Prevalence and Risk Factors for Multidrug-Resistant Organism Carriage in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography: Implications for Duodenoscope Contamination Risk

Aims Endoscopic retrograde cholangiopancreatography (ERCP) carries a risk of patient-to-patient multidrug-resistant organism (MDRO) transmission via contaminated duodenoscopes, as demonstrated by multiple reported outbreaks. The prevalence of MDRO carriage among ERCP patients remains unknown, yet quantifying this rate is crucial for assessing such risk. Moreover, the absence of identified risk factors for MDRO carriage in this population hampers the development of targeted screening protocols and adoption of infection prevention strategies. This study evaluated the prevalence of MDRO carriage among ERCP patients in four countries and identified associated risk factors.

Methods This observational study included adult patients undergoing ERCP at tertiary care centers in four countries (the Netherlands, India, Italy, and the United States), irrespective of the procedure’s indication. Rectal and nose-throat swabs were collected and analyzed for MDROs. Multivariable logistic regression was used to identify independent risk factors for MDRO carriage.

Results Among the 1244 patients included, 462 (37.1%) were carriers of an MDRO. Extended-spectrum beta-lactamase-producing Enterobacterales were the most common MDRO overall (337/1244, 27.1%) followed by carbapenamase-producing Enterobacterales (94/1244, 7.6%). MDRO prevalence varied greatly between countries: 290/349 (83.1%) in India, 66/209 (31.6%) in Italy, 69/343 (20.1%) in the United States, and 37/343 (10.8%) in the Netherlands. Multivariable analysis, adjusted for country, identified congestive heart failure (adjusted odds ratio [aOR] 2.18, p<0.01), and penicillin use in the past six months (aOR 1.71, p=0.02) as significant risk factors. Trends were noted for chronic lung disease (1.60, p=0.053), diabetes mellitus (aOR 1.38, p=0.09) and prior endoscopy within six months (aOR 1.35, p=0.08).

Conclusions Patients undergoing ERCP exhibit a high prevalence of MDROs, with considerable variation across countries, MDRO species, and resistance mechanisms. This prevalence results in frequent exposure of duodenoscopes to MDROs, increasing the risk of contamination and subsequent endoscope-to-patient transmission. Identifying risk factors facilitates targeted MDRO screening prior to ERCP. A prevention bundle that includes MDRO screening, enhanced reprocessing protocols, or single-use duodenoscopes can reduce duodenoscope contamination and mitigate the risk of future duodenoscope-related MDRO outbreaks.

 

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Conflicts of Interest

M. C. Vos: Research support from Boston Scientific, 3M, and Pentax Medical.M. J. Bruno: Research support from Boston Scientific, 3M, Pentax Medical, Cook Medical, Mylan, and ChiRoStim; consultant and speaker for Boston Scientific, Pentax Medical, Cook Medical, and Ambu.A. Slivka: Research support from Boston Scientific and Olympus

Publication History

Article published online:
27 March 2025