Outpatient Colonoscopy Infection Rates Much Higher Than Previously Thought

Infection rates were thought to be in the neighborhood of one in a million, but new research shows the rate of infection is more than 1 in 1,000 for screening colonoscopies and 1.6 per 1,000 for non-screening colonoscopies.

The rates of infection following colonoscopies and upper-GI endoscopies at some outpatient specialty centers is more than 100 times higher than previously believed, Johns Hopkins researchers say.
  
Using an all-payer claims database, the researchers examined 2014 data from six states — California, Florida, Georgia, Nebraska, New York and Vermont — to track infection-related emergency room visits and unplanned inpatient admissions within seven and 30 days after a colonoscopy or EGD.

They found that:

• Patients who underwent one of the common procedures at ambulatory surgery centers were at greater-than-expected risk of bacterial infections, including E. coli and Klebsiella.
   
• The rate of infection seven or fewer days after the procedure was slightly higher than 1 in 1,000 for screening colonoscopies and about 1.6 per 1,000 for non-screening colonoscopies. Rates for EGDs within that time were more than 3 per 1,000.
   
• Almost 45 in 1,000 patients who'd been hospitalized within 30 days prior to a screening colonoscopy visited a hospital with an infection within a month.
   
• Within those parameters, the rate of infection-related hospitalization for EGDs was more than 59 patients per 1,000.
   
• Among the ASC post-procedure infections, the rates were slightly higher for diagnostic procedures, as opposed to screening procedures.
   
• ASCs with the highest volume of procedures had the lowest rates of post-endoscopic infections.

The Ambulatory Surgery Center Association reports that 64% of ASCs were owned by physicians, while 28% were affiliated with hospitals or health systems.

Study lead author Susan Hutfless, an assistant professor of medicine at the Johns Hopkins University School of Medicine, said that many ASCs lack electronic medical records connected to hospital emergency departments, so they're unlikely to learn about patients' infections.

"If they don't know their patients are developing these serious infections, they're not motivated to improve their infection control," Hutfless said in remarks accompanying the study.

Hutfless said patients should be aware of infection risk associated with all endoscopic procedures.