Urogenital Tract Infection

Case of Life-Threatening Pneumonia during the Treatment of a Patient with Acute Bacterial Prostatitis: Kyung Kgi Park, Sung Dae Kim, Young-Joo Kim, Jung-Sik Huh; Urogenit Tract Infect 2023;18(3):114-118. Published online December 31, 2023; DOI: https://doi.org/10.14777/uti.2023.18.3.114

Abstract PDF PubReader ePub: Acute bacterial prostatitis is an acute urinary tract infection associated with a bladder outlet obstruction or an immunosuppressed state. A 51-year-old man patient visited the hospital with fever, chills, and acute urinary retention that started the day before his visit after consuming a significant amount of alcohol. Conservative treatments, including catheterization for urinary drainage and antibiotics, were performed. On the third day of treatment for acute prostatitis, he complained of dyspnea. The level of oxygen differentiation was reduced significantly, and the tracheal insertion and ventilator were maintained after the radiological examination. The ventilator was discontinued, and the prostate abscess was operated on the eighth day of hospitalization. He was discharged without complications. This paper reports a case of life-threatening pneumonia and a prostate abscess during the treatment of a patient with acute bacterial prostatitis with a review of the relevant literature.

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Antibiotic Sensitivity of Bacterial Strains from Prostate Abscess Pus Aspirated Using Ultrasound Guidance: Kyung Kgi Park, Sung Dae Kim, Young-Joo Kim, Jung-Sik Huh; Urogenit Tract Infect 2022;17(1):26-30. Published online April 30, 2022; DOI: https://doi.org/10.14777/uti.2022.17.1.26

Abstract PDF PubReader ePub: Purpose: A prostate abscess is a rare occurrence often caused by immune dysfunction. The diagnostic modality for a prostate abscess is computed tomography or transrectal ultrasound. Transrectal ultrasound-guided aspiration is one such method. If treatment is dependent on the abscess size. This study examined the bacterial strains drained under transrectal ultrasound and their antibiotic sensitivity.
Materials and Methods: The medical records of eight patients diagnosed with a prostatic abscess and treated by transrectal ultrasound-guided aspiration from March 2009 to December 2020 were reviewed retrospectively. The general characteristics, associated diseases, and bacterial strains and their antibiotic sensitivities were identified in blood, urine, and pus cultures.
Results: Eight patients were hospitalized. The average age was 59.5±6.05 years, and the average length of hospitalization was 16.88±5.49 days; 75% had diabetes. No patients had catheterization, spinal injury, or prostate biopsy prior to diagnosis. The mean prostate volume was 47.05±27.3 ml, and the mean prostate abscess size was 2.08±0.83 ml. Under transrectal ultrasonography, the prostate abscess size was 5.43±5.31 ml, and catheters were inserted for treatment in four cases (50%). In the abscess culture test, Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus were found in four, three, and one case, respectively. E. coli and K. pneumoniae responded well to amikacin treatment, while seven cases responded well to Piperacillin/Tazobactam treatment.
Conclusions: Prostate abscesses occur mainly in diabetic patients. The most common cultures are E. coli and K. pneumoniae. Intravenous injection of amikacin or Piperacillin/Tazobactam may be helpful as a treatment prior to bacterial identification.

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Virus in the Urine of Healthy People and Patients with Infectious Diseases: Sunho Park, Eui Tae Kim, Jung-Sik Huh; Urogenit Tract Infect 2021;16(2):44-48. Published online August 31, 2021; DOI: https://doi.org/10.14777/uti.2021.16.2.44

Abstract PDF PubReader ePub: There has been a sustained effort to overcome the multiple infectious diseases that confront humankind. Urinary tract infections (UTIs) are most commonly caused by bacterial pathogens, primarily Escherichia coli. However, UTIs by viral pathogens have not been significantly reported. The human urinary tract, both in the healthy and diseased states, is home to many viruses despite the traditional belief that urine is sterile in healthy individuals. The most common viral pathogens found in the urinary tract are the human polyomavirus (BK virus), adenovirus, cytomegalovirus, and herpes simplex virus type-1 and type-2. Research should continue to investigate whether these viruses cause clinical infections or are mere colonizers of the urinary tract. Keywords: Urinary tract

