Urogenital Tract Infection

The Mechanism of Extended Spectrum β-Lactamase: Ki Ho Kim; Korean J Urogenit Tract Infect Inflamm 2012;7(2):89-98. Published online October 31, 2012

Abstract PDF: β-lactamases are the most widespread cause of bacterial resistance to β-lactam antibiotics, such as the penicillins and cephalosporins, and the mechanisms of these enzymes are intensely studied. The first β-lactamase was identified in an isolate of Escherichia coli in 1940. Many of the gram-negative bacteria possess a naturally occurring, chromosomally mediated β-lactamase, which probably assists the bacteria in finding a niche when faced with competition from other bacteria that naturally produce β-lactams. β-lactamases are classified into two major types on the basis of the main component of the active site: serineβ-lactamases and metallo-β-lactamases. Serineβ-lactamases are further classified into three classes: class A, C, and D; i.e.,metalloβ-lactamase is classified into class B. As is well known, the catalytic mechanism of serineβ-lactamases involves acylation and deacylation. In this paper, we have investigated the mechanisms of class A β-lactamase, most of which have extended spectrum β-lactamases belonging to that of the other classes B,C, and D β-lactamase. (Korean J UTII 2012;7:89-98)

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Superbug: Vancomycin-Resistant Enterococcus and Carbapenem Resistant Organisms: Ji Yun Chae, Mi Mi Oh; Korean J Urogenit Tract Infect Inflamm 2012;7(2):99-105. Published online October 31, 2012

Abstract PDF: The emergence of multi-drug resistant organisms, so-called ‘superbugs’, are a major public health concern. Multi-drug resistant organisms can cause serious, life-threatening infections. The acquisition of vancomycin resistance by Gram-positive bacteria and carbapenem resistance by Gram-negative bacteria made some hospital-acquired infections impossible to treat. Unless alternative treatment regimens are developed, our difficulty to treat totally resistant bacteria will halt other advances in modern medicine. Overuse of antibiotics and environmental factors all have a role in the emergence and spread of resistance. This article reviews the mechanisms and recent trends in the spread of multi-drug resistant bacteria, especially vancomycin-resistant Enterococcus and carbapenem-resistant organisms. (Korean J UTII 2012;7:99-105)

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Epidemiology of Antimicrobial-Resistance in Sexually Transmitted Infections in Korea: Implications for Rational Treatment: Jung Hoon Kim, In Ho Chang; Korean J Urogenit Tract Infect Inflamm 2012;7(2):106-120. Published online October 31, 2012

Abstract PDF: Public health control of bacterial sexually transmitted infections (STIs) is dependent on the delivery of effective therapy and so will be compromised by the emergence of resistance. The scope of the problem and the implications for treatment that follow are discussed in this review.
Emerging resistance has been documented in all the bacterial STIs, but is considered rare and unconfirmed in Chlamydia trachomatis whereas Neisseria gonorrhea is of global concern. Azithromycin resistance has now been recognized in Mycoplasma genitalium, Treponema pallidum and N. gonorrhoeae, bringing into question its widespread use for chlamydial infection and threatening its future use. Rapidly increasing levels of decreased susceptibility to the extended-spectrum cephalosporins in N. gonorrhoeae and emerging treatment failures to both cefixime and ceftriaxone, without an obvious alternative agent, are of considerable concern. Implications for treatment include choice and timing of any change in therapy, reintroduction of test of cure and definition of treatment failure in an era of molecular testing.
Emerging resistance in all bacterial STIs and the particular problem of resistant gonorrhea will present a challenge to maintaining and prescribing antimicrobial therapy which is at the forefront of public health control. (Korean J UTII 2012;7:106-120)

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Diagnosis and Notification of Sexually Transmitted Infections: Seong Woon Park, Gil Ho Lee; Korean J Urogenit Tract Infect Inflamm 2012;7(2):121-128. Published online October 31, 2012

