Urogenital Tract Infection

Recommendations for Antibacterial Prophylaxis in Endourological Procedures: Doo Yong Chung, Joo Yong Lee; Urogenit Tract Infect 2019;14(1):1-8. Published online April 30, 2019; DOI: https://doi.org/10.14777/uti.2019.14.1.1

Abstract PDF: This review discusses the evidence and newly identified findings of antibiotic prophylaxis in endourological procedures based on recently published studies. Endoscopic procedures and surgeries are performed widely to treat a variety of urologic diseases. The panel of European Association of Urology (EAU) guidelines on UTIs decided not to make recommendations for specific agents for particular procedures because there are considerable variations in Europe and worldwide regarding bacterial pathogens, their susceptibility, and the availability of antibiotic agents in 2018. In the EAU guidelines, antimicrobial prophylactic therapies cannot decrease the rate of symptomatic UTI in several procedures, including cystoscopy and extracorporeal shock wave lithotripsy. Perioperative antibiotic prophylaxis can be helpful in all patients undergoing endourological treatment, including ureteroscopic surgery and percutaneous nephrolithotomy. Because the urological practice is a part of the surgery, most urological treatment can be performed mainly by surgery. The prevention of surgical infections in each surgical field is a critical issue, but the evidence and number of guidelines are limited.

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Perioperative Risk Factors Related to Systemic Inflammatory Response Syndrome after Percutaneous Nephrolithotomy: Ho Seok Chung, Seung Il Jung; Urogenit Tract Infect 2019;14(1):9-13. Published online April 30, 2019; DOI: https://doi.org/10.14777/uti.2019.14.1.9

Abstract PDF: Percutaneous nephrolithotomy (PCNL) has become the standard treatment for large and complex kidney stones since its introduction in 1976. On the other hand, postoperative complications are not rare and can be quite significant. Of these complications, postoperative infectious complications, such as systemic inflammatory response syndrome (SIRS), remain a seminal event and a possible cause of perioperative mortality. Several recent studies have found a number of factors that increase the risk of SIRS after PCNL. These include preoperative factors (patient’s characteristics) and factors associated with the intraoperative and postoperative findings. The present study describes the perioperative risk factors of SIRS after PCNL. These findings can help decrease the incidence of infectious complications, including SIRS, in patients undergoing PCNL.

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Changes in Antibiotic Resistance of Acute Bacterial Prostatitis in a Korean Single Center: Byoung Hoon Kim, Kwibok Choi, In-Chang Cho, Seung Ki Min; Urogenit Tract Infect 2019;14(1):14-19. Published online April 30, 2019; DOI: https://doi.org/10.14777/uti.2019.14.1.14

Abstract PDF: Purpose: Acute bacterial prostatitis (ABP) is one of main infective disease in urology with various symptoms. Occurrence of complications can be minimized by appropriate treatment. We studied whether any changes in antimicrobial resistance of hospitalized ABP patients as time passed.
Materials and Methods: The study was based on retrospective study. From 2004 to 2007 as past period and 2014 to 2017 as recent period defined. Patient’s ages, length of admission days, intensive care, urinalysis, strains, and resistance to antibiotics were investigated in hospitalized patients with ABP and compared between the two periods.
Results: Fifty patients of past period and 72 patients of recent period with ABP were admitted. The mean age was increased 55.5±13.2 years to 62.0±15.3 years. The infection route was mostly community-acquired. Prostate biopsy-related was decreased 7 to 1. The mean of hospital days were 7.9±4.2 days to 6.9±3.4 days. Intensive care were 5 to 7. Average length of stay intensive care was 4.2±1.3 days to 4.1±1.4 days. Urine cultures showed no significant difference from the previous studies in strains. Extended spectrum beta-lactamases producing bacteria increased 4.3% to 25.0%, and third generation cephalosporin resistance was increased 13.0% to 40.9%. Fluoroquinolone was no significant change 26.1% to 27.3%. Aminoglycosides were identified in 4.3% to 6.8% and carbapenem in 4.3% to 2.3%.
Conclusions: The mean age of hospitalized patients with ABP increased. Antimicrobial resistance did not change to fluoroquinolone, but extended spectrum beta-lactamases producing bacteria showed increased resistance to third-generation cephalosporin. Therefore, attention should be paid to the use of empirical antibiotics.

