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Impact of Antibiotics on the Efficacy of Immune Checkpoint Inhibitors in Metastatic Urothelial Carcinoma
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Do Gyeong Lim, Ho Yeon Lee, Ho Seok Chung, Eu Chang Hwang, Seung Il Jung, Dong Deuk Kwon
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Urogenit Tract Infect 2023;18(3):75-81. Published online December 31, 2023
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DOI: https://doi.org/10.14777/uti.2023.18.3.75
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- Purpose: Emerging evidence has suggested that prior or concurrent antibiotic (ATB) use may be associated with a poor response to immune checkpoint inhibitors (ICIs) in patients with some solid tumors. This study examined the effects of ATB use on the oncological outcomes of patients receiving ICIs for mUC.
Materials and Methods: Patients receiving ICIs for mUC between 2018 and 2020 were assessed retrospectively. Those with over three cycles of atezolizumab or pembrolizumab were included. ATB use, defined as ≥ three days within 60 days before or three months after ICI administration, was compared between groups for oncological outcomes.
Results: Thirty-one patients were examined. The ATB-use and no-ATB-use groups consisted of 15 (48.4%) and 16 patients (51.6%), respectively. The ATB-use group showed a lower disease control rate (56.3% vs. 13.3%, p=0.023) than the no-ATB-use group. The objective response rate in the ATB-use group was lower than the no-ATB-use group, but the difference was statistically insignificant (43.7% vs. 13.3%, p=0.113). The ATB-use group had shorter progression-free survival (median three vs. six months, log-rank p=0.045) and shorter overall survival (median three vs. 14 months, log-rank p=0.023) than the no-ATB-use group. The most commonly used antibiotics were fluoroquinolones (46.7%), cephalosporins (40.0%), non-cephalosporin beta-lactams (6.7%), and nitrofurantoin (6.7%).
Conclusions: ATB may be associated with poorer oncological outcomes in patients with mUC who received ICI therapy. Hence, further research will be needed to understand the relationship between the modulation of ATB-related dysbiosis and gut microbiota composition with the oncological outcomes in patients with mUC.
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Performance of the Sysmex UF-1000i System in Screening for Significant Bacteriuria in Patients with Bladder Cancer Who Received Bacillus Calmette-Guérin Treatment
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Tae Hee Kim, Seung Il Jung, Myung Soo Kim, Hyun-Jung Choi, Ho Seok Chung, Eu Chang Hwang, Dong Deuk Kwon
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Urogenit Tract Infect 2020;15(2):38-46. Published online August 31, 2020
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DOI: https://doi.org/10.14777/uti.2020.15.2.38
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- Purpose: Diagnosing urinary tract infections by urine culture is time-consuming during a Bacillus Calmette-Guérin treatment. Because the urine culture results take time to collect, patients are treated presumptively, or Bacillus Calmette-Guérin is discontinued before the results. This study evaluated the ability of the Sysmex UF-1000i system to examine the urine bacterial count and determine if it could be used to predict a positive culture.
Materials and Methods: 180 patients who underwent transurethral resection for bladder tumors and received intravesical Bacillus Calmette-Guérin treatment between January 2017 and July 2018 were evaluated prospectively. For patients who received an intravesical Bacillus Calmette-Guérin treatment, urine flow cytometry, and urine cultures were assessed weekly during the treatment period.
Results: During Bacillus Calmette-Guérin instillation, 44, 146, and 27 patients had bacteriuria, pyuria, and positive urine nitrite, respectively. Multivariate analysis indicated that the predictors associated with bacteriuria included the urine flow cytometry results of ＞100 bacteria/µl (odds ratio, 22.73; p＜0.001) and positive urine nitrite (odds ratio, 5.67; p=0.012) at the time of sampling for positive urine culture. The area under the receiver operative characteristic curve for diagnosing bacteriuria by urine flow cytometry was 0.825. A urine flow cytometry cutoff value of ＞100 bacteria/µl resulted in a sensitivity and specificity of 75% and 90.91%, respectively. Using the cutoff of ＞1,000 bacteria/µl, the sensitivity and specificity were 50% and 94.85%, respectively.
