Urogenital Tract Infection

Antimicrobial Resistance and Urinary Tract Infections: Biggest Threats: Young Sam Cho, Jae Min Chung; Urogenit Tract Infect 2017;12(1):1-2. Published online April 30, 2017

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2017 Guidelines of The Korean Association of Urogenital Tract Infection and Inflammation: Acute Uncomplicated Cystitis: Ki Ho Kim, Seung-Ju Lee, Yong-Hyun Cho, Hyun-Sop Choe, Yong Gil Na, Jae Heon Kim, Hong Chung, Jae Min Chung, Jae Hung Jung, Hoon Choi, Sun-Ju Lee; Urogenit Tract Infect 2017;12(1):3-6. Published online April 30, 2017

Abstract PDF: Acute uncomplicated cystitis is the most common urinary tract infection that mainly occurs in adult females, particularly sexually active young women and postmenopausal women. It is commonly observed in primary health care settings, including urology as well as obstetrics and gynecology; more than half of healthy adult women visit clinics and hospitals at least once in their lifetime due to acute uncomplicated cystitis. The most common bacterium causing this condition is Escherichia coli, followed by Staphylococcus saprophyticus, Klebsiella pneumoniae, Proteus mirabilis, and etc. Trimethoprim-sulfamethoxazole or fluoroquinolones have been used as an empirical antibiotic treatment. However, as fluoroquinolone-resistant organisms or extended spectrum beta-lactamase-producing organisms are becoming more prevalent worldwide, information on regional antibiotic resistance and guidelines on antibiotic use are becoming increasingly more desparate.

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2017 Guidelines of The Korean Association of Urogenital Tract Infection and Inflammation: Recurrent Urinary Tract Infection: Seung-Ju Lee, Hyun-Sop Choe, Yong Gil Na, Ki Ho Kim, Jae Heon Kim, Hong Chung, Jae Min Chung, Jae Hung Jung, Hoon Choi, Sun-Ju Lee, Yong-Hyun Cho; Urogenit Tract Infect 2017;12(1):7-14. Published online April 30, 2017

Abstract PDF: Recurrent infection after an acute urinary tract infection (UTI) episode is common in adult women. It is onerous to both the patient and the physician to treat frequent recurrent UTI. Every time when UTI recurs, patients experience lower urinary tract symptoms, fatigue, and limitation in everyday life, while the physician has difficulty in counseling patients with a disease entity whose pathophysiology is less known. Currently, prophylactic treatment for recurrent UTI is limited, is ineffective in most cases, and sometimes accompanies unexpected side effects. In this guideline, we aimed to establish feasible and effective recommendations for the treatment of recurrent UTI in healthy adult women.

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Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Male Bladder Pain Syndrome/Interstitial Cystitis: How Are They Related?: Sang Wook Lee; Urogenit Tract Infect 2017;12(1):15-21. Published online April 30, 2017

Abstract PDF: 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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Is Urethral Pain Syndrome Really Part of Bladder Pain Syndrome?: Sung Tae Cho; Urogenit Tract Infect 2017;12(1):22-27. Published online April 30, 2017

Abstract PDF: Urethral pain syndrome is a symptom complex that includes dysuria, urinary urgency, frequency, nocturia, and persistent or intermittent urethral and/or pelvic pain in the absence of proven infection. Bladder pain syndrome is a clinical diagnosis, based primarily on chronic symptoms of pain from the bladder and/or pelvis associated with urinary urgency or frequency in the absence of identified cause for the symptoms. To date, the term, urethral pain syndrome, remains to be unclear in referring to a distinct subgroup of bladder pain syndrome. However, these two syndromes share many similarities, except the organ of pain. This review is intended to summarize the current state of literature with regard to similar pathophysiology and possible interrelations between urethral pain syndrome and bladder pain syndrome.

