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MULTI-RESISTANT PSEUDOMONAS AERUGINOSA OUTBREAK IN AN ENDOUROLOGY UNIT
1007 IS ANTIBIOTIC PROPHYLAXIS USEFUL FOR PATIENTS UNDERGOING URODYNAMIC STUDY? Realfonso T., Napodano G., Di Mauro U., Miracolo G., Baio A., Sanseverino R.
1008 COMPARATIVE CHARACTERISTICS OF BACTERIAL PATHOGENS OF URINE, PROSTATIC SECRETIONS AND PROSTATE BIOPSY SPECIMENS IN POST-TRAUMATIC URETHRAL STRICTURES IN MEN Kogan I.1, Naboka L.2, Ibishev S.1, Afoko A.1, Gudima A.1
Umberto I Hospital, Dept. of Urology, Nocera Inferiore, Italy Introduction & Objectives: Urodynamic study (UDS) is an essential diagnostic tool to investigate lower urinary tract dysfunctions. However the incidence of XULQDU\ WUDFW LQIHFWLRQ DIWHU WKLV LQYDVLYH SURFHGXUH LV DVVHVVHG EHWZHHQ DQG 7KHUHIRUHDQWLELRWLFSURSK\OD[LVLVXVXDOO\XVHGWRSUHYHQWWKLVFRPSOLFDWLRQ though it has not been clearly demonstrated the usefulness of antibiotic prophylaxis IRUXURG\QDPLFVWXG\:HHYDOXDWHGWKHHᚎHFWLYHQHVVRIDQWLELRWLFSURSK\OD[LVIRU patients undergoing UDS in a randomised double blind controlled trial. Material & Methods: 70 women with lower urinary tract dysfunctions who underwent urodynamic study were included in the study. All the patients signed LQIRUPHGFRQVHQW8'6FRQVLVWHGRIXURᚐRZPHWU\ᚏOOLQJF\VWRPHWU\DQGSUHVVXUH ᚐRZVWXG\ZLWK)UPXOWLFKDQQHOFDWKHWHUXUHWKUDOSUHVVXUHSURᚏOHDQGDEGRPLQDO leak point pressure measurements. Urine specimen for urine analysis and culture ZDV REWDLQHG EHIRUH DQG GD\V DIWHU 8'6 XULQDU\ FXOWXUH ุ 5 CFU/ml was DFFRXQWHGDVVLJQLᚏFDQWEDFWHULXULD3DWLHQWVZLWKVLJQLᚏFDQWEDFWHULXULDRQHQWHULQJ XULQH WHVWLQJ DQG WKRVH DᚎHFWHG E\ QHXURSDWKLHV DQG GLDEHWHV PHOOLWXV ZHUH H[FOXGHG IURP WKH VWXG\ 7KH SDWLHQWV ZHUH UDQGRPLVHG LQWR JURXSV JURXS $ SDWLHQWV UHFHLYHGDVLQJOHGRVHRIOHYRᚐR[DFLQ PJ KRXUVEHIRUH8'6 JURXS% SDWLHQWV UHFHLYHGSODFHERWDEOHWKRXUVEHIRUHDQGFRQWUROJURXS& (10 patients) did not received any therapy. Results: After UDS, urinary tract infection occurred in 8.6% (6/70) of the patients. 87,ZDVGLYLGHGLQWRJURXSVDVIROORZLQJ LQJURXS$LQ in group B and in 10% (1/10) in group C (p >0.05). The uropathogens causing UTI were: Escherichia coli 66,6% (4/6), Proteus mirabilis 16.7% (1/6), Enterococcus IDHFDOLV $OOWKHSDWLHQWVZLWK87,VKRZHGRYHUDFWLYHEODGGHURQ8'6 5 of them had been undergone transvaginal surgery. Conclusions: ,Q RXU VWXG\ WKH SUHYDOHQFH RI 87, DIWHU 8'6 LV UHODWLYHO\ ORZ antibiotic prophylaxis is probably unnecessary in the patients undergoing urodynamic evaluation. However, our outcomes seem to identify the prior transvaginal surgery as risk factor for UTI after UDS.
