Urogenital Tract Infection

Antimicrobial Prophylaxis for Genitourinary Prosthetics: Jung Hoon Kim, Tae-Hyoung Kim; Korean J Urogenit Tract Infect Inflamm 2011;6(1):1-7. Published online April 30, 2011

Abstract PDF: Infection is the most troublesome complication in urologic prosthetic surgery. Commonly implanted devices include penile prosthesis, artificial urinary sphincter, and artificial testes. Explantation of the prosthetic device has been standard treatment for infection. This supports the need for prophylactic antibiotic therapy, with the goal of preventing bacterial seeding. Antibiotic regimens should be effective against bacteria, particularly Staphylococcus epidermidis, Staphylococcusaureus, and Pseudomonas aeruginosa.

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Update of Acute Bacterial Prostatitis: Woosuk Choi, Hwancheol Son; Korean J Urogenit Tract Infect Inflamm 2011;6(1):8-17. Published online April 30, 2011

Abstract PDF: Acute bacterial prostatitis is defined as acute infection of prostate. It is classified into category I according to the National Institutes of Health (NIH) consensus classification. Patients with acute bacterial prostatitis present with acute symptoms of urinary tract infection, including urinary frequency, dysuria and symptoms suggestive of systemic infection, such as malaise, fever and myalgia. The prostate may be swollen and tender on digital rectal examination, butprostatic massage is contraindicated. The most common pathogen is Escherichia coli. For initial therapy, high doses of bactericidal antibiotics, such as abroad-spectrum penicillin, a third-generation cephalosporin or a fluoroquinolone may be administered parentally and these regimens may be combined with an aminoglycoside. After defeverescence and normalization of infection parameters, oral antibiotic therapy can be continued for 2 to 4weeks. We should bear in mind that acute bacterial prostatitis secondary to manipulation of the lower urinary tract, such as transrectal prostatic needle biopsy,has more aggressive clinical course.

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Update of Prophylactic Antibiotics in Vesicoureteral Reflux: Jun-Mo Kim; Korean J Urogenit Tract Infect Inflamm 2011;6(1):18-24. Published online April 30, 2011

Abstract PDF: Antibiotic prophylaxis has been administered to prevent acute pyelonephritis and renal scar development in children with vesicoureteral reflux (VUR) and recurrent urinary tract infections (UTI) since the 1960s. However, randomized clinical trials, systematic reviews and meta-analyses on antibiotic prophylaxis after UTI has been published in the last 5 years demonstrate not only ineffective routine antimicrobial prophylaxis in patients with low-grade VUR is ineffective in reducing recurrent UTI, but also antimicrobial resistant rate actually increased. Because children with high-grade VUR were excluded in most of these studies, these findings cannot be applied to grade IV-V VUR. Furthermore, debatable results regarding benefits of antimicrobial prophylaxis in grade III reflux has been reported. The on-going Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) study will provide useful data to address this problem.

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Update of Non-gonococcal Urethritis: Ki Ho Kim, Young Jin Seo; Korean J Urogenit Tract Infect Inflamm 2011;6(1):25-31. Published online April 30, 2011

Abstract PDF: Urethritis in males not secondary to gonorrhea is classified as non-gonococcalurethritis (NGU). NGU is a common chlamydia-associated syndrome in men. However, Mycoplasma genitalium and Trichomonas vaginalis have been suggested as pathogens that cause NGU. In 20-30% of NGU cases, possible pathogens remain unidentified. Symptoms, if present, include mucopurulent or purulent discharge, dysuria, andurethral pruritis. Culture, nucleic acid hybridization tests, and nucleic acid amplification test are available for the detection of N. gonorrhoeae and C. trachomatis. Treatment should be initiated as soon as possible after diagnosis. Azithromycin and doxycycline are highly effective for chlamydial urethritis. However, infections with M. genitalium respond better to azithromycin.

