A prospective, multicenter, clinical study of duodenoscope contamination after reprocessing.

OBJECTIVE: Several clinical procedures utilize duodenoscopes, which are processed for reuse after the procedures are completed. However, infection outbreaks due to improper duodenoscope processing occur frequently. To address this, we aimed to assess the contamination rates of duodenoscopes after reprocessing in nonoutbreak settings. DESIGN AND SETTING: Prospective study in 16 clinical sites in the United States. METHODS: We sampled and cultured reprocessed duodenoscopes following the FDA/CDC/ASM guideline; "Duodenoscope Surveillance Sampling and Culturing - Reducing the Risks of Infection." High-concern (HC) organisms were those highly associated with disease, including gram-negative rods, Staphylococcus aureus, Staphylococcus lugdunensis, ß-hemolytic Streptococcus, Enterococcus spp, and yeasts. We evaluated duodenoscopes with ≥1 CFU of organisms after reprocessing. The reprocessing environments were also sampled and cultured. RESULTS: We assessed 859 newer-model (NM) duodenoscopes (TJF-Q180V) and 850 older-model (OM) duodenoscopes (TJF-160F/VF); of these, 35 NM samples (4.1%) and 56 OM samples (6.6%) were contaminated with HC organisms. We detected and classified the HC organisms as gastrointestinal (45.4%), human origin (16.7%), environmental (24.1%), waterborne (13.0%), and unidentified (0.9%). CONCLUSIONS: We detected an overall HC contamination rate of 5.3% in nonoutbreak settings. Although the relationship between endoscopic contamination and the occurrence of infections remains unclear, attempts should continue to be made to further reduce contamination rates. Additional improvements to the manufacturer's instructions for use, human factors during the reprocessing procedure, ongoing training programs, cleanliness of reprocessing environments, and the design of the distal end of the duodenoscope should be considered.

Emergence of multidrug-resistant Corynebacterium striatum as a nosocomial pathogen in long-term hospitalized patients with underlying diseases.

During a 53-month period (March 1994 to August 1998), 48 Corynebacterium striatum isolates recovered from clinical specimens were characterized. The organisms were identified by both phenotypic characteristics and 16S rRNA gene sequence analysis. Thirty-six (75%) were isolated from sputum/bronchial aspirates, 10 (21%) from wound exudates/pus, 1 (2%) from vaginal discharge, and 1 (2%) from an otorrheic specimen. All 48 patients had been hospitalized for treatment of an underlying disease and had received antibiotics previously. The C. striatum isolates were considered pathogenic based on their abundance within polymorphonuclear neutrophils and their dominant growth in culture. Sensitivities of isolates to 11 antibiotics were determined by broth microdilution. MIC90 values of the isolates were 1 microg/mL for vancomycin, 16 microg/mL for penicillin and ampicillin, 32 microg/mL for minocycline, and > or = 32 microg/mL for cephalosporins, imipenem, ofloxacin, and macrolides. Restriction fragment-length polymorphism analysis with pulsed-field gel electrophoresis was used to determine the clonal identity. The pulse-field gel electrophoresis profiles revealed 14 distinct patterns with 20 subtypes. The isolates for the nosocomial outbreaks of C. striatum included 3 types (A, D, and E) with 4 subtypes (A1, A2, D2, and E). All 4 genotypes had broad-spectrum resistance to antimicrobial agents. Furthermore, type E strain isolated from 3 patients in the same ward was sensitive only to vancomycin. We conclude that C. striatum should be considered an emerging multidrug-resistant nosocomial pathogen in patients hospitalized for a prolonged period and/or in immunocompromised patients with such underlying conditions as cerebrovascular disease, pulmonary disease, diabetes, or malignancy.

[Prevention of vertical transmission of Group B Streptococcus].

Group B Streptococcus (GBS) are pathogens that involve a risk of vertical transmission. They are the infecting organism in approximately one quarter of all cases of neonatal sepsis and meningitis, making prevention of GBS infection an important goal. The United States Centers for Disease Control and Prevention (CDC) recommends administration of antibiotic prophylaxis to GBS-colonized pregnant women at least 4 hours before delivery, but the time of antibiotic prophylaxis administration is not generally reported in Japan. The purpose of the present study was to identify the care provided to GBS-colonized pregnant and intrapartum women in order to prevent of vertical transmission of GBS. The subjects were women (n=150) judged during pregnancy to have been colonized by GBS, who delivered vaginally at one of two hospitals between January 2000 and December 2004, and their neonates (n=151). The relation between the care provided and GBS transmission was analyzed. GBS was transmitted to the neonates of 18 of the 150 women (transmission rate 12.0%). The relation between transmission to the neonate and time between administration of antibiotic prophylaxis and delivery was investigated, and transmission to the neonate was found to be significantly greater when it was less than 3.5 hours (transmission to 9 neonates of 53 women) than more than 3.5 hours (transmission 4 neonates of 83 women) (p < 0.05). The time between admission and delivery was significantly shorter in the cases of transmission (p < 0.05). This indicates the need for thorough health guidance for expectant mothers, especially multipara, during pregnancy regarding the timing of admission for delivery, in order to ensure sufficient time between administration of antibiotic prophylaxis and delivery.