NDLI: Uncovering the spread of drug-resistant bacteria through next-generation sequencing based surveillance: transmission of extended-spectrum β-lactamase-producing Enterobacterales by a contaminated duodenoscope

Content Provider	Springer Nature : BioMed Central
Author	Cimen, Cansu Bathoorn, Erik Loeve, Arjo J. Fliss, Monika Berends, Matthijs S. Nagengast, Wouter B. Hamprecht, Axel Voss, Andreas Lokate, Mariëtte
Abstract	Contamination of duodenoscopes is a significant concern due to the transmission of multidrug-resistant organisms (MDROs) among patients who undergo endoscopic retrograde cholangiopancreatography (ERCP), resulting in outbreaks worldwide. In July 2020, it was determined that three different patients, all had undergone ERCP with the same duodenoscope, were infected. Two patients were infected with blaCTX-M-15 encoding Citrobacter freundii, one experiencing a bloodstream infection and the other a urinary tract infection, while another patient had a bloodstream infection caused by blaSHV-12 encoding Klebsiella pneumoniae. Molecular characterization of isolates was available as every ESBL-producing isolate undergoes Next-Generation Sequencing (NGS) for comprehensive genomic analysis in our center. After withdrawing the suspected duodenoscope, we initiated comprehensive epidemiological research, encompassing case investigations, along with a thorough duodenoscope investigation. Screening of patients who had undergone ERCP with the implicated duodenoscope, as well as a selection of hospitalized patients who had ERCP with a different duodenoscope during the outbreak period, led to the discovery of three additional cases of colonization in addition to the three infections initially detected. No microorganisms were detected in eight routine culture samples retrieved from the suspected duodenoscope. Only after destructive dismantling of the duodenoscope, the forceps elevator was found to be positive for blaSHV-12 encoding K. pneumoniae which was identical to the isolates detected in three patients. This study highlights the importance of using NGS to monitor the transmission of MDROs and demonstrates that standard cultures may fail to detect contaminated medical equipment such as duodenoscopes.
Related Links	https://aricjournal.biomedcentral.com/counter/pdf/10.1186/s13756-024-01386-5.pdf
Ending Page	11
Page Count	11
Starting Page	1
File Format	HTM / HTML
ISSN	20472994
DOI	10.1186/s13756-024-01386-5
Journal	Antimicrobial Resistance & Infection Control
Issue Number	1
Volume Number	13
Language	English
Publisher	BioMed Central
Publisher Date	2024-03-08
Access Restriction	Open
Subject Keyword	Medical Microbiology Drug Resistance Infectious Diseases Klebsiella pneumoniae Citrobacter freundii Endoscopic retrograde cholangiopancreatography (ERCP) Duodenoscope Nosocomial transmission Contamination Extended-spectrum β-lactamase (ESBL) Next-generation sequencing (NGS) Multi locus sequence typing (MLST) SHV-12 CTXM-15
Content Type	Text
Resource Type	Article
Subject	Public Health, Environmental and Occupational Health Infectious Diseases Microbiology (medical) Pharmacology (medical)
Journal Impact Factor	4.8/2023
5-Year Journal Impact Factor	5.8/2023

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