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Chest Feb 2020Several recent cases associating cleaned and high-level disinfected duodenoscopes with outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) and related... (Review)
Review
Several recent cases associating cleaned and high-level disinfected duodenoscopes with outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) and related multidrug-resistant organisms (MDROs) may cause bronchoscopists, pulmonologists, and other stakeholders to inquire about the effectiveness of today's practices for reprocessing flexible bronchoscopes. The primary objectives of this study were to address this question and investigate the risk of bronchoscopes transmitting infections of CRE and related MDROs. The published literature and the US Food and Drug Administration's medical device database of adverse events were searched beginning in 2012, when endoscopy first emerged as a recognized risk factor for transmission of CRE. The Internet was also searched during this same time frame to identify other relevant cases. Several cases associating reprocessed bronchoscopes with infections of CRE or a related MDRO were identified. This study's findings suggest that bronchoscopes may pose an underrecognized potential for transmission of CRE and related MDROs, warranting greater public awareness, enhanced preventive measures, and updated reprocessing guidance. This study's data also suggest that the cleaning and high-level disinfection of bronchoscopes performed in accordance with published guidelines and manufacturer instructions may not always be sufficiently effective to eliminate this risk. Several factors were identified that can adversely affect a bronchoscope's reprocessing and pose a risk of transmission of these multidrug-resistant bacteria, including use of a damaged or inadequately serviced bronchoscope, and formation of an inaccessible biofilm. Recommendations are provided to improve the safety of flexible bronchoscopes, including supplementing their reprocessing with an enhanced measure such as sterilization when warranted, and strict adherence to a periodic servicing and maintenance schedule consistent with the bronchoscope manufacturer's instructions.
Topics: Anti-Bacterial Agents; Bronchoscopes; Bronchoscopy; Carbapenem-Resistant Enterobacteriaceae; Colistin; Cross Infection; Disinfection; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae Infections; Equipment Contamination; Equipment Reuse; Humans; Klebsiella Infections; Klebsiella pneumoniae; Pseudomonas Infections; Pseudomonas aeruginosa; beta-Lactam Resistance
PubMed: 31421109
DOI: 10.1016/j.chest.2019.08.003 -
Nature Communications Jan 2024The unequal distribution of medical resources and scarcity of experienced practitioners confine access to bronchoscopy primarily to well-equipped hospitals in developed...
The unequal distribution of medical resources and scarcity of experienced practitioners confine access to bronchoscopy primarily to well-equipped hospitals in developed regions, contributing to the unavailability of bronchoscopic services in underdeveloped areas. Here, we present an artificial intelligence (AI) co-pilot bronchoscope robot that empowers novice doctors to conduct lung examinations as safely and adeptly as experienced colleagues. The system features a user-friendly, plug-and-play catheter, devised for robot-assisted steering, facilitating access to bronchi beyond the fifth generation in average adult patients. Drawing upon historical bronchoscopic videos and expert imitation, our AI-human shared control algorithm enables novice doctors to achieve safe steering in the lung, mitigating misoperations. Both in vitro and in vivo results underscore that our system equips novice doctors with the skills to perform lung examinations as expertly as seasoned practitioners. This study offers innovative strategies to address the pressing issue of medical resource disparities through AI assistance.
Topics: Adult; Humans; Bronchoscopes; Artificial Intelligence; Pilots; Robotics; Bronchoscopy
PubMed: 38172095
DOI: 10.1038/s41467-023-44385-7 -
Acta Oto-laryngologica 1955
Topics: Bronchoscopes; Bronchoscopy; Humans
PubMed: 13248521
DOI: No ID Found -
Infection Control and Hospital... Jan 2019Recovery of multidrug-resistant (MDR) Pseudomonas aeruginosa and Klebsiella pneumoniae from a cluster of patients in the medical intensive care unit (MICU) prompted an...
OBJECTIVE
Recovery of multidrug-resistant (MDR) Pseudomonas aeruginosa and Klebsiella pneumoniae from a cluster of patients in the medical intensive care unit (MICU) prompted an epidemiologic investigation for a common exposure.
METHODS
Clinical and microbiologic data from MICU patients were retrospectively reviewed, MICU bronchoscopes underwent culturing and borescopy, and bronchoscope reprocessing procedures were reviewed. Bronchoscope and clinical MDR isolates epidemiologically linked to the cluster underwent molecular typing using pulsed-field gel electrophoresis (PFGE) followed by whole-genome sequencing.
