Contaminated sponges as source of Klebsiella pneumoniae prostatitis outbreak after transrectal ultrasound-guided
Victor Renault1, Samuel Chelly2, Marie Prime1
1Regional Center for Infection Prevention and Control Pays de la Loire, CHU de Nantes, Nantes, France.
Objectives:
The infection rates following transrectal ultrasound-guided (TRUS) prostate biopsy range from 1-5%, mostly caused by Escherichia coli. We investigated an abnormal increase in Klebsiella pneumoniae prostatitis rate following TRUS prostate biopsy in a urological surgery center.
Methods:
The outbreak occurred in a 217-bed private hospital performing TRUS prostate biopsies. After an antibiotic prophylaxis (single 3 g dose of fosfomycin-trometamol 2 hours before the procedure), each biopsy was placed on a pre-impregnated sponge and then transferred to a plastic cassette for pathological analysis. The outbreak investigation relied on a retrospective analysis of cases defined as the occurrence of a urinary or systemic infection caused by K. pneumoniae within 7 days following a TRUS prostate biopsy, including a review of procedures and microbiological analysis.
Results:
Between January 1 and March 31, 2024, 13/49 (27%) patients who underwent TRUS prostate biopsy developed clinical symptoms of prostatitis requiring hospitalization. The incidence rate was 20% (5/25, three with E. coli) from January 3 to February 20, 2024 and increased to 33% (8/24, seven with K. pneumoniae) from February 21 to March 31, 2024. During the investigation, K. pneumoniae strains isolated from clinical samples and moistened sponges were genotypically similar, confirming the latter as the source of infection. The pack of sponges in use was discarded, with sterilization of sponges and trays before their use. No other case of K. pneumoniae prostatitis was identified following these measures from April to December 2024.
Conclusions:
This investigation underlines the critical need for evaluation of practices around the preparation of sponges and cassettes in contact with the puncture needle when performing TRUS prostate biopsy.
Insights
An outbreak of Klebsiella pneumoniae prostatitis after transrectal ultrasound-guided (TRUS) prostate biopsies was linked to contaminated sponges. Implementing sterilization protocols resolved the issue, highlighting the need for careful procedural checks.
Area of Science:
- Urology
- Infectious Disease
- Microbiology
Background:
- Transrectal ultrasound-guided (TRUS) prostate biopsy infection rates are typically 1-5%, primarily due to Escherichia coli.
- An unusual rise in Klebsiella pneumoniae prostatitis cases post-TRUS biopsy was observed at a urological center.
Purpose of the Study:
- To investigate an abnormal increase in Klebsiella pneumoniae prostatitis following TRUS prostate biopsies.
- To identify the source and implement control measures for the K. pneumoniae outbreak.
Main Methods:
- Retrospective analysis of TRUS biopsy procedures and patient infections within 7 days.
- Microbiological analysis of clinical samples and biopsy materials (sponges, cassettes).
- Genotypic comparison of K. pneumoniae strains from patients and environmental sources.
Main Results:
- A significant increase in prostatitis cases occurred, with K. pneumoniae identified as the causative agent in a majority of later cases.
- Genotypically similar K. pneumoniae strains were isolated from patient infections and pre-impregnated sponges used during biopsies.
- Contaminated sponges were identified as the source of the outbreak.
Conclusions:
- Contaminated sponges used in TRUS prostate biopsy procedures led to a K. pneumoniae outbreak.
- Sterilization of sponges and trays, and discarding contaminated supplies, halted the outbreak.
- Evaluation of practices involving sponges and cassettes is crucial to prevent future infections.
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