{"indexed":{"date-parts":[[2018,4,13]],"date-time":"2018-04-13T00:22:27Z","timestamp":1523578947711},"reference-count":36,"publisher":"Cambridge University Press (CUP)","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"published-print":{"date-parts":[[2015,6]]},"abstract":"<jats:sec id=\"S0899823X15000665_abs1\" sec-type=\"general\">\n               <jats:title>BACKGROUND<\/jats:title>\n               <jats:p>We identified an outbreak of AmpC\u2013producing <jats:italic>Escherichia coli<\/jats:italic> infections resistant to third-generation cephalosporins and carbapenems (CR) among 7 patients who had undergone endoscopic retrograde cholangiopancreatography at hospital A during November 2012\u2013August 2013. Gene sequencing revealed a shared novel mutation in a <jats:italic>bla<\/jats:italic>\n                  <jats:sub>CMY<\/jats:sub> gene and a distinctive <jats:italic>fumC\/ fimH<\/jats:italic> typing profile.<\/jats:p>\n            <\/jats:sec>\n            <jats:sec id=\"S0899823X15000665_abs2\" sec-type=\"general\">\n               <jats:title>OBJECTIVE<\/jats:title>\n               <jats:p>To determine the extent and epidemiologic characteristics of the outbreak, identify potential sources of transmission, design and implement infection control measures, and determine the association between the CR <jats:italic>E. coli<\/jats:italic> and AmpC <jats:italic>E. coli<\/jats:italic> circulating at hospital A.<\/jats:p>\n            <\/jats:sec>\n            <jats:sec id=\"S0899823X15000665_abs3\" sec-type=\"methods\">\n               <jats:title>METHODS<\/jats:title>\n               <jats:p>We reviewed laboratory, medical, and endoscopy reports, and endoscope reprocessing procedures. We obtained cultures from endoscopes after reprocessing as well as environmental samples and conducted pulsed-field gel electrophoresis and gene sequencing on phenotypic AmpC isolates from patients and endoscopes. Cases were those infected with phenotypic AmpC isolates (both carbapenem-susceptible and CR) and identical <jats:italic>bla<\/jats:italic>\n                  <jats:sub>CMY-2<\/jats:sub>, <jats:italic>fumC<\/jats:italic>, and <jats:italic>fimH<\/jats:italic> alleles or related pulsed-field gel electrophoresis patterns.<\/jats:p>\n            <\/jats:sec>\n            <jats:sec id=\"S0899823X15000665_abs4\" sec-type=\"results\">\n               <jats:title>RESULTS<\/jats:title>\n               <jats:p>Thirty-five of 49 AmpC <jats:italic>E. coli<\/jats:italic> tested met the case definition, including all CR isolates. All cases had complicated biliary disease and had undergone at least 1 endoscopic retrograde cholangiopancreatography at hospital A. Mortality at 30 days was 16% for all patients and 56% for CR patients. Two of 8 reprocessed endoscopic retrograde cholangiopancreatography scopes harbored AmpC that matched case isolates by pulsed-field gel electrophoresis. Environmental cultures were negative. No breaches in infection control were identified. Endoscopic reprocessing exceeded manufacturer\u2019s recommended cleaning guidelines.<\/jats:p>\n            <\/jats:sec>\n            <jats:sec id=\"S0899823X15000665_abs5\" sec-type=\"conclusion\">\n               <jats:title>CONCLUSION<\/jats:title>\n               <jats:p>Recommended reprocessing guidelines are not sufficient.<\/jats:p>\n               <jats:p>\n                  <jats:italic>Infect Control Hosp Epidemiol<\/jats:italic> 2015;00(0): 1\u20139<\/jats:p>\n            <\/jats:sec>","DOI":"10.1017\/ice.2015.66","type":"article-journal","created":{"date-parts":[[2015,3,30]],"date-time":"2015-03-30T03:29:10Z","timestamp":1427686150000},"page":"634-642","source":"Crossref","is-referenced-by-count":50,"title":"Endoscopic Retrograde Cholangiopancreatography\u2013Associated AmpC Escherichia coli Outbreak","prefix":"10.1017","volume":"36","author":[{"given":"Kristen A.","family":"Wendorf","affiliation":[]},{"given":"Meagan","family":"Kay","affiliation":[]},{"given":"Christopher","family":"Baliga","affiliation":[]},{"given":"Scott J.","family":"Weissman","affiliation":[]},{"given":"Michael","family":"Gluck","affiliation":[]},{"given":"Punam","family":"Verma","affiliation":[]},{"given":"Marisa","family":"D\u2019Angeli","affiliation":[]},{"given":"Jennifer","family":"Swoveland","affiliation":[]},{"given":"Mi-Gyeong","family":"Kang","affiliation":[]},{"given":"Kaye","family":"Eckmann","affiliation":[]},{"given":"Andrew S.","family":"Ross","affiliation":[]},{"given":"Jeffrey","family":"Duchin","affiliation":[]}],"member":"56","published-online":{"date-parts":[[2015,3,30]]},"reference":[{"key":"S0899823X15000665_ref9","volume":"6","first-page":"428","year":"1993","journal-title":"Clin Microbiol 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