536. Escherichia coli infection by inadequate disinfection of a biopsy needle used in transrectal ultrasound guided prostate biopsy
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Transrectal ultrasound(TRUS)-guided prostate biopsies are common procedures in urology
Objective: It was notified about 4 patients hospitalized with a recent increase of urinary tract infection with Escherichia coli bacteremia after TRUS in October 2008. We investigated the cause.
Methods: We investigated patients undergone prostate biopsies from January, 2005 through October, 2008. We surveyed for additional cases, reviewed medical records, evaluated biopsy procedure, equipment and infection control practices
Results: TRUS was performed in 1800 patients during 4 years and a total of 6 cases were identified as infection. Two cases occurred sporadically. The rest occurred in October 2008. E. coli was isolated in 3 of 4 patients in blood, urine. E. coli isolated in each patients had different antibiogram.
We obtained samples for bacterial culture from environmental surfaces, equipment, solutions used during prostate biopsy procedures and grew no bacteria. We reviewed biopsy process, discovered recent change. Biopsy needle including prostate tissue was expelled into saline but formaline and the same biopsy needle was again passed through rectum for repeated specimen collection without disinfectant. Formaline hadn’t been used due to recently reported teratogenic effect during 1month. Eeight to twelve tissue cores were obtained in each patient. After these events, we wiped biopsy needle with alcohol, no more infection occurred.
Conclusions: Our investigation suggests auto-inoculation through biopsy needle with endogenous E. coli that resulted in four clinical infections. Potential causes include the lack of adequate disinfection. Clinicians performing TRUS guided prostate biopsy procedures should follow standard disinfection practices at the clinic.
Kyung-Hwa Park, MD, Chonnam National University, Gwangju, South Korea and  K. Park, None.