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Comparison of Monomicrobial versus Polymicrobial Candiduria: Time to Awareness of Candiduria: Hyunji Kim, Mi-Kyung Lee, Tae-Hyoung Kim; Urogenit Tract Infect 2019;14(1):20-25. Published online April 30, 2019; DOI: https://doi.org/10.14777/uti.2019.14.1.20

Abstract PDF: Purpose: Candiduria, which is the presence of Candida species in urine, is becoming increasingly common in hospital settings. These normal commensals in humans are often associated with the presence of other microorganisms. In this study, patients presenting with monomicrobial and polymicrobial candiduria were compared.
Materials and Methods: A retrospective study was performed on the demographic, clinical, and laboratory data of 185 patients presenting with candiduria between July 2014 and June 2015 at Chung-Ang University Hospital. The threshold for a positive Candida species urine culture was set to 10³ CFU/ml. Data on the following were evaluated: distribution of Candida species; patient age and sex; length of hospital stay; presence of diabetes mellitus (DM), chronic kidney disease (CKD), a urinary catheter, and fever; antibiotic administration; urinalysis; complete blood cells; and C-reactive protein.
Results: Monomicrobial candiduria was more common (128/185, 69.2%) than polymicrobial candiduria (57/185, 30.8%). The most prevalent species was Candida albicans (monomicrobial vs. polymicrobial candiduria, 61.7% vs. 54.4%), followed in order by Candida tropicalis (18.8% vs. 24.6%), and Candida glabrata (14.8% vs. 12.3%), with no significant difference between the two groups. Significant differences in the length of stay, underlying DM or CKD, accompanying symptoms, and urine white blood cells (WBC) and bacterial counts were observed between the two groups (p＜0.05).
Conclusions: The length of stay, underlying DM or CKD, accompanying symptoms, and urine WBC and bacterial counts were more associated with polymicrobial candiduria. The early detection and treatment of candiduria will become increasingly important as the Korean population ages.

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Introduction to the GRADE Approach for Evidence-Based Clinical Practice Guideline Development: Eu Chang Hwang, Jae Hung Jung; Urogenit Tract Infect 2019;14(1):26-27. Published online April 30, 2019; DOI: https://doi.org/10.14777/uti.2019.14.1.26

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Korean Translation of the GRADE Series Published in the BMJ, ‘GRADE: An Emerging Consensus on Rating Quality of Evidence and Strength of Recommendations’ (A Secondary Publication): Do Kyung Kim, Eu Chang Hwang, Ho Won Kang, Ja Yoon Ku, Hyun Jin Jung, Hong Wook Kim, Jae Hung Jung, Guideline Development Committee in the Korean Association of Urogenital Tract Infection and Inflammation; Urogenit Tract Infect 2019;14(1):28-32. Published online April 30, 2019; DOI: https://doi.org/10.14777/uti.2019.14.1.28

Abstract PDF: Clinical practice guidelines are statements that include recommendations intended to optimize patient care based on a systematic review of the evidence assessing the benefits and harm of alternative care options. Guideline developers should use an explicit, judicious, and transparent methodology to make trustworthy guidelines. Although there are a variety of frameworks that can help translate enormous medical knowledge into recommendations, the most widely adopted tool for grading the quality of evidence and making recommendations is GRADE (Grading of Recommendations, Assessment, Development and Evaluations). This article is the first translation of a series published in the BMJ with regard to the GRADE Approach for Evidence Based Clinical Practice Guideline Development to provide informative knowledge for moving from evidence to recommendations to Korean guideline developers.

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