Urogenital Tract Infection

Antimicrobial Prophylaxis for Recurrent Urinary Tract Infection: Min Gu Park, Dae Yeon Cho; Korean J Urogenit Tract Infect Inflamm 2014;9(1):1-8. Published online April 30, 2014

Abstract PDF: Recurrent uncomplicated urinary tract infection (UTI) is a common problem in women, causing considerable morbidity and expense, and is a management burden for clinicians. In management of recurrent UTI, non-antimicrobial approaches to prevention of UTI, such as behavioral modifications should first be tried as a way of minimizing antimicrobial exposure, however, antimicrobial treatment of prophylaxis may be necessary in those who continue to have recurrences. Continuous antimicrobial prophylaxis, post-coital prophylaxis with low dose antimicrobials, and intermittent self-treatment with antimicrobials have all been shown to be effective in prevention of recurrent uncomplicated UTIs. The decision regarding which approach to use for prophylaxis depends on the frequency and pattern of recurrence and the patient’s preference to commit to a specific method. The risk of adverse events and the plan for pregnancy should be considered before starting any regimen of antimicrobial prophylaxis. The susceptibility of the organisms causing the previous UTIs and history of the patient’s drug allergies should be considered before selection of antimicrobials. Before initiation of any prophylaxis regimen, eradication of a previous UTI should be confirmed by a negative urine culture. Continuous antimicrobial prophylaxis is usually used for long periods, thus likely contributing to the widespread problem of antimicrobial resistance. Post-coital prophylaxis and self-treatment approach result in less antimicrobial use, but should be used in the appropriate settings.

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Non-Antibiotic Prophylaxis for Recurrent Urinary Tract Infections: Ki Ho Kim; Korean J Urogenit Tract Infect Inflamm 2014;9(1):9-13. Published online April 30, 2014

Abstract PDF: Urinary tract infections (UTI) are one of the most common infections affecting women. In a recent study of college women with their first UTI, 27% experienced at least one culture-confirmed recurrence within the six months following the initial infection and 2.7% had a second recurrence during this time period. Women with recurrent UTI have an increased susceptibility to vaginal colonization with uropathogens due to a greater propensity for them to adhere to their epithelial cells. Risk factors include frequent sexual intercourse, spermicide use, first UTI at an early age, and maternal history of UTI. Effectiveness of continuous or post-coital prophylaxis with low-dose antimicrobials or intermittent self-treatment with antimicrobials in management of recurrent uncomplicated UTIs in women has been demonstrated. However, antibiotics are the main driving force in development of antibiotic resistance and can lead to resistance of not only the causative microorganisms, but also the commensal flora. The increasing prevalence of Escherichia coli isolates (the most prevalent uropathogen) that are resistant to antimicrobial agents has stimulated interest in non-antibiotic methods for prevention of UTIs. We discuss the overall use of non-antibiotic methods for prevention of recurrent UTI, including the use of immunostimulant OM-89, a vaginal vaccine or estrogen, lactobacilli prophylaxis, and cranberry.

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Antimicrobial Prophylaxis for Prostatic Surgery: Seung Il Jung; Korean J Urogenit Tract Infect Inflamm 2014;9(1):14-20. Published online April 30, 2014

Abstract PDF: Antimicrobial prophylaxis is the periprocedural systemic administration of an antimicrobial agent intended to reduce the risk of postprocedural local and systemic infection. However, the use of antibiotics in urologic surgery has been controversial for decades. Significant progress in prostate surgery was made during the previous decade, however, controversy over antibiotic prophylaxis for prostatic surgery remains. In the context of surgical field classification, transurethral resection of the prostate and radical prostatectomy can be categorized according to a clean-contaminated operation. Therefore, in this regard, administration of prophylactic antibiotics is appropriate for prevention of postoperative infectious complications. Unfortunately, however, studies of the prophylactic effect of antimicrobial therapy with prostatic surgery have been limited. There is currently a lack of information on the risk factors for infectious complications associated with prostate surgery in Korea. In addition, the Korean National Health Insurance System recently recommended the use of current guidelines for surgical site infection focusing on gastrointestinal surgery, not urinary tract infection in patients undergoing prostate surgery without any Korean evidence. Because many urological procedures are associated with urine exposure and endourological procedures, these guidelines cannot be adapted to urologic prostatic surgery. In open or laparoscopic prostatic surgery (radical prostatectomy or prostatectomy), the urinary tract is opened during the procedure; thus, postoperative bacteriuria is probably the main source of postoperative infectious complications.

