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Viewpoint |

Endoscopes and the “Superbug” Outbreak

Rajesh N. Keswani, MD1; Nathaniel J. Soper, MD2
[+] Author Affiliations
1Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
2Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA Surg. 2015;150(9):831-832. doi:10.1001/jamasurg.2015.1255.
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This Viewpoint reports on the transmission of carbapenem-resistant Enterobacteriaceae through duodenoscopes, the device used to perform endoscopic retrograde cholangiopancreatography.

News reports over the past 2 years have transformed a relatively uncommon procedure, endoscopic retrograde cholangiopancreatography (ERCP), into a household name at the center of a widespread “superbug” outbreak. The bacteria being transmitted between patients via ERCP, carbapenem-resistant Enterobacteriaceae (CRE), are frightening because of their resistance to all (or nearly all) currently available antibiotics. Owing to the associated significant mortality rate and their ability to transmit antibiotic resistance to other bacteria, the director of the Centers for Disease Control and Prevention referred to CRE as “nightmare bacteria” (http://www.cdc.gov/media/dpk/2013/dpk-vs-hai.html). Thus, the current national attention focusing on the transmission of CRE through duodenoscopes, the device used to perform ERCP, is not simply media-created hyperbole but, instead, is a deafening wake-up call. Surgeons and physicians should understand the issues pertaining to these iatrogenic infections, should oversee efforts to improve endoscopic reprocessing, should try to decrease the nonindicated use of ERCP, and should help educate patients.

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