ishikawa kiyohito

BACKGROUND: Acute uncomplicated cystitis (AUC) is a urinary tract infection and is generally treated using antimicrobial therapy. Escherichia coli is the main causative agent of AUC. Recently, the prevalence of fluoroquinolone (FQ)-resistant-E. coli has demonstrated a noticeable increase. In this study, we aimed to investigate the effectiveness of appropriate antimicrobial treatment in AUC caused by E. coli in real-world clinical settings. METHODS: This retrospective cohort study reviewed the records of patients with AUC treated at the urology department of Minami Cooperative Hospital between April 2016 and December 2020. Effectiveness was defined as clinical improvement. RESULTS: The study cohort of 730 patients had a median age of 65.5 years (interquartile range, 57-78 years) and 23.2% were aged <55 years. E. coli was detected in 73.4% of patients, of whom 26.7% had levofloxacin (LVFX)-resistant strains. LVFX-resistant E. coli was associated with age ≥55 years and recurrent cases. Effectiveness was determined in 75.1% of cases, of which 75% complied with the Japanese or other international guidelines. The overall treatment effectiveness was highest with β-lactam (BL)/β-lactamase inhibitor (BLI) combinations (94.7%). The effectiveness of first- and third-generation cephalosporins (CPs) was 81.1-83.3%, and that of FQs and sulfamethoxazole-trimethoprim (ST) was 82.6-83.8%. For LVFX-resistant E. coli, the treatment effectiveness was highest (100%) with BL/BLI combinations, intermediate (75-81%) with first- and third-generation CPs and ST, and lowest (50%) with FQs. CONCLUSIONS: BL/BLI combinations had the highest effectiveness for the treatment of AUC.

The composition of the distal ileum microbiota and the impact of fecal exposure during intracorporeal urinary diversion (ICUD) on gastrointestinal (GI) complications remain unclear. This study included 146 patients with bladder cancer who underwent ICUD without bowel preparation and received only a single day of antibiotic prophylaxis. Fecal samples were collected directly from the distal ileum during surgery, and ascitic fluid was obtained postoperatively from abdominal drains. Among the patients, 129 (88.3%) had minimal microbial growth in ileal feces, while 17 (11.7%) showed significant colonization. The most commonly identified organisms were Streptococcus, Enterococcus, Enterobacter, Klebsiella, and Candida. The incidence of GI complications was significantly higher in patients with positive ileal fecal cultures compared to those with no detectable growth (39.4% vs. 7.7%, P < 0.001), and even more pronounced in patients with positive ascitic cultures (72.5% vs. 11.3%, P < 0.001). Multivariate analysis identified positive ascitic cultures as an independent predictor of GI complications. Additionally, frailty was significantly associated with the presence of microbial growth in ascitic fluid. These findings suggest that, although the distal ileal microbiota is largely suppressed under short-term antibiotic prophylaxis, the presence of intra-abdominal bacteria or fungi is strongly linked to postoperative GI complications, including ileus. Frailty may contribute to microbial dysbiosis and the persistence of intra-abdominal pathogens, particularly Enterococcus and Enterobacter species.

OBJECTIVE: This multicenter study aimed to analyze the risk factors for fluoroquinolone (FQ) resistance and to clarify the clinical characteristics of acute bacterial prostatitis (ABP) in Japan. METHODS: A total of 124 patients clinically diagnosed with ABP at 13 medical institutions participating in the Japanese Research Group for Urinary Tract Infection between January and December 2017 were retrospectively reviewed. RESULTS: Of the 124 patients included in this study, 37 were outpatients, and 87 were inpatients. The main underlying medical conditions before the onset of ABP were severe dysuria, urinary retention, transurethral manipulation, indwelling urinary catheter, and transrectal prostate biopsy (TRBx). The main symptoms were fever (≥37.5 °C), prostate tenderness, dysuria, micturition pain, urinary retention, and macrohematuria. Bacteremia was observed in 14 patients. Prostatic abscess was observed in three patients. Escherichia coli was the predominant organism, accounting for 48 % (51/106). FQ-resistant E. coli was detected in 33 % (17/51), and extended-spectrum beta-lactamase-producing E. coli in 12 % (6/51). TRBx (odds ratio [OR] = 48.60, 95 % confidence interval [CI]: 5.49-430.00, p < 0.001) and inpatient status (OR = 29.00, 95 % CI: 1.95-430.00, p = 0.014) were risk factors for the detection of FQ-resistant bacteria. CONCLUSIONS: The detection rate of FQ-resistant bacteria was significantly higher with TRBx ABP and inpatient status. These findings have important implications for the management of ABP and antimicrobial treatment, especially for TRBx ABP, which should be considered a separate category.

