- Email: [email protected]
P355 Overactive bladder as a mask of chronic prostatitis
S154
Posters / International Journal of Antimicrobial Agents 42S2 (2013) S41–S159
sequencing. The isolate was non-susceptible to amikacin, gentamicin, ciprofloxacin, levofloxacin, cefotaxime, cefepime, imipenem, and colistin, but susceptible to aztreonam, minocycline, tigecycline, and cotrimoxazole. The carbapenem resistance was not transferred to Escherichia coli J53 (azide R). D. tsuruhatensis CRS1243 harbored bla IMP-1 gene in class 1 integron located on Tn402 -like transposon. Between the 5'-conserved segment and the tni module, the gene cassettes were orfE, aac(6')-31-like , orfE, orfE, aac(6')-II , aacA7 , bla IMP-1 , aacA7 , aac(6')-II and qacE2 . Conclusion: This is the first report of D. tsuruhatensis producing IMP-1 metallo-b-lactamase. Although CRS1243 had no clinical significance, this bla IMP-1 gene linked to mobile element might spread among Delftia or other species. P354 Gender features of cystitis – How to prevent relapse in women E. Kulchavenya1 *. 1 Research TB Institute, Medical University, Novosibirsk, Russian Federation E-mail address : [email protected] Introduction: Cystitis is one of the commonest diseases in urology especially in women, with recurrent course. The purpose was to estimate the influence of the method of contraception on relapse of the cystitis and evaluate the efficiency of phytotherapy and rational contraception on frequency of cystitis. Methods: We retrospectively analyzed history cases of 215 women with recurrent cystitis; second part of our study was prospective one with 3 groups of sexually active women with recurrent cystitis (age 27–36), who used condom. 1st group (26 patients) received standard therapy and continue to use a condom, 2nd group (31 patients) after antibacterial therapy changed method contraception on pills, and 3rd group (32 patients) after antibacterial therapy changed method contraception on pills, and additionally received a Canefron during one month. Results: Among 215 patients 44 were in menopause. Among 175 women in reproductive age 19 took oral combined contraceptive, 63 used for contraception coitus interruptus, and other 93 used condom. Thus there was negative correlation between oral contraceptives and relapses of cystitis and, on contrary – positive correlation between condom and relapses. In prospective study in 1st group 11 (43.3%) had relapse and 7 from them (26.9%) had it twice at that. In 2nd group relapse was in eight patients (25.8%), and in 4 from them (12.9%) – twice. Best results showed 3rd group, where patients instead of condoms used oral contraceptives as well as two courses Canefron. One relapse was in five patients among (15.6%), none had it twice in a year. Conclusions: 1. Barrier methods of contraception predisposes to recurrent course of bacterial cystitis. 2. Oral combines contraceptives increases resistance of urothelium to the influence of bacterial agent. In women with recurrent cystitis the frequency of relapses decreased twice after changing condom on oral contraceptives. 3. Combination of oral contraceptives and phytotherapy with Canefron decreased the frequency of relapses in three times in comparison with standard antibacterial therapy. P355 Overactive bladder as a mask of chronic prostatitis E. Kulchavenya1 *. 1 Research TB Institute, Medical University, Novosibirsk, Russian Federation E-mail address : [email protected] Introduction: Chronic prostatitis is one of the commonest diagnosis among out-patient men, but in some cases the over-diagnosis may be. Perineal pain and dysuria are often interpreted as chronic prostatitis, although they are symptoms of another disease. Methods: 154 patients addressed to the doctor because of chronic prostatitis (CP) were enrolled in study, the age was between 27 and 49, on average 36.7±4.5 years. All had a long history (on average 6.2±3.7 years), received from 4 till 38 courses of the therapy (on average 8.3±4.7). Overactive bladder (OAB) was not suspected early in any patient. All patients were inspected routinely with ultra-sound investigations, uroflowmetry and filling valid questionnaires.
