Urogenital Tract Infection

Antibiotic Resistance and Novel Antibiotics for the Treatment of Urinary Tract Infections: Florian Wagenlehner; Urogenit Tract Infect 2016;11(2):43-48. Published online August 31, 2016

Abstract PDF: Surveillance data on antibiotic resistance need to be considered with respect to the origin of isolates, types of surveillance studies, and types of types of registered infections. Antibiotic resistance in gram-negative uropathogens has been investigated in both local and multinational studies. A compilation of worldwide studies for example showed resistance rates of gram-negative uropathogens against fluoroquinolones in 10% to 80%, against cephalosporines in 5% to 70% and against carbapenems in 0% to 35%. A specific surveillance study in the field of urology—the global prevalence of infections in urology (GPIU) study—is a point prevalence study with a global effort to create surveillance data in patients at various urological departments with health-care associated urogenital infections (HAUTIs). The GPIU study has been performed annually since 2003, with a total inclusion of 27,542 patients, thus far. Resistance rates of most uropathogens against all tested antibiotics were high, especially with multidrug resistance. A concerning finding was that the severity of HAUTI is also increasing—25% being urosepsis in recent years. In order to keep up with this alarming trend, novel antibiotics for the treatment of urinary tract infections need to be developed. Several strategies are currently employed: Beta-lactam/beta-lactamase inhibitor combinations are extended to cephalosporines and carbapenems. Novel fluroroquinolones have been developed, and so called siderophore antibiotics are being tested. Novel aminoglycosides and novel tetracyclines are also in the clinical development phases. Thus, several antibiotic substances are currently being developed, or in the late clinical phases of development.

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New Era of Post Urinary Tract Infection Pain Syndrome: Kwang Woo Lee, Young Ho Kim; Urogenit Tract Infect 2016;11(2):49-55. Published online August 31, 2016

Abstract PDF: Urinary tract infection (UTI) in most cases is accompanied by pain. However, in some cases, including asymptomatic bacteriuria (ASB), pain is absent and thus, cannot be characterized. A study with an animal UTI model to quantify pelvic pain showed that Escherichia coli (NU14 strains) isolated from urine of patients with acute UTI caused pain, while E. coli (83972 strains) isolated from urine of patients with ASB caused no pain. The difference in pain response was not related to bladder colonization or inflammation, but to lipopolysaccharde (LPS) and Toll-like receptor 4, which is an LPS receptor. As the association between interstitial cystitis (IC) and UTI was epidemiologically suggested, an experiment was performed to investigate whether repeated infection with uropathogenic E. coli (UPEC) causes chronic pain through central sensitization. The results showed that repeated infection with the wild type UPEC caused temporary pain, while repeated infection with UPEC (SΦ 874 strains) in the absence of O-antigen caused chronic pain. Chronic pain following UTI is related to voiding dysfunction and anxious/depressive behavior. These relationships are mediated by transient receptor potential vanilloid type 1 at the stage of pain development and by C-C chemokine receptor type 2 at the stage of pain maintenance. Based on these findings, temporary E. coli infection causes chronic pain, which is one of the characteristics of neuropathic pain. This pattern is similar with the symptoms of IC, supporting the possibility of infection as an etiology of IC.

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The Prevalence of Urinary Tract Infections in Institutionalized vs. Noninstitutionalized Elderly Persons: Jung-Sik Huh; Urogenit Tract Infect 2016;11(2):56-61. Published online August 31, 2016

Abstract PDF: This review involves the prevalence of urinary tract infections (UTIs) in elderly persons in Korea. The global average life expectancy has been increasing due to recent advances in medical technology, economic development, and availability of hygienic environment. UTIs and asymptomatic bacteriuria are common diseases in both genders of all ages, but have been particularly increasing in elderly populations. The common causes of this increase are overactive bladder, benign prostatic hyperplasia, and neurogenic bladder. Institutionalized patients are susceptible to bacterial infections due to urinary incontinence, fecal contamination, and poor perineal hygiene. UTIs are the second most common infection, constituting 25% of all infection occurrences in elderly populations living at home. Several studies involving elderly persons living in the community have reported that the prevalence of UTIs is 0.07/person-year in postmenopausal women, 0.12/person-year in elderly persons with diabetes mellitus, and 0.05/person-year in men. The incidence of UTIs in elderly individuals increases with age, particularly in institutionalized elderly patients compared with those at home. However, no study has compared the prevalence of UTIs between institutionalized and noninstitutionalized elderly persons in Korea. Such comparison and evaluation may help to prevent UTIs in elderly Korean people.

