Urogenital Tract Infection

The Clinical Guidelines for Acute Uncomplicated Cystitis and Acute Uncomplicated Pyelonephritis: Ki Ho Kim, Jae Heon Kim, Seung-Ju Lee, Hong Chung, Jae Min Chung, Jae Hung Jung, Hyun Sop Choe, Hun Choi, Sun-Ju Lee, The Committee of The Korean Association of Urogenital Track Infection and Inflammation; Urogenit Tract Infect 2017;12(2):55-64. Published online August 31, 2017

Abstract PDF: To date, there has not been an establishment of guidelines for urinary tract infections, due to limited domestic data in Korea, unlike other North American and European countries. The clinical characteristics, etiology, and antimicrobial susceptibility of urinary tract infections vary from country to country. Moreover, despite the same disease, antibiotic necessary to treat it may vary from country to country. Therefore, it is necessary to establish a guideline that is relevant to a specific country. However, in Korea, domestic data have been limited, and thus, guidelines considering the epidemiological characteristics pertaining specifically to Korea do not exist. Herein, describe a guideline that was developed by the committee of The Korean Association of Urogenital Tract Infection and Inflammation, which covers only the uncomplicated urinary tract infections, as covering all parts in the first production is difficult.

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Genetic Variation in Mycoplasma genitalium: Gilho Lee; Urogenit Tract Infect 2017;12(2):65-76. Published online August 31, 2017

Abstract PDF: Mycoplasma genitalium (MG) is the smallest self-replicating bacterium. Although small in size, unique MG genome induces distinctive and often serious characteristics in the infected cells. Due to its small genome and chronic symptomatic characteristics in the infected host, it first appears as a weak, insignificant, and easily controllable microbe. However, it is not a monotonous chrysalis, but rather a multicolored butterfly with various capabilities. Repetitive DNA sequence in MG’s immunodominant MgPa operon has been considered as an efficient strategy to evade the host immune surveillance and mediate MG’s genetic flexibility. Because of MG’s pathogenicity in multiple organs, various antimicrobials are prescribed, further exerting selection pressure on microbes. Consequently, a rapidly increasing drug resistance in macrolide and moxifloxacin has been frequently reported globally, radically decreasing the overall cure rate of infection. Re-infection can be defined as a new MG infection through antigenic variation, while persistent infection refers to recurrent infections caused by the same MG isolate through acquisition of antimicrobial resistance. Therefore, we must differentiate between re-infection and persistent MG infection, and approach them accordingly. The genetic mechanisms of DNA variation in the MgPa operon and antibiotic resistance must be considered for the management of multicolored infection. In this respect, the unique genetic characteristics of MG will be described in detail. We hope that with this manuscript, clinicians can expand their understanding of recurrent MG infections and better choose an appropriate treatment for the infection in clinical setting.

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The Antibiotic Susceptibility of Escherichia coli from Community-Acquired Uncomplicated Urinary Tract Infection: A Focused on Fosfomycin: Hyun-Sop Choe, Seung-Ju Lee, In Ho Chang, Tae-Hyoung Kim, Hong Chung, Jae Min Chung, Sang Don Lee, Jae Hung Jung, Ki Ho Kim, Seung Ki Min, Yong Gil Na, Hana Yoon, Ho Song Yu, Mi-Kyung Lee, Sun-Ju Lee; Urogenit Tract Infect 2017;12(2):77-81. Published online August 31, 2017

Abstract PDF: Purpose: To assess the antibiotic susceptibility of Escherichia coli from community-acquired uncomplicated urinary tract infection (UTI).
Materials and Methods: Between August and December of 2015, confirmed cases of E. coli as a pathogen of community-acquired uncomplicated UTI were collected and assessed for antibiotic susceptibility in 10 designated hospitals. Additional fosfomycin susceptibility test was performed by a central laboratory using the disk diffusion method.
Results: A total of 347 E. coli isolates were collected from urine samples of community-acquired uncomplicated UTIs patients. The susceptibility rates of antibiotics were as follows: amikacin 100.0% (347), imipenem 100.0% (347), ciprofloxacin 57.1% (198), cefotaxime 74.9% (260), ampicillin 30.0% (104), trimethoprim/sulfamethoxazole 66.9% (232), and fosfomycin 98.0% (340). All fosfomycin-resistant E. coli isolates were extended-spectrum β-lactamase (ESBL)-producing. In 85 cases of ESBL-producing E. coli, the fosfomycin susceptibility rate was 91.8% (78/85).
Conclusions: Fosfomycin may be a useful option for the treatment of community-acquired uncomplicated UTIs. Further studies evaluating the role of fosfomycin in the treatment of UTIs and its clinical efficacy are necessary.

