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Outbreak of Cystoscopy Related Infections With Pseudomonas Aeruginosa: New Mexico, 2007

2008; Lippincott Williams & Wilkins; Volume: 180; Issue: 2 Linguagem: Inglês

10.1016/j.juro.2008.04.003

1527-3792

Aaron M. Wendelboe, Jan Baumbach, David B. Blossom, P Frank, Arjun Srinivasan, C. Mack Sewell,

Healthcare cost, quality, practices

No AccessJournal of UrologyAdult Urology1 Aug 2008Outbreak of Cystoscopy Related Infections With Pseudomonas Aeruginosa: New Mexico, 2007 Aaron M. Wendelboe, Joan Baumbach, David B. Blossom, Patricia Frank, Arjun Srinivasan, and C. Mack Sewell Aaron M. WendelboeAaron M. Wendelboe Epidemic Intelligence Service Program, Office of Workforce and Career Development, Atlanta, Georgia Epidemiology and Response, New Mexico Department of Health, Las Cruces, New Mexico , Joan BaumbachJoan Baumbach Epidemiology and Response, New Mexico Department of Health, Las Cruces, New Mexico , David B. BlossomDavid B. Blossom Epidemic Intelligence Service Program, Office of Workforce and Career Development, Atlanta, Georgia Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia , Patricia FrankPatricia Frank Public Health Divisions, New Mexico Department of Health, Las Cruces, New Mexico , Arjun SrinivasanArjun Srinivasan Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia , and C. Mack SewellC. Mack Sewell Epidemiology and Response, New Mexico Department of Health, Las Cruces, New Mexico View All Author Informationhttps://doi.org/10.1016/j.juro.2008.04.003AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Personnel at the New Mexico Department of Health investigated a Pseudomonas aeruginosa outbreak potentially associated with outpatient cystoscopy performed by a urologist during January 1 to April 22, 2007. Materials and Methods: We compared infection rates with baseline rates, reviewed infection control procedures and performed environmental sampling at the urologist office. We also performed a case-control study. Cases had blood or urine cultures positive for P. aeruginosa during January 1 to April 22, 2007. Controls had blood or urine cultures ordered through the same laboratory. Clinical and environmental isolates were typed by pulsed field gel electrophoresis. Results: A total of 23 case-patients were identified, including 17 with urinary tract infections alone, 2 with bacteremia alone and 4 with urinary tract infections plus bacteremia. Seven case-patients experienced P. aeruginosa infection after cystoscopy was performed by this urologist. On multivariate analysis cystoscopy done by this urologist was the strongest risk factor for positive P. aeruginosa culture (OR 46.5, 95% confidence limits 3.1, 705). Recent hospitalization, having a urinary catheter and age 75 years or older were also independently associated with case status. Multiple breaches in cystoscope reprocessing procedures were identified. The urologist cystoscope was culture positive for P. aeruginosa. All 4 available clinical isolates from patients in whom cystoscopy was done by this urologist had pulsed field gel electrophoresis patterns identical to those of specimens from the cystoscope. The implementation of proper reprocessing methods terminated the outbreak. Conclusions: Our investigation implicated a contaminated cystoscope as the likely source of these infections. Health care personnel who disinfect cystoscopes should follow manufacturer recommendations and guidelines on reprocessing flexible endoscopes. The development of cystoscope specific guidelines might promote increased compliance with correct reprocessing procedures. References 1 : The epidemiology, pathogenesis and treatment of Pseudomonas aeruginosa infections. Drugs2007; 67: 351. Google Scholar 2 : Principles and Practice of Infectious Diseases. In: . Philadelphia: Churchill Livingstone2000: 25. Google Scholar 3 : Nosocomial Pseudomonas aeruginosa urinary tract infections. JAMA1982; 248: 1615. Google Scholar 4 : Outbreak of Pseudomonas aeruginosa infections after transrectal ultrasound-guided prostate biopsy. Urology2007; 69: 912. Google Scholar 5 : An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes. N Engl J Med2003; 348: 221. Google Scholar 6 : Epidemiology of infections due to Pseudomonas aeruginosa. Rev Infect Dis, suppl.1984; 6: S627. Google Scholar 7 : Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol1995; 33: 2233. Google Scholar 8 : APIC guideline for infection prevention and control in flexible endoscopy: Association for Professionals in Infection Control. Am J Infect Control2000; 28: 138. Google Scholar 9 : Multi-society guideline for reprocessing flexible gastrointestinal endoscopes: Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol2003; 24: 532. Google Scholar 10 MaxiCide Plus: 28-Day Sterilizing and Disinfection Solution. Melville, New York: Henry Schein. Google Scholar © 2008 by American Urological AssociationFiguresReferencesRelatedDetailsCited byLegemate J, Kamphuis G, Freund J, Baard J, Oussoren H, Spijkerman I and de la Rosette J (2019) Pre-Use Ureteroscope Contamination after High Level Disinfection: Reprocessing Effectiveness and the Relation with Cumulative Ureteroscope UseJournal of Urology, VOL. 201, NO. 6, (1144-1151), Online publication date: 1-Jun-2019. Volume 180Issue 2August 2008Page: 588-592 Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordsurinary tract infectionsinfection controlepidemiologyPseudomonas aeruginosadisinfectionAcknowledgmentsPaul Torres, Rey Griego and Debbie Sena Johnson, laboratorians, Scientific Laboratory Division, New Mexico Department of Health processed the clinical and environmental samples. Drs. Julie Magri, Office of Workforce and Career Development, Centers for Disease Control and Prevention, and Michael Landen, Epidemiology and Response Division, New Mexico Department of Health assisted with the case-control study design and with the manuscript.MetricsAuthor Information Aaron M. Wendelboe Epidemic Intelligence Service Program, Office of Workforce and Career Development, Atlanta, Georgia Epidemiology and Response, New Mexico Department of Health, Las Cruces, New Mexico More articles by this author Joan Baumbach Epidemiology and Response, New Mexico Department of Health, Las Cruces, New Mexico More articles by this author David B. Blossom Epidemic Intelligence Service Program, Office of Workforce and Career Development, Atlanta, Georgia Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia More articles by this author Patricia Frank Public Health Divisions, New Mexico Department of Health, Las Cruces, New Mexico More articles by this author Arjun Srinivasan Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia More articles by this author C. Mack Sewell Epidemiology and Response, New Mexico Department of Health, Las Cruces, New Mexico More articles by this author Expand All Advertisement PDF downloadLoading ...