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Changes of Causative Organism and Antimicrobial Resistance in Urinary Tract Infections After the COVID-19
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Young Ho Choi, Jong Hyun Tae, Mi-Kyung Lee, Tae-Hyoung Kim
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Urogenit Tract Infect 2022;17(2):42-49. Published online August 31, 2022
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DOI: https://doi.org/10.14777/uti.2022.17.2.42
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- Purpose: During the coronavirus disease 2019 (COVID-19) pandemic, several studies reported changes in the distribution of microorganisms that cause major legal, respiratory, and gastrointestinal infectious diseases and increases in the antimicrobial resistance rates in Korea. On the other hand, there has been little domestic research on the causative organism of urinary tract infection (UTI). This study investigated the influence of the COVID-19 pandemic on the distribution of causative organisms and the antimicrobial resistance rate in UTI.
Materials and Methods: This study analyzed 17,201 urine cultures retrospectively from patients who visited Chung-Ang University Hospital from January 2018 to December 2021. Tests were then conducted to determine if there was a significant difference between the data for the eight quarters of the pre-COVID-19 period (January 2018 to December 2019) and the data for the eight quarters post-COVID-19 period (January 2020 to December 2021).
Results: Escherichia coli was the most common causative organism in all periods, but it decreased in the post-COVID-19 period. Enterococcus faecalis increased in the post-COVID-19 period. The ciprofloxacin resistance rate of E. coli and Klebsiella pneumoniae increased, but the ciprofloxacin and levofloxacin resistance rate of E. faecalis decreased.
Conclusions: There was little difference in the causative organism distribution of UTI and antimicrobial resistance rates before and after the COVID-19 pandemic. On the other hand, changes in some causative organisms are identified. Nevertheless, because this study was limited to a single medical institute, data from a broader spectrum of bacterial species collected from multiple institutions will be needed to obtain definitive results.
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Efficacy and Tolerability of Solifenacin Fumarate with Overactive Bladder Patients: A Multicenter Observational Study
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Jae Hun Shim, Se Young Choi, Joon Hee Gook, Yong-June Kim, Woo Heon Cha, Dae Hee Kim, Kyeong Hee Kim, Young Woong Park, Jin Mo Um, Il Sung Lim, Kyung Keun Seo, Kyu Seon Cho, Young Jae Lee, Mi-Kyung Lee, Tae-Hyoung Kim
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Urogenit Tract Infect 2021;16(1):8-15. Published online April 30, 2021
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DOI: https://doi.org/10.14777/uti.2021.16.1.8
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- Purpose: Overactive bladder (OAB) is characterized by a series of highly prevalent symptoms among older adults. This study used the Overactive Bladder Symptom Score (OABSS) and Patient Perception of Bladder Condition (PPBC) tools to evaluate the efficacy and stability of solifenacin fumarate in the treatment of OAB.
Materials and Methods: This was a prospective, multicenter, single-arm, 12-week study that enrolled 163 OAB patients. The patients received 5 mg/day of solifenacin fumarate. The changes in the OABSS, symptoms, and PPBC scores were evaluated at 0, 4, and 12 weeks. Subgroup analysis of the OABSS and PPBC scores based on sex, diabetes mellitus (DM) status, and body mass index (BMI) were also evaluated.
Results: At the baseline (week 0), the mean OABSS for all patients was 8.45±2.38 (p=0.199). Subsequently, the mean OABSS declined to 5.41±2.69 (p=0.255) at four weeks and 4.21±2.61 (p=0.240) at 12 weeks. The OABSS subscore and PPBC score decreased significantly during the study (p<0.01). After cases were stratified according to sex, DM status, and BMI, the mean OABSS (mean and subscore) and PPBC score at four and 12 weeks were also improved significantly relative to the baseline scores (both p<0.05). The overall incidence of adverse events was 7.36% (12 cases), and three patients (1.82%) permanently discontinued solifenacin fumarate because of the adverse events.
Conclusions: Solifenacin fumarate is a safe and effective treatment alternative for relieving OAB symptoms, considering the balance between the efficacy, patientsʼ well-being, and tolerability.
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Comparison of Monomicrobial versus Polymicrobial Candiduria: Time to Awareness of Candiduria
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Hyunji Kim, Mi-Kyung Lee, Tae-Hyoung Kim
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Urogenit Tract Infect 2019;14(1):20-25. Published online April 30, 2019
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DOI: https://doi.org/10.14777/uti.2019.14.1.20
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- Purpose: Candiduria, which is the presence of Candida species in urine, is becoming increasingly common in hospital settings. These normal commensals in humans are often associated with the presence of other microorganisms. In this study, patients presenting with monomicrobial and polymicrobial candiduria were compared.
Materials and Methods: A retrospective study was performed on the demographic, clinical, and laboratory data of 185 patients presenting with candiduria between July 2014 and June 2015 at Chung-Ang University Hospital. The threshold for a positive Candida species urine culture was set to 103 CFU/ml. Data on the following were evaluated: distribution of Candida species; patient age and sex; length of hospital stay; presence of diabetes mellitus (DM), chronic kidney disease (CKD), a urinary catheter, and fever; antibiotic administration; urinalysis; complete blood cells; and C-reactive protein.