1 Rostov State Medical University, Dept. of Urology, Rostov on Don, Russia, 2Rostov State Medical University, Dept. of Microbiology, Rostov on Don, Russia
Introduction & Objectives: Post-traumatic urethral strictures are usually accompanied by infections of the lower urinary tract. The development of infection of the prostate in urethral strictures remains unclear. Our research is geared towards the study of the infectious factor of the prostate before urethral stricture surgery. Material & Methods: We studied 60 patients between the ages of 28 and 45 years with post traumatic urethral strictures prospectively. We carried out bacteriological analysis of the urine of all subjects, prostatic secretion (EPS) of 40 men and we performed transrectal biopsy (PB) for the remaining 20 patients with obliteration of the urethra for bacteriological investigations before surgery. Results: In all cases we isolated bacterial pathogens from urine, EPS and PB. The average level of bacteriuria was 106 colony forming units (CFU)/ml. Infectivity of the EPS and PB was CFU 104 /ml in both cases. In the urine and PB enterobactereacae LQFOXGLQJ(VFKHULFKLDVSSSUHGRPLQDWHGEXWLQWKH(36ದJUDPSRVLWLYHᚐRUD1RQ clostridial anaerobes (Propionibacterium sp., Peptostretococcus species) were seen PRUHIUHTXHQWO\ S LQ3% DQG(36 FRPSDUHGWRXULQH %DFWHULDOPL[HGLQIHFWLRQZDVVHHQLQRIFDVHVLQWKHXULQHRI(36 and 80% of PB. Mixed infections were dominated by 2-component (50%) and less IUHTXHQWO\FRPSRQHQWDVVRFLDWLRQV,QRIFDVHVZHKDGDVWURQJFRUUHODWLRQ (r=1, p<0,001) between E.coli, E.faecalis, Streptococcus sp, S epidermidis , & P. aerugenosa in urine and EPS. In 90, 2% (r=1, p<0, 01) – between E. coli. Proteus sp. P. aeruginosa in urine and PB in one and the same patient. These pathogens were the most frequent ones associated with Chronic Prostatitis (CP). Conclusions: Patients with urethral strictures have accompanying chronic bacterial prostatitis before the operative treatment of their strictures. In the EPS and PB bacterial mixed infection predominates with a high frequency of aerobes and QRQFORVWULGLDO DQDHURELF SDWKRJHQV 7KHVH ᚏQGLQJV DOORZ XV WR FKRRVH DGHTXDWH antibacterial therapy for chronic prostatitis using only urine analysis.
1009 MULTI-RESISTANT PSEUDOMONAS AERUGINOSA OUTBREAK IN AN ENDOUROLOGY UNIT Dasgupta R., French G., Glass J.M. Guys Hospital, Dept. of Urology, London, United Kingdom Introduction & Objectives: There has been recent interest in the emergence of antibiotic resistance, which can have disastrous consequences for a high turnover specialty such as endourology. In our tertiary referral unit, which performed over 750 ureteroscopies in a 12 months period, we describe an outbreak of multiresistant Pseudomonas aeruginosa which infected 19 patients and caused one death. The control of such an outbreak and subsequent monitoring of infected individuals is of paramount importance, particularly in the context of a virulent organism that is resistant to common antibiotics. Material & Methods: We review the fate of 19 individuals who developed LGHQWLFDOVWUDLQFLSURᚐR[DFLQDQGJHQWDPLFLQUHVLVWDQW3VHXGRPRQDVDHUXJLQRVD