New Delhi Metallo-β-Lactamase-Producing Carbapenem-Resistant Escherichia coli Associated With Exposure to Duodenoscopes

TLDR: Exposure to duodenoscopes with bacterial contamination was associated with apparent transmission of NDM-producing E coli among patients at 1 hospital and facilities should be aware of the potential for transmission of bacteria including antimicrobial-resistant organisms via this route.

Abstract: Importance Carbapenem-resistant Enterobacteriaceae (CRE) producing the New Delhi metallo-β-lactamase (NDM) are rare in the United States, but have the potential to add to the increasing CRE burden. Previous NDM-producing CRE clusters have been attributed to person-to-person transmission in health care facilities. Objective To identify a source for, and interrupt transmission of, NDM-producing CRE in a northeastern Illinois hospital. Design, Setting, and Participants Outbreak investigation among 39 case patients at a tertiary care hospital in northeastern Illinois, including a case-control study, infection control assessment, and collection of environmental and device cultures; patient and environmental isolate relatedness was evaluated with pulsed-field gel electrophoresis (PFGE). Following identification of a likely source, targeted patient notification and CRE screening cultures were performed. Main Outcomes and Measures Association between exposure and acquisition of NDM-producing CRE; results of environmental cultures and organism typing. Results In total, 39 case patients were identified from January 2013 through December 2013, 35 with duodenoscope exposure in 1 hospital. No lapses in duodenoscope reprocessing were identified; however, NDM-producingEscherichia coliwas recovered from a reprocessed duodenoscope and shared more than 92% similarity to all case patient isolates by PFGE. Based on the case-control study, case patients had significantly higher odds of being exposed to a duodenoscope (odds ratio [OR], 78 [95% CI, 6.0-1008],P  Conclusions and Relevance In this investigation, exposure to duodenoscopes with bacterial contamination was associated with apparent transmission of NDM-producingE coliamong patients at 1 hospital. Bacterial contamination of duodenoscopes appeared to persist despite the absence of recognized reprocessing lapses. Facilities should be aware of the potential for transmission of bacteria including antimicrobial-resistant organisms via this route and should conduct regular reviews of their duodenoscope reprocessing procedures to ensure optimal manual cleaning and disinfection.