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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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The New Korean Guideline for Sexually Transmitted Infections
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Dong-Hoon Lim, Seung-Ju Lee, Bongsuk Shim, Chul-Sung Kim, Min Eui Kim, Yong-Hyun Cho
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Korean J Urogenit Tract Infect Inflamm 2011;6(1):96-113. Published online April 30, 2011
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- Sexually transmitted infections (STIs) are increasing worldwide. To have a well-designed localized guideline on STIs is crucial in controlling the condition. We reviewed the newly developed Korean STI guideline, 2011 that will provide comprehensive information regarding STI management.
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Recurrent Cystitis
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Min Eui Kim
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Korean J Urogenit Tract Infect Inflamm 2010;5(2):134-142. Published online October 31, 2010
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- Recurrent cystitis is common among young healthy women with anatomically and physiologically normal urinary tract, and represents the main cause of morbidity and health care burden in this population. The interaction between specific infecting bacteria and urinary tract epithelial characteristics implies the pathogenesis of the disease. Several pathogen-related factors, including periurethral bacterial colonization and Escherichia coli virulence, as well as host behavioral risk factors, including voiding dysfunction, high intercourse frequency, oral contraceptive and spermicide use predispose people to recurrent cystitis. The management of recurrent cystitis is the same as that for sporadic cystitis. Continuous or post-coital prophylaxis with low dose antimicrobials or intermittent self-treatment with antimicrobials has all been demonstrated to be effective in managing recurrent cystitis. Prospective prevention methods for recurrent cystitis include the use of natural compounds, bacterial interferenceand immunization. These approaches appear to be promising for the management of cystitis. Further understanding of the pathogenesis of recurrent cystitis will lead to more effective and safe methods to prevent these common infections.
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Aminoglycosides Resistance of Escherichia coli Isolates from Acute Uncomplicated Cystitis
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Gilho Lee, Min Eui Kim, Yong-Hyun Cho, Chul Sung Kim, Young Ho Kim, Seung Ju Lee
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Korean J Urogenit Tract Infect Inflamm 2010;5(1):51-56. Published online April 30, 2010
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- "Purpose: The aim of the study was to determine the aminoglycosides resistance of Escherichia coli (E. coli) strains isolated from acute uncomplicated cystitis. Materials and Methods: All 219 female patients who presented with symptoms of acute cystitis by E. coli infection were included in this study. We used gentamicin, tobramycin, and amikacin for detecting the resistance to aminoglycosides. The prevalence of gentamicin, tobramycin, and amikacin resistance of E. coli was 25.1%, 24%, and 0.4%, respectively. Results: The resistant isolates to tobramycin or gentamicin definitively showed an associated resistance to other antibiotics such as ciprofloxacin and trimethoprin-sulfamethoxazole, while the resistance to amikacin was not. In addition, 3 aminoglycosides resistant E. coli isolates did not associated with the history of recurrent cystitis. Conclusions: We recommend the clinical use of amikacin for the ciprofloxacin or trimethoprim- sulfamethoxazole resistant E. coli isolates from urinary tract infection, instead of gentamicin or tobramycin."
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Antibiotic Prophylaxis Practice in Urology: a Survey of 21 Korean Medical Institutions
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Jae I Koh, Young Ho Kim, Min Eui Kim
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Korean J Urogenit Tract Infect Inflamm 2009;4(1):72-79. Published online April 30, 2009
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- "Purpose: To evaluate current prophylactic antibiotics usage in various urologic diagnostic and surgical procedures to utilize as basic data for a making Korean guideline of antibiotic prophylaxis in urology. Materials and Methods: From October to November 2006, a survey of 21 medical institutions was conducted for preoperative shaving of operation site, type of commonly used antibiotics, and time and duration of administration in various diagnostic and surgical procedures Results: The common antibiotic prophylaxis practices were administration of oral fluoroquinolone for 2∼3 days in diagnostic procedures, combination of intravenous second generation cephalosporin and aminoglycoside for 2∼3 days in endourologic operations, and 4∼5 days in open surgeries. The prophylactic antibiotics were used 81% in cystoscopy, 95% in transrectal prostate biopsy, 43% in extracorporeal shock wave lithotripsy, 95% in transurethral resection of prostate, 93% in laparoscopic surgeries, and 95% in nephrectomy. Conclusions: This survey showed that prophylactic antibiotics were inappropriately employed in a variety of diagnostic and surgical procedures. Inappropriate antibiotic use increases the emergence of antimicrobial-resistent bacteria, medical costs and the risk of the adverse reactions of antibiotics. To establish the Korean guideline of antibiotic prophylaxis in urology, well-designed prospective studies should be encouraged."
