Brief ReportAn outbreak of Pseudomonas aeruginosa urinary tract infections following outpatient flexible cystoscopy
Section snippets
Methods
The 4 reusable cystoscopes used in urology consultation are hand-cleaned and disinfected according to national recommendations.8 Microbiological controls are performed at least once per year and before reuse in cases of device maintenance, and are considered in conformity if bacteria are undetectable (<1 colony forming unit per cystoscope).8
The patients who developed P aeruginosa positive clinical samples between July 9, 2015, (last date of the cystoscope conform analysis) and June 30, 2016 (30
Results
In November 2015, patient 4 presented with a bacteremia after a P aeruginosa UTI. On May 20, 2016, patient 10 developed lower urinary tract symptoms and P aeruginosa bacteremia. Five days later, a third similar case was notified to the infection control team for patient 11 presenting with a positive urine culture for P aeruginosa. The 3 patients underwent a bladder examination with the same cystoscope number 419, which was then quarantined from May 31, 2016, and an outbreak investigation was
Discussion
Cystoscopy-related outbreaks are scarcely reported in the literature, and the risk of patient contamination through cystoscopy is poorly known.3, 6 Several outbreaks occurring after bronchoscopy are associated with the use of a damaged device, inadequate disinfection, and manufacturing defect.10, 11, 12 The outbreak reported here was relayed by a cystoscope contaminated by P aeruginosa, probably in biofilm attached on to the channel scratch, which allowed it to resist disinfectants.13 Indeed,
Conclusions
The example of this outbreak urges us not to trivialize UTI occurring after an elective cystoscopy. Patients should be advised to signal the occurrence of urologic symptoms after urologic exploration. In case of concomitant infections caused by P aeruginosa, the cystoscope should be suspected as a potential reservoir.
References (13)
- et al.
Urinary tract infection and patient satisfaction after flexible cystoscopy and urodynamic evaluation
Urology
(2000) Should antibiotics be given prior to outpatient cystoscopy? A plea to urologists to practice antibiotic stewardship
Eur Urol
(2014)- et al.
Outbreak of cystoscopy related infections with Pseudomonas aeruginosa: New Mexico, 2007
J Urol
(2008) - et al.
Carbapenem-resistant Enterobacteriaceae and endoscopy: an evolving threat
Am J Infect Control
(2016) - et al.
An outbreak of Pseudomonas aeruginosa infections following thoracic surgeries occurring via the contamination of bronchoscopes and an automatic endoscope reprocessor
J Infect Chemother
(2008) - et al.
A microbiological evaluation of level of disinfection for flexible cystoscopes protected by disposable endosheaths
BMC Urol
(2013)
Cited by (9)
Pulling the plug on a pseudomonas outbreak: ancillary equipment as vectors of infection
2023, Journal of Hospital InfectionHigh-level disinfection evaluation in the ambulatory setting
2023, American Journal of Infection ControlEnvironmental impact of single-use and reusable flexible cystoscopes
2023, BJU InternationalMicro-cost analysis of single-use vs. reusable cystoscopy in a single-payer healthcare system
2022, Canadian Urological Association JournalPost-cystoscopy infections and device malfunctions in reprocessed flexible cystoscopes in a national database
2022, Canadian Journal of Urology
Funding/support: This work was supported, in part, by Association pour la recherche et le développement microbiologie et pharmacie, Sauzet, France (SIREN 384 036 661; SIRET 384 036 661 00021).
Conflicts of interest: None to report.
Elodie Sorbets and Marine Evrevin contributed equally as first author. Sara Romano-Bertrand and Sylvie Parer contributed equally as last author.