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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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Acute Bacterial Prostatitis
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U-Syn Ha, Yong-Hyun Cho
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Korean J Urogenit Tract Infect Inflamm 2011;6(2):115-128. Published online October 31, 2011
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- Bacterial prostatitis represents a small portion of the prostatitis spectrum, and acute bacterial prostatitis (ABP) is uncommon. But ABP is a urologic emergency. Even if there is a wide consensus for the diagnosis and treatment of ABP, many physicians need detailed guidelines with clear evidence. We suggest the diagnosis and treatment criteria of ABP with extensive review of the current literatures. The initial diagnosis of ABP is based on signs and symptoms like fever or voiding problem. Patients with symptoms should undergo urine analysis and culture of the urine. An imaging study of the prostate including transrectal ultrasound (TRUS) is suggested to exclude prostatic abscess (LoE 4). Elevated levels of prostate-specific antigen (PSA) are helpful to distinguish ABP from other febrile UTI. The predominant causative organisms are Gram-negative bacteria, mainly Escherichia coli. Appropriate management of ABP includes rapid initiation of broad-spectrum parenteral antibiotics and symptomatic support.
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Factors of Progression to Chronic Infections from Acute Bacterial Prostatitis
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Byung Il Yoon, Seol Kim, Tae Seung Shin, U-Syn Ha, Dong Wan Sohn, Yong-Hyun Cho
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Korean J Urogenit Tract Infect Inflamm 2011;6(2):178-185. Published online October 31, 2011
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- "Purpose: We conducted a retrospective analysis of acute bacterial prostatitis (ABP) to evaluate the factors of progressing to chronic bacterial prostatitis (CBP) and inflammatory chronic pelvic pain syndrome (CPPS) from ABP. Materials and Methods: The clinical records of 480 cases compatible with a confirmed diagnosis of ABP from five urological centers between 2001 and 2010 were reviewed. We defined chronic infection (CI) as a progression to CBP and inflammatory CPPS after treatment of ABP in admission periods when followed-up at 3 months or more. Results were analyzed according to two groups: recovered without CI (group A, n=428) and developed to CI (group B, n=52). Results: Of the 480 ABP patients, 1.3% (6/480) progressed to CBP and 9.6% (46/480) progressed to inflammatory CPPS. The progression rate of CI was 10.9% (52/480). The factors that affected progress to CI were diabetes, prior manipulation, prostate volume, absence of cystostomy and urethral catheterization (p<0.05). Conclusions: The identification and characterization of influential factors may accelerate the development of preventive, diagnostic and therapeutic strategies for the treatment of CI from ABP."
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Changes in Detection Rate of Causative Organisms in Patients with Urethritis Symptoms and Signs
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Seung Hyuk Yim, Myung Sun Choi, U-Syn Ha, Dong Wan Sohn, Yong-Hyun Cho
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Korean J Urogenit Tract Infect Inflamm 2010;5(2):176-181. Published online October 31, 2010
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- "Purpose: Male urethritis is one of the most common sexually transmitted infections (STIs), but the etiology is still unclear in many cases. We retrospectively studied and compared the detection rate of the causative organisms in patients with urethritis symptoms and signs between 2000 and 2009. Materials and Methods: We reviewed the medical records of 181 patients with urethritis symptoms and signs who had undergone a gram stain, urethral swab culture, multiplex polymerase chain reaction (mPCR) assay in 2000 and 2009 at a single hospital. Changes in detection rate of the causative organisms between 2000 and 2009 were analyzed. Results: The common pathogens in 2009/2000 were Ureaplasma urealyticum (27.40% vs. 13.89%, p=0.025), Mycoplasma species (12.33% vs. 5.56%, p=0.107), Chlamydia trachomatis (10.96% vs. 12.04%, p=0.827) and Neisseria gonorrhoeae (4.11% vs. 1.85%, p=0.367). Detection rate of Ureaplasma urealyticum significantly increased in 2009 compared to 2000 (p=0.025). Conclusions: Ureaplasma urealyticum was the most common pathogen of nongonococcal urethritis in our study. In particular, Ureaplasma urealyticum was found to have increased significantly in recent years."
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The Correlation between Post-void Residual Urine Volume and Urinary Tract Infection in Asymptomatic Men Visited for Prostate Examination
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Seung Hyuk Yim, U-Syn Ha, Dong Wan Sohn, Yong-Hyun Cho
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Korean J Urogenit Tract Infect Inflamm 2010;5(1):63-67. Published online April 30, 2010
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- "Purpose: The large post-void residual urine (PVR) could be related to various complications, especially urinary tract infections (UTIs). Although numerous cut-off value of PVR related to UTIs have been proposed there is still debate on that. We investigated the correlation between PVR and UTIs. Materials and Methods: From January 2008 to December 2008, retrospective analysis was performed on 351 asymptomatic male patients who visited our clinic for prostate examination. The prostate specific antigen (PSA) level, peak urine flow rate, PVR, voided urine volume, International Prostatic Symptom Score (IPSS) and urine culture results were obtained. PVR was measured by portable bladder scanner. A positive result of urine culture was defined as growth of more than 100,000 bacteria per ml. We investigated the association between urine culture results and PVR, and estimated cut-off value of PVR predicting bacteriuria using ROC analysis. Results: The mean age of patients was 63.3±10.4years and 8.83% of the total patients (31 patients) showed positive in urine culture. Mean PVR volume was significantly higher in the group with positive urine culture compare to the group with negative urine culture (105.6mL vs 41.8mL, p<0.001), but we couldn't validate cut-off value of PVR for predicting UTIs. Conclusions: Significant bacteriuria was found in 8.83% of the asymptomatic male patients. Although the positive relationship between PVR and the risk of UTIs was found we couldn't validate cut-off value of PVR for predicting UTIs."
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Treatment and Prevention of Catheter-Associated Urinary Tract Infections
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Seung Hyuk Yim, U-Syn Ha, Dong Wan Sohn, Seung-Ju Lee, Chang Hee Han, Choong Bum Lee, Yong-Hyun Cho
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Korean J Urogenit Tract Infect Inflamm 2009;4(2):159-169. Published online October 31, 2009
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- Urinary tract infections (UTIs) represent the second most often observed infectious diseases in community, following the respiratory tract infections. Approximately 40% of nosocomial infections originate in the urinary tract; about 80% of urinary tract infections is related to urinary catheterization. The duration of catheterization is the most important risk factor for development of UTIs and additional risk factors include female sex, diabetes mellitus, renal function impairment, lack of antimicrobial therapy, and not maintaining a closed drainage system. There are many methods for preventing catheter-associated urinary tract infections (CAUTI); (i) an indwelling catheter should be introduced under antiseptic conditions; (ii) urethral trauma should be minimized by the use of adequate lubricant and the smallest possible catheter; (iii) the catheter system should remain closed; and (iv) the duration of catheterization should be minimal. Antimicrobial urinary catheters can prevent or delay the onset of CAUTI, but the effect on morbidity is not known. Antibiotic treatment is recommended only in symptomatic infection (bacteremia, pyelonephritis, epididymitis, prostatitis), but systemic antimicrobial treatment of asymptomatic CAUTI is only recommended in the following circumstances; (i) patients undergoing urological surgery or implantation of prosthesis; (ii) treatment may be part of a plan to control nosocomial infection due to a particularly virulent organism prevailing in a treatment unit; (iii) patients who have a high risk of serious infectious complications; and (iv) infections caused by strains causing a high incidence of bacteremia.
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KAUTI
