An outbreak of postoperative rapidly developing and multidrug-resistant klebsiella pneumoniae urosepsis due to a contaminated ureteroscope

Introduction: Outbreaks caused by microorganisms contaminating the inside of rigid ureteroscopes are extremely rare. Some of these outbreaks, especially those caused by multidrug-resistant (MDR) infections, can cause serious problems, even death. Among these serious infections, we have no data about Klebsiella pneumoniae outbreaks caused by rigid ureteroscopes and their management and consequences. Aim: We aimed to report the outcomes of an outbreak of rapidly developing MDR K. pneumoniae urosepsis linked to rigid ureteroscopy (URS). Materials and methods: Data for 68 patients who had ureteroscopic lithotripsy (URS-L) operations using the same ureteroscope were retrospectively reviewed. Among them, 17 patients with postoperatively developing urosepsis were included in the study. Samples were taken from the operating room, camera heads, endoscopes, and ancillary instruments for culture workup. K. pneumoniae was produced in a swab culture obtained from the water inlet channel of the ureteroscope. Results: All patients had sepsis signs that developed within hours (2-7 hours). MDR K. pneumoniae was detected in the urine cultures of all patients. It was sensitive only to amikacin, tigecycline, colistin, and netilmicin. All patients were treated with tigecycline (100 mg intravenous daily). It was observed that K. pneumoniae growth continued without any symptoms in the first and fourth weeks of followup in 4 patients. These patients were accepted as colonization; no additional treatment was given. Conclusions: In the case of rapidly developing urosepsis after the URS procedure in a patient, instruments, devices, and endoscopes should be immediately checked for contamination to prevent the emergence of an outbreak. © 2022 Folia Medica. All rights reserved.