In 27 patients (17.5%) the OAB was diagnosed, and in 19 – alongside with CP, and on eight patients OAB was as independent disease. All patients with OAB received trospium chloride 30 mg daily in one month; patients with OAB in combination with CP received also standard therapy for CP. Efficiency was estimated by scales, uroflowmetry. Results: Main complaint was perineal pain – 132 patients (85.7%), with scrotal irradiation in 72 (46.7%), intensify in ejaculation in 26 (16.9%). Dysuria was revealed in 112 patients (72.7%), with irritative symptoms in 93 (60.4%), urgency in 27 (17.5%), obstructive symptoms in 67 patients (43.5%) – some patients showed simultaneously irritative and obstructive symptoms. Nocturia was in 18 patients (11.7%). Average IPSS score was 11.4±2.7, average NIH-CPSI – 18.2±4.3. 146 patients (94.8%) had high number of leucocytes in expressed prostatic secretion (EPS), 86 patients (55.8%) presented growth of microflora in EPS. Sexually transmitted infection agents were revealed by PCR in 74 patients (48.0%); in one (0.6%) M. tuberculosis was found. Volume of prostate gland was 28.4±3.6 ml. Qmax was in whole cohort on average 18.3±2.6 ml/sec, Qave – 12.2±3.4 ml/sec. However the comparison of uroflow in 27 patients with urgency and the rest 127 patients without urgency showed a big difference: in first group Qmax was 38.4±3.5 and Qave – 18.2±2.7, in second group Qmax was 14.2±29; Qave – 8.6±3.3. Bladder volume in OAB group was 157.2±9.6 ml, in CP group – 314.0±12.8 ml. As 27 patients with urgency had irritative symptoms and on average 14.9±3.2 micturitions per day, their dysuria was estimated as OAB. In 19 from them CP was confirmed and 8 had no prostate inflammation. All these 27 patients received trospium chloride 30 mg daily, CP patients also took standard therapy for prostatitis. In one month frequency decreased on 56.1%, bladder volume increased on 82.8%; episodes of urgency decreased more than twice. Conclusion: 1. Frequency and urgency in CP patients are indication for excluding of the OAB. OAB may mask CP and accompany it. P356 Extended-spectrum b-lactamases-producing Enterobacteriaceae bacteremia: demographics and outcomes on the controlled carbapenem-use hospital K. Muranaka1 *, N. Hosokawa1 , D. Suzuki1 , T. Mikawa1 , Y. Uwamino1 , K. Tochitani1 , R. Hase1 , H. Kitazono2 , Y. Otsuka3 . 1 Department of Infectious Diseases, Kameda Medical Center, Kamogawa, 2 Department of General Medicine, Tokyo Bay Urayasu-Ichikawa Medical Center, Urayasu, 3 Department of Laboratory Medicine, Kameda Medical Center, Kamogawa, Japan E-mail address : [email protected] Introduction: Extended-spectrum b-lactamases (ESBLs) are enzymes which present the resistance for all b-lactams except carbapenems. Recently Gram-negative organisms with the enzymes are increasing. Though we should select the appropriate antibiotics susceptive to the target bacteria, it is also important reducing broad spectrum antibiotic uses not to spread resistant organisms. In our practice, the use of carbapenem requires preauthorization of infectious disease (ID) department. Therefore ID physicians evaluate the necessity of carbapenem based on medical history (hospital admission, antibiotic uses and past resistant bacteria) and the severity of each case. Objectives: The aim of this study is to determine whether ESBLsproducing Enterobacteriaceae should be treated by carbapenem as an empirical therapy. Methods: We researched retrospectively the medical records of ESBLs-producing Enterobacteriaceae bacteremia (ESBLEB) cases from April 2009 to January 2013 of a community hospital in Chiba, Japan. We identified the species by MicroScan Walk Away 96 (Siemens) and measured their MIC by dry plate ‘Eiken’. We picked up Enterobacteriaceae resistant to third generation cephalosporin and aztreonam. We used both the double disk method and the Cica-BetaTest for these bacteria for detection of ESBLs. Results: We included 37 ESBLEB cases. One relapse case was included, but we evaluated it as one case. Hospital acquired cases were 48% and community acquired cases were 52%. Twenty five patients (68%) were men and only one case was under the age of 60. Patients’ conditions with ESBLEB were 43% malignancy cases, 24% chemotherapy within