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Case of Fournier’s Gangrene in a Patient with Long-Term Indwelling Catheterization due to Urinary Incontinence after Open Radical Prostatectomy: Kyung Kgi Park, Sung Dae Kim, Young-Joo Kim, Jung-Sik Huh; Urogenit Tract Infect 2020;15(1):6-9. Published online April 30, 2020; DOI: https://doi.org/10.14777/uti.2020.15.1.6

Abstract PDF PubReader ePub: Fournier’s gangrene is a life-threatening disease that needs to be treated as soon as possible. An 82-year-old male, who exchanged a urethral catheter once a month for urinary incontinence management after open radical prostatectomy, presented with an acute onset of mental change and general weakness. After ten days’ hospitalization, the disease was diagnosed. The scrotal wall was opened, and the infectious tissue was exposed to the air and kept open with an aseptic dressing. After 45 days, his scrotal wound healed and returned to its typical appearance without scarring and wound disruption. He recovered fully from the infection. This paper reports a case of Fournier’s gangrene in a patient with long-term indwelling catheterization due to urinary incontinence after an open radical prostatectomy with a literature review.

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The Prevalence of Urinary Tract Infections in Institutionalized vs. Noninstitutionalized Elderly Persons: Jung-Sik Huh; Urogenit Tract Infect 2016;11(2):56-61. Published online August 31, 2016

Abstract PDF: This review involves the prevalence of urinary tract infections (UTIs) in elderly persons in Korea. The global average life expectancy has been increasing due to recent advances in medical technology, economic development, and availability of hygienic environment. UTIs and asymptomatic bacteriuria are common diseases in both genders of all ages, but have been particularly increasing in elderly populations. The common causes of this increase are overactive bladder, benign prostatic hyperplasia, and neurogenic bladder. Institutionalized patients are susceptible to bacterial infections due to urinary incontinence, fecal contamination, and poor perineal hygiene. UTIs are the second most common infection, constituting 25% of all infection occurrences in elderly populations living at home. Several studies involving elderly persons living in the community have reported that the prevalence of UTIs is 0.07/person-year in postmenopausal women, 0.12/person-year in elderly persons with diabetes mellitus, and 0.05/person-year in men. The incidence of UTIs in elderly individuals increases with age, particularly in institutionalized elderly patients compared with those at home. However, no study has compared the prevalence of UTIs between institutionalized and noninstitutionalized elderly persons in Korea. Such comparison and evaluation may help to prevent UTIs in elderly Korean people.

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Infectious Complications after Prostate Biopsy: A Prospective Multicenter Prostate Biopsy Study: Eu Chang Hwang, Ho Song Yu, Seung Il Jung, Dong Deuk Kwon, Sun Ju Lee, Tae-Hyoung Kim, In Ho Chang, Hana Yoon, Bongsuk Shim, Kwang Hyun Kim, Donghyun Lee, Jung-Sik Huh, Dong Hoon Lim, Won Jin Jo, Seung Ki Min, Gilho Lee, Ki Ho Kim, Tae Hwan Kim, Seo Yeon Lee, Seung Ok Yang, Jae Min Chung, Sang Don Lee, Chang Hee Han, Sang Rak Bae, Hyun Sop Choe, Seung-Ju Lee, Hong Chung, Yong Gil Na, Seung Woo Yang, Sung Woon Park, Young Ho Kim, Tae Hyo Kim, Won Yeol Cho, June Hyun Han, Yong-Hyun Cho, U-Syn Ha, Heung Jae Park, The Korean Association of Urogenital Tract Infection and Inflammation (KAUTII); Urogenit Tract Infect 2016;11(1):17-24. Published online April 30, 2016