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Recurrent Urinary Tract Infection by Bladder Stone Resulting from Subureteral Injection Polydimethylsiloxane (Macroplastique^®) for Treatment of Vesicoureteral Reflux: Jae Young Choi, Hyun Tae Kim, Young Hwii Ko, Young Hwan Lee, Phil Hyun Song; Urogenit Tract Infect 2016;11(2):62-65. Published online August 31, 2016

Abstract PDF: While endoscopic subureteral injection of bulking agents has become a first-line therapy for the treatment of vesicoureteral reflux (VUR), mainly due to its high success rates with minimal complications, polydimethylsiloxane (PDS) administration can be associated with bladder calcification in a minority of patients. A 10-year-old girl with prior history of subureteral administration of PDS as a treatment modality for bilateral VUR six years ago showed recurrent lower urinary tract symptoms, including dysuria, frequency, and urgency, for the past 6 months. She was admitted to our institution for right pyelonephritis with hydronephrosis. Radiologic examination had revealed two yellowish impacted stones attached to the previous site of PDS administration without recurrence of VUR. The stones were completely removed by cystolitholapaxy. This study suggests that such a late-complication should be considered in patients with recurrent urinary tract infection or lower urinary tract symptom despite complete disappearance of VUR by prior subureteral administration therapy.

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Unexpected Septic Shock after Ureteroscopic Lithotripsy in a Patient Preoperatively Treated for a Urinary Tract Infection: Jong Wook Kim, Hyoung Kook Jeong, Jong Jin Park, Ji Yun Chae, Hong Seok Park, Du Geon Moon, Mi Mi Oh; Urogenit Tract Infect 2016;11(2):66-68. Published online August 31, 2016

Abstract PDF: We describe a case of life-threatening septic shock after ureteroscopic lithotripsy. Prior to surgery, the patient had a confirmed sterile urine culture posttreatment for a urinary tract infection due to extended spectrum beta-lactamase-positive Escherichia coli.

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Acute Bacterial Prostatitis by Salmonella Infection: Yu Mi Seo, Pil Won Seo, Gilho Lee; Urogenit Tract Infect 2016;11(2):69-72. Published online August 31, 2016

Abstract PDF: Acute Salmonella prostatitis is a very rare disease. Herein, we report on a healthy 37-year-old man presented with recently developed lower abdominal pain, fever, dysuria, frequency, and perineal pain. Clinical symptoms and signs, as well as abdominal computed tomography scan suggested acute bacterial prostatitis. The initial urine culture revealed significant colonies of Salmonella species. We could not, however, find Salmonella species from subsequent specimens from blood and stool. Three days after admission, we examined his prostate and performed prostatic massage. While we could not find Salmonella species in the follow-up urine specimen, we found Salmonella species in his expressed prostatic secretion. His symptoms and signs were improved with ciprofloxacin treatments.

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Renal Actinomycosis Initially Misdiagnosed as Renal Cell Carcinoma with Renal Vein Thrombosis: Jong Wook Kim, Hyoung Kook Jeong, Jong Jin Park, Ji Yun Chae, Hong Seok Park, Du Geon Moon, Mi Mi Oh; Urogenit Tract Infect 2016;11(2):73-75. Published online August 31, 2016

Abstract PDF: This case report describes an uncommon case of renal actinomycosis in a 63-year-old man. The patient underwent radical nephrectomy for suspicious renal cell carcinoma with renal vein thrombosis and spinal metastasis. The postoperative diagnosis of renal and spinal actinomycosis was established in accordance with the results from histological examination. Three years after surgery, the patient did not show any symptoms of recurrence.

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