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Beyond Empirical Antibiotics: Toward Precision-Based Urinary Tract Infection Management and Korea-Specific Guidelines
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Sang Rak Bae, Hee Jo Yang
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Urogenit Tract Infect 2026;21(1):11-14. Published online April 30, 2026
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DOI: https://doi.org/10.14777/uti.2550048024
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 Abstract
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- Urinary tract infection (UTI) remains one of the most common bacterial infections, yet rising antimicrobial resistance and changing healthcare environments have challenged the traditional empiric approach to antibiotic therapy. Recent international guidelines from the European Association of Urology (EAU), Infectious Diseases Society of America (IDSA), and American Urological Association (AUA) collectively demonstrate a paradigm shift toward precision diagnostics, evidencebased antibiotic selection, standardized nonantibiotic prevention strategies, and simplified disease classification systems. The EAU has emphasized culture-based diagnosis, expanded nonantibiotic prophylaxis, and introduced a new framework distinguishing localized from systemic UTI. The IDSA has strengthened restrictions on treating asymptomatic bacteriuria, provided guidance for managing antimicrobial-resistant organisms, and simplified UTI categories. The AUA similarly highlights culture-directed diagnosis and the minimization of prophylactic antibiotics in women with recurrent UTI while formalizing nonantibiotic preventive measures. In Korea, unique resistance patterns, high extended-spectrum beta-lactamase and fluoroquinolone resistance rates, and frequent movement of patients between long-term care facilities and hospitals underscore the need for Korea-specific UTI guidelines. Although national surveillance systems such as KARMS (Korean Antimicrobial Resistance Monitoring System) and KorGLASS (Global Antimicrobial Resistance Surveillance System in Korea) provide valuable data, the evidence base remains insufficient to match the robustness of international guideline development. Establishing updated, Korean-contextualized UTI guidelines is essential for improving patient safety, optimizing antimicrobial stewardship, and effectively responding to the growing threat of resistance. The field is at a pivotal turning point, requiring proactive leadership and coordinated action within Korea’s urological and infectious disease communities.
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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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Abstract
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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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