Gastroenterology Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Infectious Diseases Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Gastrointest Endosc. 2018 Jan;87(1):104-109.e3. doi: 10.1016/j.gie.2017.05.001. Epub 2017 May 10.
In 2015, the U.S. Food and Drug Administration and Centers for Disease Control and Prevention (CDC) issued guidance for duodenoscope culturing and reprocessing in response to outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) duodenoscope-related infections. Based on this guidance, we implemented best practices for reprocessing and developed a systematic process for culturing endoscopes with elevator levers. The aim of this study is to report the outcomes and direct costs of this program.
First, clinical microbiology data from 2011 to 2014 were reviewed retrospectively to assess for possible elevator lever-equipped endoscope-related CRE infections. Second, a program to systematically culture elevator lever-equipped endoscopes was implemented. Each week, about 25% of the inventory of elevator lever-equipped endoscopes is cultured based on the CDC guidelines. If any cultures return bacterial growth, the endoscope is quarantined pending repeat culturing. The costs of the program, including staff time and supplies, have been calculated.
From 2011 to 2014, none of 17 patients with documented CRE infection had undergone ERCP or endoscopic ultrasound in the previous 36 months. From June 2015 to September 2016, 285 cultures were performed. Three (1.1%) had bacterial growth, 2 with skin contaminants and 1 with an oral contaminant. The associated endoscopes were quarantined and reprocessed, and repeat cultures were negative. The total estimated cost of our program for an inventory of 20 elevator lever-equipped endoscopes was $30,429.60 per year ($1521.48 per endoscope).
This 16-month evaluation of a systematic endoscope culturing program identified a low rate of positive cultures after elevator lever endoscope reprocessing. All positive cultures were with non-enteric microorganisms. The program was of modest cost and identified reprocessing procedures that may have led to a low rate of positive cultures.
2015 年，美国食品和药物管理局及疾病控制与预防中心（CDC）发布了针对耐碳青霉烯类肠杆菌科（CRE）的十二指肠镜相关感染爆发的十二指肠镜培养和再处理指南。基于该指南，我们实施了再处理的最佳实践，并制定了培养带提升杆的内镜的系统流程。本研究旨在报告该方案的结果和直接成本。
首先，回顾性审查 2011 年至 2014 年的临床微生物学数据，以评估是否存在带提升杆的内镜相关 CRE 感染。其次，实施了系统培养带提升杆的内镜的方案。每周，根据 CDC 指南，对约 25%的带提升杆的内镜库存进行培养。如果任何培养物出现细菌生长，则对内镜进行隔离，等待重复培养。已计算出该方案的成本，包括人员时间和用品。
2011 年至 2014 年期间，17 例确诊 CRE 感染的患者中，无一人在过去 36 个月内接受过 ERCP 或内镜超声检查。从 2015 年 6 月至 2016 年 9 月，共进行了 285 次培养。其中 3 次（1.1%）有细菌生长，2 次为皮肤污染物，1 次为口腔污染物。相关内镜被隔离并重新处理，重复培养结果为阴性。我们的方案对 20 个带提升杆的内镜库存的总成本估计为每年 30429.60 美元（每台内镜 1521.48 美元）。
本研究对系统内镜培养方案进行了 16 个月的评估，发现带提升杆的内镜再处理后阳性培养率较低。所有阳性培养物均为非肠道微生物。该方案成本适中，确定了可能导致低阳性培养率的再处理程序。
