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Scopes spawn superbugs

Equipment could be the cause for multiple deaths

Medical scopes suspected of spreading deadly bacteria are under scrutiny since an outbreak at UCLA Medical Center emerged this month. But problems with the devices were recorded years ago: The same type of scopes was implicated in a previously unreported outbreak of antibiotic-resistant superbugs six years ago in Florida that affected 70 patients, including 15 who died.

Duodenoscopes, which are specialized medical scopes, are used in about 500,000 procedures a year in the United States, according to the FDA. The risk that endoscopes can transmit bacteria between patients, even after cleaning, has been known in the medical community for decades.

But the devices are in the spotlight now because outbreaks in Los Angeles and Seattle involve drug-resistant superbugs. The Seattle outbreak at Virginia Mason Medical Center began in 2012 and didn’t become widely public until late January, with reports in USA Today and the Seattle Times. Thirty-two patients were affected, including 11 who died.

The Florida outbreak is one of a handful now coming to light that states previously haven’t made public. The cases were linked to the same kind of duodenoscopes that were involved in the UCLA outbreak. They affected patients at two hospitals in Highlands County in central Florida in 2008 and 2009, according to G. Steve Huard, a spokesman for the Florida Department of Health. The outbreak was reported to the Food and Drug Administration, the Centers for Disease Control and Prevention as well as the device manufacturers, Huard said. He said he couldn’t identify the hospitals involved, citing Florida law that makes the information confidential.

The FDA warned in a safety alert Feb. 19 that the complex design of the scopes means it “may not be possible” to effectively clean them. That was the day after the Los Angeles Times reported that 179 patients at UCLA might have been exposed to potentially life-threatening bacteria, known as CRE, that resist last-resort antibiotics. Seven UCLA patients have been confirmed infected, including two who died, according to the hospital.

Patients who contract CRE generally are being treated for other serious medical problems, and deaths in any outbreak may be attributable to other causes. Bloomberg learned about the Florida outbreak after asking state health officials about records of CRE infections.

The FDA apparently has no record of the earlier Florida cases in Highlands County.

“We are aware, via a search of medical literature, of cases of CRE at two hospitals in the Tampa area during that time,” FDA spokeswoman Leslie Wooldridge said in an email. Tampa is in Hillsborough County, about 100 miles from Highlands County.

A paper on the Tampa cases, published in 2012, describes seven cases in two hospitals. Based on the medical literature, the Tampa outbreaks “were due to inadequate cleaning procedures,” Wooldridge said, and the FDA has no record of problems with the devices being reported at the time.

In the newly revealed Highlands County outbreak, the number of patients affected and the number of deaths appear to be greater than in other outbreaks that have come to light.

“It’s catastrophic. I’m stunned to hear it,” said Lawrence Muscarella, a patient safety consultant who has been tracking endoscope-related outbreaks. He said hospitals have a responsibility to tell patients when they may have been exposed, though they’re not required by law to do so.



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