The Olympus TJF-Q180V duodenoscope.
[From article]
The bacteria arrived at UCLA unnoticed in September, hitching a ride on a patient.
Unbeknownst to doctors, that patient — a woman being evaluated for a liver transplant — was carrying an unusually potent version of CRE, or carbapenem-resistant enterobacteriaceae.
Some Americans carry these bacteria with no ill effects, but years of antibiotic overuse have created virulent strains immune to most treatments. By some estimates, CRE kills up to half of infected patients.
The Olympus TJF-Q180V duodenoscope.
The source patient at UCLA underwent a procedure Oct. 3 known as ERCP, or endoscopic retrograde cholangiopancreatography.
[. . .]
The medical scope had picked up the bacteria from the woman’s intestinal tract, and the standard cleaning didn’t remove it.
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The medical records turned up 34 patients, including Young, with a CRE infection. But about half of them had CRE before coming to UCLA.
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More conventional testing methods, such as looking at levels of antibiotic resistance, had given doctors the false impression that patient infections were unrelated. Tiny pieces of DNA were carrying an antibiotic-resistant gene from one cell to another, creating different-looking bugs.
[. . .]
The bug came from dirty scopes.
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Doctors had confirmed that the transplant patient, admitted four months earlier in September, had passed the bug onto a scope made by Olympus Corp.
Sitting on the edge of his bed, Rubin called the endoscopy lab and halted ERCP procedures. Next, he alerted L.A. County public health authorities.
The hospital pulled the cleaning logs to determine what scopes were used on the infected patients. Rubin needed a list of all patients who may have been exposed, so they could be notified for testing.
[. . .]
The public learned of the UCLA outbreak when The Times broke the news on Feb. 18. In all, eight patients had been infected by the contaminated scopes, and three of them died. Nearly 180 other patients were exposed and advised to get tested.
The incident prompted the FDA to issue a safety alert to all U.S. hospitals the next morning, Feb. 19, warning them to take extra caution when cleaning the scopes.
[. . .]
The company warned European hospitals and doctors in January 2013 that lethal bacteria could become trapped at the tip of its scopes. It had issued no warning in the U.S., however.
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This might be his life for some time to come — never fully free of the dangerous bacteria.
Every subsequent surgery or procedure runs the risk of stirring up the superbug, and there’s no guarantee past treatments will rescue him the next time.
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A North Carolina woman who lost her husband to a contaminated Olympus scope sobbed in front of the panel of medical experts and lashed out at the company and the FDA, accusing them of letting patients die.
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After two days of testimony, the medical experts determined that the duodenoscopes were unsafe. But they said the devices shouldn’t be pulled off the market because they are used in a potentially life-saving procedure with no better alternative.
FDA officials are weighing their next steps. A redesign of the duodenoscope isn’t expected anytime soon. Meanwhile, UCLA and other hospitals have ordered more Olympus scopes — because new cleaning methods take the devices out of service longer.
[. . .]
The outbreak makes him wonder what other medical devices touted by companies and cleared by regulators pose a similar danger.
http://graphics.latimes.com/superbug/
Los Angeles Times
August 2, 2015
Chad Terhune.
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