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Rikiya Taoka,
Yoshikazu Togo,
Tatsuhiko Kubo,
Masahito Kido,
Kenta Miki,
Hiroshi Kiyota,
Shin Egawa,
Takashi Sugawara,
Mitsuru Yasuda,
Masahiro Nakano, [......],
Toyohiko Watanabe,
Hiromi Kumon,
Kanao Kobayashi,
Akio Matsubara,
Takehiko Sho,
Ryoichi Hamasuna,
Tetsuro Matsumoto,
Hiroshi Hayami,
Masayuki Nakagawa,
Shingo Yamamoto
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ABSTRACT: To propose an appropriate prophylactic antimicrobial therapy for patients undergoing brachytherapy, we evaluated the relationships between various antimicrobial prophylaxis (AMP) protocols and the incidence of postimplant infections in a multicenter cohort study conducted in Japan. The records of 826 patients with localized prostate cancer who underwent a transperineal (125)I brachytherapy procedure between January 2009 and December 2010 were retrospectively reviewed. Perioperative infections, including surgical site and remote infections, were recorded up to postoperative day 30. A total of 6 (0.73 %) patients had a perioperative infection following seed implantation, of whom all received AMP for 1 or more days. None of the patients who received a single-dose protocol of AMP using fluoroquinolone p.o. or penicillin with a beta-lactamase inhibitor i.v. developed a perioperative infection. Statistical analysis showed that a single-dose protocol was more significantly related to a lower risk of perioperative infection as compared to the other AMP protocols examined (p = 0.045). Furthermore, our results indicated that bacteriuria and preoperative hair removal were risk factors of perioperative infection with statistical significance (p = 0.007, p = 0.004). Analysis of patient clinical parameters, including age, American Society of Anesthesiologists score, diabetes mellitus, prostate volume, numbers of implanted seeds and needle punctures, operation time, and indwelling duration time of the Foley catheter, did not reveal significant differences in terms of perioperative infection. Our results indicated that a single-dose AMP protocol is sufficient to prevent perioperative infections following seed implantation. On the other hand, AMP is only one of several measures to prevent perioperative infectious complications. It is necessary to know that the patient must have no bacteriuria and that preoperative hair removal should be avoided.
Journal of Infection and Chemotherapy 05/2013; · 1.80 Impact Factor
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Hiroshi Hayami,
Satoshi Takahashi,
Kiyohito Ishikawa,
Mitsuru Yasuda,
Shingo Yamamoto,
Shinya Uehara,
Ryoichi Hamasuna,
Tetsuro Matsumoto,
Shinichi Minamitani,
Akira Watanabe, [......],
Kengo Tsuneyoshi,
Shinji Matsushita,
Takashi Yamane,
Takaoki Hirose,
Shigeru Fujihiro,
Katsuhisa Endo,
Yasuhiko Oka,
Koh Takeyama,
Takahiro Kimura,
Tetsuji Uemura
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ABSTRACT: The Japanese surveillance committee conducted the first nationwide surveillance of antimicrobial susceptibility patterns of uropathogens responsible for female acute uncomplicated cystitis at 43 hospitals throughout Japan from April 2009 to November 2010. In this study, the causative bacteria (Escherichia coli and Staphylococcus saprophyticus) and their susceptibility to various antimicrobial agents were investigated by isolation and culturing of bacteria from urine samples. In total, 387 strains were isolated from 461 patients, including E. coli (n = 301, 77.8 %), S. saprophyticus (n = 20, 5.2 %), Klebsiella pneumoniae (n = 13, 3.4 %), and Enterococcus faecalis (n = 11, 2.8 %). S. saprophyticus was significantly more common in premenopausal women (P = 0.00095). The minimum inhibitory concentrations of 19 antibacterial agents used for these strains were determined according to the Clinical and Laboratory Standards Institute manual. At least 87 % of E. coli isolates showed susceptibility to fluoroquinolones and cephalosporins, and 100 % of S. saprophyticus isolates showed susceptibility to fluoroquinolones and aminoglycosides. The proportions of fluoroquinolone-resistant E. coli strains and extended-spectrum β-lactamase (ESBL)-producing E. coli strains were 13.3 % and 4.7 %, respectively. It is important to confirm the susceptibility of causative bacteria for optimal antimicrobial therapy, and empiric antimicrobial agents should be selected by considering patient characteristics and other factors. However, the number of isolates of fluoroquinolone-resistant or ESBL-producing strains in gram-negative bacilli may be increasing in patients with urinary tract infections (UTIs) in Japan. Therefore, these data present important information for the proper treatment of UTIs and will serve as a useful reference for future surveillance studies.
