Urogenital Tract Infection

Acute Bacterial Prostatitis: U-Syn Ha, Yong-Hyun Cho; Korean J Urogenit Tract Infect Inflamm 2011;6(2):115-128. Published online October 31, 2011

Abstract PDF: Bacterial prostatitis represents a small portion of the prostatitis spectrum, and acute bacterial prostatitis (ABP) is uncommon. But ABP is a urologic emergency. Even if there is a wide consensus for the diagnosis and treatment of ABP, many physicians need detailed guidelines with clear evidence. We suggest the diagnosis and treatment criteria of ABP with extensive review of the current literatures. The initial diagnosis of ABP is based on signs and symptoms like fever or voiding problem. Patients with symptoms should undergo urine analysis and culture of the urine. An imaging study of the prostate including transrectal ultrasound (TRUS) is suggested to exclude prostatic abscess (LoE 4). Elevated levels of prostate-specific antigen (PSA) are helpful to distinguish ABP from other febrile UTI. The predominant causative organisms are Gram-negative bacteria, mainly Escherichia coli. Appropriate management of ABP includes rapid initiation of broad-spectrum parenteral antibiotics and symptomatic support.

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Prevention of Infections Associated with Urological Surgery: Hygiene and Education: Bong-Suk Shim; Korean J Urogenit Tract Infect Inflamm 2011;6(2):129-139. Published online October 31, 2011

Abstract PDF: The safety of the patient depends upon a clean environment in the wards and operating theatre. Good hospital hygiene is an integral and important component of a strategy for preventing hospital acquired infections. The hospital environment must be visibly clean, free from dust and spoilage, acceptable to the patients, their family and visitors and to the staff. Each hospital should have rules and recommendations for maintaining a clean environment with scheduled routines. All staff must maintain good personal hygiene. Appropriate hospital clothing is recommended in conjunction with all patient contact in the wards, the out-patient departments and operating area. Careful hand washing and disinfection and appropriate clothing are key measures to limit cross-contamination and each hospital must have written policies and procedures for these matters. Regular teaching and training of staff in infection control is required to reach the aims of reducing health acquired infections.

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HIV Infection in Urological Practice: Seung-Ju Lee; Korean J Urogenit Tract Infect Inflamm 2011;6(2):140-154. Published online October 31, 2011

Abstract PDF: This review evaluates the scientific evidence suggesting that urological factors increase the efficiency of human immunodeficiency virus (HIV) transmission and discusses the important urological manifestations of HIV infection. Level 1 evidence suggests that sexually transmitted infections (STIs) are substantially associated with an increased risk of HIV infection. Several randomized controlled trials show that improved STI control can play a vital role in comprehensive programs to prevent sexual transmission of HIV. However, there is limited evidence that control of STIs reduces HIV incidence at a population level. HIV has become a chronic manageable condition thanks to highly active antiretroviral therapy. Urologists face a challenge in trying to manage the genitourinary manifestations of HIV infection.

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Urinary Tract Infections in Pregnancy: Bong Suk Shim, Mi Mi Oh, Young-suk Lee, Ha Na Lee; Korean J Urogenit Tract Infect Inflamm 2011;6(2):155-164. Published online October 31, 2011

Abstract PDF: Urinary tract infections (UTIs) are more common during pregnancy because of changes in the urinary tract. Symptomatic UTI occurs in 1% to 2% of pregnancies, while asymptomatic bacteriuria has been reported in 2% to 11% of pregnant women. UTIs during pregnancy can lead to serious consequences if left untreated. Asymptomatic bacteriuria is associated with an increased risk of pyelonephritis and adverse outcomes of pregnancy. Therefore, antepartum screening is recommended to detect asymptomatic bacteriuria in pregnancy. Oral antibiotics are the treatment of choice for asymptomatic bacteriuria and cystitis. Antibiotic agent is selected by drug safety concerns and urine culture susceptibility data. The standard course of treatment for pyelonephritis is hospital admission and intravenous antibiotics. Antibiotic prophylaxis is indicated in some cases. Prompt treatment of symptomatic UTIs and asymptomatic bacteriuria is warranted in pregnant women.

