Urogenital Tract Infection

Healthcare-Associated Urinary Tract Infection: Multi Drug Resistance and Risk Factors: Jin Bong Choi, Seung-Ju Lee; Urogenit Tract Infect 2018;13(2):21-25. Published online August 31, 2018

Abstract PDF: A new category of infections called healthcare-associated (HCA) infections was created due to increased procedures performed in outpatient clinics of hospitals. The risk of HCA infections is on the rise as the use of long-term care facilities (LTCFs) is increasing. HCA-urinary tract infection (UTI) is one of the most frequently occurring bacterial infections. In clinical and microbiological analyses, HCA-UTI is similar to hospital-acquired-UTI. The prevalence of multidrug-resistant (MDR) organisms in HCA-UTI has increased and is varied according to the type of LTCFs and regions. Finally, prior investigations reported the association between several risk factors and MDR acquisition, which vary considerably according to study design. Therefore, additional research is needed to develop a more accurate methodology.

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Potential Mechanisms Underlying the Increased Excitability of the Bladder Afferent Pathways in Interstitial Cystitis/Bladder Pain Syndrome: Doo Sang Kim; Urogenit Tract Infect 2018;13(2):26-34. Published online August 31, 2018

Abstract PDF: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic debilitating disorder associated with lower urinary tract symptoms, including frequency, urgency, and suprapubic pain, which inconveniences the patients and seriously impairs their quality of life. Although the etiology of IC/BPS is unknown, intense research has been conducted focusing on the involvement of the bladder afferent nerve in regard to the cellular mechanisms underlying neurogenic inflammation of the urinary bladder. The involvement of neurogenic inflammation in patients with IC/BPS is supported by several animal models of bladder inflammation as well as clinical studies. Chronic bladder inflammation can result in functional and anatomical changes in the primary afferent neurons through the expression of inflammation-related proteins/receptors in the urinary bladder and bladder afferent pathways, leading to pain symptoms in patients with IC/BPS. In addition, neurogenic inflammation of the bladder mucosa can induce the central sensitization as well as the peripheral sensitization, and the neuroimmune overactivity and toll-like receptor (TLR) signaling of the immune cells involve complex mechanisms of central sensitization. This review presents the potential mechanisms underlying the afferent hyperexcitability of the bladder in IC/BPS and summarizes the neurogenic inflammation, neurotrophic factors, TLRs, and neuroimmune communication.

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Association between an Interleukin 4 Gene Polymorphism, rs2243268, and Urogenital Tuberculosis: Bongsuk Shim, Sang Don Lee, Tae-Hyoung Kim, Seung Il Jung, Won Yeol Cho, Gilho Lee; Urogenit Tract Infect 2018;13(2):35-39. Published online August 31, 2018

Abstract PDF: Purpose: Urogenital tuberculosis (UGT) is rarely reported in developed countries. This study evaluated the genetic susceptibility of Korean patients to UGT.
Materials and Methods: A total of 35 UGT patients who were confirmed pathologically, 44 intrapulmonary tuberculosis (IPT) patients who were confirmed radiologically, and 102 controls over a 6 year period were enrolled in this study. The region of rs2243268 in interleukin-4 (IL-4) gene was amplified from whole blood samples, and the DNA sequences were read using the Sanger method.
Results: Twenty women and 15 men were diagnosed with UGT. The occurrence of the CC, AC, and AA genotypes of rs2243268 were 26 (74.3%), 8 (22.9%), and 1 (2.9%), respectively, in UGT; 28 (63.6%), 15 (34.1%), and 1 (2.3%), respectively, in IPT; and 51 (50.0%), 45 (44.1%), and 6 (5.9%), respectively, in the control groups (p=0.115). The bivariate data of CC and AC/AA were 74.3% and 25.7% in UGT, 63.6% and 36.4% in IPT, and 50.0% and 50.0% in the control groups, respectively (p=0.029). The UGT was significantly different from the control group among the three genotypes (p=0.038, Fisher’s exact test) and bivariate genotypes (p=0.017, Fisher’s exact test). In addition, people carrying the CC genotype had a higher risk of UGT (odds ratios, 2.889; 95% confidence intervals, 1.233-6.770; p=0.015).
Conclusions: A single nucleotide polymorphism in the IL-4 gene, rs2243268, is associated with the development of clinical tuberculosis. The CC type of rs2243268 increases the risk of UGT significantly compared to the CA/AA type.

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Effect of Alpha-Blockers on Patients with Benign Prostatic Hyperplasia with Inflammatory Cells in the Prostatic Fluid: Yu-Mi Seo, Hyung-Jee Kim; Urogenit Tract Infect 2018;13(2):40-44. Published online August 31, 2018

Abstract PDF: Purpose: To determine if alpha-blocker monotherapy is effective on patients with benign prostatic hyperplasia (BPH) and prostatic inflammation.
Materials and Methods: Patients who were admitted for the treatment of lower urinary tract symptoms for 18 months were enrolled in this study. All were subjected to an International Prostate Symptom Score (IPSS) evaluation, prostate specific antigen analysis, urinalysis, residual urine testing, prostate massage, and transrectal prostate ultrasonography. The presence of inflammation in the secretion after the prostate massage was observed at high magnification. Patients with a leukocyte count of more than 15 were diagnosed as positive and classified as group 1 (experimental group), whereas those with a leukocyte count of less than 15 were diagnosed as negative and classified as group 2 (control group). Silodosin was administered (4 mg twice a day for two months).
Results: Group 1: After one and two months, there was no significant difference in the maximum urinary flow rate (Qmax) and post-void residual volume (PVR) compared to the baseline. The total IPSS was significantly improved over the 8-week study period. All symptoms except for Qmax and PVR showed significant improvement in the second month. Group 2: After one and two months, significant improvement was observed in all domains of the IPSS, and Qmax and PVR assessment, except for the PVR at one month.
Conclusions: In patients with BPH who have not been treated properly, other treatments based on prostatitis may be needed in addition to alpha blockers if there is inflammation on expressed secretion of prostate.

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