RESULTS
Of the 33 case patients, 23 (70%) were exposed to a common bronchoscope (B1). Both MDR P. aeruginosa and K. pneumonia were recovered from the bronchoscope's lumen, and borescopy revealed a luminal defect. Molecular testing demonstrated genetic relatedness among case patient and B1 isolates, providing strong evidence for horizontal bacterial transmission. MDR organism (MDRO) recovery in 19 patients was ultimately linked to B1 exposure, and 10 of 19 patients were classified as belonging to an MDRO pseudo-outbreak.
CONCLUSIONS
Surveillance of bronchoscope-derived clinical culture data was important for early detection of this outbreak, and whole-genome sequencing was important for the confirmation of findings. Visualization of bronchoscope lumens to confirm integrity should be a critical component of device reprocessing.
Topics: Anti-Bacterial Agents; Bronchoscopes; Disease Outbreaks; Drug Resistance, Multiple, Bacterial; Equipment Contamination; Humans; Intensive Care Units; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Pennsylvania; Pseudomonas Infections; Pseudomonas aeruginosa; Retrospective Studies; Whole Genome Sequencing
PubMed: 30451128
DOI: 10.1017/ice.2018.263 -
Emergency Medicine Australasia : EMA Aug 2022
Topics: Bronchoscopes; Hospitals; Humans; Intubation, Intratracheal; Laryngoscopy; Rapid Sequence Induction and Intubation
PubMed: 35672080
DOI: 10.1111/1742-6723.14030 -
Chest Jun 2019
Topics: Bronchoscopes
PubMed: 31174640
DOI: 10.1016/j.chest.2019.01.023 -
Physics in Medicine and Biology Jan 2021Electromagnetic-based navigation bronchoscopy requires accurate and robust estimation of the bronchoscope position inside the bronchial tree. However, respiratory...
Electromagnetic-based navigation bronchoscopy requires accurate and robust estimation of the bronchoscope position inside the bronchial tree. However, respiratory motion, coughing, patient movement, and airway deformation inflicted by bronchoscope significantly hinder the accuracy of intraoperative bronchoscopic localization. In this study, a real-time and automatic registration procedure was proposed to superimpose the current location of the bronchoscope to corresponding locations on a centerline extracted from bronchial computed tomography (CT) images. A centerline-guided Gaussian mixture model (CG-GMM) was introduced to register a bronchoscope's position concerning extracted centerlines. A GMM was fitted to bronchoscope positions where the orientation likelihood was chosen to assign the membership probabilities of the mixture model, which led to preserving the global and local structures. The problem was formulated and solved under the expectation maximization framework, where the feature correspondence and spatial transformation are estimated iteratively. Validation was performed on a dynamic phantom with four different respiratory motions and four human real bronchoscopy (RB) datasets. Results of the experiments conducted on the bronchial phantom showed that the average positional tracking error using the proposed approach was equal to 1.98 [Formula: see text] 0.98 mm that was reduced in comparison with independent electromagnetic tracking (EMT), iterative closest point (ICP), and coherent point drift (CPD) methods by 64%, 58%, and 53%, respectively. In the patient assessment part of the study, the average positional tracking error was 4.73 [Formula: see text] 4.76 mm and compared to ICP, and CPD methods showed 31.4% improvement of successfully tracked frames. Our approach introduces a novel method for real-time respiratory motion compensation that provides reliable guidance during bronchoscopic interventions and, thus could increase the diagnostic yield of transbronchial biopsy.
Topics: Algorithms; Bronchi; Bronchoscopes; Electromagnetic Phenomena; Humans; Movement; Normal Distribution; Phantoms, Imaging; Tomography, X-Ray Computed
PubMed: 33181494
DOI: 10.1088/1361-6560/abca07 -
Annals of Internal Medicine Dec 1971
Topics: Biopsy; Bronchoscopes; Fiber Optic Technology; Humans; Image Enhancement; Methods; Optics and Photonics
PubMed: 5134909
DOI: 10.7326/0003-4819-75-6-971 -
Pediatric Pulmonology Oct 2022
Topics: Bronchoscopes; Bronchoscopy; Child; Humans
PubMed: 35751167
DOI: 10.1002/ppul.26043 -
Chest Aug 1978
Topics: Bronchoscopes; Bronchoscopy; Fiber Optic Technology; Humans; Male; Middle Aged
PubMed: 679765
DOI: 10.1378/chest.74.2.235a