Urogenital Tract Infection

Management of Antibiotic-Resistant Acute Pyelonephritis: Ha Na Lee, Hana Yoon; Urogenit Tract Infect 2017;12(3):95-102. Published online December 31, 2017

Abstract PDF: Acute pyelonephritis (APN) is a common urinary tract infection that affects a large proportion of women. Although antimicrobial therapy is a successful treatment in most cases, empirically, antibiotic resistance has emerged as a serious issue, including high resistance rate of fluoroquinolone and the advent of extended-spectrum β-lactamase (ESBL)-producing organisms. Several agents can be considered for the management of antibiotic resistant APN. Fosfomycin trometamol is effective in treating ESBL-producing bacterial infection. Oral trimethoprim/sulfamethoxazole, β-lactam agents, such as cephalosporin, and fluoroquinolone can be regarded as appropriate agents if pathogen is susceptible. Carbapenem, such as imipenem, meropenem, and doripenem, is one of the best and widely used agents for treating antibiotic resistant APN. However, there have recently been concerns regarding the increased rates of resistance to carbapenems. Daptomycin, linezolid, and tigecycline can be considered as solutions to antibiotic resistant organisms. Antibiotic resistant APN should be treated as other systemic infections to prevent antibiotic overuse with proper treatment duration considering carbapenem-saving strategy.

6 View
0 Download

Hyperuricemia and Urologic Disease: In-Chang Cho, Seung Ki Min; Urogenit Tract Infect 2017;12(3):103-109. Published online December 31, 2017

Abstract PDF: Gout is a disease that causes painful inflammatory arthritis related to hyperuricemia, due to the incorrect metabolism of uric acid. Decreased renal excretion of urate is thought to be the major hyperuricemic mechanism. Most genes responsible for the serum uric acid (SUA) level encode uric acid transporters or related regulatory proteins. The acquired effects can also modulate SUA level and uric acid excretion, which can result in acute gout. Interestingly, kidney related comorbidities in gout, such as hypertension, chronic kidney disease (CKD), and urolithiasis, all have a fairly high prevalence. Recent advancements in genetics and molecular physiology have greatly improved our understanding of renal reabsorption and secretion of filtered uric acid. Furthermore, the baseline SUA level appears to be established by a net balance between absorption and secretion through the epithelium of the kidneys and intestines. There have also been considerable progress in the management of gout patients with CKD. Increased prevalence of gout with CKD can be balanced by an expanded spectrum of treatment options for this important disease. Another issue is that lowering of the uric acid level can reduce the incidence of cardiovascular disease, renal disease, and urological complications. Basic research and clinical studies on these mechanisms might be helpful in determining the appropriate treatment for hyperuricemic patients. Based on currently existing literature, there have been improvements associated with medications that lower uric acid, particularly xanthine oxidase inhibitors. Here, we review the pathogenesis and epidemiology of hyperuricemia, specific diseases related to uric acid, and up-to-date perspectives on their management.

7 View
0 Download

Risk Factors of Sepsis and Factors Influencing the Decision to Perform Emergency Drainage in Obstructive Acute Pyelonephritis Secondary to Urinary Calculi: Young Hwan Jung, Seung Chan Jeong, Minki Baek, Dong Soo Ryu; Urogenit Tract Infect 2017;12(3):110-116. Published online December 31, 2017

Abstract PDF: Purpose: To investigate the risk factors for sepsis and analyze the criteria for emergency drainage in patients with obstructive acute pyelonephritis (APN) secondary to urinary calculi.
Materials and Methods: We included 64 patients with obstructive APN secondary to urinary calculi. Patients were divided into two groups: the sepsis and non-sepsis groups. Independent risk factors for sepsis were also identified. Forty-three patients in the sepsis group were further divided into two subgroups: those who underwent emergency drainage and those who did not. A retrospective analysis was performed.
Results: Of the 64 patients, 43 showed signs of sepsis. There was a lower lymphocyte count and lymphocyte percentage, as well as a higher C-reactive protein level and neutrophil-to-lymphocyte ratio (NLR) in the sepsis group compared with the non-sepsis group. Increased sepsis showed a statistically significant association with increased Charlson comorbidity index (CCI). Four out of 21 patients in the non-sepsis group underwent emergency drainage compared with 26 out of 43 patients in the sepsis group. Independent variables for sepsis in a multivariate logistic regression analysis showed positive blood culture, high NLR, and increased CCI score. Among sepsis patients, the likelihood of performing emergency drainage increased with higher creatinine, positive urine culture, and higher CCI score.
Conclusions: In patients with obstructive APN secondary to urinary calculi, a high CCI score were associated with a higher probability of progression to sepsis. In patients with higher creatinine and higher CCI scores, proactive treatment is usually necessary.