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Clinical Outcome of Acute Bacterial Prostatitis; A Multicenter Study: Seong Ju Lee, Jin Mo Koo, Bong Suk Shim, Yong Hyun Cho, Chang Hee Han, Seung Ki Min, Sung Joo Lee, Hwan Cheol Son, Jun Mo Kim, Jong Bo Choi, Tae Hyoung Kim, Sang Kuk Yang, Kil Ho Lee, Yong Kil Na, Sung Ho Lee, Hee Jong Jung, Seung Il Jung, Chul Sung Kim, Jae Min Chung, Young Jin Seo, Won Yeol Cho, Kweon Sik Min, Sang Don Lee; Korean J Urogenit Tract Infect Inflamm 2011;6(2):165-170. Published online October 31, 2011

Abstract PDF: "Purpose: Proper guidelines concerning antibiotic administration for acute bacterial prostatitis (ABP) are unclear. We retrospectively analyzed treatment status and clinical outcomes to establish a proper treatment guideline. Materials and Methods: The clinical records of 669 patients from 21 hospitals diagnosed with ABP were reviewed. Prior manipulation, antibiotics administration, mean length of treatment, complication and procedure were analyzed. Results: The mean age of 538 patients (80.4%) without manipulation (group 1) and 131 patients (19.6%) with manipulation (group 2) was 58.3 years (range 19-88 years). Transrectal prostate biopsy was the most common cause of acute bacterial prostatitis (n=66; 50.4%). Of the clinical symptoms in the non-manipulation and manipulation groups, fever was most common (88.2% and 86.3%, respectively). Acute urinary retention (14.3% and 28.1%, respectively) was significantly increased in the manipulation group (p<0.05). Escherichia coli was the most frequently isolated bacterium from urine (72.0% and 66.7% of cases, respectively). Mean length of treatment was 6.5days and 7.9days, respectively; the difference was significant (p<0.05). Combination antibiotic therapy with third generation cephalosporin+aminoglycoside was used in 49.3% and 55.5% of cases, respectively. For single antibiotic therapy, second generation quinolones were used the most (35.5% and 34.3%, respectively). Sequale occurred in 29 group 1 patients (5.4%) and 20 group 2 patients (15.3%); the difference was significant (p<0.05). Conclusions: Prior manipulation was associated with 20% of ABP patients. Regardless of manipulation, clinical outcome was similar after treating with appropriate antibiotics."

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Prophylactic Effectiveness of Second Generation Cephalosporin According to Prostatic Operation Methods: Seong Woong Na, Eu Chang Hwang, Seung Il Jung, Dong Deuk Kwon, Kwangsung Park, Soo Bang Ryu; Korean J Urogenit Tract Infect Inflamm 2011;6(2):171-177. Published online October 31, 2011

Abstract PDF: "Purpose: There is no definitive standard concerning the use of prophylactic antibiotics for prostatic operations, except for transurethral resection of prostate (TUR-P). This study prospectively investigated the prophylactic effectiveness of a second generation cephalosporin according to prostatic operation method. Materials and Methods: From October 2010 to January 2011, prostatic operations were conducted for 67 patients: group I (radical prostatectomy, n=18), group II (TUR-P, n=38), group III (laser TUR-P, n=11) for 11: group III). Prophylactic antibiotics were intravenously administered beginning 1 hour preoperatively and orally with several days postoperatively. Prophylactic effectiveness was evaluated by comparison of urine analysis and presence of bacteriuria. Results: In group I, no patient had preoperative Foley catheter installation, and mean antibiotic prescription period pre- and post-operatively was 5.83 days and 6.94 days. Five group I patients (27.8%) displayed bacteriuria. In group II, 9 patients had preoperative Foley catheter installation and mean antibiotic prescription period was 3.76 days and 5.68 days, respectively. Five patients (13.2%) had postoperative bacteriuria; two in preoperative catheterized patients and three in preoperative non-catheterized patients. In group III, mean antibiotic prescription period was 1.73 days and 5.09 days, respectively. There was no postoperative bacteriuria. Conclusions: Prophylactic use of a second generation cephalosporin for prostatic operation, except laser TUR-P, was limited in preventing postoperative pyuria with bacteriuria. There was a tendency of higher occurrence of postoperative bacteriuria in patients with preoperative Foley catheter installation."

