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Antimicrobial Prophylaxis in Transurethral Enucleation and Resection of the Prostate: A Comparison of 1-Day Treatment and More than 2-Day Treatment
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Min Seok Kim, Won Jin Cho, Seung Baik, Dong Hoon Lim, Joon Nho, Chul Sung Kim
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Korean J Urogenit Tract Infect Inflamm 2014;9(2):104-110. Published online October 31, 2014
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To evaluate the efficacy of 1-day treatment of antimicrobial prophylaxis by analysis of the incidence and risk factors for postoperative infectious complications such as bacteriuria and urinary tract infection in the transurethral enucleation and resection of the prostate (TUERP). Materials and Methods: A retrospective review of 78 patients who underwent TUERP was performed. Of 78 patients, 32 patients received antibiotics less than 1 day (group A). The other 46 patients received antibiotics for more than 2 days (group B). All patients had urinalysis and urine culture preoperatively, on the day of removal, at 1-2 weeks and 3-4 weeks after discharge. The incidence and the risk factors for postoperative infectious complication were investigated. Results: The incidence of infectious complications after TUERP was not statistically significant between group A and group B (18.8% vs. 15.2%, p=0.680). Multivariate analysis documented only two independent risk factors of postoperative infectious complications: preoperative catheterization (OR, 4.189; 95% CI, 1.071-16.382; p=0.040) and diabetes mellitus (DM) (OR, 5.589; 95% CI, 1.469-21.256; p=0.012). Comparative analysis performed in subgroups with two risk factors also showed no difference in the incidence of infectious complication regardless of antibiotic duration. Conclusions: No significant difference in the incidence of postoperative infectious complications was observed between two groups. Therefore, it seems reasonable to prescribe prophylactic antibiotics less than 1 day for reducing postoperative infectious complications after TUERP. Preoperative urethral catheterization and DM were identified as significant risk factors for postoperative infectious complications and preventive management directed against the risk factors preoperatively is recommended.
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Malakoplakia in the Urinary Bladder
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Seung Baik, Chul Sung Kim, Dong Hoon Lim
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Korean J Urogenit Tract Infect Inflamm 2013;8(2):125-128. Published online October 31, 2013
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Malakoplakia is a rare chronic granulomatous disease, which was originally described in the urinary bladder, but can involve many other organs and soft tissues. Malakoplakia is often associated with immunosuppression or immunodeficiency and is believed to be caused by an alternation in the bacterial phagocytic system. Histologically, the presence of Michaelis-Gutmann bodies is pathognomonic. We report on a case of malakoplakia of the bladder in a 62-year-old female.
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Clinical Outcome of Acute Bacterial Prostatitis; A Multicenter Study
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Seong Ju Lee, Jin Mo Koo, Bong Suk Shim, Yong Hyun Cho, Chang Hee Han, Seung Ki Min, Sung Joo Lee, Hwan Cheol Son, Jun Mo Kim, Jong Bo Choi, Tae Hyoung Kim, Sang Kuk Yang, Kil Ho Lee, Yong Kil Na, Sung Ho Lee, Hee Jong Jung, Seung Il Jung, Chul Sung Kim, Jae Min Chung, Young Jin Seo, Won Yeol Cho, Kweon Sik Min, Sang Don Lee
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Korean J Urogenit Tract Infect Inflamm 2011;6(2):165-170. Published online October 31, 2011
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- "Purpose: Proper guidelines concerning antibiotic administration for acute bacterial prostatitis (ABP) are unclear. We retrospectively analyzed treatment status and clinical outcomes to establish a proper treatment guideline. Materials and Methods: The clinical records of 669 patients from 21 hospitals diagnosed with ABP were reviewed. Prior manipulation, antibiotics administration, mean length of treatment, complication and procedure were analyzed. Results: The mean age of 538 patients (80.4%) without manipulation (group 1) and 131 patients (19.6%) with manipulation (group 2) was 58.3 years (range 19-88 years). Transrectal prostate biopsy was the most common cause of acute bacterial prostatitis (n=66; 50.4%). Of the clinical symptoms in the non-manipulation and manipulation groups, fever was most common (88.2% and 86.3%, respectively). Acute urinary retention (14.3% and 28.1%, respectively) was significantly increased in the manipulation group (p<0.05). Escherichia coli was the most frequently isolated bacterium from urine (72.0% and 66.7% of cases, respectively). Mean length of treatment was 6.5days and 7.9days, respectively; the difference was significant (p<0.05). Combination antibiotic therapy with third generation cephalosporin+aminoglycoside was used in 49.3% and 55.5% of cases, respectively. For single antibiotic therapy, second generation quinolones were used the most (35.5% and 34.3%, respectively). Sequale occurred in 29 group 1 patients (5.4%) and 20 group 2 patients (15.3%); the difference was significant (p<0.05). Conclusions: Prior manipulation was associated with 20% of ABP patients. Regardless of manipulation, clinical outcome was similar after treating with appropriate antibiotics."
