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Superbug outbreaks: Where and how they happened

An outbreak of a deadly superbug that endangered nearly 180 patients at UCLA’s Ronald Reagan Medical Center in recent months is the latest in a series of incidents linked to contaminated medical scopes in the United States. At least four similar outbreaks have occurred at medical facilities throughout the country since 2012. From January 2013 through December 2014, at least 135 patients nationwide may have been exposed to the drug-resistant superbug known as CRE (carbapenem-resistant enterobacteriaceae), according to the Food and Drug Administration.

Below are recent outbreaks and the number of patients confirmed to be infected with the CRE superbug.

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University of Pittsburgh Medical Center, 18 patients

Eighteen patients were sickened in a CRE outbreak at the University of Pittsburgh Medical Center in 2012. Hospital officials cited the difficulty of cleaning duodenoscopes used in a procedure known as ERCP, or endoscopic retrograde cholangiopancreatography, as the main cause.

Hospital officials launched an investigation into the incident, according to a report in the Pittsburgh Tribune.

Some patients died, but hospitals said none of the deaths were directly caused by a CRE infection. The patients suffered from heart or other chronic disorders, doctors told the Pittsburgh Tribune.

It’s not clear how many of the infected patients died or what manufacturer produced the contaminated scopes.

Advocate Lutheran General Hospital, Park Ridge, Ill.; about 38 patients

Nearly 40 patients who received endoscopic procedures at Advocate Lutheran General, a suburban medical facility roughly 30 miles north of Chicago, tested positive for a strain of CRE in late 2013 and early 2014, according to reports in the Chicago Tribune.

The hospital asked any patients who underwent the procedure from January to September of 2013 to return to the facility to be screened for CRE after a strain of the bacteria was found on several of the hospital’s duodenoscopes, which were manufactured by Pentax Medical Co., the Pittsburgh Tribune reported. A total of 243 patients underwent a procedure with the scopes during the nine-month period in question, and the hospital tested 114 of them.

Thirty-eight tested positive, according to the report. In total, 44 patients tested positive for the strain in northeastern Illinois during this outbreak, according to a 2014 CDC field report.

Aurora Sinai Medical Center, Milwaukee; 1 patient

In the summer of 2013, hospital officials in Wisconsin’s largest city feared they might face a CRE outbreak after a patient who had received medical care outside the country tested positive for the drug-resistant bacteria, according to a report in the Milwaukee Journal-Sentinel.

Thirty patients who were in the same hospital wing as the patient were screened for CRE, but it did not appear that anyone else tested positive for the bacteria during that incident. It was also unclear if medical investigators ever drew a line from contaminated duodenoscopes to the patient’s symptoms.

At least 33 cases of CRE were reported in the state between 2011 and 2013, and reports of the virus are not uncommon, the report said. As of February 2014, the CDC had confirmed cases of CRE in 47 states. Alaska, Idaho and Maine are the only states without confirmed cases of the bacteria, according to the CDC.

Virginia Mason Medical Center; Seattle; 32 patients

Contaminated endoscopes were also linked to a bacterial outbreak in Seattle that left 32 patients sickened and 11 dead last month.

Hospital officials have said that many of the deceased patients were already critically ill. Like the Pittsburgh cases, it was not immediately clear if CRE was the leading cause in any of their deaths. The endoscopes in that outbreak were found to be contaminated with both CRE and another drug-resistant bug known as Hyper-AmpC, according to a report in the Seattle Times.

The patients affected were likely treated between 2012 and 2014, according to the Seattle Times report. It was not immediately clear which company manufactured the contaminated scopes.

UCLA Ronald Reagan Medical Center, Los Angeles; 7 patients

Los Angeles is the latest large CRE outbreak linked to medical scopes in the U.S. Nearly 180 patients at the university’s Ronald Reagan Medical Center may have been exposed to CRE as a result of duodenoscopes used in ERCP procedures.

Seven patients tested positive for the bug, and CRE was confirmed as a factor in the deaths of two of them, according to UCLA officials. The outbreak was discovered in January, and hospital officials believe the affected patients would have been treated between October 2014 and January 2015.

The incident is under investigation by Los Angeles County health officials, and prompted the U.S. Food and Drug Administration to issue an advisory letter concerning the duodenoscopes used in the procedures, which contain a cavity that has been described as difficult to disinfect.

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