Urogenital Tract Infection

Bladder Dysfunction and Urinary Tract Infection: Ju-Hyun Shin, Yong-Gil Na; Korean J Urogenit Tract Infect Inflamm 2009;4(1):1-12. Published online April 30, 2009

Abstract PDF: Urinary tract infection is responsible for major morbidity and mortality in the patients with the bladder dysfunction. Several factors appear to be responsible for an increased risk of infection in the bladder dysfunction. Significant residual urine, elevated intravesical pressure, frequent exposure to antibiotics and catheter use contribute to an increased risk of symptomatic urinary tract infection. The goals of lower urinary tract management in voiding dysfunction patients include achieving complete bladder emptying, maintenance of low intravesical pressures. Through these measures the aim is to prevent renal damage, while maximizing the patient's quality of life and independence.

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Recent Trend on the Diagnosis and Management of Urinary Tuberculosis: Soo Dong Kim, Won Yeol Cho; Korean J Urogenit Tract Infect Inflamm 2009;4(1):13-19. Published online April 30, 2009

Abstract PDF: "Genitourinary tuberculosis is not very common but it is considered as a severe form of extra-pulmonary tuberculosis. Recently, the prevalence rate of genitourinary tuberculosis is increasing, even in developed countries where the incidence used to be low. The tuberculosis recrudescence was caused by the AIDS pandemic, emergence of resistant bacilli, human migration patterns, and world poverty. The diagnosis of genitourinary tuberculosis is made based on culture studies by isolation of the causative organism; however, biopsy material on conventional solid media may occasionally be required. Modern short-course anti-tuberculous drug regimens are effective in all forms of tuberculosis and is considered the first line therapy in genitourinary tuberculosis. And, radical or reconstructive surgery also necessary to treat of genitourinary tuberculosis. All urologist have to know genitourinary tuberculosis inside out and reduce a complication by early diagnosis and right medical and surgical treatment."

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Antimicrobial Prophylaxis for Urologic Surgery: Chul Sung Kim; Korean J Urogenit Tract Infect Inflamm 2009;4(1):20-36. Published online April 30, 2009

Abstract PDF: "Surgical site infections (SSI) remain a significant contributor to postoperative morbidity and mortality. Antimicrobial prophylaxis to prevent SSI is one of the most widely accepted practices in surgery. Despite the evidence of effectiveness and the publication of guidelines for antimicrobial prophylaxis to prevent SSIs, prophylaxis use is often suboptimal. Optimal prophylaxis requires application in appropriate types of operations, selection of safe and effective antimicrobials, initial administration and redosing to maintain effective serum and tissue levels throughout the operation and discontinuation when the patient is no longer receiving a benefit and the antimicrobial agent should be bactericidal, safe, and inexpensive. Based on the published evidence, the infusion of the first antimicrobial dose should begin within 60 minutes before the surgical incision is made and prophylactic antimicrobials should be discontinued within 24 hours of the end of surgery. The initial antimicrobial dose should be adequate based on the patient's weight, adjusted dosing weight or body mass index. An additional dose of antimicrobial should be given intraoperatively if the operation is still continuing two half-lives after the initial dose. Antimicrobial prophylaxis is recommended at the time of many clean-contaminated and some clean operations. To reduce the risk of SSI, a systematic but realistic approach must be applied with the awareness that this risk is influenced by characteristics of the patient, operation, personnel and hospital."

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Current Status of Antimicrobial Resistance among Bacterial Pathogens Causing Urinary Tract Infection in Korea: Seung-Ju Lee; Korean J Urogenit Tract Infect Inflamm 2009;4(1):37-46. Published online April 30, 2009

