Urogenital Tract Infection

Clinical Significance of Toll-Like Receptor and Toll-Like Receptor Blocker: Jae Young Choi, Phil Hyun Song, Young Hwii Ko; Urogenit Tract Infect 2016;11(1):1-6. Published online April 30, 2016

Abstract PDF: The mammalian Toll-like receptor (TLR) family, consisting of 13 members, plays an important role in innate recognition of specific patterns of microbial products. TLR-dependent recognition subsequently causes an activation of antigen-specific adaptive immunity. TLR-mediated signaling pathways consist of two pathways that induce gene expression: the myeloid differentiation primary response gene 88 (MyD88)-dependent pathway and Toll/interleukin-1 receptor-domain containing adaptor protein-inducing interferon--dependent pathway. Synthetic TLR agonists, as well as TLR antagonists, affect and manipulate the host defense systems, and some of these immunomodulating agents may help to overcome intrinsic disturbances of the TLR system to offer new treatment options in urinary tract infection (UTI). Future studies are necessary to clarify additional associations between TLRs and severity of UTI, which may help in developing new treatment options.

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National Trends of Antimicrobial Resistance in Uncomplicated Cystitis: Hyun-Sop Choe, Seung-Ju Lee; Urogenit Tract Infect 2016;11(1):7-11. Published online April 30, 2016

Abstract PDF: Acute uncomplicated cystitis is a common bacterial infection of the urinary bladder in women. Antibiotic resistance against Escherichia coli is increasing nationwide in Korea; therefore, we reviewed the local available data regarding acute cystitis. The recently determined susceptibilities of E. coli to gentamicin, fluoroquinolone, 3rd generation cephalosporin, and amikacin are 75%, 85-95%, 95%, and 97%, respectively. The resistance rates of E. coli to trimethoprim/sulfamethoxazole, fluoroquinolone, and even 3rd generation cephalosporin are higher in Korea compared with other countries, however, the studies that determined those resistance rates included data collected at tertiary referral hospitals, which may have been overestimated. Continuous monitoring of antibiotic resistance and opportune establishment and revision of treatment guidelines are required for the optimal management of acute cystitis.

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What Are the Predictive Factors of Severe Conditions in Acute Obstructive Pyelonephritis?: Jun Kamei, Yukio Homma; Urogenit Tract Infect 2016;11(1):12-16. Published online April 30, 2016

Abstract PDF: Acute obstructive pyelonephritis is a common urological infection, often requiring emergency drainage, which shows rapid progression to serious conditions, including severe sepsis or septic shock. Therefore, during an initial evaluation, knowledge of factors for prediction of severe conditions or mortality is important for immediate identification of patients requiring intensive care. Previous studies examining the characteristics of patients with acute obstructive or calculous pyelonephritis reported rates of septic shock and mortality of 20.8-33.3% and 0-7.4%, respectively. Thrombocytopenia, older age, low serum albumin, and bacteremia were relatively common predictors for septic shock. In contrast, age over 80 years, systemic inflammatory response syndrome, disseminated intravascular coagulation status, disturbance of consciousness, male gender, and having only one kidney were predictive factors for mortality.

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Infectious Complications after Prostate Biopsy: A Prospective Multicenter Prostate Biopsy Study: 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); Urogenit Tract Infect 2016;11(1):17-24. Published online April 30, 2016

Abstract PDF: 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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Predictive Parameters of Testicular Salvage of Pediatric Testicular Torsion: A 6-Year Experience of a Single Center: Seungsoo Lee, Bu Kyung Park, Moon Kee Chung, Jae Min Chung, Sang Don Lee; Urogenit Tract Infect 2016;11(1):25-29. Published online April 30, 2016