Conclusions: Rapid urinary tract infection diagnosis using Sysmex UF-1000i can be used to determine whether to treat an infection and to avoid unnecessary Bacillus Calmette-Guérin discontinuation and urine culture tests.
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Rates and Risk Factors of Bacteriuria in Patients with Bladder Cancer Who Underwent Treatment with Bacillus Calmette-Guérin
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Seong Jong Eun, Myung Soo Kim, Seung Il Jung, Hyun-Jung Choi, Ho Seok Chung, Eu Chang Hwang, Dong Deuk Kwon
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Urogenit Tract Infect 2020;15(2):47-53. Published online August 31, 2020
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DOI: https://doi.org/10.14777/uti.2020.15.2.47
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- Purpose: This study evaluated the rate and predictors of bacteriuria in patients who underwent transurethral resection of bladder tumor (TURBT) and Bacillus Calmette-Guérin (BCG) treatment.
Materials and Methods: We prospectively evaluated 266 patients who underwent TURBT and intravesical BCG treatment between January 2017 and September 2019. Urinalysis and urine culture were performed at the baseline, one to two weeks after TURBT and weekly during the BCG treatment period. The primary outcomes were the bacteriuria rates in BCG-treated patients, while the secondary outcomes were the risk factors of bacteriuria during BCG treatments.
Results: Of the 266 patients, the rate of bacteriuria was 4.5% before TURBT, 5.3% in the postoperative period, and 24.4% in the BCG treatment period. After BCG instillation, urinalysis showed that 204 and 38 patients tested positive for pyuria and nitrite, respectively. Multivariate analysis indicated that the risk factors associated with bacteriuria during BCG treatment included age (odds ratio [OR]: 1.06; p=0.003), sex (female) (OR, 5.41; p=0.007), diabetes mellitus (DM) (OR, 2.82; p=0.023), postoperative bacteriuria (OR, 8.08; p=0.032), bacterial counts>100/µl in urine flow cytometry (OR, 29.72; p<0.001), and positive urine nitrite test (OR, 6.20; p=0.001) at the time of positive urine culture sampling.
Conclusions: Approximately 25% of the patients suffered from bacteriuria during intravesical BCG treatment. Old age, female sex, DM, and postoperative bacteriuria were found to be the risk factors of bacteriuria during BCG treatment. Predictive factors could aid in clinical decisions during BCG treatments as well as decisions on BCG discontinuation.
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Optimal Modified Extended Antibiotic Prophylaxis for Prostate Biopsy: The Addition of Two Intravenous Doses of Amikacin to Ciprofloxacin
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Seong Hyeon Yu, Seung Il Jung, Myung Soo Kim, Ho Seok Chung, Dong Deuk Kwon
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Urogenit Tract Infect 2018;13(3):72-78. Published online December 31, 2018
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DOI: https://doi.org/10.14777/uti.2018.13.3.72
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- Purpose: This retrospective study was undertaken to investigate whether increasing amikacin dosage for ciprofloxacin prophylaxis in patients with fluoroquinolone (FQ)-resistant rectal flora reduce infectious complications after transrectal ultrasound-guided prostate biopsy (TRUSPB).
Materials and Methods: A total of 430 patients with FQ-resistant rectal flora based on rectal swab cultures were divided into two groups. Patients in both groups were administered ciprofloxacin (400 mg, intravenous [IV], twice daily) on the same day as TRUSPB and one day after biopsy. However, whereas group 1 patients (n=202) were administered a single injection of amikacin (1g, IV) one hour before TRUSPB, patients in group 2 (n=228) were administered two injections of amikacin (1g, IV) before one hour TRUSPB and again on the day after TRUSPB.
Results: Of the 430 study subjects, 129 (30.0%) showed extended-spectrum beta-lactamase (ESBL) positivity. The overall incidence rate of infectious complications was 2.8% (12/430). Infectious complication rates were 4.0% (8/202) in group 1 and 1.3% (3/228) in group 2 (p=0.075). Urinary tract infection and acute prostatitis were more frequent in group 1 (3.5% vs. 0.4%, p=0.029). Infectious complication rates in ESBL negative patients were 3.4% (5/145) in group 1 and 1.3% (2/156) in group 2, whereas those in ESBL positive patients were 7.0% (4/57) in group 1 and 1.4% (1/72) in group 2.