Abstract PDF: Antimicrobial resistance among bacterial pathogens causing urinary tract infection (UTI) is a leading concern, with a high level of Gram-negative organisms resistant to trimethoprim/sulfamethoxazole and fluoroquinolones in Korea. The Korean Association of Urogenital Tract Infection and Inflammation has conducted multicenter surveillance studies for antimicrobial resistance since 2002. The present article reviews the current status of antimicrobial resistance among uropathogens in Korea based on the last 2008 study. Main etiologic pathogens of community-acquired UTI were E. coli (60.0%), E. faecalis (10.2%) and K. pneumoniae (4.1%). Nosocomial pathogens causing UTI were E. coli (38.7%), K. pneumoniae (15.1%) and P. aeruginosa (6.5%). Community-acquired UTIs were divided by uncomplicated UTI and complicated UTI. These are categorized by uncomplicated cystitis, uncomplicated pyelonephritis, complicated UTI with pyelonephritis and complicated UTI without pyelonephritis. Ciprofloxacin resistance rates in community-acquired E. coli were 24.8%, 18.4%, 25.0% and 40.9% for each category, respectively. In contrast, nosocomial E. coli showed higher resistance rate (76.4%) against ciprofloxacin. Among E. coli isolates form uncomplicated cystitis, the resistance rates to TMP/SMX, cefuroxime, cefpodoxime and amikacin were 32.4%, 9.9%, 6.4% and 0.3%, respectively. The concordance rate of the empirical antimicrobial agents were 66.7% in nosocomial UTI and 86.3% in community-acquired UTI. Among E. coli and K. pneumoniae isolates, 9.9% and 22.8% were extended spectrum β-lactamase (ESBL) producers, respectively. These results demonstrated that several uropathogens isolated in Korea have high resistance to various classes of antimicrobial agents. Fluoroquinolone-resistant E. coli and ESBL-producing K. pneumoniae constitute serious problem for UTI in Korea.

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Antibiotic Resistance Patterns of Escherichia coli in Pediatric Urinary Tract Infections for 8 Years from 2001 to 2008: Jae-I Koh, Jun-Mo Kim, Hee-Bong Shin, Min-Eui Kim; Korean J Urogenit Tract Infect Inflamm 2009;4(1):47-55. Published online April 30, 2009

Abstract PDF: "Purpose: Because the most common causative organism of the pediatric urinary tract infections (UTI) is Escherichia coli (E. coli), epidemiologic data and antibiotic resistance patterns of E. coli in several regions are important for empirical treatment in children with UTI. Materials and Methods: Between February 2001 and November 2008, we retrospectively analyzed positive urine samples of 618 pediatric patients under 15 years of age with the first UTI by E. coli. Mean age was 1.12±2.5 years. We divided the period into early (2001-2004, 217 patients) and late (2005-2008, 401 patients), and analyzed resistance patterns in two age groups: group 1, ≤ 12 months and group 2, 1-15 years. Results: Although resistance to ampicillin (75.1%), co-trimoxazole (34.1%), gentamycin (25.2%), cephalothin (21.5%) was significant resistance against amikacin (0.8%), cefoxitin (3.9%), ciprofloxacin (9.7%), imipenem (0.3%) was less than 10%. Antibiotics resistance rates was significantly decreased from early to late period in gentamycin (35% to 20.0%), cephalothin (32.7% to 15.5%), cefotaxime (17.5% to 8.7%), and there was no antibiotics with increased resistance rates between the early and the late period. In comparison between group 1 and 2, resistance to ampicillin (71.3% Vs 85.1%), amoxacillin-clavulanic acid (7.6% Vs 17.9%), cephalothin (19.1% Vs 28.0%), and co-trimoxazole (30.4% Vs 44.0%) was significantly increased with age. Conclusions: Although the resistance rates of E. coli to commonly used antimicrobial agents like as ampicillin, co-trimoxazole, gentamycin, first-generation cephalosporins was high in children with UTI, there was a trend toward decreasing resistance in our region. Amoxacillin-clavulanic acid, second-generation cephalosporins, amikacin could be reasonable alternative in the empirical treatment of the first UTI in children."

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Is the Prophylactic Intravenous Antibiotics before the Prostate Biopsy Effective?: Jong Wan Lim, Moung Jin Lee, Seung Hoon Cho, Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2009;4(1):56-61. Published online April 30, 2009

