Urogenital Tract Infection

Current Updates in Pharmacokinetics and Pharmacodynamics of Fluoroquinolones: Young Hwii Ko, Phil Hyun Song; Korean J Urogenit Tract Infect Inflamm 2015;10(1):1-6. Published online April 30, 2015

Abstract PDF: The ultimate goal of antimicrobial treatment is to decrease the morbidity and mortality related to infection. Maximizing these outcomes requires an understanding of the complex interactions between the drug administered, the host, and the infecting pathogen. Pharmacokinetics, which deals with the disposition of a drug in the body, focuses on such parameters as absorption, distribution, and elimination. Pharmacodynamics more specifically focuses on the interaction between the drug concentration at the site of action over time and the resulting antimicrobial effect. Use of quinolones has increased in vitro activity against several important pathogenic organisms as well as augmented pharmacokinetic parameters. These properties result in enhanced pharmacodynamic characteristics and should improve therapeutic outcomes against selected pathogens. In this article the pharmacokinetics and pharmacodynamic potential of these quinolones, particularly fluoroquinolones, is reviewed.

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Inflammation of Prostate and Prostate-Specific Antigen: In-Chang Cho, Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2015;10(1):7-11. Published online April 30, 2015

Abstract PDF: Noncancerous conditions (e.g., benign prostatic hyperplasia and prostatitis) can elevate serum prostate-specific antigen (PSA) levels, limiting the specificity of PSA screening for prostate cancer. In recent years, several studies have also demonstrated a relationship between chronic prostatitis/chronic pelvic pain syndrome and increased PSA levels. However, in asymptomatic patients, routine screening for this diagnosis is not performed before transrectal biopsy to rule out prostate cancer. These asymptomatic men with elevated PSA levels frequently show evidence of inflammation when their expressed prostatic secretions are examined, or on their prostate biopsy specimens. This raises the problem of appropriate evaluation in the presence of chronic prostatitis and elevated PSA levels not only in prostate cancer screening programs, but also in cancer-negative biopsy findings. Thus, there has been investigation into ways to decrease the confounding from inflammation, including repeat PSA measurements after a period of observation or a course of empiric antibiotics. This article reviews the evidence regarding elevations in PSA due to prostatitis and describes the controversy over the optimal approach to reduce its confounding impact on prostate cancer screening. Nowadays, it appears that in patients with prostatic inflammation and increased PSA, an antimicrobial regimen may provide more acceptable initial treatment than proceeding directly to prostate biopsy. Additional evidence is necessary in the form of a randomized clinical trial in which all patients undergo biopsy, regardless of the PSA response to antibiotic or placebo.

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Treatment of Neisseria gonorrhoeae in the Era of Multidrug Resistance: Ji Yun Chae, Mi Mi Oh; Korean J Urogenit Tract Infect Inflamm 2015;10(1):12-18. Published online April 30, 2015

Abstract PDF: Neisseria gonorrhoeae (NG) is becoming increasingly less susceptible to the extended spectrum cephalosporin (ESC), which has been recommended for first-line treatment, and cases of treatment failure are being reported globally. An era of untreatable gonorrhea may have started, and it calls for novel treatment strategies. Essential actions should include use of higher doses of ceftriaxone administered as part of dual therapy and further development of alternative drug combinations. This review focuses on the global spread of ESC resistant NG and potential treatment options for the future.

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Unusual Presentation of Secondary Syphilis in Korea: 2010-2014 Review: Dan Song, Jae Heon Kim; Korean J Urogenit Tract Infect Inflamm 2015;10(1):19-24. Published online April 30, 2015

Abstract PDF: The prevalence of syphilis differs according to the object and district. Diagnosis of syphilis remains challenging, as the absence of classical features of disease, such as the secondary syphilis orogenital lesion rash, might make accurate diagnosis difficult. However, recent studies have reported a growing prevalence of symptomatic syphilis in Korea. The main reason is the rise in primary and secondary syphilis. The most common clinical features of primary and secondary syphilis are orogenital lesions, masculopapapular rash, and generalized lymphadenopathy. An increasing number of unusual clinical presentations have been reported among secondary syphilis cases. The aim of this study was to remind us of the significance of syphilis by highlighting the unusual clinical presentation of secondary syphilis.