urosepsis, with 24-month microbiological and radiological follow-up. The procedure for attempting to isolate the source of the organism is discussed. Results: )ROORZLQJWKHLGHQWLᚏFDWLRQRIDPXOWLUHVLVWDQW3VHXGRPRQDVVSSLQ SDWLHQWV ZKR KDG XQGHUJRQH HOHFWLYH ᚐH[LEOH XUHWHURVFRS\ IRU XUROLWKLDVLV RI VFUHHQHG SDWLHQWV ZHUH IRXQG WR KDYH LQIHFWHG XULQH DIWHU UHFDOO One patient died as a result of urosepsis, and 2 others required admission to LQWHQVLYHFDUH$W\HDUVIROORZXSSDWLHQWVUHPDLQFRORQLVHGOLNHO\UHODWHG to residual stone disease that would conventionally be regarded as clinically LQVLJQLᚏFDQW7KHVRXUFHRIWKHRUJDQLVPZDVQHYHULGHQWLᚏHGGHVSLWHWHVWLQJ all endoscopic equipment and sterilisation machinery while quarantining the RSHUDWLQJVXLWH$QWLELRWLFSURSK\OD[LVKDVEHHQUHYLHZHGDQGPRGLᚏHG Conclusions: The lessons learnt are valuable for management of any outbreak, recognition of fatal antibiotic resistance patterns, and rationalising antibiotic SURSK\OD[LV PHDVXUHV 7KH PDQDJHPHQW RI RWKHUZLVH FOLQLFDOO\ LQVLJQLᚏFDQW stone burden should also be considered, in view of the prolonged period of FRORQLVDWLRQXSWR\HDUVLQLQGLYLGXDOV
1010 RELATIONSHIP BETWEEN QUINOLONE USE AND EMERGENCE OF CIPROFLOXACIN-RESISTANT ESCHERICHIA COLI IN URINARY TRACT INFECTION Hyun J.S.1, Chang I.H.2, Oh Y.M.2, Choi N.Y.2, Bang S.H.2, Kwon O.J.2, Ahn S.H.2, Moon K.H. 1
Gyeongsang National University Hospital, Dept. of Urology, Seoul, South Korea, KEPCO Medical Foundation Hanil General Hospital, Dept. of Urology, Seoul, South Korea, Yeungnam University Hospital, Dept. of Urology, DaeGoo, South Korea
2
Introduction & Objectives: Because the main factor responsible for the development and spread of bacterial resistance is increased use of antibiotics. 7KH SXUSRVH RI RXU VWXG\ LV WR GHᚏQH WKH UHODWLRQ EHWZHHQ TXLQRORQH XVH DQG LVRODWLRQ UDWHV RI FLSURᚐR[DFLQUHVLVWDQW &,3525 (VFKHULFKLD FROL (FROL LQ urinary tract infection (UTI). Material & Methods: )URPWRRIWKHSDWLHQWVZHGHWHUPLQHG DQWLPLFURELDO XVH LQ WHUPV RI GHᚏQHG GDLO\ GRVH ''' DQG DQWLPLFURELDO XVH density (AUD) and surveyed the isolation rates of CIPRO-R E.coli in urinary tract infection in inpatients and outpatients, and analyzed the correlation between prescription episodes and resistance rates. Results: 2IWKH &,3525(FROLLVRODWHV ZHUHLQSDWLHQWV DQG ZHUHRXWSDWLHQWV7KHUHZDVDVWDWLVWLFDOO\VLJQLᚏFDQWFRUUHODWLRQ between the isolation rates of CIPRO-R E.coli and upward trend in quinolone use inpatients (r=0.815, p<0.05) as well as outpatients (r=0.804, p<0.05). A logistic UHJUHVVLRQ DQDO\VLV LGHQWLᚏHG SUHYLRXV TXLQRORQH XVH DV WKH LQGHSHQGHQW ULVN IDFWRU RGGUDWLR > &, @ IRU&,3525(FROLLQLQSDWLHQWV Also, these CIPRO-R E.coli showed low sensitivity to ampicillin and trimethoprim/ VXIDPHWKR[D]RO 70360; LQLQSDWLHQWV DQGRXWSDWLHQWV 27.1%) infections, respectively. Conclusions: 2XU VWXG\ VKRZV D VLJQLᚏFDQW FRUUHODWLRQ EHWZHHQ FLSURᚐR[DFLQ resistance and quinolone use, and previous quinolone use seems to be the risk factor for CIPRO-R E.coli bacteriuria. For the prevention of CIPRO-R E.coli, a strict rationale for antimicrobial therapy under constant surveillance is required.
