Endoscopes and Deadly CRE Infections

Over 500,000 patients per year in the U.S. undergo an endoscopic procedure to diagnose and treat certain diseases in the liver, pancreas, and bile ducts. The scopes used in these procedures--the duodenoscope--are routinely cleaned and sterilized for reuse in accordance with manufacturer's instructions, but now we have learned that these scopes can harbor deadly bacteria despite the hospital following the manufacturer's instructions.

In early 2015, two patients at Ronald Reagan UCLA Medical Center died after undergoing an endoscopic procedure and being exposed to carbepenem-resistant Enterobacteriaceae (CRE). In total, the hospital estimated that up to 179 patients may have been exposed to CRE from two different duodenscopes and notified the patients of the possible exposure.

CRE bacteria have evolved over time to become resistant to antibiotics. CRE infections are a relatively new phenomenon that the Centers for Disease Control has warned us about over the past decade. With the recent death cases associated with the use of duodenoscopes, the CDC has recommended that hospitals consider taking extra step to clean and sterilize the devices to assure that CRE and other high risk bacteria are removed from the devices before reusing them. The CDC has also advised that patients undergoing procedures with the device be advised on the risk of CRE and other high risk infections before obtaining consent for the procedure from the patient.

Some hospitals, on their own volition, have modified their sterilization protocols beyond that advised by the CDC to further reduce the risk of CRE infections, but not all hospitals have followed suit. Many continue to follow the manufacturer's instructions, which appear to be inadequate, and so we can anticipate that CRE infections will continue to be associated with use of the duodenoscope until all hospitals and manufacturers establish and follow new protocols to prevent the transmission of CRE and other high risk infections during endoscopic procedures.