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Characteristics of Infections Associated with Endoscopic Procedures. An Overview of Causes and Prevention Strategies

https://doi.org/10.31146/2415-7813-endo-67-3-10-17

Abstract

Infections pose a serious problem in ensuring epidemiological safety during endoscopic interventions. The experience of the last two decades shows that changes in pathogens, with ESCAPE pathogens dominating, complicate control of outbreaks, increasing the number of affected patients and mortality rates. Unfortunately, in our country there is virtually no registration of infections associated with endoscopic interventions. The aim of this work is to summarize the world literature data on the prevalence and characteristics of infections associated with diagnostic and therapeutic endoscopic interventions. Materials and methods. We conducted a systematic review of 47 literature sources for the period from 1991 to 2025 from the PubMed and Embase databases to study the distribution of cases/outbreaks of HAI in endoscopy with an analysis of the causes of their occurrence and the most effective strategies for their relief. Results. The article presents data on the prevalence of HAI in therapeutic and diagnostic endoscopy. The features of the endogenous type of infection are analyzed, which is mainly determined by internal risk factors on the part of the patient, the complexity of the intervention, the competencies of the doctor and the effectiveness of antibiotic prophylaxis, if used. The leading risk factors for outbreaks in diagnostic endoscopy are analyzed. Discussions continued the effectiveness of high-level disinfection and the acceptability of endoscope sterilization, as well as the need to improve the effectiveness of microbiological quality control of endoscope processing. The place of the Epidemiological Safety System (ESS) of endoscopic interventions, developed in our country, in a set of measures to prevent HAI was determined.

About the Authors

T. A. Grenkova
G.N. Gabrichevsky Moscow Research Institute for Epidemiology and Microbiology
Russian Federation


N. V. Gudova
G.N. Gabrichevsky Moscow Research Institute for Epidemiology and Microbiology
Russian Federation


E. R. Mehtiev
G.N. Gabrichevsky Moscow Research Institute for Epidemiology and Microbiology
Russian Federation


References

1. Yakovlev S.V., Suvorova M.P., Beloborodov V.B. et al. Multicentre Study of the Prevalence and Clinical Value of Hospital-Acquired Infections in Emergency Hospitals of Russia: ERGINI Study Team. Antibiot Khimioter. 2016; 61(5-6):32-42. English, Russian. PMID: 29537739.

2. State report [On the state of sanitary and epidemiological well-being of the population in the Russian Federation in 2018]. (in Russ.) Available at: https://www.rospotrebnadzor.ru/upload/iblock/798/gosudarstvennyy-doklad-o-sostoyanii-sanitarno_epidemiologicheskogo-blagopoluchiya-naseleniya-v-rossiyskoy-federatsii-v-2018-godu.pdf (Accessed: 05.05.2025.)@@ Государственный доклад «О состоянии санитарно-эпидемиологического благополучия населения в Российской Федерации в 2018 году». https://www.rospotrebnadzor.ru/upload/iblock/798/gosudarstvennyy-doklad-o-sostoyanii-sanitarno_epidemiologicheskogo-blagopoluchiya-naseleniya-v-rossiyskoy-federatsii-v-2018-godu.pdf

3. Wang P., Xu T., Ngamruengphong S., Makary M.A., Kalloo A., Hutfless S. Rates of infection after colonoscopy and osophagogastroduodenoscopy in ambulatory surgery centres in the USA. Gut. 2018 Sep;67(9):1626-1636. doi: 10.1136/gutjnl-2017-315308.

4. Hutfless S., Shiratori Y., Chu D. et al. Risk factors for infections after endoscopic retrogradecholangiopancreatography (ERCP): a retrospective cohort analysis of US Medicare Fee-For-Service claims, 2015-2021, BMJ Open. 2022;12: e065077. doi: 10.1136/bmjopen-2022-065077.

5. Sharif-Kashani B., Shahabi P., Behzadnia N. et al. Incidence of fever and bacteriemia following flexible fiberoptic bronchoscopy: a prospective study. Acta Med. Iran. 2010.48:385-388. PMID: 21287478.

6. Othman M.O., Guerrero R., Elhanafi S. et al. A prospective study of the risk of bacteremia in directed cholangioscopic examination of the common bile duct. Gastrointest Endosc. 2016 Jan;83(1):151-7. doi: 10.1016/j.gie.2015.05.018.

7. Berner J.S., Gaing A.A., Sharma R., Almenoff P.L., Muhlfelder T., Korsten M.A. Sequelae after esophageal variceal ligation and sclerotherapy: a prospective randomized study. Am J Gastroenterol. 1994 Jun;89(6):852-8. PMID: 8198093.

