Update: The following trident of peer-reviewed articles, in three different medical journals, authored (or co-authored) by Dr. Muscarella may be the most comprehensive and historical collection published to date discussing the risk of reusable medical instrumentation (e.g., flexible endoscopes, including duodenoscopes and bronchoscopes) transmitting a deadly superbug.

  1. Muscarella LF. Use of ethylene-oxide gas sterilisation to terminate multidrug-resistant bacterial outbreaks linked to duodenoscopes. BMJ Open Gastroenterol 2019 Aug 5;6(1):e000282. | Click here.
    • This article by Dr. Lawrence Muscarella reviewed the specific details of 23 superbug outbreaks (17 in the U.S., 6 overseas) linked to duodenoscopes. The article focuses additionally on the specific mitigations hospitals implemented to prevent additional infections.

  2. Mehta AC, Muscarella LF. Related “Superbug” Infections. Chest 2019 Aug 14;pii:S0012-3692(19)31457-6. | Click here.
    • This article co-authored by Lawrence Muscarella, PhD and Atul Mehta, MD of the renowned Cleveland Clinic reviewed the specific details of 12 superbug outbreaks linked to bronchoscopes;. This article concludes that this risk is under-recognized and under-appreciated. Actions are recommended to improve patient safety.

  3. Muscarella LF. Risk of transmission of carbapenem-resistant Enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy. World J Gastrointest Endosc 2014 Oct 16;6(10):457-74. | Click here.
    • This article by Dr. Lawrence Muscarella was the first, in 2014, to introduce to the public the risk of duodenoscopes transmitting carbapenem-resistant Enterobacteriaceae (CRE) and related superbugs, whose infections are associated with a mortality rate of as high as 50%.

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Related articles by Dr. Muscarella: