title: An outbreak of achromobacter xylosoxidans associated with ultrasound gel used during transrectal ultrasound guided prostate biopsy.
abstract: OBJECTIVE
  We describe an outbreak of Achromobacter xylosoxidans after transrectal ultrasound guided prostate biopsy at a urology unit at a tertiary care center as well as clinical and microbiological investigation, and intervention.
  
  
  METHODS
  In September 2008, several days after undergoing transrectal ultrasound guided prostate biopsy, 4 patients were hospitalized with fever. We reviewed the procedure and infection control practices in the urology service. Environmental cultures were obtained from equipment and materials used for the procedure. Isolates were identified by routine laboratory procedures with molecular confirmation and characterized by pulsed field gel electrophoresis.
  
  
  RESULTS
  A. xylosoxidans was isolated from the urine of 2 patients, of whom 1 also had a positive blood culture. Review of transrectal ultrasound guided prostate biopsy revealed that the lubricant gel used in the procedure, which the biopsy needle passes through, was held in a plastic container that was repeatedly refilled from a large bag. A. xylosoxidans was isolated from this container. Pulsed field gel electrophoresis showed that the isolates obtained from patients and the gel were identical.
  
  
  CONCLUSIONS
  Contaminated lubricant gel was the cause of this outbreak. The practice of repeatedly refilling gel containers with nonsterile gel was replaced by the use of individual sterile gel sachets in each patient. No further cases occurred. During an invasive procedure involving a sterile body site, such as transrectal ultrasound guided prostate biopsy, using sterile gel is essential. Our experience emphasizes the crucial need to review all invasive procedures from an infection control perspective.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Karen
authors.initials: K
authors.lastname: Olshtain-Pops
authors.forename: Colin
authors.initials: C
authors.lastname: Block
authors.forename: Violeta
authors.initials: V
authors.lastname: Temper
authors.forename: Carlos
authors.initials: C
authors.lastname: Hidalgo-Grass
authors.forename: Ilana
authors.initials: I
authors.lastname: Gross
authors.forename: Allon E
authors.initials: AE
authors.lastname: Moses
authors.forename: Ofer N
authors.initials: ON
authors.lastname: Gofrit
authors.forename: Shmuel
authors.initials: S
authors.lastname: Benenson
mesh_terms: D042441:Achromobacter denitrificans; D000368:Aged; D001707:Biopsy, Needle / Q000295:instrumentation* / Q000379:methods; D004196:Disease Outbreaks; D004340:Drug Contamination; D004866:Equipment Contamination; D005782:Gels; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology; D012007:Rectum; D014463:Ultrasonography
chemical_list: D005782:Gels