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Extended-spectrum β-lactamases Producing Bacteria in Urinary Tract Infection: Gilho Lee; Korean J Urogenit Tract Infect Inflamm 2011;6(1):32-41. Published online April 30, 2011

Abstract PDF: Multi-drug-resistant Enterobacteriaceae that produce extended-spectrum β-lactamases (ESBLs) have emerged in the communities and hospitals. Because β-lactamases are bacterial enzymes that hydrolyze β-lactamring in antibiotics, cephalosporins are not usually effective. Most ESBLs can be divided into three groups: TEM, SHV, and CTX-M. Recently, AmpC β-lactamase is included in this category. The clinical significance of ESBL bacteria is well known. Initially, ESBL bacteria exhibitmulti-drug resistance, such as co-trimoxazole, tetracycline, gentamicin, and fluroquinolone, as well as broad-spectrum cephalosporins. In addition, they can be transmitted to other places andother people. Moreover, inappropriate empirical therapy to urinary tract infection secondary to ESBL bacteria is usually associated with higher mortality. For these reasons, gram-negative pathogens that produce ESBLs remain an important cause oftherapy failure with newly developed cephalosporins, and incur serious complications and have consequences in infection control in the community. Consequently, it is an urgent issue to understand the characteristics of ESBL bacteria to minimize their spread and to treat ESBL associated urinary tract infection. We herein review the clinical significances of ESBL bacteria in urinary tract infection.

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Comparison of Clinical Symptoms Scored According to NIH-CPSI in Patients with Chronic Prostatitis Syndrome Category IIIa and IIIb: Jae Young Choi, Moung Jin Lee, Seung Hoon Cho, Sung Bin Kim, Seung Tae Lee, Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2011;6(1):42-47. Published online April 30, 2011

Abstract PDF: "Purpose: With little evidence, the causes of inflammatory and non-inflammatory chronic pelvic pain syndrome (CPPS), which cover a majority of cases of prostatitis syndromes, have not been fully explicated. The mechanisms of these two CPPS may be different. Although the clinical symptoms are expected to be disparate, we compared the clinical symptoms between the two using National Institutes of Health chronic prostatitis symptoms index (NIH-CPSI) over several parameters. Materials and Methods: The chronic pelvic pain syndrome patients (n=256) at our institution between April 2009 and March 2010 were included. After classifying these patients into two groups, the inflammatory CPPS and the non-inflammatory CPPS groups, we compared the two groups in terms of pain or discomfort, urinary symptom, quality of life, prostate volume measured by transrectal ultrasonography (TRUS), prostate specific antigen (PSA) and maximum flow rate (Qmax) difference. Result: There was no statistically significant difference between the two groups in pain or discomfort, urinary symptom, quality of life, prostate volume measured by TRUS, and Qmax difference. However, inflammatory CPPS patients showed meaningfully higher PSA scores than non-inflammatory CPPS patients. No significant difference was observed between patient age and compared among the age groups. Pain or discomfort, urinary symptom, quality of life, prostate volume measured by TRUS, and Qmax difference within each age group were not significantly different between the inflammatory CPPS & non-inflammatory groups. Conclusions: There was no statistically significant difference between the two groups except PSA. It remains unreliable to distinguish inflammatory CPPS from non-inflammatory CPPS based solely on clinical symptoms."

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Changes of Interleukin-1β in the Prostate Secretions of Chronic Nonbacterial Prostatitis Patients: Hana Yoon, Dong Hyeon Lee; Korean J Urogenit Tract Infect Inflamm 2011;6(1):48-53. Published online April 30, 2011

Abstract PDF: "Purpose: To measure changes in prostate cytokine secretion in chronic non-bacterial prostatitis (NBP) patients and examine the clinical usefulness of these changes in differentiating the pathophysiologic mechanism of NBP and subsequent selection of treatment modalities. Materials and Methods: Sixty male patients were diagnosed with chronic NBP, and a control group comprised of 30 male patients without clinical evidence of NBP were enrolled in this study. Prostate secretion (centrifuged VB3) was analyzed at the initialdiagnosis and 8 weeks after treatment initiation. Patients who showed more than 10 white blood cells (WBCs)/high power field (HPF) 8 weeks after treatment initiation were categorized into group A. Group B patients had less than 3 WBCs/HPF. Group B was further subclassified into two groups according to presence of symptoms after treatment: Bp (symptom-persisted) and Br (symptom-resolved). IL-1β, C3, C4, IgG were measured and the results were analyzed. Results: There were significant differences in the IL-1β level in the control group compared to group A, Bp and Br (p<0.05). C3, C4, IgG showed higher levels in groups A and B than in the control group, albeit without statistical significance (p>0.05). Conclusions: Elevated IL-1β in group Bp suggests that chronic NBP patients who did not respond to treatment could exhibitclinical manifestations of autoimmune reactions rather than infection of external origin. We suggest that a more advanced diagnostic technique using cytokine at the initial stage of disease manifestation tohelp clinicians avoid unnecessary antibiotic treatment and manage the condition more effectively."

