Contaminated sponges as source of Klebsiella pneumoniae prostatitis outbreak after transrectal ultrasound guided prostate biopsy
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Published version
Author(s)
Type
Journal Article
Abstract
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.
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.
Date Issued
2025-11-01
Date Acceptance
2025-09-09
Citation
International Journal of Infectious Diseases, 2025, 160
ISSN
1201-9712
Publisher
Elsevier
Journal / Book Title
International Journal of Infectious Diseases
Volume
160
Copyright Statement
© 2025 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
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Publication Status
Published
Article Number
108058
Date Publish Online
2025-09-10