Eur Urol Suppl 2008;7(3):323
1008 COMPARATIVE CHARACTERISTICS OF BACTERIAL PATHOGENS OF URINE, PROSTATIC SECRETIONS AND PROSTATE BIOPSY SPECIMENS IN POST-TRAUMATIC URETHRAL STRICTURES IN MEN Kogan I.1, Naboka L.2, Ibishev S.1, Afoko A.1, Gudima A.1
Umberto I Hospital, Dept. of Urology, Nocera Inferiore, Italy Introduction & Objectives: Urodynamic study (UDS) is an essential diagnostic tool to investigate lower urinary tract dysfunctions. However the incidence of XULQDU\ WUDFW LQIHFWLRQ DIWHU WKLV LQYDVLYH SURFHGXUH LV DVVHVVHG EHWZHHQ DQG 7KHUHIRUHDQWLELRWLFSURSK\OD[LVLVXVXDOO\XVHGWRSUHYHQWWKLVFRPSOLFDWLRQ though it has not been clearly demonstrated the usefulness of antibiotic prophylaxis IRUXURG\QDPLFVWXG\:HHYDOXDWHGWKHHᚎHFWLYHQHVVRIDQWLELRWLFSURSK\OD[LVIRU patients undergoing UDS in a randomised double blind controlled trial. Material & Methods: 70 women with lower urinary tract dysfunctions who underwent urodynamic study were included in the study. All the patients signed LQIRUPHGFRQVHQW8'6FRQVLVWHGRIXURᚐRZPHWU\ᚏOOLQJF\VWRPHWU\DQGSUHVVXUH ᚐRZVWXG\ZLWK)UPXOWLFKDQQHOFDWKHWHUXUHWKUDOSUHVVXUHSURᚏOHDQGDEGRPLQDO leak point pressure measurements. Urine specimen for urine analysis and culture ZDV REWDLQHG EHIRUH DQG GD\V DIWHU 8'6 XULQDU\ FXOWXUH ุ 5 CFU/ml was DFFRXQWHGDVVLJQLᚏFDQWEDFWHULXULD3DWLHQWVZLWKVLJQLᚏFDQWEDFWHULXULDRQHQWHULQJ XULQH WHVWLQJ DQG WKRVH DᚎHFWHG E\ QHXURSDWKLHV DQG GLDEHWHV PHOOLWXV ZHUH H[FOXGHG IURP WKH VWXG\ 7KH SDWLHQWV ZHUH UDQGRPLVHG LQWR JURXSV JURXS $ SDWLHQWV UHFHLYHGDVLQJOHGRVHRIOHYRᚐR[DFLQ PJ KRXUVEHIRUH8'6 JURXS% SDWLHQWV UHFHLYHGSODFHERWDEOHWKRXUVEHIRUHDQGFRQWUROJURXS& (10 patients) did not received any therapy. Results: After UDS, urinary tract infection occurred in 8.6% (6/70) of the patients. 87,ZDVGLYLGHGLQWRJURXSVDVIROORZLQJ LQJURXS$LQ in group B and in 10% (1/10) in group C (p >0.05). The uropathogens causing UTI were: Escherichia coli 66,6% (4/6), Proteus mirabilis 16.7% (1/6), Enterococcus IDHFDOLV $OOWKHSDWLHQWVZLWK87,VKRZHGRYHUDFWLYHEODGGHURQ8'6 5 of them had been undergone transvaginal surgery. Conclusions: ,Q RXU VWXG\ WKH SUHYDOHQFH RI 87, DIWHU 8'6 LV UHODWLYHO\ ORZ antibiotic prophylaxis is probably unnecessary in the patients undergoing urodynamic evaluation. However, our outcomes seem to identify the prior transvaginal surgery as risk factor for UTI after UDS.