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The Effect of Inflammatory Histological Extent of Prostate on the Lower Urinary Tract Symptoms in Benign Prostatic Hyperplasia Patients: Seong Ju Lee, Dong Hyeon Lee, Young Yo Park, Bongsuk Shim, Woon-Sup Han; Korean J Urogenit Tract Infect Inflamm 2011;6(1):54-60. Published online April 30, 2011

Abstract PDF: "Purpose: to investigate for clinical correlation between inflammatory histological findings of the prostate and lower urinary tract symptoms in benign prostatic hyperplasia patients. Materials and Methods: A total of 274 patients whose prostate-specific antigen (PSA) was higher than 4.0 ng/dl, had underwent prostate biopsy. International prostate symptom score questionnaire, uroflowmetry, and transrectal ultrasonography were also performed. Patients were divided into 3 groups and granted points according to the extent of lymphocytic infiltration: 0 point for patients with normal findings; 1 point for patients with lower than 50% of lymphocytic infiltration; 2 points for patients with higher than 50% of lymphocytic infiltration or secretor destruction by neutrophil infiltration findings. We quantified the extent of inflammation by using total prostatitis pathology score and classified 0-5 points, 6-10 points, 11-15 points, higher than 16 points into grade 1-4, respectively. Results: Of the 274 patients, 71 who diagnosed with prostate cancer from their biopsy were excluded. Of the remaining 203 patients, 106 (52.21%) were classified grade 1, 57 (28.08%) were grade 2, 31 (15.27%) were grade 3, and 9 (4.43%) were grade 4. There were 142 patients (69.96%) in the group with core 2, which means severe inflammation, and 61 patients (30.04%) in the group without core 2. In addition, prostate volume, storage symptoms score and total scores in IPSS and quality of life were significantly higher in the group with core 2. Conclusions: Lower urinary tract symptoms deteriorated as prostatic inflammation became severe. However, further studies are required to determine correlation more accurately."

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Clinical Features of Bacteremia Caused by Ciprofloxacin-Resistant Bacteria after Transrectal Ultrasound-Guided Prostate Biopsy: Bo Sung Shin, Eu Chang Hwang, Seung Il Jung, Dong Deuk Kwon, Kwangsung Park, Soo Bang Ryu, Jin Woong Kim; Korean J Urogenit Tract Infect Inflamm 2011;6(1):61-66. Published online April 30, 2011

Abstract PDF: "Purpose: Fluoroquinolone is considered the prophylactic antibiotic of choice for Transrectal ultrasound (TRUS)-guided biopsy. However, failure of quinolone prophylaxis due to emerging quinolone-resistant enterobacteriae has been increasing. We reviewed bacteremia cases after TRUS-guided biopsy to identify antibiotic-resistant bacterial strains with the objective to prevent urosepsis. Materials and Methods: A total of 2,348 patients underwent TRUS-guided biopsy at our institution between January 2004 and December 2009. All patients received intravenous ciprofloxacin for prophylaxis. We retrospectively evaluated patients who developed infectious symptoms, such as fevers and chills. Results: Eleven (0.4%) of 2,348 patients developed infectious symptoms. Escherichia coli was the pathogen responsible for post-biopsy infections occurring in a; 11 (100%) patients with positive blood cultures, which confirmed ciprofloxacin-resistant E. coli, with one isolate producing extended-spectrum beta lactamase. Ten out of 11 E. coli isolates (91%) were resistant to ampicillin and 9 of 11 E. coli isolates (82%) were resistant to gentamicin. Ten out of 11 E. coli isolates (91%) were susceptible to third generation cephalosporins. All such patients were admitted to the hospital and treated with a third generation cephalosporin. One patient who habored an E. coli isolate producing extended-spectrum beta-lactamase received imipenem. Conclusions: Ciprofloxacin is effective in reducing infectious complications. However, recently, bacteremiccases are increasing due to ciprofloxacin resistant E. coli. For patients with infectious symptoms after transrectal prostate biopsy, early antibiotics change, including third generation cephalosporins, are recommended to prevent urosepsis."

