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Superbug blamed for hospital deaths

SEATTLE — An outbreak of drug-resistant superbugs spread by contaminated medical scopes infected at least 32 patients at Virginia Mason Medical Center in Seattle between 2012 and 2014, new reports show.Eleven of those patients died, but it's not clear what role, if any, the infections played, doctors said.

The rare bacteria likely were transmitted from patient to patient by specialized endoscopes, flexible tools used to treat pancreatic cancer and other gut problems, which had been cleaned according to manufacturers' directions but still harbored the potentially deadly germs.

Investigators found a rare type of bacteria known as CRE — carbapenem-resistant Enterobacteriaceae — on some scopes after disinfection, matching the same dangerous germs found in dozens of already critically ill patients who had undergone a specific procedure. CRE bacteria can elude most last-resort antibiotics and may kill up to 50 percent of people infected, according to the Centers for Disease Control and Prevention.

The Seattle outbreak appears to be among the worst so far in the U.S., where problems with dirty endoscopes have been tied to superbug infections in Chicago and Pittsburgh in recent years. It raises new questions about the design, disinfection and regulation of the devices, critics charge.

Virginia Mason officials say they have overhauled their cleaning protocol for the devices, known as duodenoscopes, even though investigations by local and federal health officials found no breach in infection-control practice at the hospital.

"This makes us the safest place in the country to have this done," said Dr. Andrew Ross, section head for the gastroenterology department.

Some patients may have been aware of their infections. However, neither the patients nor their families have been notified specifically about the outbreak or its source — not by Virginia Mason nor by Public Health — Seattle & King County. Officials said Wednesday there's little the very sick people could have done in response to this information.

"Are you going to create unnecessary fear in the public about something we can't do anything about?" said Dr. Chris Baliga, Virginia Mason's medical director of infection prevention.

"Patients are at the same or higher risk all across the country," said Dr. Jeffrey Duchin, King County interim health officer, who helped investigate the outbreak. "We didn't feel like it was a new issue that warranted emergency notification."

That couldn't be further from the truth, said Lawrence F. Muscarella, a Philadelphia infection-control expert who has been monitoring endoscope-associated superbug outbreaks for several years.

"My concern now is that when we talk about there being a risk, there is no longer just a risk. It's a reality. People are dying from it," Muscarella said.

He's worried that growing numbers of patients undergoing a special procedure known as endoscopic retrograde cholangiopancreatography, or ERCP, which examines and treats disease of the bile or pancreatic ducts, may be contracting the dangerous, hard-to-treat CRE infections spread by the medical devices.

Worse, Muscarella said, he's convinced that the design of the scopes is to blame. The distal ends of the long, flexible scopes include so-called "elevator wire channels," or tiny flaps that hold stents and other accessories — but may also harbor bacteria that can't be cleaned, even with recommended disinfection techniques, Muscarella said.