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Effectiveness of Topical Ofloxacin Ointment for Genitourinary Post-Operative Patients with Urinary Catheterization: Yoo Seok Kim, Soon Ki Kim, Gyeong In Lee, Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2015;10(1):25-30. Published online April 30, 2015

Abstract PDF: Purpose: Catheter associated urinary tract infection and discomfort is common in patients with an indwelling urinary catheter. We investigated the effectiveness of prophylactic topical antibiotic ointment for genitourinary post-operative patients with a urinary catheter. Materials and Methods: We investigated 112 inpatients between March 2013 and October 2013, who had an indwelling urinary catheter ≥24 hours after a genitourinary operation in our institution from medical records. Among 112 patients, 59 patients applied ofloxacin ointment to urethral meatus around the indwelling catheter twice a day (ointment group: 52.7%) and 53 patients did not (non-ointment group: 47.3%). All patients were examined by urine analysis and urine culture before the operation, urethral sweep culture after catheter removal, and severity of pain was recorded as visual analogue scale (VAS) score while having an indwelling urinary catheter. Results: Mean duration of urinary catheter of both groups did not differ statistically (3.08±2.19 day, 2.91±2.25 day). Patients with pyuria detected at pre-operative urinalysis were 22.1% vs. 15.1%, pre-operative urine culture positive were 6.8% vs. 9.4%, urethra meatal culture positive after urethral catheter removal were 16.9% vs. 13.2%, respectively, and all results showed no significant differences between two groups. VAS scores of the ointment group (3.52±1.66) while having an indwelling urinary catheter were significantly lower than those of the non-ointment group (5.61±1.75) (p＜0.001). Conclusions: Application of topical antibiotic ointment for genitourinary post-operative patients with urinary catheter had no benefit in reducing growth of urethral microorganisms, but it may decrease pain from an indwelling urinary catheter.

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Risk Factors Analysis Related to Complications of Transrectal Ultrasound-Guided Prostate Needle Biopsy: The Influence of Asymptomatic Pyuria on Complications: Chae Han Jeon, Wonho Jung, Ji Yong Ha, Choal Hee Park, Chun Il Kim, Byung Hoon Kim; Korean J Urogenit Tract Infect Inflamm 2015;10(1):31-35. Published online April 30, 2015

Abstract PDF: Purpose: In clinical settings, patients with asymptomatic pyuria were common undergoing transrectal ultrasonography prostate needle biopsy (TRUSBx). The purpose of this study was to analyze the effects of asymptomatic pyuria on the occurrence of complications of TRUSBx. Materials and Methods: A total of 1,054 patients underwent TRUSBx from January 2007 to December 2011. For these patients, complications, presence of asymptomatic pyuria, anti-coagulant usage, TRUSBx history, previous hospitalization within 1 month, prostate volume, diabetes, types of prophylactic antibiotics (quinolone or 3rd generation cephalosporin), and biopsy results were compared and analyzed. Results: Of 1,054 cases, 26 (2.5%) developed complications requiring treatment. Seven cases (0.7%) had gross hematuria, 10 cases (0.9%) had dysuria, 7 cases (0.7%) had acute urinary retention, and 2 cases (0.2%) had sepsis. Asymptomatic pyuria was shown in 353 cases (33.4%). Complication rate of asymptomatic pyuria cases was 4.2% compared with 1.6% for non-pyuria cases (p=0.011). Higher complication rate was also observed in cases with previous TRUSBx history (p<0.001), hospitalization within 1 month (p< 0.001), and diabetes (p<0.001). However prostate volume, use of anticoagulant, type of antibiotics, and presence of prostate cancer were not significantly different. In multivariate analysis, previous TRUSBx history, hospitalization within 1 month, and diabetes were statistically significant with higher complication rate. Conclusions: A high incidence of complications was observed for previous TRUSBx history, hospitalization within 1 month, and diabetes. In univariate analysis, a high incidence of complications was observed for asymptomatic pyuria cases. Therefore, detailed caution is required for patients with such factors during TRUSBx.

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Efficacy of Collatamp on Pediatric Urologic Surgery: Jeong Woo Yoo, Yeong Jin Seo, Kyung Seop Lee, Ki Ho Kim; Korean J Urogenit Tract Infect Inflamm 2015;10(1):36-40. Published online April 30, 2015

Abstract PDF: Purpose: The purpose of this study is to evaluate efficacy of Collatamp (EUSA Pharma [Europe]; a gentamicin-containing collagen implant, GCCI) in pediatric urologic surgery. Materials and Methods: The study comprised a retrospective analysis of 35 consecutive children who underwent pediatric urologic surgery for treatment of hydrocele, undescended testis and varicocele between March 2013 and March 2015. Collatamp containing 130 mg gentamicin and 280 mg collagen were immersed in 300 ml normal saline for up to 6 hours. At set times after immersion the GCCI were removed, the saline diluted in normal human serum and the gentamicin content assayed by a validated immunoassay (Cedia, Microgenics Ltd., UK) to provide an estimate of the loss from each implant. Patients were classified according to two groups: patients with Collatamp (group A) and those without Collatamp (group B). Postoperative complication, operative time and age, etc. were assessed at postoperative 7 days. Results: Sixteen hydrocele, 16 undescended testis, and 3 varicocele patients were identified, with a median age of 87.43±54.10 months, operation time of 103.60±29.41 minutes, and hospitalization period of 3.20±0.68 days. Mean age, operation time, and hospitalization period in group A, B was 64.81±60.32 months, 100.80±46.80 months (p=0.02), 122.30±40.70 minutes, 103.61±29.39 minutes (p=0.17), and 3.20±0.40 days, 3.20±0.80 days (p=0.67), respectively. No statistically significant differences in postoperative complication were observed between the two groups. However, cost was higher in group A than in group B (300,000 won vs, 15,900.82±3,905.72 won). Conclusions: Collatamp may be useful and effective in preventing wound infection in pediatric urologic surgery, although Collatamp is more expensive.

