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Preventive Effect of Lactobacillus Fermentation Extract on Inflammation and Cytokine Production in Lipopolysaccharide-Induced Cystitis in Mice
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Hyun Suk Yoon, Yong Tae Kim, Bong Suk Shim, Hana Yoon
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Urogenit Tract Infect 2018;13(3):51-57. Published online August 31, 2018
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DOI: https://doi.org/10.14777/uti.2018.13.3.51
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- Purpose: The effects of Lactobacillus fermentation extract (LFE) on cystitis induced by Escherichia coli lipopolysaccharide (LPS) in the mouse bladder were investigated by pathological analyses and measurement of the levels of tumor necrosis factor-alpha (TNF-α) and interleukin-18 (IL-18).
Materials and Methods: LFE was administered orally (5 µg/L) to mice for 10 days after which the study group (n=12) received transurethral injection of 5 µg/L LPS. The bladder tissue was then harvested after 24 hours and subjected to hematoxylin and eosin staining. A semi-quantitative score was used to evaluate inflammation (bladder inflammation index, BII). TNF-α immunohistochemical staining and multiplex cytokine assays were also performed. TNF-α and IL-18 levels were determined. The results were compared with those of the control group (n=12).
Results: The BII in the control and study groups was 2.7±0.5 and 1.1±0.7, respectively, with the control group scores differing significantly from the study group scores (p<0.001). TNF-α immunohistochemical staining results were similar. The TNF-α levels determined by the multiplex cytokine assay were 2.82±1.35 pg/mg and 1.55±0.56 pg/mg for the control and study groups, respectively, and the difference between these groups was statistically significant (p=0.007).
Conclusions: Oral administration of LFE appears to have a preventive effect against the inflammatory responses and TNF-α expression induced by transurethral instillation of LPS in the mouse bladder. Further studies are required to determine the clinical application of this finding.
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Management of Antibiotic-Resistant Acute Pyelonephritis
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Ha Na Lee, Hana Yoon
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Urogenit Tract Infect 2017;12(3):95-102. Published online December 31, 2017
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- Acute pyelonephritis (APN) is a common urinary tract infection that affects a large proportion of women. Although antimicrobial therapy is a successful treatment in most cases, empirically, antibiotic resistance has emerged as a serious issue, including high resistance rate of fluoroquinolone and the advent of extended-spectrum β-lactamase (ESBL)-producing organisms. Several agents can be considered for the management of antibiotic resistant APN. Fosfomycin trometamol is effective in treating ESBL-producing bacterial infection. Oral trimethoprim/sulfamethoxazole, β-lactam agents, such as cephalosporin, and fluoroquinolone can be regarded as appropriate agents if pathogen is susceptible. Carbapenem, such as imipenem, meropenem, and doripenem, is one of the best and widely used agents for treating antibiotic resistant APN. However, there have recently been concerns regarding the increased rates of resistance to carbapenems. Daptomycin, linezolid, and tigecycline can be considered as solutions to antibiotic resistant organisms. Antibiotic resistant APN should be treated as other systemic infections to prevent antibiotic overuse with proper treatment duration considering carbapenem-saving strategy.
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The Antibiotic Susceptibility of Escherichia coli from Community-Acquired Uncomplicated Urinary Tract Infection: A Focused on Fosfomycin
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Hyun-Sop Choe, Seung-Ju Lee, In Ho Chang, Tae-Hyoung Kim, Hong Chung, Jae Min Chung, Sang Don Lee, Jae Hung Jung, Ki Ho Kim, Seung Ki Min, Yong Gil Na, Hana Yoon, Ho Song Yu, Mi-Kyung Lee, Sun-Ju Lee
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Urogenit Tract Infect 2017;12(2):77-81. Published online August 31, 2017
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- Purpose: To assess the antibiotic susceptibility of Escherichia coli from community-acquired uncomplicated urinary tract infection (UTI).
Materials and Methods: Between August and December of 2015, confirmed cases of E. coli as a pathogen of community-acquired uncomplicated UTI were collected and assessed for antibiotic susceptibility in 10 designated hospitals. Additional fosfomycin susceptibility test was performed by a central laboratory using the disk diffusion method.