Conclusions: Increasing the dosage of amikacin for ciprofloxacin prophylaxis reduce infectious complications in patients with FQ-resistant rectal flora and to be more effective in ESBL positive patients with FQ-resistant rectal flora.
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Infectious Complications after Prostate Biopsy: A Prospective Multicenter Prostate Biopsy Study
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Eu Chang Hwang, Ho Song Yu, Seung Il Jung, Dong Deuk Kwon, Sun Ju Lee, Tae-Hyoung Kim, In Ho Chang, Hana Yoon, Bongsuk Shim, Kwang Hyun Kim, Donghyun Lee, Jung-Sik Huh, Dong Hoon Lim, Won Jin Jo, Seung Ki Min, Gilho Lee, Ki Ho Kim, Tae Hwan Kim, Seo Yeon Lee, Seung Ok Yang, Jae Min Chung, Sang Don Lee, Chang Hee Han, Sang Rak Bae, Hyun Sop Choe, Seung-Ju Lee, Hong Chung, Yong Gil Na, Seung Woo Yang, Sung Woon Park, Young Ho Kim, Tae Hyo Kim, Won Yeol Cho, June Hyun Han, Yong-Hyun Cho, U-Syn Ha, Heung Jae Park, The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII)
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Urogenit Tract Infect 2016;11(1):17-24. Published online April 30, 2016
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- Purpose: Recent studies have highlighted an increasing trend of infectious complications due to fluoroquinolone-resistant organisms among men undergoing transrectal prostate biopsy. This study evaluated the current incidence of infective complications after trans-rectal prostate biopsy for identification of risk factors in Korean men who received fluoroquinolone prophylaxis.
Materials and Methods: A prospective, multicenter study was conducted in Korea from January to December 2015. Prostate biopsies performed with fluoroquinolone prophylaxis during 3 months in each center were included. A pre-biopsy questionnaire was used for identification of patient characteristics. Clinical variables including underlying disease, antibiotic prophylaxis, enema, povidoneiodine cleansing of the rectum, and infectious complications were evaluated. The primary outcome was the post-biopsy infection rate after fluoroquinolone prophylaxis. Univariable and multivariable analyses were used for identification of risk factors for infectious complications.
Results: The study included 827 patients, of whom 93 patients (11.2%) reported receiving antibiotics in the previous 6 months and 2.5% had a history of prostatitis. The infectious complication rate was 2.2%. Post-biopsy sepsis was reported in 2 patients (0.2%). In multivariable analysis predictors of post-biopsy sepsis included person performing biopsy (adjusted odds ratio [OR], 4.05; 95% confidence interval [CI], 1.31-12.5; p=0.015) and operation history within 6 months (adjusted OR, 5.65; 95% CI, 1.74-18.2; p=0.004).
Conclusions: The post-prostate biopsy infectious complication rate in this study was 2.2%. Person performing biopsy (non-urologists) and recent operation history were independent risk factors for infectious complications after trans-rectal prostate biopsy.
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Risk Factors of Infectious Complications after Transurethral Prostate Surgery in Patients with Preoperative Sterile Urine
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Eu Chang Hwang, Seong Hyeon Yu, Jong Beom Kim, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park
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Korean J Urogenit Tract Infect Inflamm 2013;8(1):27-31. Published online April 30, 2013
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- Purpose: To determine the risk factors of infectious complications after transurethral surgery of the prostate in patients with sterile urine.
Materials and Methods: A total of 183 patients who underwent transurethral resection of the prostate or holmium laser enucleation of the prostate were reviewed. All patients had urinalyses and urine cultures preoperatively, on the day of catheter removal, and at two weeks postoperatively. Patients were divided into two groups according to whether preoperative urinalysis showed sterile urine (group I, n=99) or not (group II, n=84). Clinical parameters were compared between the two groups. Univariate and multivariate logistic regression were used for estimation of infectious complications after surgery in group I.