Journal of Infection and Chemotherapy 05/2013; · 1.80 Impact Factor
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ABSTRACT: PURPOSE: Urinary tract infection (UTI) often causes bacteremia, resulting in shock. The purpose of this study is to investigate urological bacteremia and bacteremia shock cases and seek for the clinical factors associated with urological bacteremic shock. METHODS: Seventy consecutive cases with bacteremia caused by UTI from the Department of Urology, Kobe University Hospital were studied. These cases were diagnosed from 2000 to 2010 and had full data available for analysis. We investigated the potential clinical factors associated with bacteremic shock (systolic blood pressure ≤90 mmHg with UTI), including: (1) the number of basal general diseases (such as diabetes, malignancy, immune diseases, heart diseases, liver diseases, and kidney diseases), (2) causative bacteria, (3) antibiotics and therapeutic intervention, (4) gram-negative bacteria, (5) resistance to imipenem (which is often used in this infection), and (6) serum white blood cell counts and C-reactive protein (CRP) at the time of diagnosis of bacteremic UTI. RESULTS: A total of 81 causative bacteria were isolated: 42 cases were gram-negative and 39 were gram-positive bacteria. In detail, Escherichia coli was the most common, followed by Methicillin-resistant Staphylococcus aureus. The comparison data revealed that urological bacteremic shock cases had significantly increased CRP (p < 0.001). Our univariate analyses showed indwelling urinary tract catheters (p = 0.02) as a significant clinical factor associated with urological bacteremic shock and multivariate analyses showed that the presence of indwelling urinary tract catheters before UTI was a significant clinical factor associated with urological bacteremic shock (p = 0.04). CONCLUSIONS: Indwelling urinary catheters before UTI and high CRP were clinical factors associated with urological bacteremic shock. This result should be considered during decision-making for UTI treatments in high risk cases or urological bacteremia cases.
International Urology and Nephrology 04/2013; · 1.47 Impact Factor
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ABSTRACT: The objective of this study was to retrospectively investigate postoperative infectious complications (PICs) in our early experience with holmium laser enucleation of the prostate (HoLEP) followed by mechanical morcellation for symptomatic benign prostatic hyperplasia.
A retrospective review was performed of the clinical data for 90 consecutive patients who underwent HoLEP at our institution between February 2008 and March 2011. All patients were evaluated for the emergence of PICs, including prophylactic antibiotic administration (PAA) and the influence of the kind or duration of PAA on PIC. The details of cases with PICs were also examined.
The patients' mean age was 71 years (range, 50 to 95 years), and their mean prostate volume was 60 mL (range, 2 to 250 mL). There were 7 cases (7.78%) with PICs; in detail, 3 patients were diagnosed with prostatitis, 2 with pyelonephritis, and 2 with epididymitis. Three patients had positive urine cultures: 1 had Serratia marcescens/Proteus mirabilis, 1 had S. marcescens, and 1 had Klebsiella pneumonia; only one case had urological sepsis. Our statistical data showed no significant differences between 2 or fewer days and 3 or more days of PAA and PIC occurrence. There was also no significant effect on PIC occurrence of sulbactam/ampicillin compared with other antibiotics.
The results of this retrospective study showed that PIC occurrence did not depend on the duration or the kind of PAA. Further prospective study is necessary for the evaluation and establishment of prophylactic measures for PICs.
