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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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Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Male Bladder Pain Syndrome/Interstitial Cystitis: How Are They Related?
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Sang Wook Lee
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Urogenit Tract Infect 2017;12(1):15-21. Published online April 30, 2017
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- To date, the heterogeneous pathophysiology of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and bladder pain syndrome/interstitial cystitis (BPS/IC) has not been fully elucidated. Thus, it is difficult to make a full comparison between CP/CPPS and male BPS/IC. Controversy and confusion surrounding the terminologies and classifications of CP/CPPS and BPS/IC complicates the issue. CP/CPPS and male BPS/IC are not mutually exclusive conditions, in that they have similarities in their pathogenesis and clinical presentation. Based on the working definitions of these terms, it would be correct to say that male BPS/IC is subsumed by CP/CPPS, and that male BPS/IC can be regarded as CP/CPPS with clear bladder-specific features. Although the term CP/CPPS may be inappropriate, especially since “CP” may be misleading, the perspective that CP/CPPS and male BPS/IC are male urological chronic pain syndromes could enhance the understanding of the relationship between the two. The European Association of Urology classification for chronic pelvic pain is systematic and corresponds well with our knowledge of chronic pain. Therefore, this classification might be the solution to the problems associated with the existing terminologies and taxonomy of CP/CPPS and BPS/IC. In the management of urological chronic pelvic pain in men, clinical phenotyping systems (the UPOINT or UPOINTs system) profile patients and indicate how tailored treatment could be achieved as individualized, multimodal therapeutic regimens. It would be prudent to include bladder-specific features, such as painful filling or painful urgency, in the criteria for the organ-specific domain of the UPOINT(s) system.
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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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Uropathogens Based on Antibiotic Susceptibility
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Sang Wook Lee, Young Ho Kim
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Urogenit Tract Infect 2015;10(2):67-73. Published online October 31, 2015
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- Urinary tract infections are one of the most commonly encountered infections in clinical practice. Due to the emergence of and increase in urinary tract bacteria that are resistant to trimethoprim-sulfamethoxazole, penicillin, cephalosporins, and fluoroquinolones, selection of appropriate antibiotics in treatment of these infections is important. In addition, the emergence of extended-spectrum betalactamase- producing organisms makes antibiotic selection difficult. This article provides a review of disease-specific uropathogens and their susceptibilities to antimicrobial agents.
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