8. da Silveira Rohr M.R., Siqueira E.S., Brant C.Q. et al. Prospective study of bacteremia rate after elastic band ligation and sclerotherapy of esophageal varices in patients with hepatosplenic schistosomiasis. Gastrointest. Endosc. 1997. 46:321-323. doi: 10.1016/s0016-5107(97)70118-4.

9. Lo G.H., Lai K.H., Shen M.T., Chang C.F. A comparison of the incidence of transient bacteremia and infectious sequelae after sclerotherapy and rubber band ligation of bleeding esophageal varices. Gastrointest.edosc. 1994. 40:675-679. doi: 10.1016/s0016-5107(94)70108-3.

10. Nelson D.B., Sanderson S.J., Azar M.M. Bacteremia with esophageal dilation. Gastrointest. Endosc. 1998.48:563-567. doi: 10.1016/S0016-5107(97)80122-8.

11. Zuccaro G., Richter J.E., Rice T.W. et al. Viridans streptococcal bacteremia after esophageal stricture dilation. Gastrointest. Endosc. 1998; 48:568-573. doi: 10.1016/s0016-5107(98)70037-9.

12. Bonilha D.Q., Correia L.M., Monaghan M. et al. Prospective study of bacteremia rate after elective band ligation and sclerotherapy with cyanoacrylate for esophageal varices in patients with advanced liver disease. Arq. Gastroenterol. 2011 Oct-Dec;48(4):248-51. doi: 10.1590/s0004-28032011000400006.

13. de Blic J, Marchac V, Scheinmann P.Complications of flexible bronchoscopy in children: prospective study of 1,328 procedures. Eur.Respir. J. 2002.20(5):1271-1276. doi: 10.1183/09031936.02.02072001.

14. Park J.S., Lee C.H., Yim J.J. et al. Impact of antibiotic prophylaxis on postbronchoscopy fever: a randomised controlled study.Int J Tuberc Lung Dis. 2011 Apr;15(4):528-35. doi: 10.5588/ijtld.10.0386.

15. Rennard S.I., Aalbers R., Bleecker E., Klech H., Rosenwasser L., Olivieri D., Sibille Y. Bronchoalveolar lavage: performance, sampling procedure, processing and assessment. Eur Respir J Suppl. 1998 Mar;26:13S-15S. PMID: 9585873.

16. Sinha S., Guleria R., Pande J.N., Pandey R.M. Bronchoscopy in adults at a tertiaty centre: indications and complications. J. Indian Med. Assoc. 2004.102:152-153. doi: 10.1016/j.mayocp.2015.12.006.

17. Othman M.O., Guerrero R., Elhanafi S. et al. A prospective study of the risk of bacteremia in directed cholangioscopic examination of the common bile duct. Gastrointest Endosc. 2016 Jan;83(1):151-7. doi: 10.1016/j.gie.2015.05.018.

18. Jurado R.L., Klein S. Infective endocarditis associated with fiberoptic bronchoscopy in a patient with mitral-valve prolapse. Clin Infect Dis. 1998 Mar;26(3):768-9. doi: 10.1086/517125.

19. Djupesland P., Solgaard T., Mair I.W. Cerebral abscess complicating dilatation of a corrosive esophageal stricture. Eur Arch Otorhinolaryngol. 1991;248(5):308-10. doi: 10.1007/BF00176761.

20. Kumar P., Mehta S.K., Devi B.I., Goenka M.K., Khandelwal N., Kochhar S., Kak V.K. Pyogenic meningitis and cerebral abscesses after endoscopic injection sclerotherapy. Am J Gastroenterol. 1991 Nov;86(11):1672-4. PMID: 1951249.

21. Nagamine N., Kaneko Y., Kumakura Y., Ogawa Y., Ido K., Kimura K. Occurrence of pyogenic meningitis during the course of endoscopic variceal ligation therapy. Gastrointest Endosc. 1999 Jan;49(1):110-3. doi: 10.1016/s0016-5107(99)70457-8.

22. Toyoda K., Saku Y., Sadoshima S., Fujishima M. Purulent meningitis after endoscopic injection sclerotherapy for esophageal varices.Intern Med. 1994 Nov;33(11):706-9. doi: 10.2169/internalmedicine.33.706.

23. Wang W.M., Chen C.Y., Jan C.M., Chen L.T., Wu D.C. Central nervous system infection after endoscopic injection sclerotherapy. Am J Gastroenterol. 1990 Jul;85(7):865-7. PMID: 2196787.

24. Muscarella L.F. Risk of transmission of carbapenem-resistant Enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy. World J Gastrointest Endosc. 2014 Oct 16;6(10):457-74. doi: 10.4253/wjge.v6.i10.457.

25. Aumeran C., Poincloux L., Souweine B. et al. Multidrug-resistant Klebsiella pneumoniae outbreak after endoscopic retrograde cholangiopancreatography. Endoscopy. 2010 Nov;42(11):895-9. doi: 10.1055/s-0030-1255647.