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Recent Antimicrobial Susceptibilities for Uropathogenic Escherichia coli in Patients with Community Acquired Urinary Tract Infections: A Multicenter Study: 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; Urogenit Tract Infect 2017;12(1):28-34. Published online April 30, 2017

Abstract PDF: 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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The Effects of Microwave Thermotherapy for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Prospective, Randomized Study: Hong Chung, Hoon Choi, Tag Keun Yoo, Jeong Man Cho, Hong Sup Kim; Urogenit Tract Infect 2017;12(1):35-41. Published online April 30, 2017

Abstract PDF: Purpose: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) causes pain and urinary symptoms that involve the prostate and/or other parts of the male. We analyzed the clinical outcomes of medication and microwave thermotherapy.
Materials and Methods: A total of 132 patients with CP/CPPS for at least 3 months were assigned to one of the three study groups (group A: medication; group B: thermotherapy; group C: combination therapy). The NIH-CPSI was recorded at baseline, and at weeks 2, 4, 8, and 12 post-therapy. EPS was evaluated, and semen analysis was performed to assess the changes in prostatic inflammation. Moreover, patient satisfaction questionnaire was completed.
Results: Comparisons between groups A and B, as well as between groups B and C showed no significant changes in pain, quality of life, and total scores. At week 12, group C, when compared with group A, had a significantly improved voiding score (4.19±3.02 vs. 2.71±2.30, p=0.019) and EPS (12.47±15.91 vs. 3.73±4.82, p=0.003). At week 4, the patient satisfaction score in group C was significantly different from that in other groups (p=0.043), but there was no difference at week 12 (p＞0.05). There was no statistically significant difference in laboratory test results, PSA, and prostate volume between the three groups at baseline and week 12. Complications of thermotherapy resolved with conservative management.
Conclusions: Our results showed that a combination of medication and thermotherapy improved NIH-CPSI and patient satisfaction in CP/CPPS more than medication alone. We suggested that thermotherapy could be another treatment option for CP/CPPS.

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Symptoms of Bacillus Calmette-Guerin Cystitis in Bladder Cancer Patients according to Tuberculosis Sequelae by Chest Radiography: Won Ik Seo, Pil Moon Kang, Jang Ho Yoon, Seok Jin Choi, Wansuk Kim; Urogenit Tract Infect 2017;12(1):42-48. Published online April 30, 2017

Abstract PDF: Purpose: Bacillus Calmette-Guerin (BCG) vaccination has been administered to most infants at birth in Korea; however, tuberculosis (TB) remains extant. TB can leave sequelae on chest radiography according to the immune response of the host. We investigated the symptoms of cystitis after intravesica instillations in bladder cancer, depending on the TB sequelae on chest radiography.
Materials and Methods: One hundred forty-two patients with non-muscle invasive bladder cancer (NMIBC) underwent transurethral resection and intravesical BCG therapy for bladder cancer. Patients received a BCG induction course―with or without a maintenance course―and were divided into the two groups: Group A, which included patients with visible sequelae of TB on chest radiography (n=31) and group B, which included patients without visible sequelae of TB (n=111). Cystitis symptoms of BCG intravesical therapy were compared between the two groups. The recurrence and progression rates of bladder cancer were also analyzed.
Results: The overall rate of cystitis symptoms was 32.3% (10/31) in group A and 33.3% (37/111) in group B. One patient in group A and three in group B did not complete the treatment course due to severe cystitis symptoms (p=0.876). Pyuria was reported when cystitis symptoms occurred in 80% (8/10) in group A and 56.8% (21/37) in group B. The recurrence and progression rates were not different between the two groups.
Conclusions: Our results show that there was no significant difference of cystitis symptoms in accordance with the presence of TB sequelae in chest radiography when BCG instravesical therapy for NMIBC was performed.

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Acute Pyelonephritis with Enterococcus hirae and Literature Review: Ga Hee Lee, Hae Won Lee, Yoo Jin Lee, Bong Soo Park, Yang Wook Kim, Sihyung Park; Urogenit Tract Infect 2017;12(1):49-53. Published online April 30, 2017

Abstract PDF: To control for acute infectious disease, identification of the causative agent and determining the antibiotic susceptibility of the pathogen are crucial. If a particular organism is rare and relevant etiological information is scarce, it becomes difficult to determine appropriate antibiotic and therapy duration. Enterococcus hirae is a pathogen that infects animals, but rarely causes human infections. We present two cases of E. hirae-related pyelonephritis with successful treatment. Herein, our experience is discussed with relevant literature review.

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