Min Eui Kim

Antimicrobial resistance in community-acquired urinary tract infections: results from the Korean Antimicrobial Resistance Monitoring System

The Korean Antimicrobial Resistance Monitoring System was established and the first nationwide surveillance of bacterial uropathogens was conducted during the period from January 2008 to June 2009. With the cooperation of 34 medical centers throughout South Korea, a total of 1994 strains belonging to clinically relevant bacterial uropathogens were collected from patients with community-acquired urinary tract infections (UTIs). To compare with past data, understand a trend of antimicrobial resistance, and ultimately determine new regimens for empirical treatment of uncomplicated cystitis, the antimicrobial susceptibilities against Escherichia coli in uncomplicated cystitis to commonly prescribed drugs were investigated. In uncomplicated cystitis, the most prevalent causative organism was E. coli (72.7%), followed by Enterococcus faecalis (10.7%) and Klebsiella pneumoniae (3.5%). Among E. coli isolates from acute uncomplicated cystitis, 38.5% were susceptible to ampicillin, 80.7% to amoxicillin/clavulanate, 67.3% to trimethoprim/sulfamethoxazole, 74.6% to ciprofloxacin, 77.5% to levofloxacin, 86.0% to cefazolin, 86.1% to cefuroxime, 93.6% to cefpodoxime, 94.7% to ceftriaxone, 99.5% to amikacin, 80.9% to tobramycin, and 76.6% to gentamicin. An increasing tendency of resistance to ciprofloxacin (24.8%) has been observed compared with the similar studies in 2006 (23.4%) and 2002 (15.2%) from patients with uncomplicated cystitis. These data provide much needed information on the prevalence of antimicrobial resistance in community-acquired UTIs in South Korea and will be a useful reference for future periodic surveillance studies.

Screening for Chlamydia and Gonorrhea by Strand Displacement Amplification in Homeless Adolescents Attending Youth Shelters in Korea

We conducted the screening of sexually transmitted infections to define the prevalence of genital Chlamydia trachomatis and Neisseria gonorrhoeae infections and status of sexual risk behavior among homeless adolescents (10-19 yr old) in Korea. Adolescents who ran away from home and are under the care of youth shelters in ten cities in Korea served as the study population. Participants filled out a self-administered questionnaire related to sexuality. First-void urine was analyzed for chlamydial and gonococcal infection by strand displacement amplification (BDProbTecTMET, BD Diagnostic Systems, MD, U.S.A.). A total of 175 adolescents from 15 youth shelters took part in the study. Their median age was 16 yr, and 54.9% of them reported having sexual intercourse at least once. The prevalence of C. trachomatis and N. gonorrhoeae among homeless adolescents was 12.6% and 15.4%, respectively. Factors significantly associated with the infections were number of sexual partners during the past year and lifetime. This is the first community-based sexually transmitted infection (STI) screening among adolescent in Korea. Screening programs targeting sexually active adolescents are important for detection of STIs. They should be considered an alternative population-based surveillance system in order to control STIs nationally.

Virulence Characteristics and Phylogenetic Background of Ciprofloxacin Resistant Escherichia coli in the Urine Samples from Korean Women with Acute Uncomplicated Cystitis

To clarify the characteristics of the virulence factors (VFs) of ciprofloxacin resistant Escherichia coli (CFRE) with acute uncomplicated cystitis (AUC), we determined the VFs and the phylogenetic background of all 54 CFRE strains and the 55 randomly selected ciprofloxacin sensitive E. coli strains (CFSE) from patients with AUC in 22 Korean hospitals. The prevalence of the VFs was as follows: fimA, papEF, papGIII, sfaI, dafaBC, cnf1, and hlyA were presented in 96%, 54%, 68%, 91%, 49%, 72%, and 29% of the samples, respectively. The expressions of papEF, cnf1, and hlyA were significantly more prevalent in the CFSE. Moreover, the expressions of cnf, and papEF significantly reduced the risk of ciprofloxacin resistance. The CFSE was also marginally associated with the group B2 (P=0.05). Although the presence of pyuria and a previous cystitis history were not related with the phylotyping and the expressions of VFs, group B2, and fimA and papEF were more expressed in the younger age patients (P<0.05). In conclusion, the CFRE exhibits a selective loss of VFs and the non-B2 phylotype in Korean AUC patients. The group B2 and the presence of fimA and papEF are associated with a younger age of AUC patients.