(Background) The purpose of this study was to investigate the current status of urologists regarding the prevention of perioperative infections in preparation for the revision of the Guidelines for the Prevention of Perioperative Infections in Urological Field (2015). (Methods) From January 26 to March 30, 2022, we administered questionnaires to members of the Japanese Urological Association on their adherence to the guidelines and administration methods of antimicrobial prophylaxis for perioperative infections. There were 362 respondents. (Results) The respondents reported adhering to the guidelines completely (15.5%), to some extent (55.5%), poorly (24.3%), and not at all (4.7%). Adherence rates also varied for surgical procedures, ranging from 73.8% in transurethral resection of bladder tumor to 32.9% in laparoscopic (robot-assisted) contaminated surgery. Excluding contaminated surgery and transurethral resection of prostate, where long-term administration is relatively acceptable, open clean-contaminated surgery had the highest rate of long-term administration (≥72 h) (27.2%) and transurethral resection of bladder tumor had the lowest rate (7.3%). Adherence rates for clean surgery and transurethral ureteral lithotripsy shortened to a single dose of antimicrobial agents were low. (Conclusion) The selected antimicrobial agents were generally in compliance with the guidelines. With the exception of contaminated surgery, they were administered long-term in clean-contaminated surgery where the urinary tract and genitalia were exposed. Surgical procedures in which a single prophylactic dose of antimicrobial agents was administered had a low compliance rate. After the revision of the guidelines, it is considered important to update the clinical paths at each facility.

The Committee for the Development of Guidelines for Infection Control in the Urological Field, including Urinary Tract Management of the Japanese Urological Association, together with its systematic review team and external reviewers, have prepared a set of practice guidelines, an abridged version of which is published herein. These guidelines cover the following topics: (i) foundations of infection control, standard precautions, route-specific precautions, and occupational infection control (including vaccines); (ii) the relationship between urologists and infection control; (iii) infection control in urological wards and outpatient clinics; (iv) response to hepatitis B virus reactivation; (v) infection control in urological procedures and examinations; (vi) prevention of infections occurring in conjunction with medical procedures and examinations; (vii) responses to urinary tract tuberculosis and bacillus Calmette-Guérin; (viii) aseptic handling, cleaning, disinfection, and sterilization of urinary tract endoscopes (principles of endoscope manipulation, endoscope lumen cleaning, and disinfection); (ix) infection control in the operating room (principles of hand washing, preoperative rubbing methods, etc.); (x) prevention of needlestick and blood/bodily fluid exposure and response to accidental exposure; (xi) urinary catheter-associated urinary tract infection and purple urinary bag syndrome; and (xii) urinary catheter-associated urinary tract infections in conjunction with home care. In addressing these topics, the relevant medical literature was searched to the extent possible, and content was prepared for the purpose of providing useful information for clinical practice.