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The Risk Factors of Recurrent Febrile Urinary Tract Infection within 1 Year in Urinary Stone Patients with Acute Obstructive Pyelonephritis: Sin Woo Lee, Sol Yoon, Jungmo Do, Deok Ha Seo, Chunwoo Lee, Seong Uk Jeh, See Min Choi, Sung Chul Kam, Jeong Seok Hwa, Ky Hyun Chung, Jae Seog Hyun; Urogenit Tract Infect 2017;12(2):82-88. Published online August 31, 2017

Abstract PDF: Purpose: To identify and evaluate the risk factors for the development of recurrent febrile urinary tract infection (fUTI) among patients with previous urinary stone and acute obstructive pyelonephritis (OPN).
Materials and Methods: We retrospectively reviewed the medical records of 52 patients, who had urinary tract stones presented with OPN, between 2010 and 2015. Following their initial treatment, patients who were subsequently admitted with fUTI were included.
Results: The mean age of patients was 62.2±14.6 years, and the mean follow-up duration was 26.0±20.39 months. Escherichia coli was found to be the dominating organism (68.2%, 15/22) in the initial urine culture. Patients were divided into two groups: The recurrent fUTI group (n=23) and the non-recurrent fUTI group (n=29). Between these two groups, significant differences were found with respect to diabetes history (recurrent group: 47.8% vs. non-recurrent group; 17.2%, p=0.018), stone location (kidney, 60.9% vs. ureter, 31.0%, p=0.031), and initially positive urine culture (60.9% vs. 27.6%, p=0.016). In a multivariate analysis, having an initially positive urine culture (95% confidence interval, 1.130-224.117; p=0.040) was identified as being an independent risk factor for developing recurrent fUTI. In a multivariate analysis, the initial laboratory test finding of acute renal insufficiency (ARI, p=0.019) and presence of a kidney stone (p=0.022) were significant factors associated with a newly-diagnosed-positive urine culture diagnosis.
Conclusions: Having an initially positive urine culture was a significant risk factor for the development of recurrent fUTI in urinary stone patients with acute OPN. In addition, repeated urine tests were also needed in patients with ARI or renal stones during the follow-up period.

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Type Distribution of Human Papillomavirus in Genital Warts of Korean Men: Kyoung Ho Ryu, Jeong Ho Cho, Min Chong Lee, Tae Young Jung; Urogenit Tract Infect 2017;12(2):89-94. Published online August 31, 2017

Abstract PDF: Purpose: To analyze the distribution of human papillomavirus (HPV) types and the characteristics of genital condyloma in Korean men.
Materials and Methods: Between January 2015 and December 2015, we reviewed the medical charts of 435 male patients diagnosed with genital condyloma. A total of 441 samples were identified. The detection rate of each HPV type and its associated characteristics (age, number of HPV types, low-risk and/or high-risk types, number of lesions) were analyzed. Our sample population was divided into two groups: The non-urethral condyloma group and the urethral condyloma group. In addition, subgroup analysis was also performed.
Results: Among the total 441 specimens, 409 (92.7%) were non-urethral condyloma and 32 (7.3%) were urethral condyloma. Single-type infection was observed in 56.7% and multiple-type infection was seen in 43.3%. HPV type 6 and type 11 were the most common types in total genital condyloma and subgroups. HPV type 11, which was detected in 43.8% of those in the urethral condyloma group and in 22.0% of those in the non-urethral condyloma group (p=0.009), showed a statistically significant difference with respect to the type-specific detection rate.
Conclusions: As in previous studies, our study also showed that HPV type 6 was the most prevalent type among all genital condylomas, followed by HPV type 11. A subgroup analysis also showed the same result.

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