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Systematic Literature Review of the Urological Field and Considerations in COVID-19
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Joongwon Choi, Hyun Soo Ryoo, Jae Hyun Ryu, Yun Beom Kim, Seung Ok Yang, Jeong Kee Lee, Tae Young Jung, Jung Hoon Kim, Tae-Hyoung Kim
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Urogenit Tract Infect 2021;16(1):1-7. Published online April 30, 2021
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DOI: https://doi.org/10.14777/uti.2021.16.1.1
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 Abstract
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- Coronavirus disease 2019 (COVID-19) was declared a worldwide pandemic in March 2020 after originating in China. Widespread uncertainty resulting from the pandemic has revolutionized urology practice worldwide, similar to that observed in other fields. The urological manifestations of COVID-19 were investigated by performing a literature search using a combination of keywords related to COVID-19 and urology. To date, COVID-19 has not been associated with any lower urinary tract symptoms, and there is no level 1 evidence that associates it with urinary malignancy and urolithiasis. Viral RNA has been detected in urine (5.74%), but there is no evidence of actual infection via urine. COVID-19 has transformed the standard urological practice into crisis-based care and has changed the medical and surgical priorities dramatically in the field. Most hospitals have established quarantine guidelines for each hospital, and procedures must be performed according to the present circumstances. Furthermore, in the absence of high-level evidence, specific efforts are needed to minimize the risk of COVID-19 infections during care.
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Current Opinions Regarding Defense Mechanisms during Urinary Tract Infection
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Jung Hoon Kim, Jong Kyou Kwon, In Ho Chang
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Korean J Urogenit Tract Infect Inflamm 2013;8(2):63-72. Published online October 31, 2013
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Abstract
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- Mucosal tissues in the gastrointestinal tract are exposed to a significant number of microorganisms, many of which present a danger to the host. In contrast, the urogenital tract is colonized rather infrequently with bacterial organisms and devoid of physical barriers such as a multi-layered mucus or ciliated epithelia, thereby necessitating separate host defense mechanisms. Recurrent urinary tract infection(UTI) represents successful microbial host evasion and poses a major health problem. In recent years, considerable advances have been made in our understanding of the mechanisms underlying the immune homeostasis of the urogenital tract. The system of pathogen-recognition receptors, including the Toll-like receptors, is able to sense danger signaling and thus activate the host immune system of the genitourinary tract. Various soluble antimicrobial molecules, including iron-sequestering proteins, defensins, cathelicidin, and Tamm-Horsfall protein, have been more clearly defined. In addition, involvement of signaling mediators such as cyclic adenosine monophosphate or the circulatory hormone vasopressin in the defense of uropathogenic microbes and maintenance of mucosal integrity has been demonstrated. Beyond this, specific receptors that are hijacked by uropathogenic Escherichia coli in order to enable invasion and survival within the urogenital system, paving the way for chronic forms of UTI, have been identified. The majority of these findings offer novel avenues for conduct of basic and translational research for development of effective therapies against the diverse forms of acute and chronic UTI.
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Epidemiology of Antimicrobial-Resistance in Sexually Transmitted Infections in Korea: Implications for Rational Treatment
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Jung Hoon Kim, In Ho Chang
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Korean J Urogenit Tract Infect Inflamm 2012;7(2):106-120. Published online October 31, 2012
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Abstract
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- Public health control of bacterial sexually transmitted infections (STIs) is dependent on the delivery of effective therapy and so will be compromised by the emergence of resistance. The scope of the problem and the implications for treatment that follow are discussed in this review.
Emerging resistance has been documented in all the bacterial STIs, but is considered rare and unconfirmed in Chlamydia trachomatis whereas Neisseria gonorrhea is of global concern. Azithromycin resistance has now been recognized in Mycoplasma genitalium, Treponema pallidum and N. gonorrhoeae, bringing into question its widespread use for chlamydial infection and threatening its future use. Rapidly increasing levels of decreased susceptibility to the extended-spectrum cephalosporins in N. gonorrhoeae and emerging treatment failures to both cefixime and ceftriaxone, without an obvious alternative agent, are of considerable concern. Implications for treatment include choice and timing of any change in therapy, reintroduction of test of cure and definition of treatment failure in an era of molecular testing.