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Effects of Diabetes Mellitus and HbA1c on Treatment Prognosis in Uncomplicated Acute Pyelonephritis: Min Ho Bae, Chang Hoo Park, Young Sam Cho, Kwan Joong Joo, Chil Hun Kwon, Heung Jae Park; Korean J Urogenit Tract Infect Inflamm 2015;10(1):41-48. Published online April 30, 2015

Abstract PDF: Purpose: We investigated potential difference in the clinical features of hospitalized female acute pyelonephritis (APN) patients with and without diabetes mellitus (DM). The additional purpose of the study was to determine whether HbA1c has a role in predicting clinical outcome in terms of morbidity compared with those considered to have normal glycemic control in female APN patients with DM. Materials and Methods: Among the female patients who received inpatients care due to APN from January 2011 to December 2013, 282 patients (86 with DM and 196 without DM) were selected and their medical records were analyzed. Laboratory results (white blood cell, blood urea nitrogen, serum creatinine, fasting plasma glucose, HbA1c) were dichotomized. Primary outcomes for comparison between the groups of patients with or without DM were early clinical response rate and length of in-hospital stay. Subgroup analysis was also performed in DM patients according to HbA1c status (<6.5%, ≥6.5%). Results: In multivariate logistic regression analysis, DM was not found to show independent association with poor early clinical response or longer hospital stay. HbA1c was the common risk factor of poor early clinical response (odds ratio [OR] 4.88, 95% confidence interval [CI] 1.61-14.8) and longer hospital stay (OR 4.20 95% CI 1.52-11.60) in APN patients with DM. Conclusions: Strict glucose control may be more important prognostic factor than presence or absence of DM in APN patients. As a marker of prolonged hospitalization and poor early clinical response, HbA1c can complement the present clinical and laboratory parameters used as guide in the proper treatment of DM patients with APN.

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Encrusted Cystitis and Pyeloureteritis in Patient with Hepatocellular Carcinoma: Jea Whan Lee, Whi-An Kwon, Seung Chol Park, Tae Hoon Oh, Young Hwan Lee, Joung Sik Rim; Korean J Urogenit Tract Infect Inflamm 2015;10(1):49-52. Published online April 30, 2015

Abstract PDF: Encrusted cystitis and pyeloureteritis are rare chronic infectious conditions characterized by mucosal inflammation and encrustations of the urinary tract. It is caused by fastidious growing urea splitting microorganisms, mainly Corynebacterium. Herein, we report an unusual case of an 80-year-old man with encrusted cystitis and pyeloureteritis who was previously treated with transcatheteral arterial chemoembolization for hepatocellular carcinoma. Abdomino-pelvic computerized tomography showed a bilateral hydronephrosis with calcifications of renal pelvis, ureter, and bladder. Cystoscopy showed calcified bladder mucosa with necrosis and bleeding. After transurethral removal of calcified plaques, the patient was treated with antibiotic and oral urine acidification. One-month follow-up cystoscopy showed that inflammation was improved and calcification was significantly reduced.

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Two Different Coagulopathy Episodes in a Single Patient with Metastatic Prostate Cancer: Insoo Rheem, Gilho Lee; Korean J Urogenit Tract Infect Inflamm 2015;10(1):53-56. Published online April 30, 2015

Abstract PDF: We reported a case of two different episodes of critical coagulopathy in a single patient with metastatic prostate cancer (mPC). The patient initially visited the emergency room with a huge left retroperitoneal hematoma, high serum prostate-specific antigen level, and signs of acute disseminated intravenous coagulation (DIC) from mPC. With blood product replacement and anti-androgen therapy, the DIC-related symptoms and signs were relieved. During the follow-up, he was treated with docetaxel chemotherapy for hormone refractory PC. Four years later, he visited the emergency room again with relapsed coagulopathy and severe anemia that were not replaced with blood products. The laboratory findings were consistent with thrombotic thrombocytopenic purpura rather than DIC. A satisfactory recovery was achieved with a new cycle of docetaxel chemotherapy. Differentiation of the coagulopathies in PC is difficult; therefore, we describe the different features of two overlapping coagulopathies, which will be helpful in deciding on urgent treatment.

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