Introduction
Duodenoscopes have been implicated in patient-to-patient transmission of multidrug-resistant organisms (MDROs). Current gastrointestinal MDRO surveillance relies primarily on rectal screening, yet the duodenum is the primary site of duodenoscope exposure to MDRO. This study evaluated the predictive value of rectal and throat-nose screening for detecting MDROs in duodenal fluid as a marker of duodenoscope contamination risk.
Aims & Methods
The aim of this study was to evaluate the predictive value of rectal and throat-nose screening for detecting MDROs in duodenal fluid as a marker of duodenoscope contamination risk. This study was conducted at two tertiary care centers in India and the Netherlands. Adult patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) were included. Rectal swabs, throat-nose swabs, and duodenal aspirates were collected and analyzed for MDROs. The detected MDROs were compared using species identification, antibiotic susceptibility patterns, and whole-genome sequencing.
Results
A total of 512 participants were included: 339 from the Netherlands and 173 from India. Rectal MDRO carriage was observed in 33.8% (173/512), throat-nose carriage in 0.2% (1/512), and duodenal carriage in 22.9% (117/512). Due to the low prevalence of carriage in the nose or throat, only the predictive value efficacy of rectal screening was assessed. Rectal screening showed a sensitivity of 38.5% for genetically related strains in duodenal fluid. For detecting any duodenal MDRO, rectal screening demonstrated a sensitivity of 90.6%, specificity of 83.0%, a positive predictive value (PPV) of 61.3%, and a negative predictive value (NPV) of 96.7%.
Conclusion
Rectal screening is unreliable for detecting strain-specific duodenal MDROs. While effective in identifying non-carriers, it overestimates true duodenal MDRO carriage. Thus, utility of rectal screening in guiding infection prevention strategies for duodenoscope contamination is greater in regions with low MDRO prevalence.
Disclosure
This study was supported by an unrestricted research grant from Boston Scientific and received material support from Copan Italia SpA. The study was investigator-initiated, and neither Boston Scientific nor Copan Italia had any role in the design of the study protocol, data analysis, interpretation of results, or preparation of the abstract.