Results: Compared with group II, group I showed younger age, fewer post voided residuals, low prostate specific antigen levels, short-term duration of oral antibiotic therapy, and low incidence of infectious complications (p＜0.05). In univariate analysis in group I, age, diabetes mellitus (DM), prostate volume, resection weight, and duration of oral antibiotic therapy showed an association with infectious complications (p＜0.05). Factors showing independent association with infectious complications in group I were DM (odds ratio [OR], 7.31; 95% confidence interval [CI], 1.83-29.0; p=0.005), resection weight (OR, 1.03; 95% CI, 1.01-1.06; p=0.039), and duration of oral antibiotics (OR, 0.64; 95% CI, 0.43-0.94; p=0.025).
Conclusions: Kinds of antibiotics showed no effect on infectious complication, therefore, second generation cephalosporin is recommended for reduction of antibiotic resistance. Clinicians should be aware of the high risk for infectious complication in patients with DM and who underwent large volume resection of the prostate.
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Clinical Study According to Presence of Prior Manipulation in Patients with Acute Bacterial Prostatitis
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Kwang Ho Kim, Eu Chang Hwang, Sun Ouck Kim, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwang Sung Park
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Korean J Urogenit Tract Infect Inflamm 2012;7(2):172-177. Published online October 31, 2012
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- Purpose: Acute bacterial prostatitis (ABP) is uncommon and proper guidelines concerning antibiotic administration for ABP with urologic procedure are unclear. We retrospectively analyzed clinical symptoms and etiologic organism in ABP according to presence of prior urologic manipulation.
Materials and Methods: The clinical records of 65 patients who had been treated for ABP between January 2007 and December 2011 were reviewed. We analyzed parameters including history taking, physical examination, prior manipulations, antibiotics administration, mean length of treatment, complications, urinalysis, and urine and blood culture. Results were analyzed according to two subgroups; Group 1, those without prior urologic manipulation, and Group 2, those with prior manipulation.
Results: The population of Group 1 was 22 (33.8%) and Group 2 was 43 (66.2%). The mean age of the patients in both groups were 56.5±15.6 years and 64.0±12.5 years, respectively. Of the clinical symptoms in both groups, fever was most common (81.8% and 83.7%). The mean pyuria grades were 2.82±0.37 and 3.47±0.25 each in both groups. In group 2, prostatic biopsy (36, 83.7%) was the most frequent manipulation of the patients. Dysuria and storage symptoms were significantly more frequent in Group 1. The number of diabetes mellitus patients and the admission rates were higher in Group 2. E. coli was the most frequently isolated pathogen from urine and blood (23.1% and 24.6%, respectively). Resistance to ciprofloxacin was very high in group 1 (60.0%) and group 2 (83.3%). However, there was no significant difference between the two groups.
Conclusions: Resistance rates to ampicillin and ciprofloxacin in ABP were very high in all patients. The resistance rates were higher in patients with prior manipulation, but there was no significant difference. When we consider high resistance to ciprofloxacin in ABP, more careful attention should be paid to empirical treatment of ABP patients with prior manipulation. (Korean J UTII 2012;7:172-177)
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Prophylactic Effectiveness of Second Generation Cephalosporin According to Prostatic Operation Methods
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Seong Woong Na, Eu Chang Hwang, Seung Il Jung, Dong Deuk Kwon, Kwangsung Park, Soo Bang Ryu
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Korean J Urogenit Tract Infect Inflamm 2011;6(2):171-177. Published online October 31, 2011
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- "Purpose: There is no definitive standard concerning the use of prophylactic antibiotics for prostatic operations, except for transurethral resection of prostate (TUR-P). This study prospectively investigated the prophylactic effectiveness of a second generation cephalosporin according to prostatic operation method. Materials and Methods: From October 2010 to January 2011, prostatic operations were conducted for 67 patients: group I (radical prostatectomy, n=18), group II (TUR-P, n=38), group III (laser TUR-P, n=11) for 11: group III). Prophylactic antibiotics were intravenously administered beginning 1 hour preoperatively and orally with several days postoperatively. Prophylactic effectiveness was evaluated by comparison of urine analysis and presence of bacteriuria. Results: In group I, no patient had preoperative Foley catheter installation, and mean antibiotic prescription period pre- and post-operatively was 5.83 days and 6.94 days. Five group I patients (27.8%) displayed bacteriuria. In group II, 9 patients had preoperative Foley catheter installation and mean antibiotic prescription period was 3.76 days and 5.68 days, respectively. Five patients (13.2%) had postoperative bacteriuria; two in preoperative catheterized patients and three in preoperative non-catheterized patients. In group III, mean antibiotic prescription period was 1.73 days and 5.09 days, respectively. There was no postoperative bacteriuria. Conclusions: Prophylactic use of a second generation cephalosporin for prostatic operation, except laser TUR-P, was limited in preventing postoperative pyuria with bacteriuria. There was a tendency of higher occurrence of postoperative bacteriuria in patients with preoperative Foley catheter installation."