Posters / International Journal of Antimicrobial Agents 42S2 (2013) S41–S159
sequencing. The isolate was non-susceptible to amikacin, gentamicin, ciprofloxacin, levofloxacin, cefotaxime, cefepime, imipenem, and colistin, but susceptible to aztreonam, minocycline, tigecycline, and cotrimoxazole. The carbapenem resistance was not transferred to Escherichia coli J53 (azide R). D. tsuruhatensis CRS1243 harbored bla IMP-1 gene in class 1 integron located on Tn402 -like transposon. Between the 5'-conserved segment and the tni module, the gene cassettes were orfE, aac(6')-31-like , orfE, orfE, aac(6')-II , aacA7 , bla IMP-1 , aacA7 , aac(6')-II and qacE2 . Conclusion: This is the first report of D. tsuruhatensis producing IMP-1 metallo-b-lactamase. Although CRS1243 had no clinical significance, this bla IMP-1 gene linked to mobile element might spread among Delftia or other species. P354 Gender features of cystitis – How to prevent relapse in women E. Kulchavenya1 *. 1 Research TB Institute, Medical University, Novosibirsk, Russian Federation E-mail address : [email protected] Introduction: Cystitis is one of the commonest diseases in urology especially in women, with recurrent course. The purpose was to estimate the influence of the method of contraception on relapse of the cystitis and evaluate the efficiency of phytotherapy and rational contraception on frequency of cystitis. Methods: We retrospectively analyzed history cases of 215 women with recurrent cystitis; second part of our study was prospective one with 3 groups of sexually active women with recurrent cystitis (age 27–36), who used condom. 1st group (26 patients) received standard therapy and continue to use a condom, 2nd group (31 patients) after antibacterial therapy changed method contraception on pills, and 3rd group (32 patients) after antibacterial therapy changed method contraception on pills, and additionally received a Canefron during one month. Results: Among 215 patients 44 were in menopause. Among 175 women in reproductive age 19 took oral combined contraceptive, 63 used for contraception coitus interruptus, and other 93 used condom. Thus there was negative correlation between oral contraceptives and relapses of cystitis and, on contrary – positive correlation between condom and relapses. In prospective study in 1st group 11 (43.3%) had relapse and 7 from them (26.9%) had it twice at that. In 2nd group relapse was in eight patients (25.8%), and in 4 from them (12.9%) – twice. Best results showed 3rd group, where patients instead of condoms used oral contraceptives as well as two courses Canefron. One relapse was in five patients among (15.6%), none had it twice in a year. Conclusions: 1. Barrier methods of contraception predisposes to recurrent course of bacterial cystitis. 2. Oral combines contraceptives increases resistance of urothelium to the influence of bacterial agent. In women with recurrent cystitis the frequency of relapses decreased twice after changing condom on oral contraceptives. 3. Combination of oral contraceptives and phytotherapy with Canefron decreased the frequency of relapses in three times in comparison with standard antibacterial therapy. P355 Overactive bladder as a mask of chronic prostatitis E. Kulchavenya1 *. 1 Research TB Institute, Medical University, Novosibirsk, Russian Federation E-mail address : [email protected] Introduction: Chronic prostatitis is one of the commonest diagnosis among out-patient men, but in some cases the over-diagnosis may be. Perineal pain and dysuria are often interpreted as chronic prostatitis, although they are symptoms of another disease. Methods: 154 patients addressed to the doctor because of chronic prostatitis (CP) were enrolled in study, the age was between 27 and 49, on average 36.7±4.5 years. All had a long history (on average 6.2±3.7 years), received from 4 till 38 courses of the therapy (on average 8.3±4.7). Overactive bladder (OAB) was not suspected early in any patient. All patients were inspected routinely with ultra-sound investigations, uroflowmetry and filling valid questionnaires.