Abstract PDF: "Purpose: The blood serum prostate-specific antigen (PSA) and digital rectal examination (DRE) are being more commonly used for the early diagnosis of prostate cancer, such that more patients are going through prostate biopsies. The authors investigated the value of prophylactic intravenous antibiotics to prevent infective complication after the biopsy. Materials and Methods: The subjects were 356 patients aged 40-88 year who had a prostate biopsy from January 2004 to July 2008. Among them, 89 patients who had taken prophylactic intravenous antibiotics before the biopsy were designated as Group I, and the remaining 267 patients, as Group II who didn't had taken prophylactic intravenous antibiotics before the biopsy. The patients took then oral antibiotics (fluoroquinolone) for one week, from the morning after the biopsy, to prevent infection. The occurrence of complication was monitored based on such symptoms as gross hematuria, rectal bleeding, hemospermia, dysuria, voiding difficulty, fever. Results: 87 patients (24.4%) of the total 356 patients were diagnosed with prostate cancer. Infective complication occurred in 6 patients (1.7%), among whom 2 patients (2.2%) in Group I had taken prophylactic intravenous antibiotics, and 4 patients (1.6%) in Group II did not take intravenous antibiotics. Infective complication rates of the two groups did not have statistically differences (p>0.05). Conclusions: The intake of prophylactic intravenous antibiotics before the prostate biopsy did not have a special impact on the prevalence rate of infective complication after the biopsies."

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Correlation between Female Lower Urinary Tract Symptoms, Pyuria and Urine Cytology in Female with Microscopic Hematuria: Seok Seon Yoo, Jin Mo Koo, Geun Sik Hong, Bong Suk Shim, Hana Yoon; Korean J Urogenit Tract Infect Inflamm 2009;4(1):62-66. Published online April 30, 2009

Abstract PDF: "Purpose: Due to increasing number of routine health check, urine cytology test is also increasing to rule out malignant origin of microscopic hematuria. In female, chronic inflammatory condition of the lower urinary tract with or without symptoms are not uncommon and this condition also leads to abnormal urinalysis or urinary cytologic study. In this study, we aimed to investigate the clinical correlation of the factors related with chronic inflammatory conditions in urine cytology result. Materials and Methods: We retrospectively reviewed 103 female patients with microscopic hematuria from January 2005 to January 2008. All the data of participating patients were analyzed, and were divided into two groups; normal urine cytology group and abnormal urine cytology group. In each group, correlation between lower urinary tract symptoms (LUTS), pyuria and cytology result was analyzed. Results: In each test group we found that LUTS does not influence to urine cytology results (p=0.549). In the other hand, more pyuria cause more abnormal urine cytology results (p=0.006). Conclusions: Pyuria had effect on urine cytology result. Pyuria with or without LUTS was common in female. Therefore, care should be taken to evaluate female patients with positive hematuria response to routine urine screening test."

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Clinical Characteristics of Prostatic Abscess Treated with Transurethral Resection or Incision and Drainage: Yun Seok Jung, Jang Chun Woo, Yong Seok Lee, Sung Hak Kang, Chang Hee Han, Yong-Hyun Cho; Korean J Urogenit Tract Infect Inflamm 2009;4(1):67-71. Published online April 30, 2009

Abstract PDF: "Purpose: To evaluate the clinical presentations of prostatic abscess treated with transurethral resection or incision and drainage. Materials and Methods: We retrospectively assessed the charts of 5 patients with the diagnosis of prostatic abscess and treated with transurethral resection or incision and drainage from January 2008 to March 2009. Factors analyzed included presenting features, predisposing factors, radiologic imaging, bacteriological profile, and treatment. Results: The mean patients' age was 58.8 years. Diabetes mellitus was the most common predisposing factor (40%). Four patients presented lower urinary tract symptoms and fever, and three patients had chill. The mean size of prostatic abscess was 3.82cm and four patients had leukocytosis and pyuria. Abscess was drained by transurethral resection of prostate in three cases, and by transurethral incision and drainage in two cases. There were no postoperative complications with complete abscess resolution in all patients. Conclusions: Transurethral resection or incision and drainage should be considered in a patient with large prostatic abscess, which is not responsive to the appropriate antibiotic therapy."