Results: A total of 347 E. coli isolates were collected from urine samples of community-acquired uncomplicated UTIs patients. The susceptibility rates of antibiotics were as follows: amikacin 100.0% (347), imipenem 100.0% (347), ciprofloxacin 57.1% (198), cefotaxime 74.9% (260), ampicillin 30.0% (104), trimethoprim/sulfamethoxazole 66.9% (232), and fosfomycin 98.0% (340). All fosfomycin-resistant E. coli isolates were extended-spectrum β-lactamase (ESBL)-producing. In 85 cases of ESBL-producing E. coli, the fosfomycin susceptibility rate was 91.8% (78/85).
Conclusions: Fosfomycin may be a useful option for the treatment of community-acquired uncomplicated UTIs. Further studies evaluating the role of fosfomycin in the treatment of UTIs and its clinical efficacy are necessary.
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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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Changes of Interleukin-1β in the Prostate Secretions of Chronic Nonbacterial Prostatitis Patients
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Hana Yoon, Dong Hyeon Lee
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Korean J Urogenit Tract Infect Inflamm 2011;6(1):48-53. Published online April 30, 2011
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- "Purpose: To measure changes in prostate cytokine secretion in chronic non-bacterial prostatitis (NBP) patients and examine the clinical usefulness of these changes in differentiating the pathophysiologic mechanism of NBP and subsequent selection of treatment modalities. Materials and Methods: Sixty male patients were diagnosed with chronic NBP, and a control group comprised of 30 male patients without clinical evidence of NBP were enrolled in this study. Prostate secretion (centrifuged VB3) was analyzed at the initialdiagnosis and 8 weeks after treatment initiation. Patients who showed more than 10 white blood cells (WBCs)/high power field (HPF) 8 weeks after treatment initiation were categorized into group A. Group B patients had less than 3 WBCs/HPF. Group B was further subclassified into two groups according to presence of symptoms after treatment: Bp (symptom-persisted) and Br (symptom-resolved). IL-1β, C3, C4, IgG were measured and the results were analyzed. Results: There were significant differences in the IL-1β level in the control group compared to group A, Bp and Br (p<0.05). C3, C4, IgG showed higher levels in groups A and B than in the control group, albeit without statistical significance (p>0.05). Conclusions: Elevated IL-1β in group Bp suggests that chronic NBP patients who did not respond to treatment could exhibitclinical manifestations of autoimmune reactions rather than infection of external origin. We suggest that a more advanced diagnostic technique using cytokine at the initial stage of disease manifestation tohelp clinicians avoid unnecessary antibiotic treatment and manage the condition more effectively."
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Postmenopausal Women and Urinary Tract Infection
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Hana Yoon
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Korean J Urogenit Tract Infect Inflamm 2010;5(2):129-133. Published online October 31, 2010
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- "Urinary tract infection (UTI) is a common condition in elderly women. Despite the high prevalence of bacteriuria in the elderly, factors predisposing such women to UTI have been underexplored or compared to those identified in premenopausal women. The lack of estrogen, which characterizes the postmenopause, plays an important role in the pathogenesis of this condition. In postmenopausal women with recurrent UTI, therapy with oral or intravaginal estrogen reduced the rate of recurrence significantly. For other patients, an antimicrobial prophylactic regimen should be recommended in addition to hormonal treatment. In the case of an acute UTI, the antimicrobial treatment policy is similar to that in pre-menopausal women. In the case of recurrent UTI, a urological or gynecological evaluation should be performed, in order to exclude malignant or obstructive causes, detrusor failure or a genital infection."
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비뇨기과 영역에서 수술 전 예방적 항생제 사용: 유럽비뇨기과학회 가이드라인
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Hana Yoon
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Korean J Urogenit Tract Infect Inflamm 2010;5(1):110-117. Published online April 30, 2010
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- "The aim of antimicrobial prophylaxis in urological surgery is to prevent infective complications resulting from diagnostic and therapeutic procedures. However, the evidence on the best choice of antibiotics and prophylactic regimens is limited. There is no evidence for any benefits of antibiotic prophylaxis in standard non-complicated endoscopic procedures and extracorporeal shockwave lithotripsy (ESWL), though it is recommended in complicated procedures and patients with identified risk factors. For open surgery, the same rules as in abdominal surgery can be applied. No antibiotic prophylaxis is required for clean operations, while a single or 1-day dosage is recommended in clean-contaminated operations. Opening of the urinary tract should be considered as clean-contaminated surgery. A single dose or a short course of antimicrobials can be given, either parenterally or orally. The administration route will depend on the type of intervention and patient characteristics. The use of antimicrobials should be based on knowledge of the local pathogen profile and antibiotic susceptibility pattern. Best practice includes surveillance and an audit of infectious complications."
