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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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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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New Era of Post Urinary Tract Infection Pain Syndrome
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Kwang Woo Lee, Young Ho Kim
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Urogenit Tract Infect 2016;11(2):49-55. Published online August 31, 2016
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- Urinary tract infection (UTI) in most cases is accompanied by pain. However, in some cases, including asymptomatic bacteriuria (ASB), pain is absent and thus, cannot be characterized. A study with an animal UTI model to quantify pelvic pain showed that Escherichia coli (NU14 strains) isolated from urine of patients with acute UTI caused pain, while E. coli (83972 strains) isolated from urine of patients with ASB caused no pain. The difference in pain response was not related to bladder colonization or inflammation, but to lipopolysaccharde (LPS) and Toll-like receptor 4, which is an LPS receptor. As the association between interstitial cystitis (IC) and UTI was epidemiologically suggested, an experiment was performed to investigate whether repeated infection with uropathogenic E. coli (UPEC) causes chronic pain through central sensitization. The results showed that repeated infection with the wild type UPEC caused temporary pain, while repeated infection with UPEC (SΦ 874 strains) in the absence of O-antigen caused chronic pain. Chronic pain following UTI is related to voiding dysfunction and anxious/depressive behavior. These relationships are mediated by transient receptor potential vanilloid type 1 at the stage of pain development and by C-C chemokine receptor type 2 at the stage of pain maintenance. Based on these findings, temporary E. coli infection causes chronic pain, which is one of the characteristics of neuropathic pain. This pattern is similar with the symptoms of IC, supporting the possibility of infection as an etiology of IC.
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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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- 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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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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Acute Pyelonephritis
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Ki Hak Song, Ji Young Lee, Young Ho Kim
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Korean J Urogenit Tract Infect Inflamm 2010;5(2):143-150. Published online October 31, 2010
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- Acute pyelonephritis is a very common upper urinary tract infection, and most of them may be uncomplicated and resolve without serious sequelae. Acute pyelonephritis is defined as clinical symptoms and signs such as abrupt onset of chills, fever, and flank or costovertebral angle pain and/or tenderness. The incidence of acute pyelonephritis is higher in young women than in men and then the incidence is similar to women over 65 years old. In general, acute pyelonephritis is caused by microorganisms ascending from the bladder into the upper urinary tract. E. coli is the most common uropathogen causing pyelonephritis, accounting for 70∼90% of infections. Recently, antibiotic resistance against E. coli and uropathogen is remarkably noted in uncomplicated acute pyelonephritis as well as uncomplicated UTI. The purpose of this study was to determine the recent trends of acute pyelonephritis, to suggest change to current strategies in the management and prevention of acute pyelonephritis, and to review 2010 EAU guideline and recent literatures.
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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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Infected Urachal Cyst
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Kang Sup Kim, Chang Sik Youn, Seung Woo Yang, Young Ho Kim, Eugene Hwang, Jae Sung Lim, Ki Hak Song, Chong Koo Sul
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Korean J Urogenit Tract Infect Inflamm 2009;4(2):232-234. Published online October 31, 2009
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- Although most cases of urachal cyst are asymptomatic, they are frequently detected after complication by infection. We report a 43-year-old woman who was diagnosed preoperatively an infected urachal cyst and was performed primary excision. A pus culture drained from the cyst was no growth in microscopic exam. Pathologic examination showed acute and chronic inflammation of the urachal cyst. The post-operative course was non specific and there was no evidence of wound infection.
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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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Applications and Limitations of Polymerase Chain Reaction in Sexually Transmitted Disease
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Kwang Woo Lee, Young Ho Kim
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Korean J Urogenit Tract Infect Inflamm 2008;3(2):185-193. Published online October 31, 2008
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- Sexually transmitted diseases (STDs) are one type of important infectious diseases in patients who suffer from the genitourinary tract infections. Screening and detecting STDs is a form of secondary prevention, which interrupts further transmission as well as progression of the infection and its sequelaes. In an effort to better diagnose, treat, and control STDs, a number of new diagnostic assays using molecular techniques have been developed. Improved diagnostic testing by means of polymerase chain reaction (PCR) testing is now commercially available and may increase diagnostic capability. PCR has resulted in revisions of the proportion of STDs that are asymptomatic, and has increased measured prevalence of some STDs, notably. As a consequence of these molecular tools, the diagnostic repertoire of the clinical laboratory for the diagnosis of STDs will expand significantly, allowing investigators to better diagnose and more effectively control the spread of STDs. However, with such new technology, new problems and challenges have arisen, such as the risk of sample contamination resulting in false-positive results, and the presence of inhibitors resulting in false-negative results.
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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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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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