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Aminoglycosides Resistance of Escherichia coli Isolates from Acute Uncomplicated Cystitis
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Gilho Lee, Min Eui Kim, Yong-Hyun Cho, Chul Sung Kim, Young Ho Kim, Seung Ju Lee
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Korean J Urogenit Tract Infect Inflamm 2010;5(1):51-56. Published online April 30, 2010
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- "Purpose: The aim of the study was to determine the aminoglycosides resistance of Escherichia coli (E. coli) strains isolated from acute uncomplicated cystitis. Materials and Methods: All 219 female patients who presented with symptoms of acute cystitis by E. coli infection were included in this study. We used gentamicin, tobramycin, and amikacin for detecting the resistance to aminoglycosides. The prevalence of gentamicin, tobramycin, and amikacin resistance of E. coli was 25.1%, 24%, and 0.4%, respectively. Results: The resistant isolates to tobramycin or gentamicin definitively showed an associated resistance to other antibiotics such as ciprofloxacin and trimethoprin-sulfamethoxazole, while the resistance to amikacin was not. In addition, 3 aminoglycosides resistant E. coli isolates did not associated with the history of recurrent cystitis. Conclusions: We recommend the clinical use of amikacin for the ciprofloxacin or trimethoprim- sulfamethoxazole resistant E. coli isolates from urinary tract infection, instead of gentamicin or tobramycin."
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Systemic Candidiasis in Patient with Urinary Stone
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Hyoung Sang Kim, Ja Ok Kim, Dong Hoon Lim, Jun Rho, Chul Sung Kim
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Korean J Urogenit Tract Infect Inflamm 2010;5(1):82-86. Published online April 30, 2010
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- Invasive fungal infections, especially candidemia and systemic candidiasis, have become a major cause of morbidity and mortality in the last few decades. Invasive candidiasis accounts for up to from 15 to 30% of all nosocomial infections in critically ill patients. Management of these severe infections has been challenging due to a lack of rapid and reliable diagnostic methods, leading to delay in initiating appropriate antifungal therapy. We report a case of 63 year-old male suggesting right acute pyelonephritis with upper ureteral stone and finally identified systemic candidiasis invading to both eyes.
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Prostatic Tuberculosis with Painless Gross Hematuria
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Cheol Ho Park, Yoon Il Kang, Dong Hoon Lim, Jun Rho, Chul Sung Kim
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Korean J Urogenit Tract Infect Inflamm 2009;4(2):220-223. Published online October 31, 2009
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- Genitourinary tuberculosis contributes to 10-14% of extrapulmonary tuberculosis. The most common site of genital tuberculosis is the epididymis. Prostate tuberculosis is uncommon and is usually found incidentally following transurethral resection. A 78 year old man was admitted to our hospital with painless gross hematuria. Urine culture and cytology was negative, but serum prostate specific antigen was 29.7 ng/ml. Prostate biopsy demonstrated prostatitis and nodular hyperplasia. Transurethral prostatectomy was performed and histology revealed prostate tuberculosis.