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Factors of Progression to Chronic Infections from Acute Bacterial Prostatitis: Byung Il Yoon, Seol Kim, Tae Seung Shin, U-Syn Ha, Dong Wan Sohn, Yong-Hyun Cho; Korean J Urogenit Tract Infect Inflamm 2011;6(2):178-185. Published online October 31, 2011

Abstract PDF: "Purpose: We conducted a retrospective analysis of acute bacterial prostatitis (ABP) to evaluate the factors of progressing to chronic bacterial prostatitis (CBP) and inflammatory chronic pelvic pain syndrome (CPPS) from ABP. Materials and Methods: The clinical records of 480 cases compatible with a confirmed diagnosis of ABP from five urological centers between 2001 and 2010 were reviewed. We defined chronic infection (CI) as a progression to CBP and inflammatory CPPS after treatment of ABP in admission periods when followed-up at 3 months or more. Results were analyzed according to two groups: recovered without CI (group A, n=428) and developed to CI (group B, n=52). Results: Of the 480 ABP patients, 1.3% (6/480) progressed to CBP and 9.6% (46/480) progressed to inflammatory CPPS. The progression rate of CI was 10.9% (52/480). The factors that affected progress to CI were diabetes, prior manipulation, prostate volume, absence of cystostomy and urethral catheterization (p<0.05). Conclusions: The identification and characterization of influential factors may accelerate the development of preventive, diagnostic and therapeutic strategies for the treatment of CI from ABP."

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Febrile Urinary Tract Infection in Infants: Comparative Analysis between Primary and Recurrent Infection: Suk Gun Jung, Do Hoon Kong, Sang Don Lee; Korean J Urogenit Tract Infect Inflamm 2011;6(2):186-191. Published online October 31, 2011

Abstract PDF: "Purpose: Febrile urinary tract infection (UTI) is common in infants and is associated with the risk for renal scarring and long-term complications. We retrospectively investigated the risk factors for recurrent UTI in infants with febrile UTI. Materials and Methods: We identified 108 infants (mean age 4.5±3.2 months; range 1-12 months) with febrile UTI who visited the emergency room from January, 2007 to December, 2010. We retrospectively reviewed sex, age, urine analysis, pathogen, leukocytosis, C-reactive protein (CRP), hydronephrosis, hydronephrosis grade and severity, vesicoureteral reflux (VUR), VUR grade and severity. We performed comparative studies of infants with recurrent UTI (group A; n=20, 18.5%) and primary UTI (group B; n=88, 81.5%). High-grade hydronephrosis and high-grade VUR were both defined as grade 3 or higher. Results: In 108 infants with febrile UTI, the male to female ratio was 3.2:1 (82 boys, 26 girls). On cross analysis of group A and B, there was no significant difference according to sex, age, CRP level in serum, leukocytosis and inflammation markers in urine analysis (p>0.05). Comorbidity of hydronephrosis and VUR was 52.8% (n=57) and 13.9% (n=15), respectively. Group A had more high grade hydroneprhosis, high grade reflux, bilateral reflux and a non-Escherichia coli strain in the urine culture compared with group B (p<0.05).The presence and laterality of hydronephrosis was not significantly different (p>0.05). Conclusions: During the first year after birth, high grade VUR, bilateral VUR, and a non-E. coli strain in the urine culture significantly increases the risk of recurrent UTI. Therefore, in infants with febrile UTI, imaging studies and urine culture are important for evaluation of recurrence probability."

