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Clinical Characteristics and Antimicrobial Susceptibility of Elderly Women with Acute Pyelonephritis
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Ji Kang Yun, Woong Bin Kim, Sang Wook Lee, Kwang Woo Lee, Jun Mo Kim, Young Ho Kim
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Urogenit Tract Infect 2020;15(3):71-78. Published online December 31, 2020
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DOI: https://doi.org/10.14777/uti.2020.15.3.71
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- Purpose: Acute pyelonephritis in older patients can lead to a poorer treatment response and prognosis. The objective of this study was to classify older female patients with acute pyelonephritis according to age and compare their clinical characteristics and antibiotic susceptibility.
Materials and Methods: In this retrospective study, 360 patients aged 65 years or older and hospitalized for acute pyelonephritis in a single tertiary medical facility from 2012 to 2016 were selected as research subjects. The patients were divided into three groups according to their age. Their clinical symptoms, blood tests and urinalysis, underlying diseases, causative organisms for urinary tract infections (UTIs), and antibiotic susceptibility were compared.
Results: One hundred and seventy-six patients aged 69.9±2.7 years, 142 patients aged 79.4±3.1 years, and 42 patients aged 87.3±3.1 years were assigned into the young-old, old-old, and oldest-old groups, respectively. The duration of hospitalization and fever due to acute pyelonephritis increased with age. On the other hand, the maximum body temperature was similar among the three groups. In blood tests, erythrocyte sedimentation rate and C-reactive protein increased with age. Among the underlying diseases, the incidence of diabetes and chronic renal disease was similar among the three groups, while cerebrovascular diseases, heart failure, and urinary stones were associated with aging. Older patients were more likely to have UTIs over the past year. Older groups showed a more significant decrease in sensitivity to carbapenems, amikacin, and ciprofloxacin.
Conclusions: Choosing appropriate antibiotics, considering the patientʼs age, is important when treating acute pyelonephritis.
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How Women Evaluate Syndromic Recurrent Urinary Tract Infections
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Woong Bin Kim, Sang Wook Lee, Kwang Woo Lee, Jun Mo Kim, Young Ho Kim, Min Eui Kim
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Urogenit Tract Infect 2019;14(2):46-54. Published online August 30, 2019
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DOI: https://doi.org/10.14777/uti.2019.14.2.46
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- Purpose: To investigate the clinical manifestations of patients with the principal complaint of syndromic recurrent urinary tract infection (UTI), correlate these symptoms with the results of urine cultures, and identify the characteristics that can be used to differentiate UTI from similar diseases.
Materials and Methods: A total of 212 consecutive patients with syndromic recurrent UTIs over a 24 month period were evaluated. The major symptoms were recorded using the UTISA questionnaire and VAS. The patients were divided into group A (n=98; positive urine and urethral swab cultures) and group B (n=114; negative cultures), and the symptoms were compared. For group B, cystoscopy was used to diagnose 61 patients who complained of pain levels ≥6 on the VAS.
Results: The proportion of patients with the classic symptoms of UTI (dysuria, urinary frequency, lower abdominal discomfort during bladder filling, and urgency) was similar in groups A and B. Significantly more patients complained of urethral pain in group B, and significantly fewer patients had gross hematuria, low back pain, a post-voiding sensation of residual urine, and general symptoms compared to group A. Of the 61 patients with a VAS ≥6, 29, 28, and four were diagnosed with bladder pain syndrome, interstitial cystitis, and urethral pain syndrome, respectively.
Conclusions: In patients with syndromic recurrent UTI, the classic symptoms were not sufficiently characteristic to allow bacterial cystitis to be differentiated from other bladder diseases. Diagnostic cystoscopy and VAS can assist in making a differential diagnosis in patients with non-bacterial syndromic recurrent UTIs.
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Recent Antimicrobial Susceptibilities for Uropathogenic Escherichia coli in Patients with Community Acquired Urinary Tract Infections: A Multicenter Study
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Woong Bin Kim, Kyu Hyoung Cho, Sang Wook Lee, Hee Jo Yang, Jong Hyun Yun, Kwang Woo Lee, Jun Mo Kim, Young Ho Kim, Youn Soo Jeon, Min Eui Kim
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Urogenit Tract Infect 2017;12(1):28-34. Published online April 30, 2017
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- Purpose: The aim of this study was to determine the prevalence and disease-specific antimicrobial susceptibility of Escherichia coli in urinary tract infections (UTIs).