6 View
0 Download

Intraurethral Lidocaine Usage in Office-Based Rigid Cystoscopy on Pain Experience: Kwi Bok Choi, In-Chang Cho, Seung Ki Min; Urogenit Tract Infect 2017;12(3):117-121. Published online December 31, 2017

Abstract PDF: Purpose: Cystoscopy is one of the most reliable urological examinations. However, it also a painful one. Intraurethral lidocaine gel injection is widely used to relieve pain during cystoscopy. The purpose of this study is to compare between the use of lidocaine gel and lidocaine solution as a pretreatment for cystoscopy.
Materials and Methods: Between March 2016 and May 2017, we studied 147 patients who had undergone cystoscopy at our institution. Patients were divided into four groups. Lidocaine gel and solution were administered just 10 minutes before each test. For randomization, the patient groups were divided into either odd or even number for the test day and as the patient number, irrespective of medical condition. The amount of lidocaine gel and solution of 10 ml each was uniformly injected. After the procedure, patients were asked to rate their pain on a 10-point visual analogue scale.
Results: The average degree of pain relief was in the order of solution/10 minutes, gel/immediately, gel/10 minutes, and solution/immediately. The gel was associated with significantly less pain in the immediate group than in 10-minute before group, whereas the solution was associated with significantly better pain relief in the 10-minute before group than in the immediate group. There were no complications to report in all groups.
Conclusions: Lidocaine gel and solution showed different changes of pain relief over time. Further prospective studies with a larger population is necessary to better develop a less painful method of cystoscopy in the future.

9 View
0 Download

Adherence Assay of Uropathogenic Escherichia coli In Vivo and In Vitro: Duk Yoon Kim, Je Chul Lee; Urogenit Tract Infect 2017;12(3):122-129. Published online December 31, 2017

Abstract PDF: Purpose: This study aims to investigate the specific pathogenic properties or virulent determinant characteristics of uropathogenic Escherichia coli (UPEC) as bacterial adherence in tissue culture cells in vitro and the pathogenicity in animal model in vivo.
Materials and Methods: Thirty strains of E. coli were isolated from urine of patients with acute pyelonephritis. Four cell lines—HeLa cells, HEp-2 cells, A-498 cells, and J-82 cells—were used for bacterial adherence assay. Histologic examination and scanning electron microscopy examination of pyelonephritis or cystitis, which was caused by E. coli, in mice was performed.
Results: Sixteen (53.3%) strains of E. coli appeared to adhere to at least one or more kinds of four cell lines, and seven strains were able to adhere to all four cell lines. All of the tested E. coli strains were adhered to the mouse bladder and kidneys. The number of bacteria colonized in the kidney was greater than that of bladders in the following 5 strains of E. coli: TME104, TME107, TME113, TME306, and TME119. There was no difference in the number of bacteria colonized in the bladder and kidneys in the aspects of adherence patterns to tissue culture cells.
Conclusions: Although there was no best choice cell lines in the adherence assay to identify the adherence patterns, combined assays of in vitro cell culture and in vivo model of mouse urinary tract infection appeared to be efficient methods to investigate the role of bacterial adherence in the pathogenesis of UPEC.

5 View
0 Download

Emphysematous Cystitis Combined with Prostatic Abscess and Hematogenous Spread of Infection to the Lung and Liver in a Diabetic Patient: Jangwon Lee, Harin Rhee, Il Young Kim, Eun Young Seong, Dong Won Lee, Soo Bong Lee, Ihm Soo Kwak, Sang Heon Song; Urogenit Tract Infect 2017;12(3):130-133. Published online December 31, 2017

Abstract PDF: Coexistence of emphysematous cystitis and prostatic abscess are rare occurrences. Here, we report a case of emphysematous cystitis and prostatic abscess in a 65-year-old man with a 5-year history of diabetes mellitus. This case was further complicated by the hematogenous spread of Klebsiella pneumoniae infection from the prostatic abscess to the liver and lung. Computed tomography (CT) imaging revealed a localized gas within the urinary bladder and swelling of the prostate, with fluid accumulation. Multiple low-density lesions were observed in liver segments S3, S4, and S7, suggestive of an inflammatory process. Chest CT scan revealed multiple cavitatory nodules of various sizes, with a ground glass appearance of both lung fields, which suggest septic emboli from severe uro-septicemia. The optimal antibiotic therapy was administered, and a holmium laser enucleation of the prostate operation was subsequently performed. On day 37 post-admission, the patient was discharged in a good condition, without any sequelae.

6 View
0 Download

Infected Lymphocele Extending to the Leg after Robot-Assisted Radical Prostatectomy and Pelvic Lymph Node Dissection: Hyun Jin Jung; Urogenit Tract Infect 2017;12(3):134-136. Published online December 31, 2017

Abstract PDF: Lymphocele infection is a rare complication after radical prostatectomy and pelvic lymph node dissection (PLND). Here, we present a case of lymphocele infection that extended to the leg two months after robot-assisted laparoscopic radical prostatectomy and PLND. The patient was a 60-year-old man whose chief complaints were fever, chills, and right thigh pain. Computed tomography showed infected lymphocele with right thigh abscess. After percutaneous drainage and intravenous antibiotics, the infection and right thigh abscess were resolved.

6 View
0 Download

Previous issues