ABSTRACT
OBJECTIVE: To assess the diagnostic value of an adenosinetriphosphate bioluminescence assay (ATPmetry) to monitor the effectiveness of the reprocessing of endoscopes compared with microbiologic sampling. DESIGN: Diagnostic study. SETTING: A 2,200-bed teaching hospital performing 5,000 to 6,000 endoscopic procedures annually. INCLUSION CRITERIA: All samples from bronchial or gastrointestinal endoscopes whatever the context. METHODS: Samples for microbiologic analysis and ATPmetry measurements were taken when each endoscope was inspected following reprocessing. Sampling was performed by flushing each endoscope with 300 mL Neutralizing Pharmacopeia Diluent thiosulfate rinsing solution divided equally between the endoscope channels. For each endoscope a series of 3 ATPmetry measurements were made on a vial containing the first jet from each channel and a second series on the whole sample. RESULTS: Of 165 samples from endoscopes, 11 exceeded the acceptability threshold of 25 colony-forming units/endoscope. In the first jet collected, the median (interquartile range) level of ATPmetry was 30.5 (15.3-37.7) relative light units (RLU) for samples with 25 or fewer colony-forming units compared with 37.0 (34.7-39.3) RLU for samples with more than 25 colony-forming units (P=.008). For the whole sample, the median (interquartile range) level of ATPmetry was 24.8 (14.3-36.3) RLU and 36.3 (36.0-38.3) RLU (P=.006), respectively. After adjusting on the batch of cleansing solution used, no difference in ATPmetry values was found between microbiologically acceptable and unacceptable samples. CONCLUSION: ATPmetry cannot be used as an alternative or complementary approach to microbiologic tests for monitoring the reprocessing of endoscopes in France.
Subject(s)
Disinfection/methods , Endoscopes/microbiology , Enterobacteriaceae/isolation & purification , Adenosine Triphosphatases/administration & dosage , Cross Infection/prevention & control , Disinfection/standards , Endoscopy , Equipment Contamination , France , Hospitals, Teaching , Humans , Luminescent Measurements/methods , Luminescent Measurements/standards , ROC CurveABSTRACT
BACKGROUND: The aim of the study was to describe the profile of patients and the characteristics of all bacteremias caused by multidrug-resistant (MDR) bacterial strains in a teaching hospital and to assess the mortality related to these events. METHODS: A monocentric retrospective observational cohort study was conducted. All patients with bacteremia caused by MDR bacteria between 2011 and 2013 were included. The characteristics of patients and bacteremias, antibiotic therapy within the first day, and 30-day mortality were collected from the electronic medical records database. RESULTS: A total of 228 patients were included with bacteremias caused by Enterobacteriaceae-producing extended-spectrum ß-lactamase (n = 102), Enterobacteriaceae overproducing AmpC ß-lactamase (n = 59), carbapenem-resistant Enterobacteriaceae (n = 3), ceftazidime- or carbapenem-resistant Acinetobacter baumannii (n = 2), ceftazidime- or carbapenem-resistant Pseudomonas aeruginosa (n = 23), methicillin-resistant Staphylococcus aureus (n = 40), and vancomycin-resistant Enterococcus (n = 2). The median Charlson comorbidity score was 6. Inappropriate antibiotic therapy was prescribed in 41.7% of bacteremias, and 30-day mortality was 23%. For 20.9% of the patients who had had a positive bacteriologic sample in the preceding 2 months, the initial antibiotic therapy was inappropriate. CONCLUSION: In this cohort of bacteremia patients, a high rate of mortality and numerous patient comorbidities were observed. Taking greater account of antecedents of MDR bacterial infections could improve the rate of appropriate initial antibiotic therapy.
Subject(s)
Bacteremia/microbiology , Drug Resistance, Multiple, Bacterial , Enterobacteriaceae/drug effects , Methicillin-Resistant Staphylococcus aureus/drug effects , Adolescent , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Bacteremia/mortality , Bacterial Proteins , Child , Child, Preschool , Female , France , Hospitals, University , Humans , Infant , Male , Middle Aged , Retrospective Studies , Young Adult , beta-LactamasesABSTRACT
OBJECTIVES: To evaluate the quality of gastrointestinal endoscope reprocessing and discuss the advantages of microbiological surveillance testing of these endoscopes. METHODS: Retrospective analysis of the results of endoscope sampling performed from October 1, 2006, through December 31, 2014, in a gastrointestinal endoscopy unit of a teaching hospital equipped with 89 endoscopes and 3 automated endoscope reprocessors, with an endoscopy quality assurance program in place. The compliance rate was defined as the proportion of the results classified at target or alert levels according to the French guidelines. A multivariate analysis (logistic regression) was used to identify the parameters influencing compliance. RESULTS: A total of 846 samples were taken. The overall compliance rate was 86% and differed significantly depending on the sampling context (scheduled or not scheduled), the type of endoscope, and the season. No other parameter was associated with compliance. A total of 118 samples carried indicator microorganisms such as Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Enterobacteriaceae, and Candida sp. CONCLUSION: The systematic use of an automated endoscope reprocessor does not provide totally satisfactory compliance. Microbiological surveillance is indispensable to monitor reprocessing, reinforce good practices (endoscopes, reprocessing units), and detect endoscopes requiring early technical maintenance.