Materials and Methods: A total of 862 patients older than 18 years of age, who were diagnosed with UTI between January 2013 and December 2015, were included. The results of urine culture, prevalence of extended-spectrum beta lactamase (ESBL)-producing E. coli, and antimicrobial susceptibility by disease were also examined.
Results: A total of 862 uropathogens were isolated. Among then, E. coli accounted for 756 (87.7%) isolates. The susceptibility rates of E. coli to the following antimicrobial agents were as follows: ampicillin 29.4%, cefazolin 70.5%, ceftazidime 75.1%, cefotaxime 75.0%, cefepime 76.2%, cefoxitin 88.8%, amoxicillin-clavulanic acid 63.6%, trimethoprim-sulfamethoxazole 60.6%, gentamicin 71.4%, ciprofloxacin 73.0%, piperacillin/tazobactam 93.9%, amikacin 99.2%, imipenem 99.1%, and ertapenem 99.3%. The frequency of ESBL-producing E. coli strains was 24.6%. The antimicrobial susceptibility of UTI varied by each disease, but without statistical significance.
Conclusions: It is necessary to regularly examine the disease-specific resistance rates to determine the appropriate empiric antibiotic treatment, and the national antibiotic usage policies must be reorganized according to the data obtained from these studies.
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New Era of Post Urinary Tract Infection Pain Syndrome
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Kwang Woo Lee, Young Ho Kim
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Urogenit Tract Infect 2016;11(2):49-55. Published online August 31, 2016
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- Urinary tract infection (UTI) in most cases is accompanied by pain. However, in some cases, including asymptomatic bacteriuria (ASB), pain is absent and thus, cannot be characterized. A study with an animal UTI model to quantify pelvic pain showed that Escherichia coli (NU14 strains) isolated from urine of patients with acute UTI caused pain, while E. coli (83972 strains) isolated from urine of patients with ASB caused no pain. The difference in pain response was not related to bladder colonization or inflammation, but to lipopolysaccharde (LPS) and Toll-like receptor 4, which is an LPS receptor. As the association between interstitial cystitis (IC) and UTI was epidemiologically suggested, an experiment was performed to investigate whether repeated infection with uropathogenic E. coli (UPEC) causes chronic pain through central sensitization. The results showed that repeated infection with the wild type UPEC caused temporary pain, while repeated infection with UPEC (SΦ 874 strains) in the absence of O-antigen caused chronic pain. Chronic pain following UTI is related to voiding dysfunction and anxious/depressive behavior. These relationships are mediated by transient receptor potential vanilloid type 1 at the stage of pain development and by C-C chemokine receptor type 2 at the stage of pain maintenance. Based on these findings, temporary E. coli infection causes chronic pain, which is one of the characteristics of neuropathic pain. This pattern is similar with the symptoms of IC, supporting the possibility of infection as an etiology of IC.
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Applications and Limitations of Polymerase Chain Reaction in Sexually Transmitted Disease
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Kwang Woo Lee, Young Ho Kim
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Korean J Urogenit Tract Infect Inflamm 2008;3(2):185-193. Published online October 31, 2008
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- Sexually transmitted diseases (STDs) are one type of important infectious diseases in patients who suffer from the genitourinary tract infections. Screening and detecting STDs is a form of secondary prevention, which interrupts further transmission as well as progression of the infection and its sequelaes. In an effort to better diagnose, treat, and control STDs, a number of new diagnostic assays using molecular techniques have been developed. Improved diagnostic testing by means of polymerase chain reaction (PCR) testing is now commercially available and may increase diagnostic capability. PCR has resulted in revisions of the proportion of STDs that are asymptomatic, and has increased measured prevalence of some STDs, notably. As a consequence of these molecular tools, the diagnostic repertoire of the clinical laboratory for the diagnosis of STDs will expand significantly, allowing investigators to better diagnose and more effectively control the spread of STDs. However, with such new technology, new problems and challenges have arisen, such as the risk of sample contamination resulting in false-positive results, and the presence of inhibitors resulting in false-negative results.