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Clinical Features of Bacteremia Caused by Ciprofloxacin-Resistant Bacteria after Transrectal Ultrasound-Guided Prostate Biopsy
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Bo Sung Shin, Eu Chang Hwang, Seung Il Jung, Dong Deuk Kwon, Kwangsung Park, Soo Bang Ryu, Jin Woong Kim
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Korean J Urogenit Tract Infect Inflamm 2011;6(1):61-66. Published online April 30, 2011
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- "Purpose: Fluoroquinolone is considered the prophylactic antibiotic of choice for Transrectal ultrasound (TRUS)-guided biopsy. However, failure of quinolone prophylaxis due to emerging quinolone-resistant enterobacteriae has been increasing. We reviewed bacteremia cases after TRUS-guided biopsy to identify antibiotic-resistant bacterial strains with the objective to prevent urosepsis. Materials and Methods: A total of 2,348 patients underwent TRUS-guided biopsy at our institution between January 2004 and December 2009. All patients received intravenous ciprofloxacin for prophylaxis. We retrospectively evaluated patients who developed infectious symptoms, such as fevers and chills. Results: Eleven (0.4%) of 2,348 patients developed infectious symptoms. Escherichia coli was the pathogen responsible for post-biopsy infections occurring in a; 11 (100%) patients with positive blood cultures, which confirmed ciprofloxacin-resistant E. coli, with one isolate producing extended-spectrum beta lactamase. Ten out of 11 E. coli isolates (91%) were resistant to ampicillin and 9 of 11 E. coli isolates (82%) were resistant to gentamicin. Ten out of 11 E. coli isolates (91%) were susceptible to third generation cephalosporins. All such patients were admitted to the hospital and treated with a third generation cephalosporin. One patient who habored an E. coli isolate producing extended-spectrum beta-lactamase received imipenem. Conclusions: Ciprofloxacin is effective in reducing infectious complications. However, recently, bacteremiccases are increasing due to ciprofloxacin resistant E. coli. For patients with infectious symptoms after transrectal prostate biopsy, early antibiotics change, including third generation cephalosporins, are recommended to prevent urosepsis."
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Fournier’s Gangrene: Six Years of Experience with 33 Patients and Validity of the Fournier’s Gangrene Severity Index Score in Korean Patients
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Eu Chang Hwang, Seong Woong Na, Young Jung Kim, Jun Seok Kim, Sun-Ouck Kim, Seung Il Jung, Dong Deuk Kwon, Kwangsung Park, Soo Bang Ryu, Lu Ji Wan
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Korean J Urogenit Tract Infect Inflamm 2010;5(2):199-206. Published online October 31, 2010
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- "Purpose: To identify predictive factors of survival in patients with Fournier’s gangrene (FG), and to determine the validity of the Fournier’s Gangrene Severity Index Score (FGSIS) in Korean patients. Materials and Method: Thirty-three patients with FG were enrolled. Data were collected regarding medical history, symptoms, physical examination findings, admission laboratory tests, and the extent of body surface area involved (%). The FGSIS, which was developed to assign a numerical score that describes the disease acuity, was used in our study. The data were assessed based on whether or not the patient had survived. Results: Of the 33 patients, 16 survived (48.5%, Group I) and 17 died (51.5%, Group II). Isolated FGSIS and admission laboratory parameters that were statistically different in the two groups included heart rate (p=0.009), white blood cell count (WBC; p=0.035), and serum calcium (p=0.001). The mean body surface area in Group II was statistically different from that of Group I (6.4% vs. 2.4%, p=0.001). The mean FGSIS for groups I and II was 6.6±3.7 and 8.2±4.1, respectively (p=0.26). Based on univariate regression analysis, disease severity had no correlation with the FGSIS. However, isolated parameters, including heart rate, WBC count, serum total calcium level, and the extent of body surface area involved was associated with disease severity. Conclusions: Although the FGSIS was not shown to be a predictive factor for disease severity, metabolic parameters and the extent of body surface area involved appeared to be important factors for predicting FG severity."