1 Rostov State Medical University, Dept. of Urology, Rostov on Don, Russia, 2Rostov State Medical University, Dept. of Microbiology, Rostov on Don, Russia
Introduction & Objectives: Post-traumatic urethral strictures are usually accompanied by infections of the lower urinary tract. The development of infection of the prostate in urethral strictures remains unclear. Our research is geared towards the study of the infectious factor of the prostate before urethral stricture surgery. Material & Methods: We studied 60 patients between the ages of 28 and 45 years with post traumatic urethral strictures prospectively. We carried out bacteriological analysis of the urine of all subjects, prostatic secretion (EPS) of 40 men and we performed transrectal biopsy (PB) for the remaining 20 patients with obliteration of the urethra for bacteriological investigations before surgery. Results: In all cases we isolated bacterial pathogens from urine, EPS and PB. The average level of bacteriuria was 106 colony forming units (CFU)/ml. Infectivity of the EPS and PB was CFU 104 /ml in both cases. In the urine and PB enterobactereacae LQFOXGLQJ(VFKHULFKLDVSSSUHGRPLQDWHGEXWLQWKH(36ದJUDPSRVLWLYHᚐRUD1RQ clostridial anaerobes (Propionibacterium sp., Peptostretococcus species) were seen PRUHIUHTXHQWO\ S LQ3% DQG(36 FRPSDUHGWRXULQH %DFWHULDOPL[HGLQIHFWLRQZDVVHHQLQRIFDVHVLQWKHXULQHRI(36 and 80% of PB. Mixed infections were dominated by 2-component (50%) and less IUHTXHQWO\FRPSRQHQWDVVRFLDWLRQV,QRIFDVHVZHKDGDVWURQJFRUUHODWLRQ (r=1, p<0,001) between E.coli, E.faecalis, Streptococcus sp, S epidermidis , & P. aerugenosa in urine and EPS. In 90, 2% (r=1, p<0, 01) – between E. coli. Proteus sp. P. aeruginosa in urine and PB in one and the same patient. These pathogens were the most frequent ones associated with Chronic Prostatitis (CP). Conclusions: Patients with urethral strictures have accompanying chronic bacterial prostatitis before the operative treatment of their strictures. In the EPS and PB bacterial mixed infection predominates with a high frequency of aerobes and QRQFORVWULGLDO DQDHURELF SDWKRJHQV 7KHVH ᚏQGLQJV DOORZ XV WR FKRRVH DGHTXDWH antibacterial therapy for chronic prostatitis using only urine analysis.
1009 MULTI-RESISTANT PSEUDOMONAS AERUGINOSA OUTBREAK IN AN ENDOUROLOGY UNIT Dasgupta R., French G., Glass J.M. Guys Hospital, Dept. of Urology, London, United Kingdom Introduction & Objectives: There has been recent interest in the emergence of antibiotic resistance, which can have disastrous consequences for a high turnover specialty such as endourology. In our tertiary referral unit, which performed over 750 ureteroscopies in a 12 months period, we describe an outbreak of multiresistant Pseudomonas aeruginosa which infected 19 patients and caused one death. The control of such an outbreak and subsequent monitoring of infected individuals is of paramount importance, particularly in the context of a virulent organism that is resistant to common antibiotics. Material & Methods: We review the fate of 19 individuals who developed LGHQWLFDOVWUDLQFLSURᚐR[DFLQDQGJHQWDPLFLQUHVLVWDQW3VHXGRPRQDVDHUXJLQRVD urosepsis, with 