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Antimicrobial Prophylaxis for Urologic Surgery
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Chul Sung Kim
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Korean J Urogenit Tract Infect Inflamm 2009;4(1):20-36. Published online April 30, 2009
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- "Surgical site infections (SSI) remain a significant contributor to postoperative morbidity and mortality. Antimicrobial prophylaxis to prevent SSI is one of the most widely accepted practices in surgery. Despite the evidence of effectiveness and the publication of guidelines for antimicrobial prophylaxis to prevent SSIs, prophylaxis use is often suboptimal. Optimal prophylaxis requires application in appropriate types of operations, selection of safe and effective antimicrobials, initial administration and redosing to maintain effective serum and tissue levels throughout the operation and discontinuation when the patient is no longer receiving a benefit and the antimicrobial agent should be bactericidal, safe, and inexpensive. Based on the published evidence, the infusion of the first antimicrobial dose should begin within 60 minutes before the surgical incision is made and prophylactic antimicrobials should be discontinued within 24 hours of the end of surgery. The initial antimicrobial dose should be adequate based on the patient's weight, adjusted dosing weight or body mass index. An additional dose of antimicrobial should be given intraoperatively if the operation is still continuing two half-lives after the initial dose. Antimicrobial prophylaxis is recommended at the time of many clean-contaminated and some clean operations. To reduce the risk of SSI, a systematic but realistic approach must be applied with the awareness that this risk is influenced by characteristics of the patient, operation, personnel and hospital."
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The Value of Transrectal Ultrasonography Guided Needle Aspiration in Prostate Abscess
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Dae Eun Shin, Dong Hoon Lim, Hyung Yoon Moon, Jun Rho, Chul Sung Kim
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Korean J Urogenit Tract Infect Inflamm 2007;2(2):197-202. Published online October 31, 2007
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- "Purpose: To evaluate the feasibility and effectiveness of transrectal ultrasonogram guided needle aspiration and drainage of prostatic abscess. Material and Methods: From January, 2005 to June, 2007, six patients who were diagnosed as prostate abscess and treated in Chosun University Hospital were examined. Assessment parameters included associated disease, symptoms, analysis of midstream urine, blood, and aspirated abscess for leukocyte and common pathogen, digital rectal examination, transrectal sonography, and abdomen-pelvic CT. Managment of prostatic abscess included broad-spectrum antibiotics with or without transrectal ultrasonogram guided needle aspiration. During the follow up, transrectal ultrasound examination and abdomen-pelvic CT, urine analysis and urine culture were performed on an outpatient basis. Result: For all patients, antibiotic therapy and suprapubic cystostomy were performed. Of six patients, four patients received transrectal ultrasonogram guided needle aspiration additionally. One patient was treated by transrectal ultrasonogram guided needle aspiration after the initial treatment of transurethral incision of the prostate was failed. All patients were treated effectively without complications. Conclusion: It is suggested that transrectal ultrasonogram guided needle aspiration is relatively safe and has high success rates regardless of the size, number, and location of abscess."
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Quinolone Resistance in Urologic Field: Present and Future
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Chul Sung Kim
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Korean J Urogenit Tract Infect Inflamm 2007;2(1):40-47. Published online May 31, 2007
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- Quinolone has been widely used in urology because urinary tract infection is usually caused by Gram negative pathogens. However, quinolone resistance is increasing due to the increased use of quinolones. Typical quinolone resistance occurs as a result of mutations in the target enzymes and of changes in quinolone entry and efflux pump. Recently, plasmid mediated quinolone resistance has emerged and spread worldwide. The qnr gene of the plasmid produces the Qnr protein, which prevents quinolones from inhibiting the target enzymes. The qnr-bearing strains generate quinolone resistant mutants much more frequently than qnr-free strains. Moreover, The qnr-plasmids carry multiple resistance determinants providing resistance to other antibiotics. Thus, careful attention should be paid to the understanding and prevention of quinolone resistance.
