“Superbug” infections linked to newer models of duodenoscopes featuring a sealed channel design were first recognized in 2012. This article provides a review of the published medical literature and of the FDA’s medical-device database to evaluate the potential for other types of flexible endoscopes to transmit multidrug-resistant bacteria, including carbapenem-resistant Enterobacteriaceae, or CRE. Several cases document the contamination of bronchoscopes, cystoscopes, curvilinear-array echoendoscopes, flexible laryngoscopes, gastroscopes and ureteroscopes with concerning bacteria, and in some cases these devices were linked to superbug infections or outbreaks. Public notices focusing on the potential for these other types of flexible endoscopes, too, to transmit superbugs are few, however, suggesting that these devices may pose an under-recognized risk of multidrug-resistant bacterial infections. Recommendations for preventing these devices from infecting patients with potentially untreatable bacteria are provided, including that users consider applying at least one enhanced practice, previously recommended by the FDA to mitigate the risk of duodenoscopes transmitting superbugs, to these other types of flexible endoscopes, as deemed appropriate, feasible and warranted, particularly to curvilinear-array echoendoscopes, which like duodenoscopes feature a forceps elevator mechanism. Efforts to increase public awareness about the potential for these devices to infect patients with superbugs is recommended.
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