Germs that are resistant to antibiotics are cropping up with alarming frequency at American hospitals. A lethal “superbug” known as CRE infected seven patients at the Ronald Reagan UCLA Medical Center and killed two of them. The germs were apparently transmitted on inadequately sterilized medical scopes.
The episode brought an immediate reminder and warning from the Food and Drug Administration (FDA) that the complex design of the instruments, known as duodenoscopes, makes them hard to clean after they are used. It is imperative that government agencies, medical institutions and the manufacturer take more aggressive steps to ensure sterilization and protect patients.
The scopes are flexible, lighted tubes that are threaded through the mouth, throat and stomach into the top of the small intestine. They have a hollow channel through which a doctor can insert instruments for diagnosis and treatment.
The scopes contain microscopic crevices where body fluids and debris may remain even after the instruments are cleaned and disinfected as directed by the manufacturer. From January 2013 to December 2014, the FDA received reports that some 135 patients may have been infected by the scopes. Most had infections that resist antibiotics.
CRE stands for carbapenem-resistant Enterobacteriaceae. It is particularly dangerous because the antibiotic carbapenem is generally considered a last resort for patients who don’t respond to anything else. So if carbapenem fails, the patient is in serious trouble. The Centers for Disease Control and Prevention has estimated that CRE accounts for about 9,300 infections and 610 deaths every year in the United States.
Experts say it would be difficult to stop using the scopes entirely because many patients benefit from their use and there is currently no alternative. But there are surely ways to improve sterilization and to keep them out of use until there is proof that they are completely clean.
FROM AN EDITORIAL IN THE NEW YORK TIMES