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Chronic Bacterial Prostatitis: Heung Jae Park; Korean J Urogenit Tract Infect Inflamm 2014;9(1):21-26. Published online April 30, 2014

Abstract PDF: Men with prostatitis-like symptoms who had uropathogenic bacteria localized to the prostate gland by elaborate collection and culturing techniques were diagnosed with chronic bacterial prostatitis. Chronic bacterial prostatitis is characterized by prolonged or recurrent symptoms and relapsing bacteriuria. Chronic bacterial prostatitis is caused mainly by Gram-negative uropathogens. For treatment, fluoroquinolones are considered the drug of choice because of their favorable pharmacokinetic properties and antimicrobial spectrum, with the best evidence supporting ciprofloxacin and levofloxacin. Despite conduct of intensive investigations, our knowledge regarding the diagnostic ability to differentiate bacterial from nonbacterial prostatitis, the relevance of nontraditional uropathogens, and the relationship between uropathogens localized to the prostate and recurrent urinary tract infection is still limited. In this paper, we reviewed the new concepts associated with chronic bacterial prostatitis and explored the evolution of our understanding of the etiology, diagnosis, and treatment of this significant urologic disease.

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Modulation of Antimicrobial Peptide Human β-defensin-3 by Toll-like Receptor Ligands in Vaginal Epithelial Cells: Seo Yeon Lee, Hae jong Kim, In Ho Chang, June Hyun Han, Kyung Do Kim, Young Tae Moon, Soon Chul Myung; Korean J Urogenit Tract Infect Inflamm 2014;9(1):27-33. Published online April 30, 2014

Abstract PDF: Purpose
Vaginal epithelial cells have always been exposed to various pathogens. However, this has not always caused clinical infection. In addition to a previously reported protection effect of the vagina, currently, the innate immune response is thought to be important as one of the causes explaining the phenomenon. Therefore, we investigated the innate immunity of the vagina and related mechanisms in infected vaginal epithelial cells focusing on the antimicrobial peptide human β-defensin-3 (HBD-3).
Materials and Methods: We investigated the signaling molecules, Toll-like receptors (TLRs), through which mammals sense infection in vaginal epithelial cells, with activation with lipopolysaccharide (LPS), Staphylococcus aureus peptidoglycan (PGN), or zymosan. Reverse transcriptase-polymerase chain reaction analysis of HBD-3 messenger RNA expression in vaginal epithelial cells after treatment with three pathogens was performed for investigation of pathogen-associated molecular patterns. Then, we also studied the following mechanism of innate immunity of the vagina focusing on HBD-3 in vaginal epithelial cells infected with gram-positive bacteria, gram-negative bacteria, or fungus.
Results: Vaginal epithelial cells (VK2/E6E7 cells) constitutively expressed TLR2 and TLR4 and produced antimicrobial peptide HBD-3 upon activation with LPS, PGN, or zymosan. VK2/E6/E7 cells exposed to LPS, PGN, or zymosan showed increased p38 mitogen activated protein kinase (MAPK) activity. In addition, LPS-, PGN-, and zymosan-induced HBD-3 expression was attenuated by SB203580, a p38 MAPK inhibitor, emphasizing the importance of p38 MAPK in induction of HBD-3.
Conclusions: Vaginal epithelial cells may contribute to the host innate immune defense upon exposure to gram-negative bacteria, gram-positive bacteria, or fungi in the vagina by upregulation of HBD-3 expression.