Abstract PDF: In 2010, the infectious disease surveillance system of Korea was faced with a series of changes. For sexually transmitted infections (STIs) such as syphilis, gonorrhea, chlamydia, chancroid, genital herpes, condyloma accuminata or acquired immunodeficiency syndrome (AIDS), every case had to be reported according to the Infectious Disease Prevention Law passed in 2003. But the reporting system for STIs was changed to a ‘Sentinel Surveillance System' in 2010, except for syphilis and AIDS, due to the fact that reporting every case was not practically possible and their occurrences should be continuously monitored to ensure the early detection and control of these diseases. In addition, the public health improvement or control activities of medical personnel need regular feedback of the surveillance results. However, the efficient reporting or surveillance of STIs has yet to be successfully carried out because of special requirements such as the need to protect patient's privacy. Therefore, to set up countermeasures and research to prevent the spread of STIs, first line medical personnel should be active and familiar with the reporting system so that the nationwide surveillance system can be successfully managed. (Korean J UTII 2012;7:121-128)

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Evaluationof Multiplex PCR for the Detection of Sexually Transmitted Pathogens using Clinical Specimens: Tae Hyoung Kim, Mi Kyung Lee; Korean J Urogenit Tract Infect Inflamm 2012;7(2):129-135. Published online October 31, 2012

Abstract PDF: Purpose
Multiplex PCR can allow multiple pathogens to be detected in the same reaction tube, saving time and reagents. The aim of this study was to evaluate the multiplex PCR kit (Seegene, Korea) for detection of fastidious microorganisms such as six sexually transmitted pathogens.
Materials and Methods: Using clinical specimens, multiplex PCR and single PCR were used to test for Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Neisseria gonorrhoeae, Trichomonas vaginalis and Ureaplasma urealyticum.
Results: Multiplex PCR had an overall sensitivity of 97.2% and specificity of 100% compared to the single PCR. The limits of detection for the multiplex PCR and single PCR were from 3.03×10-6 to 7.06×10-7 μg/mL and from 3.03×10-6 to 3.03×10-31 μg/mL, respectively.
Conclusions: The multiplex PCR kit has considerable potential to use as a routine method in clinical laboratories. Before introducing the new multiplex PCR method in the laboratory, thorough evaluation and validation of multiplex PCR is essential. To achieve reliable results from multiplex PCR, feasible guidelines, standardization and quality control are of major importance. (Korean J UTII 2012;7:129-135)

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The Difference of Microorganism and Antibiotics Resistance between Adults and Children with Urinary Tract Infection: Hyung Jong Nam, Seung Chan Jeong, Jong Youn Yi, Sang Don Lee; Korean J Urogenit Tract Infect Inflamm 2012;7(2):136-141. Published online October 31, 2012

Abstract PDF: Purpose
Urinary tract infection (UTI) is one of the most common infectious diseases in children and adults. It is widely known that most UTI is caused by E. coli. In most cases for those who underwent UTIs, empirical antibiotics were treatment of choice. But resistance of empirical antibiotics is increasing gradually. The proper use of antibiotics is essential in the clinical field. We evaluated the antibiotic resistance of organisms causing UTIs in children and adults patients to provide the proper use of empirical antibiotics.
Materials and Methods: From January 2011 to December 2011, 749 cases (mean age was 27.9±30.2years) who underwent positive urinary culture tests were evaluated. The age, sex, results of urine dipstick and microscopic tests, urine culture, and antibiotics resistance were reviewed.
Results: 460 men and 289 women were evaluated. Adults were 310 cases (41.4%) and children were 439 cases (58.6%). Pathogens from the results of urine culture were E. coli (35.7%), Enterococcus species(25.8%), Klepsiella (12.9%). Antibiotics resistance rate of all pathogens was 29.8% and Pseudomonas(36.1%), with E. coli (32.8%) having the highest resistance rate of all. Ampicillin (61.8%), trimethoprim/sulfamethoxazole (42.6%), and penicillin (39.4%) showed higher resistance rates than other antibiotics. The multi-drug resistance rate was 17.8% in total, adults were 17.4%, and children were 18.1%. Female urine RBC and urine WBC counts were ssociated with UTIs from a pathogen which has resistance at to at least one of the antibiotics in adults. On the other hand, older age, urine leukocyte esterase and urine RBC count was associated with antibiotics resistance in children.
Conclusions: Gram positive microorganisms including E. coli were the most common pathogen of UTIs both in adults and children. Therefore, quinolones and cephalosporins are widely used in UTIs, however antibiotic sensitivity was reduced in this study and there was no difference in adults and children. The sensitivity and drug resistance were changing steadily, affecting many factors and various pathogens gave rise to UTIs. Therefore considerations of many factors of sensitivity to antibiotics are needed.(Korean J UTII 2012;7:136-141)