Emerging resistance in all bacterial STIs and the particular problem of resistant gonorrhea will present a challenge to maintaining and prescribing antimicrobial therapy which is at the forefront of public health control. (Korean J UTII 2012;7:106-120)
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Selection of Antibiotics According to the Costs and Efficacy of Empirical Antibiotics Therapy for Extended Spectrum Beta-Lactamase Producing Uropathogens from Urine Culture Test in Patients with Acute Uncomplicated Cystitis
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Se Jun Park, Jae Hyung Ryu, Sang Ho Park, Jung Won Choe, Sang Hyup Lee, Jung Hoon Kim, Kyung Do Kim, Tae Hyoung Kim, Mi-Kyung Lee
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Korean J Urogenit Tract Infect Inflamm 2012;7(1):29-35. Published online April 30, 2012
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- "Purpose: The usage of antibiotics on urinary tract infection is high, thus, there is a high chance of acquiring resistance towards antibiotics. Followed by the usage of restricted antibiotics, the emergence of multiple drug resistant pathogens, such as ESBL producing pathogens, is frequently being reported, and the increase of resistant pathogens leads to the increase of medical treatment costs. An effective system of management and observation is needed for this. ESBL is an enzyme produced by gram-negative bacterium, which has beta-lactam rings, that restricts the effectiveness of penicillins and cephalosporins. Such antibiotics have been used as empirical antibiotics for acute cystitis. The effects of ESBL producing pathogens in patients on the curative effectiveness of empirical antibiotics are to be identified and appropriate antibiotics will be selected, according to the results with consideration to the cost. Materials and Methods: From the 4727 patients who have been diagnosed with cystitis between January 2000 and 2011 March, through urine culture test, 81 acute uncomplicated cystitis patients with ESBL producing pathogens were confirmed and their medical records were examined for this study. For 3~7 days empirical antibiotics, such as quinolone (ciprofloxacin / levofloxacin), cephalosporin (1st generation- cefroxadine / 2nd generation- cefprozil / 3rd generation- cefpodoxim, cefdinir), penicillin (amoxicillin-clavulanic acid), trimethoprim-sulfamethoxazole, were used and the curative effects were confirmed through urine culture test, with the improvements on the initial symptoms. For each antibiotic, the average medical insurance cost of domestic market as of May 2011 was applied and calculation was done after averaging for 3 days. Results: In urinalysis of 81 patients (age 44.89±17.42, 17~64), pyuria was confirmed in the urine of 79 patients (97.5%) and microscopic hematuria was confirmed in the urine of 17 patients (21.0%). In urine culture test, Escherichia coli was cultured in the urine of 79 patients (97.5%) and Klebsillea pneumonia was cultured in the urine of 2 patients (2.5%). Thirty three patients (40.7%) complained of suprapubic pain, 55 patients (67.9%) of urodynia, 69 patients (85.2%) of frequent urination and 37 patients (45.7%) of urgent urination. After taking antibiotics, not including 6 patients who have not returned, there were improvements in urine culture test and symptoms in all patients. In the reexamination of urine culture test, no significant pathogens were found. According to the cost, the cost was the cheapest in the order of trimethoprim-sulfamethoxazole (160/800mg, twice a day, 3 day therapy, 378 won), amoxicillin-clavulanic acid (250/125mg, three times a day, 3 day therapy, 3019.5 won), and ciprofloxacin (250mg, once a day, 3 day therapy, 3563.4 won). Conclusions: Even if ESBL producing pathogens were found in urine culture test of acute uncomplicated cystitis patient, curative effectiveness can be expected by just taking empirical antibiotic. In concerning the objective of this study as well as the efficacy and the cost, the most appropriate primary antibiotic is trimethoprim/sulfamethoxazole. The acute uncomplicated cystitis caused by ESBL producing pathogen has the same curative effects of antibiotics of the study, having no relations with the antibiotic sensitiveness. Therefore, the empirical antibiotic with no abnormal reactions, cheap cost and short duration of treatment should be selected for the therapy."
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Antimicrobial Prophylaxis for Genitourinary Prosthetics
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Jung Hoon Kim, Tae-Hyoung Kim
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Korean J Urogenit Tract Infect Inflamm 2011;6(1):1-7. Published online April 30, 2011
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- Infection is the most troublesome complication in urologic prosthetic surgery. Commonly implanted devices include penile prosthesis, artificial urinary sphincter, and artificial testes. Explantation of the prosthetic device has been standard treatment for infection. This supports the need for prophylactic antibiotic therapy, with the goal of preventing bacterial seeding. Antibiotic regimens should be effective against bacteria, particularly Staphylococcus epidermidis, Staphylococcusaureus, and Pseudomonas aeruginosa.
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