Urogenital Tract Infection

Moving towards Evidence-Based Clinical Practice Guidelines: Jae Hung Jung, Juan V A, Philipp Dahm; Urogenit Tract Infect 2018;13(3):45-50. Published online August 31, 2018; DOI: https://doi.org/10.14777/uti.2018.13.3.45

Abstract PDF: The Institute of Medicine in its report “Clinical Practice Guidelines we can trust” defined standards for clinical practice guidelines. However, many guidelines continue to rely on expert opinion and lack a formal framework for moving from evidence to recommendations. These guidelines may or may not be labeled as “consensus statements” and do not meet contemporary standards for guideline documents we would refer to as “evidence-based”. Therefore, the Grading of Recommendations Assessment, Development and Evaluation working group developed a novel, rigorous and transparent approach to grading certainty (quality) of evidence. In addition, it created a system for “moving from evidence to decisions”, for example for the development of evidence-based guidelines. In this article, we aim to introduce this approach to appraising the certainty of relevant evidence and estimate the benefits and detriments of health care interventions within the larger context of evidence-based medicine.

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Preventive Effect of Lactobacillus Fermentation Extract on Inflammation and Cytokine Production in Lipopolysaccharide-Induced Cystitis in Mice: Hyun Suk Yoon, Yong Tae Kim, Bong Suk Shim, Hana Yoon; Urogenit Tract Infect 2018;13(3):51-57. Published online August 31, 2018; DOI: https://doi.org/10.14777/uti.2018.13.3.51

Abstract PDF: Purpose: The effects of Lactobacillus fermentation extract (LFE) on cystitis induced by Escherichia coli lipopolysaccharide (LPS) in the mouse bladder were investigated by pathological analyses and measurement of the levels of tumor necrosis factor-alpha (TNF-α) and interleukin-18 (IL-18).
Materials and Methods: LFE was administered orally (5 µg/L) to mice for 10 days after which the study group (n=12) received transurethral injection of 5 µg/L LPS. The bladder tissue was then harvested after 24 hours and subjected to hematoxylin and eosin staining. A semi-quantitative score was used to evaluate inflammation (bladder inflammation index, BII). TNF-α immunohistochemical staining and multiplex cytokine assays were also performed. TNF-α and IL-18 levels were determined. The results were compared with those of the control group (n=12).
Results: The BII in the control and study groups was 2.7±0.5 and 1.1±0.7, respectively, with the control group scores differing significantly from the study group scores (p<0.001). TNF-α immunohistochemical staining results were similar. The TNF-α levels determined by the multiplex cytokine assay were 2.82±1.35 pg/mg and 1.55±0.56 pg/mg for the control and study groups, respectively, and the difference between these groups was statistically significant (p=0.007).
Conclusions: Oral administration of LFE appears to have a preventive effect against the inflammatory responses and TNF-α expression induced by transurethral instillation of LPS in the mouse bladder. Further studies are required to determine the clinical application of this finding.

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Analysis of Uropathogens of Febrile Urinary Tract Infection in Infant and Relationship with Vesicoureteral Reflux: Kyung Hwan Kim, Seung Hee Seo, Sang Don Lee, Jae Min Chung; Urogenit Tract Infect 2018;13(3):58-65. Published online December 31, 2018; DOI: https://doi.org/10.14777/uti.2018.13.3.58

Abstract PDF: Purpose: This study aimed to investigate the relationship between uropathogens of infants with febrile urinary tract infection (UTI) and vesicoureteral reflux (VUR).
Materials and Methods: We analyzed 308 infants hospitalized for febrile UTI between January 2010 and December 2015, and assessed the voiding cystourethrography (VCUG). The medical records, including clinical symptoms, laboratory findings, urinalysis, urine culture tests, ultrasound (US), dimercaptosuccinic acid scan, and VCUG, were retrospectively obtained. The incidences of VUR and high-grade VURs (III, IV, and V) were analyzed in 4 groups categorized by uropathogens and renal US findings.
Results: The mean age of 308 infants was 3.29±2.18 months. The male-to-female ratio was 3.46:1. In urine culture tests, 267 infants (86.69%) showed single bacterial uropathogen; Escherichia coli in 241 infants (78.25%) and non-E. coli uropathogens in 26 infants (8.44%). Multiple distinctive microorganisms were identified as causative uropathogens in 41 infants (13.31%). Abnormal findings of US and VCUG were identified in 216 and 64 patients, respectively. In 308 infants, the incidences of VUR and high-grade VUR were not different among the 4 groups. In 239 male infants, the incidences of high-grade VUR were higher in patients with non-E. coli single or multiple uropathogen and with abnormal US findings (p=0.042).
Conclusions: In male infants with non-E. coli uropathogen or multiple uropathogens and with abnormal US findings at febrile UTI, there was an increased chance of finding high-grade VURs on subsequent VCUG tests.