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전립선염과 만성골반통 증후군: 유럽비뇨기과학회 가이드라인
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Hana Yoon
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Korean J Urogenit Tract Infect Inflamm 2009;4(2):257-263. Published online October 31, 2009
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- "Prostatitis and chronic pelvic pain syndrome (CPPS) are diagnosed by symptoms and evidence of inflammation and infection localized to the prostate. Recent improvement in classification and application of modern methods, including molecular biology, should allow proper systematization of treatment. Acute bacterial prostatitis can be a serious infection. Parenteral administration of high doses of a bactericidal antibiotic is usually required, which may include a broad-spectrum penicillin, a third-generation cephalosporin, or a fluoroquinolone. Treatment is required until there is defeverescence and normalization of infection parameters (IIIB). In chronic bacterial prostatitis, and if infection is strongly suspected in CPPS, a fluoroquinolone or trimethoprim should be given orally for 2 weeks after the initial diagnosis. Antibiotics only continued if pre-treatment cultures are positive and/or the patient has reported positive effects from the treatment. A total treatment period of 4-6 weeks is recommended (IIIB). Patients with CPPS are treated empirically with numerous medical and physical modalities. Despite the existence of some scientifically valid studies, no specific recommendations have been made until now."
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Correlation between Female Lower Urinary Tract Symptoms, Pyuria and Urine Cytology in Female with Microscopic Hematuria
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Seok Seon Yoo, Jin Mo Koo, Geun Sik Hong, Bong Suk Shim, Hana Yoon
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Korean J Urogenit Tract Infect Inflamm 2009;4(1):62-66. Published online April 30, 2009
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- "Purpose: Due to increasing number of routine health check, urine cytology test is also increasing to rule out malignant origin of microscopic hematuria. In female, chronic inflammatory condition of the lower urinary tract with or without symptoms are not uncommon and this condition also leads to abnormal urinalysis or urinary cytologic study. In this study, we aimed to investigate the clinical correlation of the factors related with chronic inflammatory conditions in urine cytology result. Materials and Methods: We retrospectively reviewed 103 female patients with microscopic hematuria from January 2005 to January 2008. All the data of participating patients were analyzed, and were divided into two groups; normal urine cytology group and abnormal urine cytology group. In each group, correlation between lower urinary tract symptoms (LUTS), pyuria and cytology result was analyzed. Results: In each test group we found that LUTS does not influence to urine cytology results (p=0.549). In the other hand, more pyuria cause more abnormal urine cytology results (p=0.006). Conclusions: Pyuria had effect on urine cytology result. Pyuria with or without LUTS was common in female. Therefore, care should be taken to evaluate female patients with positive hematuria response to routine urine screening test."
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2007 UK National Guideline on the Management of Non-gonococcal Urethritis
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Hana Yoon
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Korean J Urogenit Tract Infect Inflamm 2009;4(1):134-139. Published online April 30, 2009
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- "The main objective is to reduce the number of sexually transmitted infections (STIs) and the complications that can arise in people either presenting with signs and symptoms of an STI, or undergoing investigation for possible infection. Specifically, this guideline offers recommendations on the diagnostic tests, treatment regimens and health promotion principles needed for the effective management of non-gonoccocal urethritis (NGU), covering, the management of the initial presentation, as well as how to prevent transmission and future infection. The recommendation of this guideline may not be appropriate for use in all clinical situations. Decisions to follow these recommendations must be based on the professional judgement of the clinician and consideration of individual patient circumstances and available resources."