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The Characteristics of Uropathogen after Percutaneous Nephrostomy in Patients with Palliative Care: Hyeon Ju Kim, Young-Joo Kim, Sung Dae Kim, Hyo Jung Song, Seong Hyung Kim, Jung-Sik Huh; Korean J Urogenit Tract Infect Inflamm 2012;7(2):142-148. Published online October 31, 2012

Abstract PDF: Purpose: Obstructive uropathy due to malignant diseases is not only associated with urinary tract infectionbut also renal failure. Palliative decompression using either percutaneous nephrostomy tubes or internal stents improves renal function but is associated with significant morbidity and affecting quality of life. We investigated the characteristics of uropathogens related percutaneous nephrostomy with patients with terminal care.
Materials and Methods: A retrospective chart review was conducted of patients who had a nephrostomy tube inserted for malignant ureteric obstruction between January 2007 and July 2012. We analyzed parameters including previous cancer, creatine before nephrostomy procedure, visual analogue scale, creatinine before procedure, and urinary tract infection after nephrostomy tube insertion including urine culture and blood culture.
Results: There were 143 patients with percutaneous nephrostomy in our hospital. Of these patients, 42 had percutaneous nephrostomy for ureteral obstruction with malignancy. Tumors were of urological origin in 50%of patients. Of these patients, 17 had positive urine culture results. Enterococcus faecalis was the most commonbacteria grown.
Conclusions: We considered that UTI was not a rare complication of palliative decompression of malignant Nureteral obstruction, and resistance for antibiotics increases, especially ciprofloxacin. Identification of risk factors for UTI might further improve the safety of percutaneous nephrostomy. (Korean J UTII 2012;7:142-148)

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Antibiotic Prophylaxis and Risk Factors of Infectious Complication after Endourologic Procedures of the Upper Urinary Tract: Sung Dae Kim, Dong Wan Sohn; Korean J Urogenit Tract Infect Inflamm 2012;7(2):149-157. Published online October 31, 2012

Abstract PDF: Purpose: We investigated a retrospective analysis of infectious complication and its risk factors after endourologic procedures of the upper urinary tract, focusing on antibiotic prophylaxis (AP).
Materials and Methods: We studied AP in 488 upper urinary tract examinations or treatments.Procedures included ureteral stenting, percutaneous nephrostomy, retrograde pyelography, and diagnostic ureteroscopy. We calculated that the prevalence and kind of AP and the incidence of febrile infectious complications with respect to each procedure and attempted to find the risk factors.
Results: AP was used in 456 (93.3%) cases totally. Antibiotics of quinolone were the most popular medication. There are 17 (3.7%) febrile infectious complication cases after procedure, the most common procedure was percutaneous nephrostomy in 7 cases (6.0%). Bacteriuria, hydronephrosis, whether or not ureteral stent, or nephrostomy, or Foley catheterization was applied prior to examination or treatment, and were independent risk factors for infectious complications (<0.05).
Conclusions: The data suggest that the risks of infectious complications should be evaluated carefully and AP should be recommended according to those risks before the procedures. (Korean J UTII 2012;7:149-157)

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Antimicrobial Effect of Uro-vaxom? in Catheter-Related Urinary Tract Infection: Sun Wook Kim, Byung Il Yoon, U Syn Ha, Dong Wan Sohn, Yong Hyun Cho; Korean J Urogenit Tract Infect Inflamm 2012;7(2):158-163. Published online October 31, 2012

