Endoscopic Retrograde Cholangiopancreatography–Associated AmpC Escherichia coli Outbreak. (30th March 2015)

• Record Type: Journal Article
• Authors: Wendorf, Kristen A.; Kay, Meagan; Baliga, Christopher; Weissman, Scott J.; Gluck, Michael; Verma, Punam; D'Angeli, Marisa; Swoveland, Jennifer; Kang, Mi-Gyeong; Eckmann, Kaye; Ross, Andrew S.; Duchin, Jeffrey
• Is Part Of: Infection control and hospital epidemiology. Volume 36:Number 6(2015)
• Page Start: 634
• Page End: 642
• Publication Date: 2015-03-30
• Subjects: Nosocomial infections -- Epidemiology -- Periodicals; Health facilities -- Sanitation -- Periodicals; Hospital buildings -- Sanitation -- Periodicals; Cross Infection -- Periodicals; Epidemiology -- Periodicals; Hospitals -- Periodicals; Infection Control -- Periodicals; 614.44
• DOI: 10.1017/ice.2015.66
• Languages: English
• ISSNs: 0899-823X

Abstract

<abstract abstract-type="normal"> <title> <x content-type="archive" xml:space="preserve">Abstract</x> </title> <sec id="abs1" sec-type="general"> <title>BACKGROUND</title> <p>We identified an outbreak of AmpC–producing <italic>Escherichia coli</italic> infections resistant to third-generation cephalosporins and carbapenems (CR) among 7 patients who had undergone endoscopic retrograde cholangiopancreatography at hospital A during November 2012–August 2013. Gene sequencing revealed a shared novel mutation in a <italic>bla</italic><sub>CMY</sub> gene and a distinctive <italic>fumC/ fimH</italic> typing profile.</p> </sec> <sec id="abs2" sec-type="general"> <title>OBJECTIVE</title> <p>To determine the extent and epidemiologic characteristics of the outbreak, identify potential sources of transmission, design and implement infection control measures, and determine the association between the CR <italic>E. coli</italic> and AmpC <italic>E. coli</italic> circulating at hospital A.</p> </sec> <sec id="abs3" sec-type="methods"> <title>METHODS</title> <p>We reviewed laboratory, medical, and endoscopy reports, and endoscope reprocessing procedures. We obtained cultures from endoscopes after reprocessing as well as environmental samples and conducted pulsed-field gel electrophoresis and gene sequencing on phenotypic AmpC isolates from patients and endoscopes. Cases were those infected with phenotypic AmpC isolates (both carbapenem-susceptible and CR) and identical <italic>bla</italic><sub>CMY-2</sub>, <italic>fumC</italic>, and <italic>fimH</italic> alleles or related pulsed-field gel electrophoresis patterns.</p> </sec> <sec id="abs4" sec-type="results"> <title>RESULTS</title> <p>Thirty-five of 49 AmpC <italic>E. coli</italic> tested met the case definition, including all CR isolates. All cases had complicated biliary disease and had undergone at least 1 endoscopic retrograde cholangiopancreatography at hospital A. Mortality at 30 days was 16% for all patients and 56% for CR patients. Two of 8 reprocessed endoscopic retrograde cholangiopancreatography scopes harbored AmpC that matched case isolates by pulsed-field gel electrophoresis. Environmental cultures were negative. No breaches in infection control were identified. Endoscopic reprocessing exceeded manufacturer's recommended cleaning guidelines.</p> </sec> <sec id="abs5" sec-type="conclusion"> <title>CONCLUSION</title> <p>Recommended reprocessing guidelines are not sufficient.</p> <p> <italic>Infect Control Hosp Epidemiol</italic> 2015;00(0): 1–9</p> </sec> </abstract>