Carbapenem-resistant Enterobacteriaceae and endoscopy: An evolving threat

John C. O'Horo, Ann Farrell, M. Rizwan Sohail, Nasia Safdar

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Background Several clusters of Carbapenem-resistant Enterobacteriaceae (CRE) infections associated with contaminated endoscopes have recently been reported. Interim guidelines for mitigating endoscope-associated transmission have been proposed, but there has not been a systematic appraisal of CRE prevention practices. Methods We conducted a systematic review of endoscope-associated CRE infection episodes, abstracting information on outbreak detection, mitigation, outcomes, and corrective steps taken to prevent recurrence. Results Seven distinct outbreaks were identified in the published literature, and 5 of these were associated with duodenal endoscopy, with the remaining 2 associated with cystoscopy and ureteroscopy. Several investigators noted difficulties in cleaning protocols surrounding difficult to access components, such as the elevator on duodenoscopes. The published investigations did not report any failures of sterilization. It is unclear if routine reprocessing was ineffective, or difficult to execute properly. Conclusions Meticulous cleaning protocols and increased surveillance are necessary to prevent and detect future outbreaks of CRE and to determine whether more stringent measures, such as sterilization, are needed for duodenoscopes.

Original languageEnglish (US)
Pages (from-to)1032-1036
Number of pages5
JournalAmerican journal of infection control
Issue number9
StatePublished - Sep 1 2016


  • CRE
  • ERCP
  • carbapenem-resistant Enterobacteriaceae
  • duodenoscope
  • endoscopy

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


Dive into the research topics of 'Carbapenem-resistant Enterobacteriaceae and endoscopy: An evolving threat'. Together they form a unique fingerprint.

Cite this