26. Gastmeier P. 1., Vonberg R.P. Klebsiella spp. in endoscopy-associated infections: we may only be seeing the tip of the iceberg. Infection. 2014 Feb;42(1):15-21. doi: 10.1007/s15010-013-0544-6.

27. Verfaillie C.J., Bruno M.J., Voor in ‘t Holt A.F. et al. Withdrawal of a novel-design duodenoscope ends outbreak of a VIM-2-producing Pseudomonas aeruginosa. Endoscopy. 2015 Jun;47(6):493-502. doi: 10.1055/s-0034-1391886. Epub 2015 Mar 31. Erratum in: Endoscopy. 2015 Jun;47(6):502. doi: 10.1055/s-0034-1392080. PMID: 25826278.

28. Zweigner J., Gastmeier P., Kola A., Klefisch F.R., Schweizer C., Hummel M. A carbapenem-resistant Klebsiella pneumoniae outbreak following bronchoscopy. Am J Infect Control. 2014 Aug;42(8):936-7. doi: 10.1016/j.ajic.2014.04.022.

29. Guy M., Dananché С., Cassier P. et al. Outbreak of Pseudomonas aeruginosa and Stenotrophomonas maltophilia pulmonary infections related to the contamination of bronchoscope suction valves. Abstracts The 9th Healthcare Infection Society International Conference 2014 (Handbook), 16-18 November, Lyon, France. p.21.

30. Salmon S., Balm M., Fisher C. Teo and D. What’s the scope? Pseudomonas aeruginosa outbreak in ICU, Abstracts from the 2nd International Conference on Prevention and Infection Control (ICPIC 2013), Antimicrobial Resistance and Infection Control: l20132(Suppl 1): P204. doi: 10.1186/2047-2994-2-S1-P204 Published: 20 June 2013.

31. Cetre J.C., Nicolle M.C., Salord H. et al. Outbreaks of contaminated broncho- alveolar lavage related to intrinsically defective bronchoscopes. J Hosp Infect. 2005, 61(1): 39-45. doi: 10.1016/j.jhin.2004.12.020.

32. Kirschke D.L., Jones T.F., Craig A.S., Chu P.S., Mayernick G.G., Patel J.A., Schaffner W. Pseudomonas aeruginosa and Serratia marcescens contamination associated with a manufacturing defect in bronchoscopes. N Engl J Med. 2003 Jan 16;348(3):214-20. doi: 10.1056/NEJMoa021791.

33. Srinivasan A., Wolfenden L.L., Song X. et al. An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes. N Engl J Med. 2003 Jan 16;348(3):221-7. doi: 10.1056/NEJMoa021808.

34. Ofstead C.L., Smart A.G., Hurst L.L., Lamb L.A. Endoscope processing effectiveness: A reality check and call to action for infection preventionists and clinicians. Am J Infect Control. 2025 Jul;53(7):785-793. doi: 10.1016/j.ajic.2025.04.003.

35. Flexible Bronchoscopes and Updated Recommendations for Reprocessing: FDA Safety Communication | FDA. Available at: https://www.fda.gov/medical-devices/safety-communications/flexible-bronchoscopes-andupdated-recommendations-reprocessing-fda-safety communication?utm_medium=email&utm_source=govdelivery (accessed Jun. 28, 2021)

36. Larsen S., Russell R.V., Ockert L.K., Spanos S., Travis H.S., Ehlers L.H., Mærkedahl A. Rate and impact of duodenoscope contamination: A systematic review and meta-analysis. EClinicalMedicine. 2020 Jul 15;25:100451. doi: 10.1016/j.eclinm.2020.100451.

37. Zweigner J., Gastmeier P., Kola A., Klefisch F.R., Schweizer C., Hummel M. A carbapenem-resistant Klebsiella pneumoniae outbreak following bronchoscopy. Am J Infect Control. 2014 Aug;42(8):936-7. doi: 10.1016/j.ajic.2014.04.022.

38. Ramsey A.H., Oemig T.V., Davis J.P., Massey J.P., Török T.J. An outbreak of bronchoscopy-related Mycobacterium tuberculosis infections due to lack of bronchoscope leak testing. Chest. 2002 Mar;121(3):976-81. doi: 10.1378/chest.121.3.976.

39. Corne P., Godreuil S., Jean-Pierre H., Jonquet O., Campos J., Jumas-Bilak E., Parer S., Marchandin H. Unusual implication of biopsy forceps in outbreaks of Pseudomonas aeruginosa infections and pseudo-infections related to bronchoscopy. J Hosp Infect. 2005 Sep;61(1):20-6. doi: 10.1016/j.jhin.2005.01.024.

40. Zühlsdorf B., Emmrich M., Floss H., Martiny H. Cleaning efficacy of nine different cleaners in a washer-disinfector designed for flexible endoscopes. J Hosp Infect. 2002 Nov;52(3):206-11. doi: 10.1053/jhin.2002.1284.

