Iatrogenic urinary tract infection with Pseudomonas cepacia after transrectal ultrasound guided needle biopsy of the prostate

In response to an unexplained development of Pseudomonas cepacia cystoprostatitis after transrectal ultrasound guided prostate biopsy, a retrospective review of records and biopsy protocol was performed at our institution. Between June 5, 1990 and January 9, 1991 no documented infections occurred in 272 patients undergoing transrectal ultrasound and prostate biopsy. During the next 6 months, however, 9 of 110 patients (8.2%) presented again with infectious symptomatology after transrectal ultrasound guided needle biopsy of the prostate. Culture of a majority of the specimens (67%) yielded P. cepacia. Two additional asymptomatic patients became colonized with P. cepacia. Environmental investigations revealed the ultrasound transmission gel as the source of the contamination. The proposed mechanism of infection was direct prostate or bladder seeding of contaminated transmission gel used to prepare the ultrasound transducer probe. Infections developed in immunocompetent patients despite adequate antimicrobial prophylaxis most likely secondary to underlying bladder outlet obstruction and significant direct inoculum of organisms. We currently recommend use of individualized sterile packets of transmission gel in addition to appropriate antimicrobial prophylaxis and povidone-iodine cleansing enemas when performing transrectal sonographic guided biopsies of the prostate.