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Multicenter Clinical Outcome of Gatifloxacin for Chronic Prostatitis (NIH Category II or IIIa) in Korea
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Sang Don Lee, Seung Ju Lee, Tae Kon Hwang, Duck Ki Yoon, Kyu Sung Lee, Luck Hee Sung, Myung Soo Choo, Bong Suk Shim, In Rae Cho, Min Eui Kim, Soo Bang Ryu, Chul Sung Kim, Young Gon Kim, Chun Il Kim, Hyun Yul Rhew, Yong-Hyun Cho
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Korean J Urogenit Tract Infect Inflamm 2007;2(1):53-60. Published online May 31, 2007
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- "Purpose: The objective of this study was to investigate the efficacy and safety of gatifloxacin for patients with chronic prostatitis (NIH category II or IIIa) in Korean urologic practice. Materials and Methods: A total of 16 outpatient urology clinics at tertiary care medical centers in Korea participated. Gatifloxacin (400 mg/day) treatment (S.D.) of 149 patients (20 patients with category II and 129 patients with category IIIa) with prostatitis (mean age 45.8±13.3 years) was carried out for 41.7 (33.1) days. A 4-glass test according to Meares and Stamey or two glass test was carried out at study entry and one month after the end of treatment. Clinical response, safety and bacteriological response were assessed before treatment (within 48 hours of initiation of the study medication) and at one month after treatment completion. Results: In a otal of 149 patients, the total NIH-CPSI score was significantly reduced from 20.5 to 10.0 (response rate 86.7%; 95% CI 80.2-93.2%) (p<0.05). Sub-scores of pain, urinary symptoms and impact on the quality of life were also significantly reduced from 8.9 to 3.8 (response rate 83.8%; 95% CI 76.8-90.9%), from 4.2 to 2.0 (response rate 73.3%; 95% CI 64.9-81.8%) and from 7.4 to 4.2 (response rate 79.0%; 95% CI 71.3-86.8%), respectively (p<0.05). In terms of the overall clinical efficacy assessment by investigators, out of 149 patients with prostatitis, 71.2% were assessed to be responders. Bacteriological studies in expressed prostatic secretion (EPS) or post prostate massage urine (VB3) at 1 month after treatment completion demonstrated that the overall eradication rates of pathogens was 85% and the pyuria (≥10 WBC/HPF) rates in the NIH category II and IIIa were 35% and 18.6%, respectively (overall rate 20.8%). There were 16.1% of patients that presented with some adverse events considered by investigators to be related to the drug. The majority of adverse events were considered to be of mild (87.5%) or moderate (8.3%) intensity. Conclusions: These results suggest that gatifloxacin in Korean urologic practice is well tolerated and improves the clinical outcomes in the patientswith chronic prostatitis (NIH category II or IIIa)."
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Renal Tuberculosis Mimicking Abscess in Calyceal Diverticulum
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Dong Hoon Lim, Yun Il Kang, Hyung Yoon Moon, Joon Rho, Chul Sung Kim
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Korean J Urogenit Tract Infect Inflamm 2007;2(1):96-99. Published online May 31, 2007
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- Renal tuberculosis is a rare disease, which can be easily misdiagnosed. Radiologically the following conditions may mimic renal tuberculosis: chronic pyelonephritis, papillary necrosis, medullary sponge kidney, calyceal diverticulum, renal carcinoma and xanthogranulomatous pyelonephritis. A 27 year old woman presented with recurrent episodes of urinary frequency and intermittent febrile sensation. Laboratory studies for genitourinary tuberculosis showed negative results. Excretory urography and abdominal CT scan revealed the finding of abscess in cealyceal diverticulum in the right kidney. Under the clinical diagnosis of an abscess in calyceal diverticulum, right partial nephrectomy was performed. The pathologic diagnosis revealed renal tuberculosis. We report a case of renal tuberculosis mimicking abscess in calyceal diverticulum.
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