Investigation of possible transmission of a susceptible microorganism through a contaminated duodenoscope: A case report

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Background: Despite compliance to extensive reprocessing protocols, duodenoscopes have been linked to outbreaks of susceptible and multi-drug resistant organisms (MDRO) due to persistent duodenoscope contamination. Duodenoscope-associated infections (DAIs) based on transmission of susceptible microorganisms are likely to be underreported due to detection bias. Case presentation: We describe the retrospective detection of a DAI case caused by a susceptible microorganism which at the time of clinical infection was not recognized as such. During 2017 and 2018, duodenoscopes were cultured on a daily basis due to research activities. While analyzing this data, it was found that a duodenoscope had been contaminated with Enterobacter cloacae complex over a period of 3 months. We checked whether patients treated with this duodenoscope had developed infections and found one patient with an E. cloacae cholangitis 3 months after the ERCP (Endoscopic retrograde cholangiopancreaticography) procedure. The isolates on the duodenoscope and in the patients’ blood culture were indistinguishable by amplified fragment length polymorphism (AFLP). By classical multi-locus sequence typing (MLST), both strains were of the same (but novel) sequence type. Application of whole genome MLST showed 93 (out of 3757) allelic differences. Conclusion: This case report describes a plausible link between a contaminated duodenoscope and a patient infection with E. cloacae. Transmission of susceptible E. cloacae was highly suspected from AFLP and MLST results; by WGS, 93 allelic differences were found which proves closely related strains. This report shows that DAIs by susceptible microorganisms can be easily missed and therefore its true prevalence remains underscored.

Original languageEnglish
Article number127
JournalAntimicrobial Resistance and Infection Control
Issue number1
Publication statusPublished - 28 Aug 2021

Bibliographical note

Funding Information:
JK: Grant recipient from Pentax Medical and Boston Scientific. AR: Grant recipient from 3M and Pentax Medical. CK: no conflict of interest. MB: Consultant for Boston Scientific, Cook Medical; grant recipient from 3M, Boston Scientific, Cook Medical, Pentax Medical, Mylan and InterScope. MV: Grant recipient from 3M, Pentax Medical and Boston Scientific.

Publisher Copyright:
© 2021, The Author(s).


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