van der Ploeg Koen, Severin Juliëtte A, Klaassen Corné H W, Vos Margreet C, Bruno Marco J, Mason-Slingerland Bibi C G C
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Gastrointest Endosc. 2025 Jan;101(1):141-148. doi: 10.1016/j.gie.2024.08.004. Epub 2024 Aug 9.
Periodic duodenoscope cultures are essential to timely detect contamination, but their sensitivity remains unknown. This study aims to determine the sensitivity of duodenoscope cultures and to estimate the prevalence of contaminated duodenoscope use.
We combined duodenoscope microbiologic surveillance data from March 2015 to June 2022 with usage data to evaluate patient exposure to duodenoscopes contaminated with microorganisms of gut or oral origin (MGO). We identified duodenoscopes with repeated species-level contamination within a year and used molecular typing to confirm genetic relatedness. Genetically related microorganisms over multiple duodenoscope cultures of a single duodenoscope indicated a period of sustained contamination, and a cluster was defined as overlapping periods of sustained contamination between different duodenoscopes. If microorganisms were not available for molecular analysis, we marked the period as unconfirmed. A sample was defined as false negative if it did not show the target microorganism(s) in a period of sustained contamination. We used 3 scenarios to hypothesize about contaminated use and culture sensitivity.
We included 556 duodenoscope cultures with 185 (33.3%) contaminated with MGO. The total usage of duodenoscopes was 5226. We identified 1 period of sustained contamination, 6 unconfirmed periods, and 2 clusters. Depending on our scenario assumptions, the percentage of contaminated use varied from 12.3% to 23.7% and culture sensitivity ranged from 82.2% to 98.9%.
Limited sensitivity of duodenoscope cultures leads to improper clearance of duodenoscopes for clinical use, increasing risks of outbreaks. The applicability of a single culture to end a duodenoscope's quarantine should be re-evaluated.
定期进行十二指肠镜培养对于及时检测污染至关重要，但其敏感性尚不清楚。本研究旨在确定十二指肠镜培养的敏感性，并估计使用受污染十二指肠镜的发生率。
我们将2015年3月至2022年6月的十二指肠镜微生物监测数据与使用数据相结合，以评估患者接触被肠道或口腔来源微生物（MGO）污染的十二指肠镜的情况。我们识别出一年内存在重复物种水平污染的十二指肠镜，并使用分子分型来确认基因相关性。同一十二指肠镜多次培养中基因相关的微生物表明存在持续污染期，不同十二指肠镜之间持续污染的重叠期被定义为一个簇。如果无法获得微生物进行分子分析，我们将该时期标记为未确认。如果在持续污染期样本未显示目标微生物，则该样本被定义为假阴性。我们使用3种情景来假设污染使用情况和培养敏感性。
我们纳入了556次十二指肠镜培养，其中185次（33.3%）被MGO污染。十二指肠镜的总使用次数为5226次。我们识别出1个持续污染期、6个未确认期和2个簇。根据我们的情景假设，污染使用的百分比在12.3%至23.7%之间，培养敏感性在82.2%至98.9%之间。
十二指肠镜培养的敏感性有限导致临床使用的十二指肠镜消毒不当，增加了暴发风险。应重新评估单次培养用于结束十二指肠镜隔离的适用性。