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Candida Infection Accompanying Glans Necrosis in Diabetic Patient
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Bo sung Shin, Hyunchong Ki, Eu chang Hwang, Chang Min Im, Sook Jung Yun, Seung IL Jung, Dong Deuk Kwon
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Korean J Urogenit Tract Infect Inflamm 2010;5(1):93-96. Published online April 30, 2010
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- Candida albicans is considered to be responsible for up to 35% of all cases of infectious balanitis. We report a man with glans necrosis with candidal infection. A 56 year old man visited our institute to consult for penile pain and black colored glans of penis. He had noted two months earlier due to gradually increased wounds, resulting in voiding difficulty. On the physical examination, there was hard necrotic lesion on the glans of penis with secondary meatal stenosis. Tissue culture and biopsy suggested candidial infection. We review the literature on the different forms of presentation of this condition and the differential diagnosis of ischemic penile lesions.
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Pyeloureteritis Cystica accompanied by Nonfunctioning Kidney
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Jun Back Park, Chang Min Im, Seung IL Jung, Chan Choi, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park, Soo Bang Ryu
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Korean J Urogenit Tract Infect Inflamm 2009;4(2):224-227. Published online October 31, 2009
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- Pyeloureteritis cystica is a rare cystic disease formed in the mucosa or submucosa of the renal pelvis and ureter caused by chronic inflammation and irritation, and characterized by multiple filling defects noted on the contrast imaging. The clinical course is usually slow, but manifests if the lesionscause infection or obstruction. Stones are further complication to the disease. We report a case of 69-year-old woman with right flank pain, who had an pyeloureteritis cystica withnonfunctioning kidney caused by proximal ureter stone. The diagnosis was made after nephroureterectomy, followed by pathologic examination.
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Retroperitoneal Fibrosis with Spontaneous Subcapsular Renal Hemorrhage Treated with Medical Thearpy
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Eu Chang Hwang, Ho Suck Chung, Chang Min Im, Seung Il Jung, Dong Deuk Kwon, Kwangsung Park, Soo Bang Ryu, Jun Eul Hwang1
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Korean J Urogenit Tract Infect Inflamm 2009;4(1):86-88. Published online April 30, 2009
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- Spontaneous subcapsular renal hemorrhage is relative uncommon. The literature suggests that the majority causes for this phenomenon associated with disease of the kidney, blood vessel disease, blood dyscrasia. We report a unique case of retroperitoneal fibrosis combined with subcapsular renal hemorrhage. The patient was successfully treated with medical therapy.
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Bacteremia Caused by Acinetobacter Baumannii during the Treatment of Staghorn Calculi
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Seung Il Jung, Kyung-Chul Son, Taek Won Kang, Dong Deuk Kwon, Kwangsung Park, Soo Bang Ryu
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Korean J Urogenit Tract Infect Inflamm 2008;3(1):116-119. Published online April 30, 2008
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- Acinetobacter baumannii, a gram-negative, ubiquitous bacteria present in the soil, water and on the skin surface of human beings and animals, is responsible for bronchopneumonia and bacteremia in immuno- compromised and severely illed people, but rarely represents a problem in healthy individuals. We report a case of bacteremia due to Acinetobacter baumannii in a 45-year-old women who underwent percutaneous nephrolithotomy for staghorn calculi.
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