Results: Monomicrobial candiduria was more common (128/185, 69.2%) than polymicrobial candiduria (57/185, 30.8%). The most prevalent species was Candida albicans (monomicrobial vs. polymicrobial candiduria, 61.7% vs. 54.4%), followed in order by Candida tropicalis (18.8% vs. 24.6%), and Candida glabrata (14.8% vs. 12.3%), with no significant difference between the two groups. Significant differences in the length of stay, underlying DM or CKD, accompanying symptoms, and urine white blood cells (WBC) and bacterial counts were observed between the two groups (p＜0.05).
Conclusions: The length of stay, underlying DM or CKD, accompanying symptoms, and urine WBC and bacterial counts were more associated with polymicrobial candiduria. The early detection and treatment of candiduria will become increasingly important as the Korean population ages.
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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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Management of Extended-Spectrum Beta-Lactamase-Positive Gram-Negative Bacterial Urologic Infections
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Yong Kwan Lim, Mi-Kyung Lee, Tae-Hyoung Kim
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Urogenit Tract Infect 2015;10(2):84-91. Published online October 31, 2015
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- Extended-spectrum beta-lactamases (ESBLs) are enzymes that confer increased resistance to commonly used antibiotics. The prevalence rates of ESBL producing bacteria are increasing, and the associated increase in morbidity and mortality is becoming a public health concern. ESBL producers are emerging as an important cause of urinary tract infection (UTI) and empirical therapy should therefore be carefully selected for patients with UTI. Fosfomycin or nitrofurantoin would be an appropriate choice for empirical therapy of uncomplicated UTI. Ertapenem or cefepime might be recommended for initial empirical therapy patients suspected of having complicated UTI.
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Profiles of Yeast Isolated from Urinary Tracts with and without Catheter during 2011-2013
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Jae Hyung Ryu, Tae-Hyoung Kim, Oh Joo Kweon, Mi-Kyung Lee
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Korean J Urogenit Tract Infect Inflamm 2014;9(2):93-98. Published online October 31, 2014
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Indwelling urinary catheter is considered the most important risk factor for healthcare-associated urinary tract infection (UTI). The aim of the current study was to compare the prevalence of species distribution and susceptibilities of antifungals against clinical isolates of yeasts from funguria with and without urinary catheter. Materials and Methods: We analyzed 45,839 urine specimens collected from patients between 2011 and 2013. Species identification and antifungal susceptibility test to amphotericin B, fluconazole, voriconazole, and flucytosine were performed using the VITEK 2 system (Biomérieux Inc.). Results: A total of 1,048 (2.29%) urine specimens were yeast culture positive. The most frequent species was Candida albicans (49.0%), followed by C. tropicalis (18.6%), C. glabrata (12.2%), and Trichosporon asahii (7.2%). C. tropicalis was isolated more frequently in catheterized urine than in voided urine (p＜0.05). For C. albicans and C. glabrata, frequencies of non-susceptible to fluconazole or voriconazole were higher in catheterized urine than in voided urine. Conclusions: The results of this study suggest the possibility that urinary catheter may influence species distribution of yeast and antifungal susceptibilities. Further investigation is warranted to improve infection control strategies for healthcare- associated UTI.
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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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Species Distribution and Antifungal Susceptibilities of Yeast Isolated from Catheterized Urine Specimen
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Tae-Hyoung Kim, Jong-Yeon Lee, Jae-Dong Chung, Sang-Hyup Lee, Mi-Kyung Lee
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Korean J Urogenit Tract Infect Inflamm 2011;6(1):73-79. Published online April 30, 2011
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- "Purpose: The aim of the present study was to evaluate the effect of urinary catheter on species distribution and susceptibilities of antifungals against clinical isolates of yeasts from catheter-associated urinary tract infection (CAUTI). Materials and Methods: A total 281 yeast isolates from catheterized urine in a medical and surgical ward were collected. Species identification and antifungal susceptibulity test to amphotericin B, fluconazole, voriconazole and flucytosine were performed by VITEK 2 system (bioM?rieux Inc. Hazelwood, MO, USA). Results: The most frequent species was Candida tropicalis (48.8%), followed by C. albicans (24.6%), C. glabrata (15.7%) and Trichosporon asahii (5.0%). C. tropicalis and T. asahii were more frequently isolated in a surgical ward than medical ward (p<0.05). Decreased susceptibilities to amphotericin B were observed in C. albicans and T. asahii. All isolates except C. glabrata and C. krusei were susceptible to fluconazole and voriconazole. Conclusions: The results of this study suggest the possibility that urinary catheter may lead to influence on species distribution of yeast of CAUTI. There is an need for continuous surveillance of CAUTI by yeast for the control of CAUTI."
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