title: Outbreak of urinary tract infections by Salmonella spp. after cystoscopic manipulation.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, Hospital Universitario Santa Lucía, Cartagena, España. Electronic address: doc.jimeno@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Jimeno
authors.affiliation: Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, Hospital Universitario Santa Lucía, Cartagena, España.
authors.forename: M M
authors.initials: MM
authors.lastname: Alcalde
authors.affiliation: Servicio de Microbiología, Hospital Universitario Santa Lucía, Cartagena, España.
authors.forename: M
authors.initials: M
authors.lastname: Ortiz
authors.affiliation: Servicio de Urología, Hospital Universitario Santa Lucía, Cartagena, España.
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez
authors.affiliation: Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, Hospital Universitario Santa Lucía, Cartagena, España.
authors.forename: B
authors.initials: B
authors.lastname: Alcaraz
authors.affiliation: Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, Hospital Universitario Santa Lucía, Cartagena, España.
authors.forename: F
authors.initials: F
authors.lastname: Vera
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020684:Cystoscopes / Q000382:microbiology*; D004196:Disease Outbreaks; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012480:Salmonella Infections / Q000453:epidemiology*; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000382:microbiology*
keywords: Brote; Cistoscopios; Cystoscopes; Healthcare-associated infections; Infección relacionada con la asistencia sanitaria; Outbreak; Salmonella spp.