PMD27 POST-COLONOSCOPIC INFECTION RATES: SYSTEMATIC LITERATURE REVIEW ASSESSING AN ATTRIBUTABLE RISK

More than 15 million colonoscopic procedures are performed in the USA annually. Colonoscopy is generally thought to be safe, however, recent literature has reported higher infection rates than previous expected following colonoscopy. Post-endoscopic infections may occur due to contaminated colonoscopes leading to patient hospitalization and additional costs. This study assesses the attributable risk of infection following colonoscopy. The authors conducted a systematic literature review in Pubmed and Embase on February 8, 2019. Articles published before 2013 were excluded due to new reprocessing guidelines and standards occurring after 2013. Using the weighted mean of two studies, we identified a 30-day post-colonoscopy infection rate. All identified infections were included. We identified the 30-day post-procedural infection-rate for a control group to represent the background infection risk. We calculated the difference between the infection rates to determine the infection risk attributable to colonoscopies. HCUPNet and the applicable ICD-9 codes for all diagnosed infections were used to identify the mean cost for a hospital to treat the infections. In total 1,529 articles were found in the two databases and after removal of duplicates a total number of 948 articles were identified. 906 articles were excluded and 42 articles were chosen for full-text assessment. The articles included in this study were the only two that assessed post-colonoscopic infection rates. The weighted infection rates were 0.48% ± 0.006% and 0.27% ± 0.006% for the 30-day post-colonoscopy and control groups, respectively. The attributable infection risk was 0.21% ± 0.008%. The cost per treatment of infection was $13,105. We found that the rate of post-endoscopic infections was higher than previously stated in various guidelines and subsequent high costs. Given the association between contaminated flexible endoscopes and infections, we encourage healthcare facilities to take appropriate measures to address all possible sources of infections, including cross-infections caused by contaminated flexible endoscopes.