Abstract PDF: Purpose: Urinary tract infection (UTI) is a relatively common disease, and clinically it appears diversely like urethritis, cystitis, prostatitis, and acute pyelonephritis. E. coli which is the major causative microorganism of UTI, and accounts for 50% of hospital pathogens cultured in 40% of catheter-related UTI. We evaluated the preventive effect on UTI and inhibitory effect on complications of Uro-vaxom?, and investigate the effect of Uro-vaxom? in catheter induced UTI.
Materials and Methods: A comprehensive electronic search was conducted using the Medline database to identify all publications relating to Uro-vaxom? and catheter and UTI by using keywords Uro-vaxom?, catheter, catheterization, urinary tract infection, cystitis, bacteriuria, antimicrobial agents, intensive care unit.
Results: 227 literatures which were consistent with our purposes were searched; we intensively analyzed 26 literatures which were appropriate for our literature. All literature reported antimicrobial effects of Uro-vaxom?.
Conclusions: We identified that Uro-vaxom? had a preventive effect on UTI associated with E. coli to patients who had catheterization. (Korean J UTII 2012;7:158-163)

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Analysis of Correlation between The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and International Index of Erectile Function (IIEF-5) among Korean Males Aged 40-50s: In Chang Cho, Sung Bin Kim, Yoo Seok Kim, Jae Young Choi, Seung Ki Min; Korean J Urogenit Tract Infect Inflamm 2012;7(2):164-171. Published online October 31, 2012

Abstract PDF: Purpose
Analyzed the correlation between the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and International Index of Erectile Function (IIEF-5) from questionnaires among Korean 40-50s male.
Materials and Methods: From September 1, 2011 to December 31 2012, we conducted a survey targeting 1032 Korean males who were had medical examinations in National Police Hospital, Using NIH-CPSI and IIEF-5. After explaining the content of the NIH-CPSI and IIEF-5, the paper was checked by volunteers in person, and the results were then collected. The subjects were limited to Korean males in their 40-50s. We analyzed the collected questionnaires.
Results: The average age of 1032 volunteers was 50 years old (42-59), and the average of NIH-CPSI total scores was 7.1±5.5. The average of IIEF-5 total scores was 17.4±6.5. IIEF-5 category was divided into Normal 385 (37.3%), Mild 296 (38.7%), Mild-Moderate 215 (20.8%), Moderate 98 (9.5%), and Severe 38 persons (3.7%). Among total volunteers, 72 persons were Chronic prostatitis like symptom patients (6.9%), and whose NIH-CPSI average of pain score (total 21), voiding score (total 10), quality of life score (total 12) and total scores were 7.6±3.1, 4.3±2.5, 5.8±2.3, and 17.8±6.7, respectively. There were moderate correlations of pain score, voiding score, quality of life score, but not significant (Pearson's coefficient of correlations <0.501). An average of total IIEF-5 scores in chronic prostatitis - like symptoms in the present group was 14.0±6.8. It was significantly lower than in the in the absent group. Prostatitis-like symptoms in the present group had more severe degrees of erectile dysfunction than absent group (p=0.002). Assessing each NIH-CPSI category score and total score affected to total IIEF-5 score, we analyzed the correlation between NIH-CPSI and IIEF-5 using regression analysis. There were all negative correlations between IIEF-5 and Pain score(t=-6.199, r2=0.036, p=0.000), voiding score (t=-0.157, r2=0.025, p=0.000), QOL score (t=-7.845, r2=0.056,p=0.000), and total score (t=-9.366, r2=0.078, p=0.000). Having analyzed correlations between each score of NIH-CPSI groups and IIEF-5 score by using multiple regression analysis, there were statistically significant difference negative correlations between pain score and IIEF-5 (t=-2.646, p=0.008), QOLscore (t=-4.219, p=0.000), and age (t=-3.135, p=0.002), but not to voiding score (t=0.628, p=0.530).
Conclusions: The higher the NIH-CPSI score, especially for pain and QOL scores play a larger role, and adversely affects erectile function of chronic prostatitis like symptom patients in Korean males aged 40-50s. (Korean J UTII 2012;7:164-171)

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Clinical Study According to Presence of Prior Manipulation in Patients with Acute Bacterial Prostatitis: Kwang Ho Kim, Eu Chang Hwang, Sun Ouck Kim, Seung Il Jung, Taek Won Kang, Dong Deuk Kwon, Kwang Sung Park; Korean J Urogenit Tract Infect Inflamm 2012;7(2):172-177. Published online October 31, 2012

