The medical news source Medscape published an article on January 3, 3014, about an outbreak of a concerning type of multidrug-resistant bacteria confirmed at a hospital outside of Chicago, Illinois, 2013.

Medscape interviewed this blog’s author, Lawrence F Muscarella, PhD, to learn of his perspectives about this outbreak and its causes. Read: “CDC Confirms Superbug Transmission via Endoscopy” (Medscape). (Registration to read this article is free and recommended.)

Advice: To receive advice about the causes of and actions to prevent CRE outbreaks following gastrointestinal (GI) endoscopy and ERCP, click here.

Linked by the federal Centers for Disease Control and Prevention (CDC) to gastrointestinal (GI) endoscopes, known as “ERCP endoscopes,” that were contaminated with this multidrug-resistant bacteria and were used during the medical procedure known as endoscopic retrograde cholangiopancreatography, or “ERCP,” this outbreak is the largest of this type of “superbug” in U.S. history.

The CDC’s field investigation of this outbreak is reported in the January 3, 2014, issue of the Morbidity and Mortality Weekly Report — click here to read it.

This CDC report concludes that a likely contributing factor to this “superbug” outbreak at Advocate Lutheran General Hospital (Park Ridge, IL) was the improper automated cleaning and/or disinfection of the implicated ERCP endoscopes.

The specific superbug that was the cause of this hospital’s outbreak is a type of carbapenem-resistant Enterobacteriaceae, or CRE, known as New Delhi metalo-β-lactamase (NDM)-producing Escherichia col.

The CDC reports that all of the 243 patients who underwent ERCP at Advocate Lutheran General Hospital between January and September, 2013, are at risk of infection and colonization with this “nightmarish” bacteria.  Any of these patients who have not yet contacted the hospital to be screened and evaluated for infection with CRE are urged to do so.

The CDC also reports that patients whose blood become infected with this superbug strain of E. coli, as as with an strain of CRE, have a reported mortality rate of as high as 50% (i.e., 1 out of every 2 patients whose blood becomes infected with CRE may expire).

In addition to his comments in Medscape’s aforementioned article, Dr. Muscarella has written a number of articles about this CRE outbreak at Advocate Lutheran General Hospital linked to contaminated ERCP endoscopes. These articles are “recommended reading” and are listed on this blog’s page entitled “Superbugs and ERCP.” These articles include:

  1. “Multiple Outbreaks of a ‘Nightmare Bacteria’ Linked to Contaminated Endoscopes in the U.S and Europe: Has a ‘Smoking Gun’ Been Found?” Click here.
  2. “Overlooked Outbreaks of the Superbug ‘CRE’ Following Gastrointestinal Endoscopy: An Epidemic in Our Midst?” Click here.
  3. “Investigation and Prevention of Bacterial Outbreaks during Endoscopic Retrograde Cholangiopancreatography (ERCP).” Click here.

Finally, GI endoscopes are not the only types of endoscopic instrumentation that has been reported to transmit a superbug from one patient to another. Other types of endoscopes, including bronchoscopes and cystoscopes have also been linked to patient-to-patient transmission of CRE.

Article by: Lawrence F Muscarella, PhD, president and owner of the think-tank quality and safety company “LFM Healthcare Solutions” — click here for a list of its services. Posted 2/13/2014, Rev. A.

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