a Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences , Tehran , Iran.
b Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences , Tehran , Iran.
Expert Rev Med Devices. 2019 May;16(5):413-420. doi: 10.1080/17434440.2019.1604215. Epub 2019 Apr 22.
Endogenous and exogenous infection of the biliary tract could occur during endoscopic retrograde cholangiopancreatography.
Bile samples of patients with hepatobiliary diseases, and swab samples of elevator channel samples of duodenoscope and washing instruments were prepared simultaneously and cultured aerobically and anaerobically. Antimicrobial susceptibility of the most common characterized bacterial species was tested, and their genetic relatedness was analyzed by multiple locus variable number of tandem repeats method.
Contamination with Pseudomonas aeruginosa was detected in 38.2% of the elevator channels' and 26.6% of the bile samples. Staphylococcus aureus, Enterococcus spp., Staphylococcus epidermidis, Escherichia coli, Enterobacter spp., and Clostridium perfringenes were among other bacterial isolates in the elevator channel swab samples. Highest antimicrobial resistance rate among P. aeruginosa isolates from the bile and swab samples were detected against gentamicin (100% and 73%, respectively), while the lowest one was measured to piperacillin-tazobactam (25% and 0%, respectively). Out of the 27 distinct MLVA profiles, relatedness of P. aeruginosa strains in the bile samples compared with those from the elevators was shown in three series of the samples.
Identity of P. aeruginosa strains among the bile and elevator channel samples showed possibility of cross-contamination among patients even at distinct time intervals. Expert opinion: Bacterial infection is considered as main complications of ERCP. Entry of bacteria into the biliary tract via contaminated device and its related instruments and their proliferation in this tissue could cause serious infections. To prevent this side effect, reprocessing of medical equipment via standard cleaning and disinfection procedures are needed. Our results showed incompliance of methods used for endoscope cleaning and disinfection procedure. Although host risk factors, such as sphincterotomy, could increase rate of infection with different types of bacteria, their ability for formation of biofilm and spore, which could help them to resist disinfectants and washing procedures seems to be main cause of persistent colonization and transmission among different patients. New standards for disinfection compared with currently used methods and use of materials to eliminate formation of bacterial microcolonies seem to be necessary to prevent cross-contamination.
经内镜逆行胰胆管造影术（ERCP）过程中可能会发生内源性和外源性胆道感染。
同时准备肝胆疾病患者的胆汁样本和十二指肠镜的提升通道样本拭子以及清洗仪器的拭子，进行需氧和厌氧培养。测试最常见特征细菌的药敏性，并通过多位点可变串联重复数方法分析其遗传相关性。
在提升通道中发现 38.2%的样本和 26.6%的胆汁样本受到绿脓假单胞菌污染。在提升通道拭子样本中还分离到金黄色葡萄球菌、肠球菌属、表皮葡萄球菌、大肠埃希菌、肠杆菌属和产气荚膜梭菌等其他细菌。胆汁和拭子样本中的绿脓假单胞菌分离株对庆大霉素的耐药率最高（分别为 100%和 73%），而对哌拉西林-他唑巴坦的耐药率最低（分别为 25%和 0%）。在 27 个不同的 MLVA 图谱中，胆汁样本中的绿脓假单胞菌菌株与提升通道样本中的菌株显示出在三个系列样本之间存在亲缘关系。
胆汁样本和提升通道样本中的绿脓假单胞菌菌株具有同源性，表明即使在不同的时间间隔，患者之间也可能存在交叉污染。专家意见：细菌感染被认为是 ERCP 的主要并发症。受污染的器械及其相关仪器中的细菌进入胆道并在该组织中增殖可导致严重感染。为了防止这种副作用，需要通过标准的清洗和消毒程序对医疗设备进行再处理。我们的结果显示，内镜清洗和消毒程序的方法不符合要求。尽管宿主的风险因素，如括约肌切开术，可能会增加不同类型细菌感染的风险，但它们形成生物膜和孢子的能力，使它们能够抵抗消毒剂和清洗程序，似乎是导致不同患者之间持续定植和传播的主要原因。与目前使用的方法相比，需要新的消毒标准和使用材料来消除细菌微群落的形成，以防止交叉污染。