Korean journal of urology 03/2013; 54(3):189-93.
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ABSTRACT: Purpose: The purpose of this study was to evaluate whether neo-adjuvant hormonal therapy (NHT) prior to radical retropubic prostatectomy (RRP) for prostate cancer (PCa) is beneficial in terms of surgical outcomes and for preventing or delaying biochemical recurrence via single-surgeon case series study. Materials and Methods: Fifty-three men underwent RRP by a single surgeon. The patients were divided into two groups according to whether or not NHT was performed prior to RRP. The study was analyzed retrospectively. We evaluated clinical parameters, surgical parameters, and biochemical recurrence rate. Group 1 (n=34) was treated with RRP only, while Group 2 (n=19) underwent RRP along with NHT. Results: There were no significant differences in clinical, operation-related and pathological factors between the two groups (p>0.05). There was also no significant difference in biochemical recurrence rate between the two groups at the last follow-up, although Group 2 tended to have a lower PCa recurrence rate than Group 1 and the initial prostate-specific antigen (PSA) level was significantly higher in Group 2 than Group 1 (p=0.0496). Conclusion: The present single-surgeon case series study revealed a trend toward a lower rate of PCa recurrence in NHT+RRP treated patients compared to those treated with RRP alone, but this did not reach statistical significance, despite the fact that NHT+RRP patients exhibited higher serum PSA levels preoperatively. Prospective studies with a longer duration of observation and a greater number of patients would be helpful in evaluating NHT more definitively.
Yonsei medical journal 03/2013; 54(2):410-5. · 0.77 Impact Factor
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ABSTRACT: OBJECTIVES: Silodosin is a novel drug that is highly selective to subtype alpha 1A and, since 2006, has been used in Japan for treating benign prostatic hyperplasia. This study aimed to compare the clinical effects of the alpha-adrenoceptor antagonist, silodosin, with those of naftopidil in patients presenting lower urinary tract symptoms associated with benign prostatic hyperplasia. METHODS: This was a randomized, open-label, controlled multicenter study carried out in Japan. Overall, 121 participants with lower urinary tract symptoms associated with benign prostatic hyperplasia were randomized to receive silodosin (4 mg twice daily) or naftopidil (50 mg once daily) for 4 or 8 weeks. Patients were divided into four groups: the alpha-blocker-naive groups received silodosin (35 patients) or naftopidil (33 patients) and the drug-switching groups changed from tamsulosin to silodosin (26 patients) or naftopidil (27 patients). The outcomes parameters were the International Prostate Symptom Score, quality of life, maximum urinary flow rate and post-void residual urine volume. P < 0.05 was considered statistically significant by using the Wilcoxon signed-rank and rank-sum tests, and analysis of covariance. RESULTS: In all the groups, silodosin and naftopidil significantly improved the total International Prostate Symptom Score and quality of life. However, silodosin obtained significantly better improvement in total International Prostate Symptom Score in the alpha-blocker-naive patients at 4 and 8 weeks. The maximum urinary flow rate and residual urine did not change significantly in all the treatment groups. CONCLUSIONS: The present study confirms the clinical usefulness of silodosin in the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia.
International Journal of Urology 12/2012; · 1.75 Impact Factor
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ABSTRACT: There are several mechanisms of fluoroquinolone (FQ) resistance, such as mutations in the quinolone resistance-determining regions (QRDRs) of target genes and efflux pump expression. The purpose of this study was to investigate which factor plays the main role in FQ resistance in Escherichia coli causing urinary tract infections (UTIs) from a statistical analysis of our two previous works. DNA sequencing of the QRDRs of the FQ resistance-related genes gyrA and parC as well as real-time reverse transcriptase (RT)-PCR for the expression of efflux pump genes such as marA or yhiU were performed and the correlations of mutations or efflux pump gene expression with FQ minimal inhibitory concentrations (MICs) were investigated. Significant factors for high MICs of sitafloxacin (STFX), ciprofloxacin (CPFX) and levofloxacin were the mutations S83L and D87N in gyrA and S80I and E84V in parC as well as the expression of marA. Mutations in the QRDRs of gyrA or parC had a greater effect on FQ MICs than efflux pump gene expression. Based on the regression coefficient, these mutations correlated with MICs to CPFX most, and STFX had the lowest effects from these mutations among the three tested FQs. In conclusion, in E. coli causing UTIs, mutations in the QRDRs of gyrA or parC had a greater effect on FQ resistance, especially to CPFX, than efflux pump gene expression from a statistical analysis study of our two previous works. Further research into the molecular basis for FQ resistance could lead to new therapeutic strategies against FQ-resistant E. coli.