Relationship between uncommon computed tomography findings and clinical aspects in patients with acute pyelonephritis.

Purpose Computed tomography (CT) has become popular in the diagnosis of acute pyelonephritis (APN) and its related complications in adults. The aim of this study was to investigate the relationship between uncommon CT findings and clinical and laboratory data in patients with APN. Materials and Methods From July 2009 to July 2012, CT findings and clinical data were collected from 125 female patients with APN. The six uncommon CT findings (excluding a wedge-shaped area of hypoperfusion in the renal parenchyma) studied were perirenal fat infiltration, ureteral wall edema, renal abscess formation, pelvic ascites, periportal edema, and renal scarring. The clinical parameters analyzed were the age and body mass index of the patients as well as the degree and duration of fever. Laboratory parameters related to inflammation and infection included white blood cell count, C-reactive protein (CRP) level, erythrocyte sedimentation rate, pyuria, and bacteriuria. Results The most common CT finding was perirenal fat infiltration (69 cases, 55%). A longer duration of fever, higher CRP level, and grade of pyuria were related with perirenal fat infiltration (p=0.010, p=0.003, and p=0.049, respectively). The CRP level was significantly higher in patients with renal abscess and ureteral wall edema (p=0.005 and p=0.015, respectively). Conclusions The uncommon CT findings that were related to aggravated clinical and laboratory parameters of APN patients were perirenal fat infiltration, ureteral wall edema, and renal abscess formation. The inflammatory reaction and tissue destruction may be more aggressive in patients with these CT findings.

Diagnostic Effectiveness of Dynamic Colpocystoproctography in Women Planning for Combined Surgery with Urinary Incontinence and Pelvic Organ Prolapse

Objective: To evaluate the advantage of performing the dynamic cystoproctography (DCP) in patients planning for combined surgery due to urinary incontinence and pelvic organ prolapse (POP). Materials and Methods: We performed DCP on a total of 113 consecutive women with POP and compared the findings of the physical examination with POP quantification against those of DCP including squeezing, straining and evacuation phases, and analyzed the changes to the rates of surgical planning. For statistical analysis, sensitivity, specificity, and positive predictive value of each test were performed. Results: DCP identified an additional 10 cases of cystocele, 32 cases of rectocele, 2 cases of enterocele, 4 cases of sigmoidocele, and 8 cases of rectal intussusception compared to those cases who were only included for a physical examination. The initial surgical plan was changed in a total of 24 cases (22.1%). The prevalence of bowel symptoms in the group in which the surgical plan changed was higher than in the group with no changes to the surgical plan (p = 0.023). Conclusions: DCP may be a more sensitive test for diagnosing POP compared to physical examination alone, and it is useful to patients with bowel symptoms by making surgical planning for combined surgery with stress urinary incontinence and POP.

Alterations of Macrophage Migration Inhibitory Factor Expression in the Nervous System of the Rat Cystitis Model

Objective: We evaluated the changes in the migration inhibitory factor (MIF) expression with time in the bladder and spinal cord of a Sprague-Dawley rat cystitis model. Methods: The bladder created by injecting lipopolysaccharide (LPS) and the lumbosacral spinal cord were removed at 4, 24, and 48 h, and 7 days after the induction of chronic cystitis, and 24 h after the induction of acute cystitis. The MIF expression was estimated using immunohistochemical staining, and the MIF mRNA was quantitatively analyzed using real-time polymerase chain reaction. Results: The MIF expression in the urothelial cell was lowest at 24 h after LPS injection. As the degree of inflammation decreased, the MIF expression in the urothelial cell gradually increased 48 h and 7 days. The quantitative analysis of the MIF mRNA showed that the MIF expression was highest in both the bladder and the lumbosacral spinal cord 24 h after the cystitis became most severe. In chronic cystitis, the MIF mRNA expressions in the bladder and the lumbosacral spinal cord were 2.8 and 2.1 times significantly higher than in the normal control. Conclusion: MIF is involved in urinary symptoms and pain in cystitis, and in the mechanism that prolongs the symptoms of chronic cystitis by involving bladder tissue, and the nervous system.