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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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Interstitial Cystitis/Painful Bladder Syndrome
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Young Ho Kim, Min Eui Kim
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Korean J Urogenit Tract Infect Inflamm 2007;2(2):12-22. Published online October 31, 2007
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- Painful bladder syndrome (PBS) is the term used to refer to a chronic symptom complex of urinary frequency and bladder 'pressure', discomfort or pain in the absence of any other reasonable cause for these symptoms. Interstitial cystitis (IC) is the established term used by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) consensus workshop for which a research definition was formulated in the late 1980s. The pathogenesis of IC is still not completely understood, but it is likely multifactorial. The diagnosis of IC can be made clinically and by cystoscopy and hydrodistension. The sensitivity and specificity of urinary markers and the potassium sensitivity test have not been prospectivly studied. New developments in the study of IC/PBS include the identification of a potential cells in IC and thought to inhibit proliferation. In addition, condition-specific validated questionnaires should aid evaluation, and a growing number of randomised controlled trials should enable clinicians to use evidence-based therapeutic options.
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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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Multicenter Clinical Outcome of Gatifloxacin for Chronic Prostatitis (NIH Category II or IIIa) in Korea
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Sang Don Lee, Seung Ju Lee, Tae Kon Hwang, Duck Ki Yoon, Kyu Sung Lee, Luck Hee Sung, Myung Soo Choo, Bong Suk Shim, In Rae Cho, Min Eui Kim, Soo Bang Ryu, Chul Sung Kim, Young Gon Kim, Chun Il Kim, Hyun Yul Rhew, Yong-Hyun Cho
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Korean J Urogenit Tract Infect Inflamm 2007;2(1):53-60. Published online May 31, 2007
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- "Purpose: The objective of this study was to investigate the efficacy and safety of gatifloxacin for patients with chronic prostatitis (NIH category II or IIIa) in Korean urologic practice. Materials and Methods: A total of 16 outpatient urology clinics at tertiary care medical centers in Korea participated. Gatifloxacin (400 mg/day) treatment (S.D.) of 149 patients (20 patients with category II and 129 patients with category IIIa) with prostatitis (mean age 45.8±13.3 years) was carried out for 41.7 (33.1) days. A 4-glass test according to Meares and Stamey or two glass test was carried out at study entry and one month after the end of treatment. Clinical response, safety and bacteriological response were assessed before treatment (within 48 hours of initiation of the study medication) and at one month after treatment completion. Results: In a otal of 149 patients, the total NIH-CPSI score was significantly reduced from 20.5 to 10.0 (response rate 86.7%; 95% CI 80.2-93.2%) (p<0.05). Sub-scores of pain, urinary symptoms and impact on the quality of life were also significantly reduced from 8.9 to 3.8 (response rate 83.8%; 95% CI 76.8-90.9%), from 4.2 to 2.0 (response rate 73.3%; 95% CI 64.9-81.8%) and from 7.4 to 4.2 (response rate 79.0%; 95% CI 71.3-86.8%), respectively (p<0.05). In terms of the overall clinical efficacy assessment by investigators, out of 149 patients with prostatitis, 71.2% were assessed to be responders. Bacteriological studies in expressed prostatic secretion (EPS) or post prostate massage urine (VB3) at 1 month after treatment completion demonstrated that the overall eradication rates of pathogens was 85% and the pyuria (≥10 WBC/HPF) rates in the NIH category II and IIIa were 35% and 18.6%, respectively (overall rate 20.8%). There were 16.1% of patients that presented with some adverse events considered by investigators to be related to the drug. The majority of adverse events were considered to be of mild (87.5%) or moderate (8.3%) intensity. Conclusions: These results suggest that gatifloxacin in Korean urologic practice is well tolerated and improves the clinical outcomes in the patientswith chronic prostatitis (NIH category II or IIIa)."
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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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Current Treatment of bacterial Urinary Tract Infection
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Min Eui Kim
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Korean J Urogenit Tract Infect Inflamm 2006;1(1):7-16. Published online October 31, 2006
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- Urinary tract infection (UTI) is one of the most common bacterial infections encountered in clinical practice in Europe and North America. It is estimated that 150 million cases of UTI occur on a global basis per year resulting in more than 6 billion dollars in direct health care expenditure1. Young, otherwise healthy, women are commonly affected with an estimated incidence of 0.5?0.7 infections per year2. Of the women affected 25?30% will go on to develop recurrent infections not related to any functional or anatomical urinary tract abnormality. Escherichia coli are the causative pathogen in approximately 70% to 95% and Staphylococcus saprophyticus in approximately 5% to 10% of acute uncomplicated cystitis. Occasionally other Enterobacteriaceae, such as Proteus mirabilis, Klebsiella sp, enterococci, or group B streptococci, are isolated from such patients. A similar distribution of uropathogens is found in acute uncomplicated pyelonephritis. The therapy of uncomplicated UTIs is almost exclusively antibacterial, whereas in complicated UTIs the complicating factors have to be treated as well. There are two predominant aims in the antimicrobial treatment of both uncomplicated and complicated UTIs: (1) rapid and effective response to therapy and prevention of recurrence of the individual patient treated; (2) prevention of emergence of resistance to antimicrobial chemotherapy in the microbial environment.
This article focuses on the current management of women with acute uncomplicated cystitis and pyelonephritis.(Korean J UTII 2006;1:7-16)
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