevent it. This may have been due to inadequate dosage. We suggest that patients presenting for ERCP, in whom obstruction of the biliary tract is suspected, should come prepared for immediate drainage of the obstructed system at the time of the procedure.
Insights
A Pseudomonas aeruginosa outbreak occurred after Endoscopic Retrograde Cholangiopancreatography (ERCP) due to endoscope disinfection issues. A new cleaning method prevented further infections, highlighting the importance of proper decontamination.
Area of Science:
- Infectious Disease
- Gastroenterology
- Medical Device Reprocessing
Background:
- Endoscopic Retrograde Cholangiopancreatography (ERCP) is a common procedure for diagnosing and treating biliary and pancreatic conditions.
- Nosocomial infections, particularly those caused by multidrug-resistant organisms, pose a significant risk to patients undergoing invasive procedures.
Observation:
- An outbreak of Pseudomonas aeruginosa septicaemia occurred in three patients within a 6-week period following ERCP.
- The same bacterial strain (serotype 10) was isolated from infected patients and the endoscope used.
- Inadequate disinfection of the endoscope's air and water channels was identified as the likely cause of transmission.
Findings:
- A modified decontamination technique involving glutaraldehyde rinsing of the endoscope's air and water channels effectively eliminated Pseudomonas aeruginosa.
- No further infections were observed after implementing the enhanced disinfection protocol.
- Biliary tract obstruction was identified as a predisposing factor for infection.
- Post-procedure antibiotic administration at standard dosages did not prevent infection, suggesting potential issues with dosage or efficacy.
Implications:
- Rigorous adherence to and enhancement of endoscope disinfection protocols are critical for preventing healthcare-associated infections.
- Patients with suspected biliary obstruction undergoing ERCP may benefit from prophylactic biliary drainage during the procedure.
- Further investigation into optimal antibiotic prophylaxis strategies for ERCP patients with biliary obstruction is warranted.