1875 EFFICACY OF DYNAMIC COLPOCYSTODEFECOGRAPHY IN PATIENTS WITH PELVIC ORGAN PROLAPSE

complicated given the fact that complete surgical success may be achieved in one component but not the other. The study focus was to assess satisfaction in patients undergoing multiple pelvic surgeries. METHODS: We performed a retrospective review of post-operative results on 92 consecutive women undergoing variety of AI procedures and/or prolapse repair. Multiple validated outcome measures were used to evaluate success following AI surgery (ICIQ-FLUTS, SUI item, pad use, subjective SUI cure) and prolapse (ICIQ-VS, POPQ stage). Multiple statistical analyses (Pearson’s correlation, Mann-Whitney test, and Fischer’s exact test) were performed to assess for a relationship between outcome measures and patient satisfaction. RESULTS: Eighty women (87%) reported satisfaction following surgery with mean follow-up of 12 months. Cure of both prolapse (POPQ stage 2) and SUI (subjective cure) was associated with satisfaction (p 0.05). However, even in these dual cure patients, a percentage of patients reported dissatisfaction. Interestingly, ICIQ-VS improvement was the only outcome measure evaluated that correlated with overall post-op satisfaction (p 0.05). CONCLUSIONS: Not surprisingly, cure of both incontinence and prolapse in the setting of a concomitant procedure was associated with statistically significant satisfaction. Interestingly, a variety of outcomes measures fail to correlate with patient satisfaction with the exception of ICIQ-VS. Further in patients with complete cure of concurrent pelvic surgeries a percentage still report dissatisfaction, highlighting the complicated nature of patient satisfaction.

902 MACROPHAGE MIGRATION INHIBITORY FACTOR (MIF) MRNA EXPRESSION IN THE BLADDER AND LUMBOSACRAL SPINAL CORD LPS-INDUCED CYSTITIS

INTRODUCTION AND OBJECTIVES: Macrophage migration inhibitory factor (MIF) is an important pro-inflammatory cytokine expressed at sites of inflammation. This study examined alteration of MIF expression in the bladder and lumbosacral spinal cord of LPS-induced cystitis model according to time. METHODS: Female Sprague-Dawley rats were anesthetized and a angiocatheter was introduced transurethrally into the bladder. Acute cystitis was induced by infusing LPS into the bladder and chronic cystitis was induced by LPS instillations performed every 24 hours for 4 days. In time course studies, rats were euthanized at 4 hours, 24 hours, 48 hours and 7 days after LPS treatment. Chronic cystitis rats were sacrificed 24 hours after the last instillation. The bladder and lumbosacral spinal cord (L6/S1) were then removed and assayed for MIF expression. The expression of MIF was investigated by real-time PCR. RESULTS: The MIF mRNA was up-regulated in the bladder and lumbosacral spinal cord, peaking 24 hours after LPS treatment shown by real-time PCR. Following chronic cystitis, significant MIF mRNA increased were observed in bladder and lumbosacral spinal cord (bladder: 2.8-fold, L6/S1: 2.1-fold) (p 0.05). CONCLUSIONS: LPS-induced cystitis in rats increases the MIF mRNA expression in the bladder and lumbosacral spinal cord. MIF up-regulation may represent a neural response to visceral inflammation. MIF may contribute to the development or maintenance of hyperalgesia and/or urinary bladder hyperreflexia and suggest MIF may be a potential target of inflammatory pain. Source of Funding: Astellas company