Abstract PDF: Purpose: We evaluated parameters associated with testicular salvage in boys with testicular torsion.
Materials and Methods: During 2009-2014, 19 boys younger than 18 years old underwent emergency surgery for testicular torsion in our hospital. Age, chief complaint, laterality of the torsion, physical appearance, ultrasonographic results, duration between the onset of symptoms and hospital visit, duration between the onset of symptoms and start of surgery, intraoperative appearance, surgical method (orchiopexy or orchiectomy), and any postoperative complications were analyzed retrospectively. Cases were categorized according to salvageable testes (n=14) or unsalvageable testes (n=5) groups based on testes viability.
Results: The mean age was not significantly different between the two groups. All patients were diagnosed using color Doppler ultrasonography of the scrotum. Six (42.9%) boys in the salvageable testes group and all five in the unsalvageable testes group were transferred from other clinics or hospitals (p=0.026). The mean duration between the onset of symptoms and hospital visit was 925 minutes in the salvageable testes group and 3,488 minutes in the unsalvageable testes group (p=0.042), and the mean duration between the onset of symptoms and start of surgery was 1,131 minutes in the salvageable testes group and 3,777 minutes in the unsalvageable testes group (p=0.042).
Conclusions: There was a high possibility that orchiectomy was required if surgery was delayed. However, even when a boy is admitted to the hospital more than 24 hours after the onset of symptoms, the testis can still be viable provided the surgery is performed as quickly as possible.

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Clinical Data of Urine Culture and Antimicrobial Sensitivity Tests according to the Voiding Method over 15 Years in Patients with Spinal Cord Injury: Won Jun Lee, Sang Jin Kim, Jae Hyun Ryu, Yun Beom Kim, Seung Ok Yang, Jeong Ki Lee, Tae Young Jung; Urogenit Tract Infect 2016;11(1):30-35. Published online April 30, 2016

Abstract PDF: Purpose: To analyze the results of urine cultures and antimicrobial sensitivity tests according to the voiding methods in patients with spinal cord injury (SCI) over a 15-year period.
Materials and Methods: A total of 1,579 urine culture samples, obtained from January 2000 to December 2014, for 73 SCI patients were analyzed according to the voiding method. We analyzed the following: positive urine culture rate, colony counts, isolated number of organism, major organisms, and antimicrobial sensitivity tests. The voiding methods were categorized into four methods: clean intermittent catheterization (CIC), suprapubic catheterization (SPC), urethral Foley catheter, and spontaneous voiding (SV).
Results: Among the 1,579 urine samples, 1,250 (79.2%) were positive. The CIC group showed the lowest rate of bacteriuria (p＜0.001), colony counts (p＜0.001), and polymicrobial infection (p＜0.001). Causative organisms were mostly gram-negative bacteria (86.7%). Pseudomonas aeruginosa (22.7%) was most common pathogen followed by Escherichia coli (22.3%), Klebsiella species (9.5%), Providencia species (4.4%), and Serratia marcescens (4.2%). Major pathogens and antimicrobial sensitivity tests were different according to the voiding method.
Conclusions: CIC is the best voiding method to reduce urinary tract infection (UTI) in SCI patients. To treat UTI in in SCI patients, empirical antibiotics can be chosen according to the voiding method based on the reference of our study prior to the availability of antimicrobial sensitivity results.

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Tuberculosis of the Glans Penis Presenting as Glans Gangrene: Hong Seok Shin, Jae Shin Park; Urogenit Tract Infect 2016;11(1):36-38. Published online April 30, 2016

Abstract PDF: Tuberculosis of the glans penis is rare. The clinical features of tuberculosis of the glans penis include the appearance of a superficial ulcer of the glans. We recently experienced a case of tuberculosis of the glans penis presenting as an ulcer, which progressed to glans necrosis. A 46-year-old man presented at our institution with painful ulcerative penile lesions. Initial pathological findings of the ulcers showed non-granulomatous inflammatory changes. He was treated with antibiotics and anti-inflammatory drugs for 6 months, and during that time, his glans ulcers progressed to glans gangrene. A partial glansectomy showed multiple epithelioid granulomas with central caseous necrosis, which was compatible with the findings of tuberculosis. The patient received anti-tuberculosis chemotherapy. The current case is reported to alert physicians to consider the possibility of tuberculosis when evaluating unusual penile glans lesions.

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Mondor’s Disease of the Penis Mistaken for Penile Fracture: Young Hwan Jung, Dong Soo Ryu; Urogenit Tract Infect 2016;11(1):39-41. Published online April 30, 2016

Abstract PDF: Superficial thrombophlebitis of the dorsal vein of the penis, known as penile Mondor’s disease, is an uncommon genital disease. We report on a healthy 44-year-old man who presented with painful penile swelling, ecchymosis, and penile deviation after masturbation, which initially imitated a penile fracture. Thrombosis of the superficial dorsal vein of the penis without rupture of corpus cavernosum was found during surgical exploration. The patient recovered without erectile dysfunction.

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