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      An update on gastrointestinal endoscopy-associated infections and their contributing factors

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          During clinical use, gastrointestinal endoscopes are grossly contaminated with patient’s native flora. These endoscopes undergo reprocessing to prevent infectious transmission upon future use. Endoscopy-associated infections and outbreaks have been reported, with a recent focus on the transmission of multi-drug resistant organisms. This review aims to provide an update on endoscopy-associated infections, and the factors contributing to their occurrence.


          PubMed, ScienceDirect, and CINAHL were searched for articles describing gastrointestinal endoscopy-associated infections and outbreaks published from 2008 to 2018. Factors contributing to their occurrence, and the outcomes of each outbreak were also examined.


          This review found 18 articles, 16 of which described duodenoscope-associated infections, and the remaining two described colonoscope- and gastroscope-associated infection respectively. Outbreaks were reported from the United States, France, China, Germany, the Netherlands and the United Kingdom. The causative organisms reported were Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli and Salmonella enteritidis.


          A number of factors, including lapses in reprocessing, biofilm formation, endoscope design issues and endoscope damage, contribute to gastrointestinal endoscopy associated infection. Methods of improving endoscope reprocessing, screening for contamination and evaluating endoscope damage may be vital to preventing future infections and outbreaks.

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          Most cited references 43

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          New Delhi metallo-β-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes.

          Carbapenem-resistant Enterobacteriaceae (CRE) producing the New Delhi metallo-β-lactamase (NDM) are rare in the United States, but have the potential to add to the increasing CRE burden. Previous NDM-producing CRE clusters have been attributed to person-to-person transmission in health care facilities.
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            Multisociety guideline on reprocessing flexible gastrointestinal endoscopes: 2011.

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              Klebsiella spp. in endoscopy-associated infections: we may only be seeing the tip of the iceberg.

              Two endoscopy-associated nosocomial outbreaks caused by carbapenemase-producing Klebsiella pneumoniae (CPKP) were recently observed in two German hospitals. In this study, we performed a systematic search of the medical literature in order to elucidate the epidemiology of Klebsiella spp. in endoscopy-associated outbreaks.

                Author and article information

                [1 ]GRID grid.429098.e, Ingham Institute for Applied Medical Research, ; 1 Campbell Street, Sydney, NSW 2560 Australia
                [2 ]ISNI 0000 0000 9939 5719, GRID grid.1029.a, Western Sydney University, School of Medicine, ; Sydney, 2560 Australia
                [3 ]ISNI 0000 0004 0527 9653, GRID grid.415994.4, Department of Gastroenterology and Hepatology, , Liverpool Hospital, ; Sydney, 2170 Australia
                [4 ]ISNI 0000 0004 4902 0432, GRID grid.1005.4, School of Medicine, , University of New South Wales, ; Sydney, 2033 Australia
                (+614) 99 777 181 ,
                Ann Clin Microbiol Antimicrob
                Ann. Clin. Microbiol. Antimicrob
                Annals of Clinical Microbiology and Antimicrobials
                BioMed Central (London )
                10 October 2018
                10 October 2018
                : 17
                © The Author(s) 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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                © The Author(s) 2018

                Infectious disease & Microbiology


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