Brief Report
An outbreak of Pseudomonas aeruginosa urinary tract infections following outpatient flexible cystoscopy

https://doi.org/10.1016/j.ajic.2019.05.005Get rights and content

Highlights

  • Pseudomonas aeruginosa urinary tract infections occurred after cystoscopies.

  • The investigation identified a damaged cystoscope contaminated by P. aeruginosa acting as a relay object.

  • This outbreak urges us not to trivialize urinary tract infections occurring after cystoscopy.

  • Patients should be advised to signal the occurrence of urologic symptoms after urologic exploration.

The investigation of an outbreak of Pseudomonas aeruginosa urinary tract infections after ambulatory cystoscopies identified a damaged cystoscope contaminated by P aeruginosa and acting as a relay object. This outbreak urges us not to trivialize urinary tract infections occurring after an elective cystoscopy. Patients should be advised to signal the occurrence of urologic symptoms after urologic exploration.

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)

There are more references available in the full text version of this article.

Cited by (9)

  • High-level disinfection evaluation in the ambulatory setting

    2023, American Journal of Infection Control
View all citing articles on Scopus

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.

View full text