In 27 patients (17.5%) the OAB was diagnosed, and in 19 – alongside with CP, and on eight patients OAB was as independent disease. All patients with OAB received trospium chloride 30 mg daily in one month; patients with OAB in combination with CP received also standard therapy for CP. Efficiency was estimated by scales, uroflowmetry. Results: Main complaint was perineal pain – 132 patients (85.7%), with scrotal irradiation in 72 (46.7%), intensify in ejaculation in 26 (16.9%). Dysuria was revealed in 112 patients (72.7%), with irritative symptoms in 93 (60.4%), urgency in 27 (17.5%), obstructive symptoms in 67 patients (43.5%) – some patients showed simultaneously irritative and obstructive symptoms. Nocturia was in 18 patients (11.7%). Average IPSS score was 11.4±2.7, average NIH-CPSI – 18.2±4.3. 146 patients (94.8%) had high number of leucocytes in expressed prostatic secretion (EPS), 86 patients (55.8%) presented growth of microflora in EPS. Sexually transmitted infection agents were revealed by PCR in 74 patients (48.0%); in one (0.6%) M. tuberculosis was found. Volume of prostate gland was 28.4±3.6 ml. Qmax was in whole cohort on average 18.3±2.6 ml/sec, Qave – 12.2±3.4 ml/sec. However the comparison of uroflow in 27 patients with urgency and the rest 127 patients without urgency showed a big difference: in first group Qmax was 38.4±3.5 and Qave – 18.2±2.7, in second group Qmax was 14.2±29; Qave – 8.6±3.3. Bladder volume in OAB group was 157.2±9.6 ml, in CP group – 314.0±12.8 ml. As 27 patients with urgency had irritative symptoms and on average 14.9±3.2 micturitions per day, their dysuria was estimated as OAB. In 19 from them CP was confirmed and 8 had no prostate inflammation. All these 27 patients received trospium chloride 30 mg daily, CP patients also took standard therapy for prostatitis. In one month frequency decreased on 56.1%, bladder volume increased on 82.8%; episodes of urgency decreased more than twice. Conclusion: 1. Frequency and urgency in CP patients are indication for excluding of the OAB. OAB may mask CP and accompany it. P356 Extended-spectrum b-lactamases-producing Enterobacteriaceae bacteremia: demographics and outcomes on the controlled carbapenem-use hospital K. Muranaka1 *, N. Hosokawa1 , D. Suzuki1 , T. Mikawa1 , Y. Uwamino1 , K. Tochitani1 , R. Hase1 , H. Kitazono2 , Y. Otsuka3 . 1 Department of Infectious Diseases, Kameda Medical Center, Kamogawa, 2 Department of General Medicine, Tokyo Bay Urayasu-Ichikawa Medical Center, Urayasu, 3 Department of Laboratory Medicine, Kameda Medical Center, Kamogawa, Japan E-mail address : [email protected] Introduction: Extended-spectrum b-lactamases (ESBLs) are enzymes which present the resistance for all b-lactams except carbapenems. Recently Gram-negative organisms with the enzymes are increasing. Though we should select the appropriate antibiotics susceptive to the target bacteria, it is also important reducing broad spectrum antibiotic uses not to spread resistant organisms. In our practice, the use of carbapenem requires preauthorization of infectious disease (ID) department. Therefore ID physicians evaluate the necessity of carbapenem based on medical history (hospital admission, antibiotic uses and past resistant bacteria) and the severity of each case. Objectives: The aim of this study is to determine whether ESBLsproducing Enterobacteriaceae should be treated by carbapenem as an empirical therapy. Methods: We researched retrospectively the medical records of ESBLs-producing Enterobacteriaceae bacteremia (ESBLEB) cases from April 2009 to January 2013 of a community hospital in Chiba, Japan. We identified the species by MicroScan Walk Away 96 (Siemens) and measured their MIC by dry plate ‘Eiken’. We picked up Enterobacteriaceae resistant to third generation cephalosporin and aztreonam. We used both the double disk method and the Cica-BetaTest for these bacteria for detection of ESBLs. Results: We included 37 ESBLEB cases. One relapse case was included, but we evaluated it as one case. Hospital acquired cases were 48% and community acquired cases were 52%. Twenty five patients (68%) were men and only one case was under the age of 60. Patients’ conditions with ESBLEB were 43% malignancy cases, 24% chemotherapy within