Abstract PDF: Purpose: Recent studies have highlighted an increasing trend of infectious complications due to fluoroquinolone-resistant organisms among men undergoing transrectal prostate biopsy. This study evaluated the current incidence of infective complications after trans-rectal prostate biopsy for identification of risk factors in Korean men who received fluoroquinolone prophylaxis.
Materials and Methods: A prospective, multicenter study was conducted in Korea from January to December 2015. Prostate biopsies performed with fluoroquinolone prophylaxis during 3 months in each center were included. A pre-biopsy questionnaire was used for identification of patient characteristics. Clinical variables including underlying disease, antibiotic prophylaxis, enema, povidoneiodine cleansing of the rectum, and infectious complications were evaluated. The primary outcome was the post-biopsy infection rate after fluoroquinolone prophylaxis. Univariable and multivariable analyses were used for identification of risk factors for infectious complications.
Results: The study included 827 patients, of whom 93 patients (11.2%) reported receiving antibiotics in the previous 6 months and 2.5% had a history of prostatitis. The infectious complication rate was 2.2%. Post-biopsy sepsis was reported in 2 patients (0.2%). In multivariable analysis predictors of post-biopsy sepsis included person performing biopsy (adjusted odds ratio [OR], 4.05; 95% confidence interval [CI], 1.31-12.5; p=0.015) and operation history within 6 months (adjusted OR, 5.65; 95% CI, 1.74-18.2; p=0.004).
Conclusions: The post-prostate biopsy infectious complication rate in this study was 2.2%. Person performing biopsy (non-urologists) and recent operation history were independent risk factors for infectious complications after trans-rectal prostate biopsy.

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Characteristics of Uropathogens in Patients with Bladder Stones: Sum Kim, Sung Dae Kim, Kyung Kgi Park, Young-Joo Kim, Hyeon Ju Kim, Jung-Sik Huh; Korean J Urogenit Tract Infect Inflamm 2013;8(2):109-113. Published online October 31, 2013

Abstract PDF

Purpose: Bladder stones is not a rare disease, however, the number of patients with bladder stones has decreased due to improvement of nutrition, hygiene, and optimal antibiotics. Bladder stones are typically found in adults with urinary stasis, such as foreign body, benign prostate hyperplasia, spinal cord injury, and urinary tract infection, and in children with congenital genito-urinary abnormality. The aim of this study was to identify the clinical and microbiological characteristics of patients with bladder stones.

Materials and Methods: Patients who had bladder stones between March 2009 and December 2012 were retrospectively reviewed (Jeju National University Hospital, Jeju, Korea). We analyzed the presence of spinal cord injury, cancer, previous urinary tract calculi, and urinary tract infection associated with bladder stones and also investigated the largest diameter of bladder stone, and the number of bladder stones, as well as urine and blood culture.

Results: A total of 39 patients underwent cystolithotomy or cystolithotripsy. The most common presenting symptoms were voiding disturbance (n=15, 38.5%) and hematuria (n=10, 25.6%). Of these patients, 17 (43.3%) had positive growth of organisms. Of these organisms, Escherichia coli was found in five patients, Enterococcus fecalis in three patients, Pseudomonas aeruginosa in three patients, Klebsiella pneumoniae in two patients, Staphylococcus aureus in two patients, Proteus mirabilis in one patient, and Citrobacter in one patient.

Conclusions: We believe that urinary tract infection is a major risk factor in patients with bladder stones. Proper antibiotics would be required in order to reduce the risk of formation of bladder calculi. Further investigation will be needed.

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Renal Papillary Necrosis with Calyceal Rupture: Caused by AcutePyelonephritis and Analgesic Abuse: Jung-Sik Huh, Sung-Dea Kim, Kyung Kgi Park, Young-Joo Kim; Korean J Urogenit Tract Infect Inflamm 2013;8(2):121-124. Published online October 31, 2013

Abstract PDF: Spontaneous renal rupture is a rare condition. Renal rupture most often occurs as a result of traumatic injury, a rare entity of obstructive uropathy with stones, and spontaneous causes such as malignancy. We report on a rare case of renal rupture caused by a ureter stone measuring 5 mm in size with acute pyelonephritis (APN) in a patient with renal papillary necrosis (RPN). The patient, who suffers from attacks of gouty arthritis, frequently used analgesic for pain relief. The patient was treated with temporary percutaneous drainage and antibiotics. This case demonstrates that RPN with APN can induce renal rupture even when ureter stones are small. Thus, consideration of all medical problems is important when deciding on treatment of patients with ureter stones.

