Bronchoscope-Related “Superbug” Infections

Abstract Several recent cases associating cleaned and high-level disinfected duodenoscopes with outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) and related multidrug-resistant organisms (MDROs) may cause bronchoscopists, pulmonologists and other stakeholders to inquire about the adequacy of today’s practices for reprocessing flexible bronchoscopes. The primary objectives of this study were to address these questions and investigate the risk of reprocessed bronchoscopes transmitting infections of CRE and related MDROs. The published literature and the FDA’s medical device database of adverse events were searched beginning in 2012 when endoscopy first emerged as a recognized risk factor for transmission of CRE. The Internet was also searched during this same timeframe to identify other relevant cases. Twelve cases associating reprocessed bronchoscopes with infections of CRE or a related MDRO, eight within the U.S., were identified. This study’s findings suggest that bronchoscopes pose an under-recognized potential for transmission of CRE and related MDROs, warranting greater public awareness, enhanced preventive measures and updated reprocessing guidance. The cleaning and high-level disinfection of bronchoscopes in accordance with the manufacturer’s instructions may not always be sufficiently effective to eliminate this risk. Several risk factors for the transmission of these multidrug-resistant bacteria by a reprocessed bronchoscope were identified, including use of a damaged or improperly serviced bronchoscope. Recommendations are provided to improve the safety of flexible bronchoscopes, including supplementing their reprocessing with an enhanced measure such as sterilization, and strict adherence to a periodic servicing and maintenance schedule consistent with the bronchoscope manufacturer’s instructions.