Duodenoscope-associated infections (DAIs) are exogenous infections resulting from the use of contaminated duodenoscopes. Though numerous outbreaks of DAI have involved multidrug-resistant micro-organisms (MDROs), outbreaks involving non-MDROs are also likely to occur. Detection challenges arise as these infections often resolve before culture or because causative strains are not retained for comparison with duodenoscope strains. To identify and analyse DAIs spanning a seven-year period in a tertiary care medical centre. This was a retrospective observational study. Duodenoscope cultures positive for gastrointestinal flora between March 2015 and September 2022 were paired with duodenoscope usage data to identify patients exposed to contaminated duodenoscopes. Analysis encompassed patients treated after a positive duodenoscope culture and those treated within the interval from a negative to a positive culture. Patient identification numbers were cross-referenced with a clinical culture database to identify patients developing infections with matching micro-organisms within one year of their procedure. A ‘pair’ was established upon a species-level match between duodenoscope and patient cultures. Pairs were further analysed via antibiogram comparison, and by whole-genome sequencing (WGS) to determine genetic relatedness. Sixty-eight pairs were identified; of these, 21 exhibited matching antibiograms which underwent WGS, uncovering two genetically closely related pairs categorized as DAIs. Infection onset occurred up to two months post procedure. Both causative agents were non-MDROs. This study provides crucial insights into DAIs caused by non-MDROs and it highlights the challenge of DAI recognition in daily practice. Importantly, the delayed manifestation of the described DAIs suggests a current underestimation of DAI risk.

中文翻译：

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检测十二指肠镜相关感染的搜索策略：回顾性观察研究

十二指肠镜相关感染（DAI）是由于使用受污染的十二指肠镜而导致的外源性感染。尽管许多 DAI 疫情都涉及多重耐药微生物 (MDRO)，但涉及非 MDRO 的疫情也有可能发生。由于这些感染通常在培养前消退，或者由于未保留致病菌株与十二指肠镜菌株进行比较，因此检测面临挑战。识别和分析三级医疗中心七年期间的 DAI。这是一项回顾性观察研究。 2015 年 3 月至 2022 年 9 月期间胃肠道菌群呈阳性的十二指肠镜培养物与十二指肠镜使用数据配对，以识别暴露于受污染十二指肠镜的患者。分析涵盖十二指肠镜培养阳性后接受治疗的患者以及在培养阴性到阳性期间接受治疗的患者。患者识别号与临床培养数据库进行交叉引用，以识别在手术后一年内发生匹配微生物感染的患者。 “配对”是根据十二指肠镜和患者培养物之间的物种水平匹配而建立的。通过抗菌谱比较和全基因组测序（WGS）进一步分析配对以确定遗传相关性。已鉴定出六十八对；其中，21 个表现出匹配的抗菌谱，并进行了全基因组测序，发现了两个基因密切相关的对，被归类为 DAI。感染发生在术后两个月内。两种病原体均非多重耐药菌。这项研究提供了对非 MDRO 引起的 DAI 的重要见解，并强调了日常实践中 DAI 识别的挑战。重要的是，所描述的 DAI 的延迟表现表明目前对 DAI 风险的低估。