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Incidence and Risk Factors of Urinary Tract Infection after Endoscopic Therapy for Vesicoureteral Reflux in Children: Ja Yoon Ku, Bu Kyung Park, Sang Don Lee; Korean J Urogenit Tract Infect Inflamm 2014;9(1):34-38. Published online April 30, 2014

Abstract PDF: Purpose
The purpose of this study is to evaluate the incidence and risk factors of febrile urinary tract infection (UTI) after endoscopic therapy for vesicoureteral reflux (VUR).
Materials and Methods: Analysis of the clinical data of 88 children (128 refluxing renal units; male 60%, female 40%) in a single institution during March 2011-June 2013 including age, gender, sorts and volume of agent for injection, preoperative VUR grade, recurrent UTI, bladder dysfunction, nephropathy, postoperative VUR, urinalysis, and urine culture results was performed retrospectively. All patients were followed for three to 62 months (average 25 months).
Results: After the first injection, the complete resolutions rate of VUR (by ureter) was 72.7%, consisting of grade I 4 (90%), grade II 11 (84.6%), grade III 29 (76.3%), grade IV 33 (66%), and grade V 93 (72.7%) ureters. Preoperative UTI and febrile UTI were present in 81 (92.0%) and 49 patients (55.7%), respectively. Preoperative recurrent UTI and febrile UTI were observed in 53 (60.2%) and 30 patients (34.1%), respectively. Postoperative UTI and febrile UTI occurred in eight (9.1%) and in five patients (5.7%), respectively. In multivariate analysis, only preoperative recurrent UTI (odds ratio [OR], 0.17; p=0.04) and bladder trabeculation (OR, 0.104; p=0.038) were independent variables after endoscopic therapy.
Conclusions: Our data support that the successful endoscopic correction of VUR is associated with a low incidence of febrile UTI. The highest risk factor for post injection UTI is preoperative recurrent UTI and bladder dysfunction. Therefore, patients with preoperative recurrent UTI and bladder dysfunction require careful observation after endoscopic therapy for VUR.

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Changes of Bacterial Resistant Pattern in Adult Acute Epididymitis at a Tertiary Hospital in Recent Ten Years: Jong Jin Park, Jong Wook Kim, Jae Hyun Bae, Du Geon Moon, Mi Mi Oh; Korean J Urogenit Tract Infect Inflamm 2014;9(1):39-43. Published online April 30, 2014

Abstract PDF: Purpose
We conducted a retrospective study to investigate causative bacteria of adult epididymitis and their characteristics and resistance in the recent 10 years at a tertiary hospital.
Materials and Methods: We reviewed the medical records of 121 patients who were diagnosed with acute epididymitis from 2002 to 2012. Diagnosis was based on symptoms, physical examination, and ultrasonography. We analyzed causative organisms and changes of antibiotic resistance pattern according to time course in the recent 10 years.
Results: The most commonly detected bacteria were Pseudomonas aeruginosa and Escherichia coli. Fluouroquinolone resistance has emerged since 2006 and 50% of the patients have resistance to fluouroquinolones.
Conclusions: Quinolone resistance composes a major proportion of the causative organism. Therefore, while according to the guidelines, fluoroquinolone may be the first response for elderly men, we recommend that antibiotic resistance should be considered if fever persists, and other antibiotics could be included.

