Outbreak of urinary tract infections by Salmonella spp. after cystoscopic manipulation.

INTRODUCTION

Cystoscopes are used for diagnostic and therapeutic purposes and can be vehicles for transmitting healthcare-associated infections. Performing urine cultures before manipulation or administering prophylaxis is determined by the presence or not of risk factors for urinary tract infection.

METHODS

Between October and November 2014, we identified an unusual aggregation of Salmonella spp. isolates in urine cultures at the University Hospital Santa Lucía of Cartagena (Murcia). An epidemiological investigation was conducted to assess the possible relationship between the cases.

RESULTS

Four patients had a urinary tract infection by Salmonella spp. within a short period, which suggests the presence of an outbreak. All of the patients had undergone cystoscopy. The index case had a urinary colonisation by Salmonella spp. prior to the procedure, and none of the reported cases had received prophylaxis. The environmental control cultures and the involved material cultures resulted negative. Intensification of the cystoscope cleaning and disinfection protocol achieved eradication of the outbreak.

CONCLUSION

This is the first reported outbreak of Salmonella spp. related to the use of cystoscopes. The indication for a urine culture should be carefully assessed before conducting invasive urological procedures, as should the need for antibiotic prophylaxis, for patients with risk factors for severe infection. Strict control in the cleaning and disinfection of endoscopy material can prevent the transmission of infections related to this type of procedure.