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Correlation between Genitourinary Mycoplasmas and Chlamydia Infection and Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Suk Gun Jung, Sang Don Lee; Korean J Urogenit Tract Infect Inflamm 2011;6(1):67-72. Published online April 30, 2011

Abstract PDF: "Purpose: Chronic prostatitis frequently occurs in men of all ages. Recent studies suggest that fastidious microorganisms may play a role in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The aim of this study was to investigate if correlation exists between genitourinary Mycoplasmas and Chlamydia infections and CP/CPPS. Materials and Methods: We evaluated Mycoplasmas and Chlamydia prostatitis in 222 patients diagnosed with CP/CPPS from November 2008 to January 2011 by using the Chlamydia and Mycoplasma IST2 kits. Results: Of the 222 patients, 33 (14.9%) and 189 (85.1%) were respectively classified category IIIa (inflammatory CP/CPPS) and IIIb (non-inflammatory CP/CPPS). On kit tests, 10 (30.3%) of the 33 category IIIa and 55 (29.1%) of the 189 category IIIb cases were positive for causative microorganism. Conclusions: The results suggest close correlation between genitourinary Mycoplasmas and Chlamydia infections and CP/CPPS. In addition, the Chlamydia and Mycoplasma IST2 kits may be useful for simple detection of fastidious microorganisms in CP/CPPS."

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Species Distribution and Antifungal Susceptibilities of Yeast Isolated from Catheterized Urine Specimen: Tae-Hyoung Kim, Jong-Yeon Lee, Jae-Dong Chung, Sang-Hyup Lee, Mi-Kyung Lee; Korean J Urogenit Tract Infect Inflamm 2011;6(1):73-79. Published online April 30, 2011

Abstract PDF: "Purpose: The aim of the present study was to evaluate the effect of urinary catheter on species distribution and susceptibilities of antifungals against clinical isolates of yeasts from catheter-associated urinary tract infection (CAUTI). Materials and Methods: A total 281 yeast isolates from catheterized urine in a medical and surgical ward were collected. Species identification and antifungal susceptibulity test to amphotericin B, fluconazole, voriconazole and flucytosine were performed by VITEK 2 system (bioM?rieux Inc. Hazelwood, MO, USA). Results: The most frequent species was Candida tropicalis (48.8%), followed by C. albicans (24.6%), C. glabrata (15.7%) and Trichosporon asahii (5.0%). C. tropicalis and T. asahii were more frequently isolated in a surgical ward than medical ward (p<0.05). Decreased susceptibilities to amphotericin B were observed in C. albicans and T. asahii. All isolates except C. glabrata and C. krusei were susceptible to fluconazole and voriconazole. Conclusions: The results of this study suggest the possibility that urinary catheter may lead to influence on species distribution of yeast of CAUTI. There is an need for continuous surveillance of CAUTI by yeast for the control of CAUTI."

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Emphysematous Cystitis Associated with Prostate and Urethra Involvement: Jae Min Chung, Jeong Hyun Oh, Su Hwan Kang, Seong Choi; Korean J Urogenit Tract Infect Inflamm 2011;6(1):80-83. Published online April 30, 2011

Abstract PDF: Emphysematous cystitis is primary infection of the bladder with gas production by bacteria. The infection is uncommon but commands clinical importance due to its morbidity and mortality potential. We report a 54 year-old man with emphysematous cystitis associated with prostatic and urethral involvement. He was managed with antibiotics and suprapubic catheterization.

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Uropathogenic Escherichia coli Induces Chronic Pelvic Pain: Sung Un Park; Korean J Urogenit Tract Infect Inflamm 2011;6(1):84-95. Published online April 30, 2011

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The New Korean Guideline for Sexually Transmitted Infections: Dong-Hoon Lim, Seung-Ju Lee, Bongsuk Shim, Chul-Sung Kim, Min Eui Kim, Yong-Hyun Cho; Korean J Urogenit Tract Infect Inflamm 2011;6(1):96-113. Published online April 30, 2011

Abstract PDF: Sexually transmitted infections (STIs) are increasing worldwide. To have a well-designed localized guideline on STIs is crucial in controlling the condition. We reviewed the newly developed Korean STI guideline, 2011 that will provide comprehensive information regarding STI management.

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