2-Aug-2018
A patient while undergoing a laparoscopic nephro-ureterctomy procedure contracted an iatrogenic infection, Mycobacteria Abscessus. The patient eventually had M. abscessus prostatitis.The patient had multiple cystoscopies done earlier in which the prostatic urethra was noted to be always normal until the procedure carried out on the fateful day. The culprit was pinpoint to the Endoscope Reprocessor which sterilizes the cystoscopes.
Colonisation of endoscope reprocessor with M. abscesses is likely to have occurred. It is not possible to ascertain why the machine had failed to process the endoscopes adequately. Samples were collected from the endoscopes after being reprocessed and they continued to showed positive laboratory results for Mycobacterium Abscessus.
Surveillance flexible cystoscopy after patient was found infected, he was found to have a newly developed bladder lesion. Prostate then was normal. He subsequently underwent a trans-urethral resection of bladder tumour (TURBT) during which fibrotic granulomatous lesions were also noted on the prostate (not seen previously during the cystoscopy). Both the bladder and prostate lesions were resected. The histology for the bladder lesion revealed cystitis glandularis with no bladder cancer, while the histology for the prostate lesion revealed a caseating granulomatous inflammation with negative stains for acid-fast bacilli. Urine cultures for tuberculosis grew M. Abscessus. A repeat cystoscopy, 4 months later showed necrotic debris in the prostatic urethra. Superficial mucosal biopsies showed M. Abscessus.
Obviously there isn't a clear protocol for the Endoscope Reprocessor in that hospital which gives rise to such a uneventful patient incident. Hospital must adopt a stringent set of protocol for the best interest of the patients with hardened quality assurance audit and monitoring, couple with microbiological screening of reprocessed endoscopes. Though the process owner takes full responsibilities, the Infectious Control Department shall ensure and perform the necessary audit frequently to ensure that the incident shall never repeat itself again.
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