Risk of transmission of carbapenem-resistant Enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy

Core Tip

Core tip: Gastrointestinal (GI) endoscopy, particularly ERCP, is an emerging risk factor for transmission of carbapenem-resistant Enterobacteriaceae (CRE) and their related superbugs, as well as of other certain bacteria and viruses. Several recent reports associate outbreaks of CRE following ERCP, with associated morbidity and mortality. If performed properly, however, current practices for reprocessing GI endoscopes, which include high-level disinfection, appear adequate to prevent disease transmission. Enhancing the quality and safety both of infection control in GI endoscopy departments and of the design of GI endoscopes to facilitate their thorough cleaning and reprocessing is recommended, as it is reasonable to conclude that these recent outbreaks of CRE causally linked to contaminated GI endoscopes may result in more robust and focused oversight and inspections both of manufacturers by regulatory agencies and of healthcare facilities by healthcare accrediting organizations and state health departments. Along with risk assessments, performing root cause analyses that identify the likely causes of CRE outbreaks and the actions required to prevent their recurrence is encouraged.