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Prevalence of Chronic Prostatitis Symptoms in Korean Young Adult Male using the National Institutes of Health Chronic Prostatitis Symptom Index: Sung Bin Kim, Jae Young Choi, Seung Hoon Cho, Seung Tae Lee, Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2011;6(2):192-198. Published online October 31, 2011

Abstract PDF: "Purpose: The National Institutes of Health chronic prostatitis symptom index (NIH-CPSI) was used to determine the prevalence of prostatitis-like symptoms among young adult Korean males. Materials and Methods: From February 1, 2009 to February 1 2011, we conducted a survey targeting 1095 Korean young men who were enrolled at an educational institution. After explaining about NIH-CPSI, subject completed a questionnaire. Respondents were fairly evenly distributed. We analyzed the collected questionnaires, and considered men who reported perineal and/or ejaculatory pain or discomfort and a total NIH-CPSI pain score of ≥4 as having prostatitis-like symptoms. We also analyzed the correlations of pain, urinary symptom and quality of life scores in the prevalence group. Results: The average age of 1095 volunteers was 30.1 years (range 25-35 years). Among these men, 90 (8.2%) indicated feeling pain. Of these men, 27 experienced perineal and/or ejaculatory pain or discomfort, and their total NIH-CPSI pain score exceeded 4. The estimated prevalence of prostatitis-like symptoms was approximately 2.5%. The mean pain score of men who indicated experiencing pain was 7.0, but the mean pain score of all respondents was 0.7; the difference was statistically significant. Positive correlations were evident between pain score and quality of life score (Pearson's correlation coefficient=0.965), and urinary symptom score and quality of life score (Pearson's correlation coefficient=0.891). Also, using mean score of quality of life domain of ≤6 and >6 revealed statistically significant differences of mean score of pain (8.1/5.4) and urinary symptoms (2.6/0.3). Conclusions: The estimated prevalence of prostatitis-like symptom in the examined population of young adult Korean males was 2.5%. And there were closed relationships between pain, urinary symptome, and quality of life score in prevalence group."

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Clinical Outcomes According to Prostatic Abscess in Acute Prostatitis: Woon-Bin Kim, Kwang-Woo Lee, Jun-Mo Kim, Young-Ho Kim, Min-Eui Kim; Korean J Urogenit Tract Infect Inflamm 2011;6(2):199-205. Published online October 31, 2011

Abstract PDF: "Purpose: To evaluate differentiation of clinical course and outcomes between patients with acute prostatitis only and acute prostatitis with prostatic abscess. Materials and Methods: This retrospective study examined the records of 68 patients with acute prostatitis from January 2006 to June 2010. These patients were divided into two groups according to the presence of the prostate abscess: group 1 (prostate abcess; 18 patients, mean age 59.1±13.3 years) and group 2 (acute prostatitis without prostatic abscess; 50 patients, mean age 57.7±14.6 years)-. We evaluated clinical parameters including degree and duration of fever, admission period, transrectal ultrasonographic findings, and laboratory test including prostate specific antigen (PSA), white blood cells (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), urinalysis, urine culture, and antibiotic sensitivity. Results: The degree of fever in group 1 (38.4±1.3℃) was higher than group 2 (37.7±0.9℃) (p=0.024), and duration of fever and admission period (3.2±3.0 days vs 1.5±1.6 days, respectively; p=0.006) (22.2±12.6 days vs 6.7±2.9 days, respectively; p<0.001) were longer in group 1. Total prostate volume in group 1 (46.6±20.3ml) was larger than group 2 (32.9±13.9ml) (p=0.002). The results of laboratory tests indicating inflammation in group 1 were higher than group 2 (WBC; 20,592±13258/uL vs 14,577±9097/uL, p=0.040, ESR; 65.1±22.3mm/hr vs 34.3±11.9mm/hr, p=0.001, CRP; 19.4±10.7mg/dL vs 12.1±9.4mg/dL, p=0.023). The causative organisms in group 1 were more resistant to quinolone than group 2 (p=0.019). Conclusions: The clinical course of prostate abscess is more severe and longer than acute prostiaitis. We propose that early imaging study for diagnosis of prostatic abscess in acute prostatitis patients with low response to initial empirical conservative treatment for 2 days. Because antibiotic resistant rate was higher, careful choice of antibiotics and different therapeutic plans including abscess drainage will be needed in patients with prostatic abscess."