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Antibiotic Prophylaxis Practice in Urology: a Survey of 21 Korean Medical Institutions: Jae I Koh, Young Ho Kim, Min Eui Kim; Korean J Urogenit Tract Infect Inflamm 2009;4(1):72-79. Published online April 30, 2009

Abstract PDF: "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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Expression of Multidrug Resistance of Ciprofloxacin-Resistant Escherichia coli from Outpatients with Uncomplicated Cystitis: Choong Bum Lee, Dae Haeng Cho, Moon Soo Chung, Seung-Ju Lee; Korean J Urogenit Tract Infect Inflamm 2009;4(1):80-85. Published online April 30, 2009

Abstract PDF: "Purpose: Currently, the prevalence of fluoroquinolone-resistant isolates of uropathogens has been reported to be increasing over time in some centers in Korea. We determined the in vitro susceptibilities of collected ciprofloxacin-resistant urine isolates of Escherichia coli (E. coli) from outpatients to other oral antimicrobial agents used for the treatment of acute cystitis. Materials and Methods: From January 2007 to December 2008, a total of 150 ciprofloxacin-resistant E. coli isolates from urine specimens from outpatients with acute cystitis were collected from 5 university hospitals in Korea. Clinical and Laboratory Standards Institute-specified broth microdilution testing was performed with amoxicillin/clavulanate, ampicillin, cefuroxime, cefpodoxime, and trimethoprim/sulfamethoxazole (TMP/SMX). Results: Ciprofloxacin-resistant E. coli isolates were frequently resistant to ampicillin (84.6% of isolates) and TMP/SMX (63.4%); concurrent resistance to amoxicillin/clavulanate (10.0%) or cefpodoxime (6.6%) was less common. Only 6.6% of isolates was resistant to ciprofloxacin alone; concurrently resistant to one (28.7%), two (42.7%), three (10.7%), four (9.3%), or five (2.0%) other oral antimicrobial agents, most commonly ampicillin and TMP/SMX. Conclusions: Ciprofloxacin-resistant E. coli isolates from urine were frequently multidrug resistant in Korea. Close attention is required to monitor fluoroquinolone resistance patterns and the association of multidrug resistance with fluoroquinolone resistance in uropathogens."

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Retroperitoneal Fibrosis with Spontaneous Subcapsular Renal Hemorrhage Treated with Medical Thearpy: Eu Chang Hwang, Ho Suck Chung, Chang Min Im, Seung Il Jung, Dong Deuk Kwon, Kwangsung Park, Soo Bang Ryu, Jun Eul Hwang1; Korean J Urogenit Tract Infect Inflamm 2009;4(1):86-88. Published online April 30, 2009

Abstract PDF: Spontaneous subcapsular renal hemorrhage is relative uncommon. The literature suggests that the majority causes for this phenomenon associated with disease of the kidney, blood vessel disease, blood dyscrasia. We report a unique case of retroperitoneal fibrosis combined with subcapsular renal hemorrhage. The patient was successfully treated with medical therapy.

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Serial Radiologic Changes of an Undetected Emphysematous Cystitis: Yoon Dong Kim, Mi Ho Song, Won Jae Yang, Yun Seob Song, Young Ho Park, Seong Sook Hong; Korean J Urogenit Tract Infect Inflamm 2009;4(1):89-92. Published online April 30, 2009

Abstract PDF: Emphysematous cystitis is an uncommon infection of the urinary bladder with the formation of carbon dioxide either inside the bladder cavity or within its wall. A 91-year-old non-diabetic woman was admitted for an intertrochanteric fracture of the femur. The patient also complained of lower abdominal pain. An abdominal flat X-ray revealed intramural and intraluminal air in the distended bladder indicating emphysematous cystitis, however, these findings passed unnoticed. We present the serial radiologic changes of an undetected emphysematous cystitis. The diagnostic and therapeutic aspects are discussed.

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Septic Shock Caused by Pancreatic Injury after Radical Nephrectomy: Dong-Wan Sohn, Tae Seung Shin, Sung Dae Kim, U-shin Ha, Yong-Hyun Cho; Korean J Urogenit Tract Infect Inflamm 2009;4(1):93-95. Published online April 30, 2009

Abstract PDF: A 66-year-old female patient presented with right upper quadrant pain for 3months. Preoperative computed tomography, magnetic resonance imaging, and laboratory tests were not consistent with findings of pheochromocytoma, but rather tumor originating from renal cortex. Pathology revealed pheochromocytoma and pancreatic injury was suspected after the surgery. Septic condition persisted despite of proper antibiotics, drainage, and octreotide therapy. Patient died on 8th day after radical nephrectomy. We report a morbid complication of pancreatic injury leading to septic shock and to death.

