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Duodenoscope-Associated Infections beyond the Elevator Channel: Alternative Causes for Difficult Reprocessing

Department of Gastroenterology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iași, Romania
Centre of Advanced Research in Bionanoconjugates and Biopolymers (IntelCentru), ‘‘Petru Poni’’ Institute of Macromolecular Chemistry, 41A Grigore Ghica Vodă Alley, 700487 Iași, Romania
Department of Gastroenterology Research, Clinical Emergency Hospital of Bucharest, 8 Calea Floreasca, 014461 Bucharest, Romania
Internal Medicine Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 030167 Bucharest, Romania
Author to whom correspondence should be addressed.
Molecules 2019, 24(12), 2343;
Received: 3 May 2019 / Revised: 21 June 2019 / Accepted: 25 June 2019 / Published: 25 June 2019
PDF [4449 KB, uploaded 25 June 2019]


Objectives: Duodenoscopes have been widely used for both diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) procedures, but recently, numerous outbreaks of multidrug-resistant organisms (MDRO) infections have been reported which has led to extensive research for their possible causes. Consequently, the aim of this study is to search for possible duodenoscope surface damages that could provide an alternative and plausible source of infections. Materials and Methods: In order to assess both outer and inner surfaces, a duodenoscope was dismantled and samples were taken from the outer resin polymer and from the air/water, elevator, and working (biopsy) channels that were characterized by FTIR, DSC, TGA, AFM, SEM techniques and the antimicrobial activity were tested. Results: Alterations were noticed on both the coating and working channel polymers, with external alterations increasing progressively from the proximal sample to the distal sample near the tip of the scope. However, the results showed that the coating surface was still efficient against bacterial adhesion. Changes in surface texture and also morphological changes were shown. Conclusions: The study describes the impact of routine procedural use and reprocessing cycles on the duodenoscope, showing that these may possibly make it susceptible to bacterial contamination and MDRO biofilm formation due to difficult reprocessing of the altered surfaces. View Full-Text
Keywords: nosocomial infections; endoscopic retrograde cholangiopancreatography; reprocessing; carbapenem-resistant enterobacteriaceae nosocomial infections; endoscopic retrograde cholangiopancreatography; reprocessing; carbapenem-resistant enterobacteriaceae

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Balan, G.G.; Rosca, I.; Ursu, E.-L.; Fifere, A.; Varganici, C.-D.; Doroftei, F.; Turin-Moleavin, I.-A.; Sandru, V.; Constantinescu, G.; Timofte, D.; Stefanescu, G.; Trifan, A.; Sfarti, C.V. Duodenoscope-Associated Infections beyond the Elevator Channel: Alternative Causes for Difficult Reprocessing. Molecules 2019, 24, 2343.

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