Investigators Report on CRKP Associated with Duodenoscopy

Carbapenemase-producing Enterobacteriaceae (CPE) have become a major problem for healthcare systems worldwide. While the first reports from European hospitals described the introduction of CPE from endemic countries, there is now a growing number of reports describing outbreaks of CPE in European hospitals. Kola, et al. (2015) report an outbreak of Carbapenem-resistant K. pneumoniae in a German University hospital which was in part associated with duodenoscopy.

Between Dec. 6, 2012 and Jan. 10, 2013, carbapenem-resistant K. pneumoniae (CRKP) was cultured from 12 patients staying on four different wards. The amplification of carbapenemase genes by multiplex PCR showed presence of the blaOXA-48 gene. Molecular typing confirmed the identity of all 12 isolates. Reviewing the medical records of CRKP cases revealed that there was a spatial relationship between six of the cases which were located on the same wards. The remaining six cases were all related to endoscopic retrograde cholangiopancreatography (ERCP) which was performed with the same duodenoscope. The outbreak ended after the endoscope was sent to the manufacturer for maintenance.

The researchers conclude that although the outbreak strain was also disseminated to patients who did not undergo ERCP and environmental sources or medical personnel also contributed to the outbreak, the gut of colonized patients is the main source for CPE. Therefore, accurate and stringent reprocessing of endoscopic instruments is extremely important, which is especially true for more complex instruments like the duodenoscope (TJF Q180V series) involved in the outbreak described here. Their research was published in Antimicrobial Resistance and Infection Control. 

Reference: Kola A, Piening B, Pape UF, Veltzke-Schlieker W, Kaase M, Geffers C, Wiedenmann B and Gastmeier P. An outbreak of carbapenem-resistant OXA-48 – producing Klebsiella pneumonia associated to duodenoscopy. Antimicrobial Resistance and Infection Control 2015, 4:8  doi:10.1186/s13756-015-0049-4