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Perivesical Abscess Following Transurethral Resection of Bladder Tumor and BCG Intravesical Instillation in Non-muscle Invasive Bladder Tumor Patient: Sang Deuk Kim, Young Beom Jeong, Hyung Jin Kim; Korean J Urogenit Tract Infect Inflamm 2009;4(1):96-99. Published online April 30, 2009

Abstract: There are few reports of serious complications secondary to BCG intravesical instillation such as extravasation, perivesical inflammation. We report a case of perivesical abscess developed by transurethral resection of bladder tumor and BCG intravesical instillation.

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Ciprofloxacin Resistant and Extended Spectrum β-Lactamase Producing Escherichia Coli Cultured in a Urosepsis Patient by Urinary Stone Complicated Acute Pyelonephritis: Donghoon Lim, Haepyoung Seo, Chul-Sung Kim; Korean J Urogenit Tract Infect Inflamm 2009;4(1):100-103. Published online April 30, 2009

Abstract PDF: "Urosepsis in adults comprises approximately 25% of all sepsis cases and in most cases is due to complicated urinary tract infections (UTIs). Escherichia Coli (E. coli) and other Enterobacteriaceae can be expected to be the predominant pathogens in the patients with community acquired urosepsis, which needs appropriate empirical antimicrobial treatment. However, recently, increasing worldwide prevalence of quinolone-resistant E. coli and/or extended spectrum β-lactamase (ESBL) producing E.coli has made clinicians difficult in treating UTIs. Lately, we experienced a urosepsis patient by quinolone-resistant and ESBL producing E. coli, with urinary stone complicated acute pyelonephritis, who didn't show any response to empirical antibiotics or appropriate bacterial culture results. We report this case to emphasis the importance of multi-drug resistance bacteria such as quinolone resistant and ESBL producing E. coli, although it is known widely, but easy to pass over."

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Spontaneous Bladder Rupture due to Giant Bladder Stone: Sung Dae Kim, Young-Joo Kim, Jung-Sik Huh; Korean J Urogenit Tract Infect Inflamm 2009;4(1):104-107. Published online April 30, 2009

Abstract PDF: "Spontaneous bladder rupture is a very rare condition. It is the term employed for all cases of rupture not associated with trauma, including diseases of the urinary bladder or urinary outflow obstruction. It usually presents as severe abdominal pain. But in some cases, because symptoms are insidious and often atypical among elderly patients, this condition is often undetected. We describe an unusual case of spontaneous bladder rupture due to giant bladder stone."

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Pyoderma Gangrenosum of the Penis: Young Dae Bae, Seung Min Jeoung, Hong Jae Ahn, Ji Yoon Chae, Ki Won Ko, Sang Gan Nam, Du Geon Moon; Korean J Urogenit Tract Infect Inflamm 2009;4(1):108-111. Published online April 30, 2009

Abstract PDF: Pyoderma gangrenosum is a rare ulcerating inflammatory skin disease. Genital involvement has been rarely reported. We report a 45-year-old man with penile pyoderma gangrenosum who was treated with partial penectomy.

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Status of International Consensus on Interstitial Cystitis/Bladder Pain Syndrome/Painful Bladder Syndrome: 2008 Snapshot: In Rae Cho; Korean J Urogenit Tract Infect Inflamm 2009;4(1):112-133. Published online April 30, 2009

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2007 UK National Guideline on the Management of Non-gonococcal Urethritis: Hana Yoon; Korean J Urogenit Tract Infect Inflamm 2009;4(1):134-139. Published online April 30, 2009

Abstract PDF: "The main objective is to reduce the number of sexually transmitted infections (STIs) and the complications that can arise in people either presenting with signs and symptoms of an STI, or undergoing investigation for possible infection. Specifically, this guideline offers recommendations on the diagnostic tests, treatment regimens and health promotion principles needed for the effective management of non-gonoccocal urethritis (NGU), covering, the management of the initial presentation, as well as how to prevent transmission and future infection. The recommendation of this guideline may not be appropriate for use in all clinical situations. Decisions to follow these recommendations must be based on the professional judgement of the clinician and consideration of individual patient circumstances and available resources."

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