24-month microbiological and radiological follow-up. The procedure for attempting to isolate the source of the organism is discussed. Results: )ROORZLQJWKHLGHQWLᚏFDWLRQRIDPXOWLUHVLVWDQW3VHXGRPRQDVVSSLQ SDWLHQWV ZKR KDG XQGHUJRQH HOHFWLYH ᚐH[LEOH XUHWHURVFRS\ IRU XUROLWKLDVLV RI VFUHHQHG SDWLHQWV ZHUH IRXQG WR KDYH LQIHFWHG XULQH DIWHU UHFDOO One patient died as a result of urosepsis, and 2 others required admission to LQWHQVLYHFDUH$W\HDUVIROORZXSSDWLHQWVUHPDLQFRORQLVHGOLNHO\UHODWHG to residual stone disease that would conventionally be regarded as clinically LQVLJQLᚏFDQW7KHVRXUFHRIWKHRUJDQLVPZDVQHYHULGHQWLᚏHGGHVSLWHWHVWLQJ all endoscopic equipment and sterilisation machinery while quarantining the RSHUDWLQJVXLWH$QWLELRWLFSURSK\OD[LVKDVEHHQUHYLHZHGDQGPRGLᚏHG Conclusions: The lessons learnt are valuable for management of any outbreak, recognition of fatal antibiotic resistance patterns, and rationalising antibiotic SURSK\OD[LV PHDVXUHV 7KH PDQDJHPHQW RI RWKHUZLVH FOLQLFDOO\ LQVLJQLᚏFDQW stone burden should also be considered, in view of the prolonged period of FRORQLVDWLRQXSWR\HDUVLQLQGLYLGXDOV
1010 RELATIONSHIP BETWEEN QUINOLONE USE AND EMERGENCE OF CIPROFLOXACIN-RESISTANT ESCHERICHIA COLI IN URINARY TRACT INFECTION Hyun J.S.1, Chang I.H.2, Oh Y.M.2, Choi N.Y.2, Bang S.H.2, Kwon O.J.2, Ahn S.H.2, Moon K.H. 1
Gyeongsang National University Hospital, Dept. of Urology, Seoul, South Korea, KEPCO Medical Foundation Hanil General Hospital, Dept. of Urology, Seoul, South Korea, Yeungnam University Hospital, Dept. of Urology, DaeGoo, South Korea
2
Introduction & Objectives: Because the main factor responsible for the development and spread of bacterial resistance is increased use of antibiotics. 7KH SXUSRVH RI RXU VWXG\ LV WR GHᚏQH WKH UHODWLRQ EHWZHHQ TXLQRORQH XVH DQG LVRODWLRQ UDWHV RI FLSURᚐR[DFLQUHVLVWDQW &,3525 (VFKHULFKLD FROL (FROL LQ urinary tract infection (UTI). Material & Methods: )URPWRRIWKHSDWLHQWVZHGHWHUPLQHG DQWLPLFURELDO XVH LQ WHUPV RI GHᚏQHG GDLO\ GRVH ''' DQG DQWLPLFURELDO XVH density (AUD) and surveyed the isolation rates of CIPRO-R E.coli in urinary tract infection in inpatients and outpatients, and analyzed the correlation between prescription episodes and resistance rates. Results: 2IWKH &,3525(FROLLVRODWHV ZHUHLQSDWLHQWV DQG ZHUHRXWSDWLHQWV7KHUHZDVDVWDWLVWLFDOO\VLJQLᚏFDQWFRUUHODWLRQ between the isolation rates of CIPRO-R E.coli and upward trend in quinolone use inpatients (r=0.815, p<0.05) as well as outpatients (r=0.804, p<0.05). A logistic UHJUHVVLRQ DQDO\VLV LGHQWLᚏHG SUHYLRXV TXLQRORQH XVH DV WKH LQGHSHQGHQW ULVN IDFWRU RGGUDWLR > &, @ IRU&,3525(FROLLQLQSDWLHQWV Also, these CIPRO-R E.coli showed low sensitivity to ampicillin and trimethoprim/ VXIDPHWKR[D]RO 70360; LQLQSDWLHQWV DQGRXWSDWLHQWV 27.1%) infections, respectively. Conclusions: 2XU VWXG\ VKRZV D VLJQLᚏFDQW FRUUHODWLRQ EHWZHHQ FLSURᚐR[DFLQ resistance and quinolone use, and previous quinolone use seems to be the risk factor for CIPRO-R E.coli bacteriuria. For the prevention of CIPRO-R E.coli, a strict rationale for antimicrobial therapy under constant surveillance is required.
Eur Urol Suppl 2008;7(3):323