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Principles of Antimicrobial Treatment in Urologic Field
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Kwang Woo Lee, Min Eui Kim
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Korean J Urogenit Tract Infect Inflamm 2008;3(1):24-36. Published online April 30, 2008
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- There are two prominent aims in the antimicrobial treatment: (1) rapid and effective response to therapy and prevention of recurrence of the individual patient treated, and (2) prevention of emergence of resistance to antimicrobial chemotherapy in the microbial environment. The main drawback of current antibiotic therapies is the emergence and rapid increase of antibiotic resistance. To combat this establishment proper guidelines of antimicrobial treatment should be made. This article focuses on the principles of antimicrobial treatment with urinary tract infections, prostatitis, sexually transmitted diseases, and perioperative antibiotic prophylaxis in urologic field.
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Necessity of Clinical Guideline for Syphilis
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Jun Mo Kim, Kwang Woo Lee, Young Ho Kim, Min Eui Kim
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Korean J Urogenit Tract Infect Inflamm 2008;3(1):89-94. Published online April 30, 2008
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- "Purpose: To evaluate the practical variations in the diagnosis, treatment, and follow-up in the patients with syphilis. Materials and methods: A total of 659 patients with syphilis between 2002 to 2007 were retrospectively analyzed. Clinical data of gender, nontreponemal/treponemal test (rapid plasma reagin; RPR, Treponema pallidum haemagglutination assay; TPHA, Treponema pallidum latex agglutination; TPLA, fluorescent treponemal antibody absorption; FTA-ABS), presence of HIV, follow-up after treatment were collected. Results: The 107 patients (16.2%) with RPR negative were TPHA positive. The false positive rate of RPR was 7.1%. There was a different result between TPHA/TPLA and FTA-ABS in 7 patients. In the 185 patients who had follow-up RPR test after treatment with Benzathin penicillin RPR was converted into negative in 54 patients (29.1%). AIDS was diagnosed in 4 patients. Conclusions: This results indicate that the clinical practice in management for patients with syphilis is different in each doctors. The development of guideline for syphilis is needed to provide reasonable common management in diagnosis, treatment and follow-up of various patients with syphilis."
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The Expression of CC Cytokine, Macrophage Inflammatory Protein in a Acute Cystitis and Bladder Pain Syndrome
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Jun Mo Kim, Chae Hyun Kim, Yong-Wha Lee, Kwang Woo Lee, Young Ho Kim, Min Eui Kim
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Korean J Urogenit Tract Infect Inflamm 2007;2(2):190-196. Published online October 31, 2007
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- "Purpose: Macrophage inflammatory protein-1alpha (MIP-1alpha) and MIP-1beta are members of the CC chemokine subfamily. To evaluate the changes of the expression of macrophage inflammatory protein-1 (MIP-1α and MIP-1β) by ELISA test in the patients with acute cystitis and bladder pain syndrome. Materials and Methods: From January 2007 to May 2007, urine samples were obtained from 13 female control group, 16 female patients (mean age 44.8 years) with acute cystitis and 26 female patients (mean age 48.2 years) with bladder pain syndrome. The urine level of MIP-1α and MIP-1β were compared by enzyme linked immunosorbent assay (ELISA) test. Results: The urine level of MIP-1α and MIP-1β was not significantly higher in both group than control group. But urine level of MIP-1α in patients with acute cystitis by E. coli was significantly higher than control group (p=0.006). Conclusions: Although urine level of MIP-1α and MIP-1β in patients with acute cystitis and bladder pain syndrome were not higher than control group, MIP-1α was increased in acute cystitis by E. coli. "
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Inflammatory Pseudotumor of the Bladder after Total Hip Replacement
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Kwang Woo Lee, Hyun Kee Cho, Kong Jo Kim, Jun Mo Kim, Young Ho Kim, Eun Suk Go, Min Eui Kim
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Korean J Urogenit Tract Infect Inflamm 2007;2(1):83-87. Published online May 31, 2007
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- Inflammatory pseudotumor of urinary bladder is a rare benign disease that clinically and radiologically simulates a malignant tumor. We report a case of inflammatory pseudotumor in the urinary bladder after total hip replacement.
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