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 More than 170 patients who may have been infected by the carbapenem-resistant
Enterobacteriaceae, or CRE, are being offered home testing kits that
would be analyzed by the University of California at Los Angeles
hospital system, UCLA officials said.
The possible exposures occurred at the UCLA Ronald Reagan Medical
Center between Oct. 3 and Jan. 28 during procedures in which a
specialized endoscope is inserted down the throat to diagnose and
treat pancreatic and bile duct diseases.
The UCLA hospital system said an internal investigation determined
in late January that CRE may have been transmitted to patients by
two of seven scopes being used by the center, all made by Olympus
Medical Systems Group.
It said 179 people may have been exposed, seven of whom were
confirmed to have infections, and two of whom died. The
circumstances of the deaths have not been disclosed, nor have
details on the conditions of the five other infected patients.
"It's important to emphasize: This particular outbreak of CRE is not
a threat to the health of the public in Los Angeles County," said
Benjamin Schwartz, deputy chief of the acute communicable disease
control program at the Los Angeles County Department of Public
Health.
He told a news conference that the five surviving infected patients
were being treated with antibiotics.
Zachary Rubin, an associate clinical professor and medical director
at the center, told reporters: "Our hearts go out to the people who
were involved and to the patients who passed away as a result of
this infection."
Hospitals across the United States have reported exposures from the
same type of medical equipment in recent years, and the U.S. Food
and Drug Administration has said it was working with other
government agencies and scope manufacturers to minimize risks to
patients.
HARD TO TREAT
The hospital where the infections took place had been sterilizing
the scopes, which it began using last June, according to the
standards stipulated by Olympus, the center said in a statement.
It said it now used a more rigorous process "that goes above and
beyond manufacturer and national standards" and involves a second
sterilization process using a gas called ethylene oxide.
The two infected scopes were immediately removed from use for return
to Olympus, and the hospital out of "an abundance of caution" was
notifying all patients who were examined with any of the seven
instruments during that period, it added.
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Both the Los Angeles County Department of Health Services and the
California Department of Public Health were notified as soon as the
bacteria were detected, UCLA officials said.
Superbug infections are difficult to treat because some of the
bacteria have become resistant to antibiotics, and the U.S. Centers
for Disease Control and Prevention said the germs could contribute
to death in up to 50 percent of infected patients.
Rubin said it had taken time to search through patients' charts to
find those individuals who might have been exposed.
"We don't want to start notifying people who had no risk of exposure
and cause undue anxiety," he said. "We ended up working backwards
and that unfortunately was the cause of some delay."
He said most of those possibly affected had been reached by phone:
"We haven't spoken to every single patient yet, but we've left
messages, we've sent letters."
The complex design of the endoscopes linked to the California
outbreak, known as duodenoscopes, may hinder proper cleaning, the
FDA warned on Thursday.
In addition to Olympus, two other major manufacturers of the scopes
are Fujifilm and Pentax. All three companies' disinfection
recommendations were approved by the FDA.
Some experts advocate the use of disposable, single-use instruments,
rather than reusable ones that must be sterilized after every
procedure.
In January, Virginia Mason Medical Center in Seattle said a bacteria
spread through contaminated endoscopes had infected 32 people in
that facility over two years.
(Reporting by Steve Gorman and Deena Beasley; Additional reporting
by Daniel Wallis, Dan Whitcomb, Curtis Skinner and Colleen Jenkins;
Editing by Cynthia Johnston, Lisa Von Ahn, Lisa Lambert and Peter
Cooney)
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