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Comparison of the Efficacy between the Single-Dose and Three-Day Prophylactic Antibiotic Regimens for the Prevention of Bacterial Infections in Patients with Percutaneous Nephrolithotomy: A Randomized Controlled Study: Han Kyu Chae, Myong Kim, Jung Hyun Shin, Hyung Keun Park; Urogenit Tract Infect 2018;13(3):66-71. Published online December 31, 2018; DOI: https://doi.org/10.14777/uti.2018.13.3.66

Abstract PDF: Purpose: To determine the appropriate regimen of antibiotic prophylaxis for the prevention of bacterial infections in patients receiving percutaneous nephrolithotomy (PCNL).
Materials and Methods: Forty patients, who planned to undergo PCNL from October 2015 to August 2017, were assigned randomly into two groups. Patients in the single-dose group (n=20) were administered an intravenous single dose of 2 g ceftriaxone 30 minutes before PCNL, whereas those in the three-days regimen group (n=20) were administered a preoperative intravenous single dose of 2 g ceftriaxone and an additional postoperative oral cefpodoxime proxetil (100 mg twice a day) for three days. The incidences of infectious complications in the two groups, such as pyrexia, systemic inflammatory response syndrome (SIRS), and sepsis, were compared.
Results: Fever (axillary temperature >38.0°C) did not develop in any of the patients in the single-dose group but developed in one patient (5.0%) in the three-day regimen group due to pneumonia (p=0.3). SIRS developed in a total of eight patients (20.0%), four patients from each group. None of the patients in either group developed sepsis after PCNL.
Conclusions: The three-day prophylactic antibiotic regimen did not demonstrate better efficacy for the prevention of bacterial infections in patients with PCNL compared to the single-dose prophylactic antibiotic regimen.

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Optimal Modified Extended Antibiotic Prophylaxis for Prostate Biopsy: The Addition of Two Intravenous Doses of Amikacin to Ciprofloxacin: Seong Hyeon Yu, Seung Il Jung, Myung Soo Kim, Ho Seok Chung, Dong Deuk Kwon; Urogenit Tract Infect 2018;13(3):72-78. Published online December 31, 2018; DOI: https://doi.org/10.14777/uti.2018.13.3.72

Abstract PDF: Purpose: This retrospective study was undertaken to investigate whether increasing amikacin dosage for ciprofloxacin prophylaxis in patients with fluoroquinolone (FQ)-resistant rectal flora reduce infectious complications after transrectal ultrasound-guided prostate biopsy (TRUSPB).
Materials and Methods: A total of 430 patients with FQ-resistant rectal flora based on rectal swab cultures were divided into two groups. Patients in both groups were administered ciprofloxacin (400 mg, intravenous [IV], twice daily) on the same day as TRUSPB and one day after biopsy. However, whereas group 1 patients (n=202) were administered a single injection of amikacin (1g, IV) one hour before TRUSPB, patients in group 2 (n=228) were administered two injections of amikacin (1g, IV) before one hour TRUSPB and again on the day after TRUSPB.
Results: Of the 430 study subjects, 129 (30.0%) showed extended-spectrum beta-lactamase (ESBL) positivity. The overall incidence rate of infectious complications was 2.8% (12/430). Infectious complication rates were 4.0% (8/202) in group 1 and 1.3% (3/228) in group 2 (p=0.075). Urinary tract infection and acute prostatitis were more frequent in group 1 (3.5% vs. 0.4%, p=0.029). Infectious complication rates in ESBL negative patients were 3.4% (5/145) in group 1 and 1.3% (2/156) in group 2, whereas those in ESBL positive patients were 7.0% (4/57) in group 1 and 1.4% (1/72) in group 2.
Conclusions: Increasing the dosage of amikacin for ciprofloxacin prophylaxis reduce infectious complications in patients with FQ-resistant rectal flora and to be more effective in ESBL positive patients with FQ-resistant rectal flora.

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Patient’s Factors Correlated with Prostate Volume Recovery after 5 Alpha Reductase Inhibitor Discontinuation: Kwibok Choi, Byounghoon Kim, In-Chang Cho, Seung Ki Min; Urogenit Tract Infect 2018;13(3):79-83. Published online December 31, 2018; DOI: https://doi.org/10.14777/uti.2018.13.3.79

Abstract PDF: Purpose: The 5 alpha reductase inhibitor (5ARI) reduces the size of the prostate and alleviates lower urinary tract symptoms. After stopping 5ARI, the prostate quickly recovers to its pre-medication size. The purpose of this study was to investigate the factors affecting the restoration of prostate size after 5ARI discontinuation.
Materials and Methods: Between March 2009 and May 2017, patients who visited an outpatient clinic and were diagnosed with benign prostatic hyperplasia were selected and start 5ARI medication. After 6 months of medication, the patients stopped medication for 1 year. Meanwhile, we measured the prostate volumes of patients 3 times (before and after medication, after discontinuation) and divide the patients into 3 groups (maintained, intermediate, and restored) with recovered prostate volume ratio. After classification, we investigated the relationship between the variable factors (age, serum prostate-specific antigen, initial volume, reduced volume after medication) between groups.
Results: Among the 147 selected patients, the mean age and plasma PSA level were 61.6±7.9 and 0.8±0.6, respectively. The mean initial prostate volume was 32.3±4.2 ml, which reduced to 23.2±3.2 ml after medication. After one year of discontinuation, the mean volume was 31.4±6.4 ml, with restoration to 101.5% of the reduced size. We noticed a tendency that patients with faster prostate volume recovery were generally older than those with slower recovery; however, this was not statistically significant. Other factors showed no relationship with prostate recovery.
Conclusions: When using 5ARI in elderly patients, continuous treatment seems better than intermittent treatment. If discontinuation is needed, short term follow-up is recommended.

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