Review
Copyright ©2014 Baishideng Publishing Group Inc.
World J Gastrointest Endosc. Oct 16, 2014; 6(10): 457-474
Published online Oct 16, 2014. doi: 10.4253/wjge.v6.i10.457
Table 1 Several questions that this article answers
(1) What is a “superbug”?
(2) What are carbapenem-resistant Enterobacteriaceae, or “CRE,” and their related superbugs?
(3) What are carbapenem-producing Enterobacteriaceae, or “CPE”?
(4) What important mechanism can cause CRE to become resistant to carbapenem antibiotics?
(5) What is a “carbapenemase” enzyme?
(6) What is a “β-lactam antibiotic” and a “β-lactam ring”?
(7) What are ESBL-producing Enterobacteriaceae and how do they differ from CRE?
(8) What types of infections do CRE cause?
(9) By what three mechanisms may Enterobacteriaceae acquire the genetic coding necessary to produce carbapenemases and become carbapenem-resistant?
(10) Prior to the emergence of CRE, what types of infectious agents have been historically transmitted during GI endoscopy?
(11) Is GI endoscopy a risk factor for CRE transmissions?
(12) What are some of the details and possible causes of the well-publicized CRE outbreak following ERCP performed by “Hospital X” in the mid-west (United States) that has recently raised public concerns about the risk of transmission of CRE during GI endoscopy?
(13) What are some of the details of other CRE outbreaks that similarly have been linked to GI endoscopy since this superbug’s emergence and have been published either in the medical literature or the FDA’s MAUDE database?
(14) Is high-level disinfection (whether automated or performed manually) of GI endoscopes sufficiently robust to prevent CRE transmissions? Or, is EtO sterilization of GI endoscopes required to prevent CRE transmissions?
(15) What do professional organizations including the CDC, FDA, SGNA, and ASGE currently recommend for reprocessing GI endoscopes potentially contaminated with CRE?
(16) What are some important recommendations that healthcare professionals may follow to minimize the risk of CRE transmission during GI endoscopy?
CRE: Carbapenem-resistant Enterobacteriaceae; GI: Gastrointestinal; EtO: Ethylene oxide gas; ASGE: American Society of Gastrointestinal Endoscopy.