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Chemopreventive Effect of Aspirin on the Prostate Cancer
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Bong Suk Shim, Hana Yoon
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Korean J Urogenit Tract Infect Inflamm 2008;3(2):194-198. Published online October 31, 2008
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- "Purpose: Aspirin, which widely being used in prevention of cerebrovascular or cardiovascular disease also has cancer preventive effect in the colon, esophagus, and bladder. In this study, we aimed to investigate its preventive effect in the prostatic tissue in respect of inflammation and malignancy. Materials and methods: From January 2004 to December 2007, 164 patients who had been done prostatic biopsy either due to high PSA (4ng/dL), digital rectal examination, or transrectal ultrasonography were included to this study. They were devided into three groups according to their duration of aspirin medication; group A (not medicated at all, N=74), group B (less than 5 years of medication duration, N=60), and group C (5 or more than 5 years of medication duration, N=28). Serum PSA, prostate volume, and positive yielding rate of transrectal biopy were analyzed. Results: Mean age of each group was 69.23 (A), 70.78 (B), 67.05 (C) years old (p>0.05). Mean prostatic volume was not significantly different in each group (42.48, 43.72, and 41.97gm, respectively, p>0.05). However, the positive yielding rate was significantly lower in group C (3.5%) rather than group A (38.1%) or group B (31.6%) (p<0.05). Logistic regression analysis of the effect of the duration of aspirin medication to positive yielding rate of prostatic cancer showed significantly decreased incidence of positive rate of prostatic cancer in patients with 5 year or longer duration of medication (OR=0.72; 95% CI 0.35~1.50 vs. OR=0.06; 95% CI 0.01~0.48). Conclusion: This study supports the cancer preventive effect of aspirin. Lower incidence of positive rate in the patients who take aspirin over 5 years or longer, shows that the prolonged medication of aspirin may protect the development of prostate cancer."
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Preliminary Study on Protective Effect of Urovaxom? in the Longterm Urinary Catheterized Patients
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Jae Young Yoo, Bong Suk Shim, Hana Yoon
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Korean J Urogenit Tract Infect Inflamm 2008;3(1):95-98. Published online April 30, 2008
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- "Purpose: Catheter associated urinary tract infections are a major health concern in chronic catheterizing patients due to the complications and frequent recurrence. In this study, we aimed to investigate the effect of conventional Urovaxom? administration in chronic urinary cathterizing patients in respect of prevention of recurrent symptomatic urinary tract infections (UTIs). Materials and Methods: Subjects were adult male and female patients who have been catheterized for urinary drainage with any pathologic reason more than 1 month. Among 15 eligible patients 13 patients (2 males, 11 females) were enrolled to this study. Urovaxom? was parenterally administered at least for more than 3 months. Before and after three months of drug administration urinalysis and urine culture tests were followed. Results: There were no significant adverse effects with Urovaxom? administration during the study period. All of the 13 patients showed clearance of bacterial growth after taking Urovaxom? eventhough some of them showed persistent microscopic hematuria or pyuria. Conclusions: UTIs and their associated complications are one of the bothering problems in chronic catheterizing patients. Urovaxom? showed positive effect in preventing UTIs recurrence in our small group study, eventhough further research will be required. Urovaxom? administration will give beneficial effect in some selective patients with chronic catheterization."
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European and Asian Guidelines on Management and Prevention of Catheter-associated Urinary Tract Infections
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Hana Yoon
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Korean J Urogenit Tract Infect Inflamm 2008;3(1):137-147. Published online April 30, 2008
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- The urinary tract is the commonest source of nosocomial infection, particularly when the bladder is catheterised. A systematically reviewed guideline has been published by European association of Urology and Tenke et al. updated the guideline of catheter management. Most catheter-associated urinary tract infections (UTIs) are derived from the patient’s own colonic flora and the catheter predisposes to UTI in several ways. The most important risk factor for the development of catheter-associated UTIs is the duration of catheterization. The clinician should be aware of two priorities: the catheter system should remain closed and the duration of catheterization should be minimal. While the catheter is in place, systemic antimicrobial treatment of asymptomatic catheter-associated bacteriuria is not recommended, except for some special cases. Clinicians should always consider alternatives to indwelling urethral catheters that are less prone to causing symptomatic infection. In appropriate patients, suprapubic catheters, condom drainage systems and intermittent catheterization are each preferable to indwelling urethral catheterization.
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