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Penile Necrosis in Thromboangitis Obliterans (Buerger's Disease): Jun-Mo Kim, Kwang-Woo Lee, Young-Ho Kim, Min-Eui Kim; Korean J Urogenit Tract Infect Inflamm 2011;6(2):206-208. Published online October 31, 2011

Abstract PDF: Thromboangiitis obliterans is also known as Buerger’s disease, and it usually affects small-to-medium-sized arteries and veins of the upper and lower extremities. Although as an atypical course of this disease, bilateral renal artery thrombosis and affection of spermatic cord were reported, there has been no report of penile necrosis due to Buerger’s disease in Korea. We present a case of a 47-year-old man with voiding difficulty and urinary retention due to severely atrophic penis and urethra. The patient’s medical history revealed smoking as much as 50 pack/years, and heavy alcohol consumption. Although the patient had been taking anti-coagulant medication for 2 years after diagnosis of thromboangiitis obliterans, penile necrosis was advanced. The patient could self-void after diversion of the urethra into the perineum.

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Percutaneous Management of Renal Abscess in Polycystic Kidney Disease: Hong Chung, Yong Ik Lee, Hong Sup Kim, Sang-Kuk Yang; Korean J Urogenit Tract Infect Inflamm 2011;6(2):209-212. Published online October 31, 2011

Abstract PDF: Autosomaldominant polycystic kidney disease (ADPKD) is one of the commonest hereditary disorders and the most common life-threatening genetic disease, affecting an estimated 12.5 million people worldwide. PKD are congenital and bilateral diseases, and those symptoms almost never appear until after age 40. Urinary tract infection occurs with increased frequency in ADPKD and infection in ADPKD is a particularly serious complication. Here, we report a 79-year-old man with an intermittent high fever during 2 months and bulging mass at the right flank.

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Models of Inflammation of the Lower Urinary Tract: Korean J Urogenit Tract Infect Inflamm 2011;6(2):213-229. Published online October 31, 2011

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Guideline for the Prevention of Health Care-associated Infection in Urological Practice in Japan: Jae Min Chung; Korean J Urogenit Tract Infect Inflamm 2011;6(2):230-239. Published online October 31, 2011

Abstract PDF: The present guideline for the prevention of health care-associated infection in urological practice is partially a result of numerous discussions of the working group in the Japanese Society of Urinary Tract Infection Cooperative Study Group. The results of these discussions were systematically organized by the Japanese Urological Association. They surveyed the literature including standard precautions, environmental considerations in both the inpatient and outpatient settings, the management of urinary catheters, endoscopy techniques, and the disinfection and sterilization of instruments used in endoscopies and related procedures. The concept of this guideline is to show the minimum precautions that urologists and other medical professionals should observe when they work in the urological field. Standard precautions based on hand hygiene and the use of personal protective equipment should be observed in both the inpatient and outpatient settings. In the inpatient setting, the management of the toilet is important. Collecting urine should be restricted only when it is necessary to determine a patient’s urinary output. The management for urinary catheter and infection are created based on the “European and Asian guidelines on management and prevention of catheter-associated urinary tract infections”. In addition, we propose that nephrostomy should be carried out after maximum barrier precautions have been taken. Urinary catheters are replaced in the event of an occlusion or if there are signs that an occlusion might occur, but the same catheter cannot be left in place for more than 2 months. Regarding the handling of urine containing Mycobacterium tuberculosis, airborne infection countermeasures are unnecessary, except for the laboratory personnel. For the procedures using urological endoscopes, aseptic techniques are recommended. Endoscopes and related devices should be used by sterilization or high-level disinfection, but formaldehyde gas cannot be used.

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