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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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The Risk Factors of Urinary Tract Infection with Fever after Transrectal Ultrasonography Guided Biopsy of Prostate: Hyeon Ju Kim, Young-Joo Kim, Jung-Sik Huh; Korean J Urogenit Tract Infect Inflamm 2012;7(1):36-42. Published online April 30, 2012

Abstract PDF: "Purpose: Recently, incidence of prostatic cancer has increased due to the development of the prostatic cancer screening test. The common procedure is the transrectal technique, whereby following prophylactic antibiotics, a core biopsy needle is passed through the rectum. Complications of prostate biopsy are perineal tenderness, hematuria, hematospermia, rectal bleeding, fever and sepsis. We estimated the risk factors and pathogens of urinary tract infections after transrectal ultrasound guided biopsy of prostate. Materials and Methods: A retrospective chart review was conducted of patients, who had been treated for urinary tract infection (UTI) after 365 prostatic biopsy between January 2009 and January 2012. We analyzed the parameters including past medical history, kind of antibiotics, number of biopsies, pathology, urine culture and blood culture. Results: Hematuria was most common (5.4%), while UTI occurred in 4.9% of the cases. The symptoms of UTI were dysuria and fever. Average admission day was 6.2 days. E. coli was identified in 7 patients. It was observed that higher numbers of biopsies correlated with UTI. The other conditions investigated didn't correlate with complications after biopsies. Conclusions: We considered that UTI was a rare complication of prostatic biopsy and complications after biopsy were low. A higher number of fragments taken during biopsies showed a correlation with UTI. "

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Spontaneous Bladder Rupture due to Giant Bladder Stone: Sung Dae Kim, Young-Joo Kim, Jung-Sik Huh; Korean J Urogenit Tract Infect Inflamm 2009;4(1):104-107. Published online April 30, 2009

Abstract PDF: "Spontaneous bladder rupture is a very rare condition. It is the term employed for all cases of rupture not associated with trauma, including diseases of the urinary bladder or urinary outflow obstruction. It usually presents as severe abdominal pain. But in some cases, because symptoms are insidious and often atypical among elderly patients, this condition is often undetected. We describe an unusual case of spontaneous bladder rupture due to giant bladder stone."

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Clinical Characteristics of Urinary Tract Infection after Transrectal Ultrasonography Guided Biopsy of Prostate: Hyeon Ju Kim, Jung-Sik Huh; Korean J Urogenit Tract Infect Inflamm 2007;2(2):179-183. Published online October 31, 2007

Abstract PDF: "Purpose: Recently, the number of patients undergoing prostate biopsy has increased due to the development of the prostatic cancer screening test. The more common is the transrectal technique whereby following prophylactic antibiotics a core biopsy needle is passed through the rectum. Complications of prostate biopsy are perineal tenderness, hematuria, hematospermia, rectal bleeding, fever and sepsis. We estimated the clinical characteristics and pathogens of urinary tract infections (UTIs) after transrectal ultrasound guided biopsy of prostate. Method and Material: A retrospective chart review was conducted of patients who had treated for UTI after 375 prostatic biopsy between January 2001 and August 2007. We analyzed parameters including history taking, physical examination, hospitalization day, urinalysis, urine culture and blood culture. Results: 18 patients had UTI. The symptoms of UTI were dysuria and fever. The mean age was 67.61 years old. The Average days of admission was 6.07 days. E. coli was identified in 3 patients. One patient had a septic shock due to quinolones resistance E. coli infection after prostate biopsy. Conclusions: We considered that UTI was rare complication of prostatic biopsy. But life-threatened uroseptic shock was happened. Therefore, careful attention should be paid to the symptoms and treatment of UTI after prostate biopsy."

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