Abstract PDF: Purpose: Acute bacterial prostatitis (ABP) is uncommon and proper guidelines concerning antibiotic administration for ABP with urologic procedure are unclear. We retrospectively analyzed clinical symptoms and etiologic organism in ABP according to presence of prior urologic manipulation.
Materials and Methods: The clinical records of 65 patients who had been treated for ABP between January 2007 and December 2011 were reviewed. We analyzed parameters including history taking, physical examination, prior manipulations, antibiotics administration, mean length of treatment, complications, urinalysis, and urine and blood culture. Results were analyzed according to two subgroups; Group 1, those without prior urologic manipulation, and Group 2, those with prior manipulation.
Results: The population of Group 1 was 22 (33.8%) and Group 2 was 43 (66.2%). The mean age of the patients in both groups were 56.5±15.6 years and 64.0±12.5 years, respectively. Of the clinical symptoms in both groups, fever was most common (81.8% and 83.7%). The mean pyuria grades were 2.82±0.37 and 3.47±0.25 each in both groups. In group 2, prostatic biopsy (36, 83.7%) was the most frequent manipulation of the patients. Dysuria and storage symptoms were significantly more frequent in Group 1. The number of diabetes mellitus patients and the admission rates were higher in Group 2. E. coli was the most frequently isolated pathogen from urine and blood (23.1% and 24.6%, respectively). Resistance to ciprofloxacin was very high in group 1 (60.0%) and group 2 (83.3%). However, there was no significant difference between the two groups.
Conclusions: Resistance rates to ampicillin and ciprofloxacin in ABP were very high in all patients. The resistance rates were higher in patients with prior manipulation, but there was no significant difference. When we consider high resistance to ciprofloxacin in ABP, more careful attention should be paid to empirical treatment of ABP patients with prior manipulation. (Korean J UTII 2012;7:172-177)

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Bladder Stone causing Acute Renal Failure and Urinary Tract Infection: Sung Dae Kim, Young Joo Kim, Jung Sik Huh; Korean J Urogenit Tract Infect Inflamm 2012;7(2):178-181. Published online October 31, 2012

Abstract PDF: Bladder stones are not a rare disease, but it is rare for such a calculus to be so large as to cause bilateral hydronephrosis. In a previous report, we described an unusual case of spontaneous bladder rupture due to a giant bladder stone. The patient was a 68-year-old man, who had undergone primary repair of bladder rupture and cystolithotripsy of a giant bladder stone with lithoclast at the age of 63 years old. Then he did loss follow-up to the hospital for 5 years. After 5 years, he came back to the hospital with the same symptoms such as decreased urine volume, suprapubic discomfort. Fortunately, the previous treatment which consisted of litholopaxy and antibiotics was effective again. Worldwide, it is the first reported case of recurrent acute renal failure and urinary tract infection after bladder spontaneous rupture due to a giant bladder stone. (Korean J UTII 2012;7:178-181)

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Genitourinary Tuberculosis with the Other Extrapulmonary Tuberculosis: Byeong Kuk Ham, Tae Il Noh, Jong Hyun Pyun, Su Hwan Shin, Ji Sung Shim, Jae Hyun Bae; Korean J Urogenit Tract Infect Inflamm 2012;7(2):182-186. Published online October 31, 2012

Abstract PDF: When the infection occurs in other parts of the body it is called extrapulmonary tuberculosis. About 15% of tuberculosis cases are extrapulmonary. Tuberculous lymphadenitis is the most commonly occurring form of extrapulmonary tuberculosis, and skeletal tuberculosis most often involves the spine, followed by tuberculous arthritis in weight-bearing joints and extraspinal tuberculous osteomyelitis. Genitourinary tuberculosis contributes to 10-20% of extrapulmonary tuberculosis. A 59 year old woman was admitted with lower back pain and lower urinary tract symptoms. A CT scan showed focal enhancing wall thickening in the left proximal ureter with left hydronephrosis and multiple enlarged lymph nodes. The Radiologic and pathologic diagnosis revealed genitourinary tuberculosis with the other extrapulmonary tuberculosis. (Korean J UTII 2012;7:182-186)

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