INTRODUCTION: The aim of this study was to monitor the development of drug-resistant bacteria isolated from acute uncomplicated cystitis (AUC) and to evaluate methodology of the survey conducted by collecting only clinical data. METHODS: We enrolled female patients at least 16 years of age diagnosed with AUC in 2018. Patient information including age, menopausal status, and results of bacteriological examination were collected and analyzed regardless of bacterial identification, antimicrobial susceptibility testing or extended-spectrum β-lactamase (ESBL) detection method. RESULTS: A total of 847 eligible cases were collected. Escherichia coli (E. coli) was the most frequently isolated bacterial species at about 70%, with proportions of fluoroquinolone-resistant E. coli (QREC) and ESBL-producing E. coli isolates at 15.6% and 9.5% of all E. coli isolates, respectively. The proportion of Staphylococcus saprophyticus (S. saprophyticus) was significantly higher in premenopausal women. Regarding the drug susceptibility of E. coli, isolates from Eastern Japan had significantly higher susceptibility to cefazolin, cefotiam and cefpodoxime and lower susceptibility to levofloxacin in postmenopausal women. ESBL-producing E. coli isolates had a high susceptibility to tazobactam-piperacillin, cefmetazole, carbapenems, aminoglycosides, and fosfomycin. In S. saprophyticus, the susceptibility to β-lactams including carbapenems was 40-60%. CONCLUSIONS: The proportions of QREC and ESBL-producing E. coli were increasing trends and lower susceptibility to LVFX in postmenopausal women was observed. Such surveillance, consisting of the collecting only clinical data, could be conducted easily and inexpensively. It is expected to be continuously performed as an alternative survey to conventional one collecting bacterial strains.

The aim of this report is to introduce an on-going, multicenter, randomized controlled trial to evaluate whether tailored antimicrobial prophylaxis guided by rectal culture screening prevents acute bacterial prostatitis following transrectal prostate biopsy (TRPB). Patients will be randomized into an intervention or non-intervention group; tazobactam-piperacillin or levofloxacin will be prophylactically administered according to the results of rectal culture prior to TRPB in the intervention group whereas levofloxacin will be routinely given in the non-intervention group. The primary endpoint is the occurrence rate of acute bacterial prostatitis after TRPB. Recruitment begins in April, 2021 and the target total sample size is 5,100 participants.

A 47-year-old woman who was diagnosed with right pyelonephritis by a local physician, but failed to respond to antimicrobial chemotherapy, was referred to our hospital. Here, the diagnosis of right pyonephrosis was confirmed byabdominal computed tomography(CT). Retrograde pyelography(RP) revealed a severe stricture at the ureteropelvic junction, and it was considered difficult to advance a guidewire through the stricture. Urine cytologywas pseudo-positive ; thus, the possibilityof a malignant tumor of the urinarytract could not be ruled out. Therefore, right nephroureterectomywas performed. The final, histopathological diagnosis was urothelial carcinoma, (G2, pT3). After surgery, the signs and symptoms of the infection were rapidlyameliorated ; however, swelling of the lymph-nodes between the aorta and vena cava was observed, which was considered to be metastasis. Therefore, 4 courses of gemcitabine ＋cisplatin therapywere administered, which resulted in complete resolution of the lymph-node swelling. The patient has remained free of recurrence for 2 years after surgery.

<p>  Pelvic organ prolapse (POP) and vesicovaginal fistula (VVF) are female benign pelvic floor diseases which can be treated by surgery. Robot-assisted laparoscopic surgery was performed on 5 cases of POP and 1 case of VVF in our hospital.</p><p>  POP cases : An average age of 5 cases was 63.6 y.o and 2 patients had hysterectomy before robot assisted laparoscopic sacrocolpopexy (RSC). In 3 cases, RSC was performed after subtotal hysterectomy. Consol time of RSC was 206.2 minutes on average. After 1 year, there is no recurrence of symptom in all patients. VVF case : A 51 y.o female suffered from total urinary incontinence after hysterectomy visited us. A 20 mm fistula between bladder and vagina was found by cystoscopy. Robot-assisted laparoscopic repair of VVF was administered for fisterectomy and reconstruction of bladder and vagina wall (Consol time was 120 minutes). The patient discharged on the 7th postoperative day and keeps urinary continence.</p>

In Japan, the criteria for multi-drug-resistant Acinetobacter baumannii (MDRA) have been developed in response to two large-scale MDRA outbreaks reported in 2010. A. baumannii can survive for a long period in a dry environment, and it is also detected frequently from carriers over a long period. For mixed infection with some other bacteria, it cannot be accurately detected due to masking by other bacteria. For these reasons, the detection of MDRP infection is delayed. Furthermore, the infection control of MDRA must require the determination of the quarantine period, release criteria, and a clean environment, without sufficient levels of evidence. It is not rare for this to take more than a year to resolve an MDRA outbreak. Therefore, it is important to monitor daily occurrence in any hospital. [Review].