41. Neves M.S., da Silva M.G., Ventura G.M., Côrtes P.B., Duarte R.S., de Souza H.S. Effectiveness of current disinfection procedures against biofilm on contaminated GI endoscopes. Gastrointest Endosc. 2016 May;83(5):944-53. doi: 10.1016/j.gie.2015.09.016.

42. Ofstead C.L., Heymann O.L., Quick M.R., Eiland J.E., Wetzler H.P. Residual moisture and waterborne pathogens inside flexible endoscopes: Evidence from a multisite study of endoscope drying effectiveness. Am J Infect Control. 2018 Jun;46(6):689-696. doi: 10.1016/j.ajic.2018.03.002.

43. Pajkos A., Vickery K., Cossart Y. Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and decontamination? J Hosp Infect. 2004 Nov;58(3):224-9. doi: 10.1016/j.jhin.2004.06.023.

44. Ren-Pei W., Hui-Jun X., Ke Q., Dong W., Xing N., Zhao-Shen L. Correlation between the growth of bacterial biofilm in flexible endoscopes and endoscope reprocessing methods. Am J Infect Control. 2014 Nov;42(11):1203-6. doi: 10.1016/j.ajic.2014.07.029.

45. DiazGranados C.A., Jones M.Y., Kongphet-Tran T. et al. Outbreak of Pseudomonas aeruginosa infection associated with contamination of a flexible bronchoscope. Infect Control Hosp Epidemiol. 2009 Jun;30(6):550-5. doi: 10.1086/597235.

46. Galdys A.L., Marsh J.W., Delgado E. et al. Bronchoscope-associated clusters of multidrug-resistant Pseudomonas aeruginosa and carbapenem-resistant Klebsiella pneumoniae. Infect Control Hosp Epidemiol. 2019 Jan;40(1):40-46. doi: 10.1017/ice.2018.263.

47. Kovaleva J., Degener J.E., van der Mei H.C. Mimicking disinfection and drying of biofilms in contaminated endoscopes. J Hosp Infect. 2010 Dec;76(4):345-50. doi: 10.1016/j.jhin.2010.07.008.

48. [Audit of Epidemiological Safety of Non-Sterile Endoscopic Interventions in Healthcare Organizations. Patient Infection Risk Assessment]. Approved at a meeting of the relevant commission of the Russian Ministry of Health in the specialty “Epidemiology” on October 25, 2023. (in Russ.) Available at: https://gabrich.ru/assets/files/mu-313798-22.pdf Accessed: 05.05.2025.@@ «Аудит обеспечения эпидемиологической безопасности нестерильных эндоскопических вмешательств в медицинских организациях. Оценка рисков инфицирования пациентов». Утверждены на заседании профильной комиссии Минздрава России по специальности «Эпидемиология» 25.10.2023 года, https://gabrich.ru/assets/files/mu-313798-22.pdf

49. Sanitary rules and regulations SanPiN 3.3686-21 «Sanitary and epidemiological requirements for the prevention of infectious diseases» dated February 25, 2021. No 62500. (in Russ.)@@ СанПиН 3.3686-21 «Санитарно-эпидемиологические требования по профилактике инфекционных болезней», утвержденные постановлением Главного государственного санитарного врача Российской Федерации от 28.01.2021 N 4 (зарегистрировано Минюстом России 15.02.2021, регистрационный N 62500.

50. Methodological guidelines MU3.1.3798-22 «Ensuring the epidemiological safety of non-sterile endoscopic interventions on the gastrointestinal tract and respiratory tract» (approved by the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing on November 25, 2022) (in Russ.)@@ Методические указания МУ 3.1.3798-22 «Обеспечение эпидемиологической безопасности нестерильных эндоскопических вмешательств на желудочно-кишечном тракте и дыхательных путях», утверждены, утвержденные Руководитель Федеральной службы по надзору в сфере защиты прав потребителей и благополучия человека, Главным государственным санитарным врачом РФ 25 ноября 2022 г.

51. Alipour N., Karagoz A., Taner A., Gaeini N., Alipour N., Zeytin H., Yildiz F., Durmaz R. Outbreak of Hospital Infection from Biofilm-embedded Pan Drug-resistant Pseudomonas aeroginosa, Due to a Contaminated Bronchoscope. J Prev Med (Wilmington). 2017;2(2):1. doi: 10.21767/2572-5483.100014.


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Grenkova T.A., Gudova N.V., Mehtiev E.R. Characteristics of Infections Associated with Endoscopic Procedures. An Overview of Causes and Prevention Strategies. Filin’s Clinical endoscopy. 2025;67(3):10-17. (In Russ.) https://doi.org/10.31146/2415-7813-endo-67-3-10-17

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