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Analysis of Urinary Stone Composition: A Retrospective Single Center Study during the Last Five Years (2009-2013): Pil Moon Kang, Won Ik Seo, Dong Il Kang; Korean J Urogenit Tract Infect Inflamm 2014;9(1):44-49. Published online April 30, 2014

Abstract PDF: Purpose
Analysis of urinary stone composition is essential for treatment and prevention of urolithiasis. We evaluated the effect of age, gender, and stone location on urinary stone components during the last five years.
Materials and Methods: We conducted a retrospective analysis of the medical records of 375 patients ranging in age from 15 years old to 93 years old (241 males and 134 females) who underwent conventional or endoscopic surgery, shock wave lithotripsy, or passed their stones spontaneously between 2009 and 2013. Stone analysis was performed using a chemical analysis method to determine the molecular composition of each stone.
Results: Of the 375 patients with urolithiasis, 152 patients (40.5%) had predominantly calcium oxalate, 85 patients (21.5%) had uric acid, 17 patients (4.5%) had calcium phosphate, 17 patients (4.5%) had magnesium ammonium phosphate, 16 patients (4.3%) had calcium carbonate, and 86 patients (22.9%) had mixed stone type. There was a decreasing prevalence of calcium oxalate stone with age group (42.5% in young adult (20-39 years, n=40), 45.0% in adult (40-60 years, n=151), and 32.7% in elderly (≥60 years, n=180) as opposed to increasing prevalence in uric acid stone (7.5% in young adult, 15.2% in adult and 32.2% in elderly). Uric acid stones were more common in males and in lower urinary tract stones.
Conclusions: In this study, the incidence of calcium oxalate decreased with age and that of uric acid increased with age and in male. In comparison of the results of previous studies for several decades, the incidence of uric acid increased in the last five years.

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Altered Mentality Patient with Emphysematous Pyelonephritis Disclosed by Abdominal Computed Tomography: Seung Baik Han, Jin Hui Paik, Hyun Min Jung, Ji Hye Kim, Yeon Sook Moon; Korean J Urogenit Tract Infect Inflamm 2014;9(1):50-52. Published online April 30, 2014

Abstract PDF: Emphysematous pyelonephritis is an acute gas forming necrotizing infection of the renal parenchyma with high mortality, which shows non-specific clinical findings. Elderly patients with altered mentality and shock require careful monitoring and abdominal computed tomography scanning is thought to be beneficial in prompt detection of infection focus and management. We report on a patient with altered mentality who showed emphysematous pyelonephritis on abdominal computed tomography and provide a review of the literature.

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Epidural Abscess on the Lumbosacral Area after Transrectal Ultrasonography Guided Prostate Needle Biopsy: Kisoo Lee, Wonyeol Cho; Korean J Urogenit Tract Infect Inflamm 2014;9(1):53-55. Published online April 30, 2014

Abstract PDF: Transrectal ultrasonography guided prostate needle biopsy (PNB) is a useful tool for diagnosis of prostate cancer when the patient has positive findings, such as elevated prostate specific antigen, or a nodule on a digital rectal exam. Because PNB can be performed through the rectum, infection and hemorrhage are the most frequent complications after PNB. Many physicians have reported on their studies, including antibiotic therapy, for decreasing these complications, and some of these treatment modalities have been applied to patients who have undergone PNB. We report on a case of epidural abscess on the lumbosacral area after PNB.

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Renal Venous Perforation during Reinsertion of a Percutaneous Nephrostomy Catheter: hil Hyun Song, Young Hwii Ko, Bong Gi Ok, Yeong Uk Kim, Kwon Soo Lee, Dae Hyeon Kwon, Hyun Tae Kim, Sin-Youl Park, Hee Chang Jung; Korean J Urogenit Tract Infect Inflamm 2014;9(1):56-59. Published online April 30, 2014

Abstract PDF: While the sustainment of percutaneous nephrostomy with regular change in chronic un-operable cases is widely performed for relief of urinary obstructions, performance of the blind procedure without fluoroscopic monitoring could result in clinical disaster. We report on a case of direct renal vein injury by mis-guidance of a nephrostomy catheter, which was successfully managed conservatively by serial venography monitoring combined with intensive conservative treatment. To the best of our knowledge, this is the first report on management of a renal vein injury during the percutaneous nephrostomy.

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