International journal of antimicrobial agents 10/2012; · 3.03 Impact Factor
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ABSTRACT: A 65-year-old man with diabetes mellitus (DM) presented with an indwelling urethral catheter placed for urinary retention by his previous doctor. Thereafter, he had fever, vomiting and general fatigue. His blood examination showed severe inflammatory findings. He was diagnosed with acute prostatitis and immediately admitted to our hospital. Pelvic computerized tomography (CT) showed a prostate abscess. We performed transrectal ultrasonographic-guided puncture of the prostate abscess for drainage and blood culture was tested. Methicillin-sensitive Staphylococcus aureus (MSSA) was cultured from the puncture fluid and blood. We administered antibiotics with strict control of DM. After the prostate abscess improved and the urethral catheter was removed, the patient was systematically examined for potential sepsis-related disease caused by MSSA septic infection. Magnetic resonance imaging (MRI) of the head indicated multiple cerebral infarction, abdominal CT indicated splenetic infarction, ultrasonography of the heart indicated vegetation on the mitral valve and aortic valve, and chest X-ray indicated pulmonary congestion. Furthermore, MRI of the lumbar spine showed a high intensity lesion at the 4th and 5th lumbar spine, indicating pyogenic spondylitis. We diagnosed prostate abscess with sepsis, infectious endocarditis, congestive heart failure and pyogenic spondylitis. Aortic valve replacement, mitral annuloplasty, tricuspid valvuloplasty and ovale hole closure surgeries were performed to treat these conditions.
Hinyokika kiyo. Acta urologica Japonica 10/2012; 58(10):565-8.
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ABSTRACT: During chemotherapy, patients are more susceptible to infectious complications as a result of bone marrow suppression, leading to neutropenia. The purpose of this study is to investigate risk factors for refractory febrile neutropenia (FN) during urological chemotherapy. Our method for suppressing FN is to use granulocyte colony-stimulating factor and prevent upper respiratory infection by masking and gargling. We studied 47 episodes of FN in 39 patients that occurred during urological chemotherapy for urothelial cancer, testicular cancer, and prostate cancer. Among our cases, there were 5 patients with refractory FN; we set risk factors for refractory FN and performed statistical analyses. The average age of the 39 patients was 60.6 years (range, 18-80 years). In 47 FN episodes, the chemotherapy regimen before the occurrence of FN included 15 (31.9 %) MVAC (methotrexate, vinblastine, adriamycin, cisplatin) for urothelial cancer, 5 (10.6 %) DE (docetaxel, estramustin) for prostate cancer, and 3 (6.4 %) TIP (paclitaxel, ifosfamide, cisplatin) for testicular cancer. The antibiotics used to treat FN included 17 (36.3 %) meropenem and 23 (49.0 %) cefepime, and the average duration of antibiotics was 4.4 days (range, 1-12). We investigated risk factors for refractory FN and showed a significant relationship between refractory FN and indwelling urinary catheter or smaller Multinational Association for Supportive Care in Cancer score by multivariate analysis. A future prospective study is needed for further evaluation for risk factors and establishing treatment protocols and guidelines for FN.
Journal of Infection and Chemotherapy 09/2012; · 1.80 Impact Factor
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Satoshi Takahashi,
Ryoichi Hamasuna,
Mitsuru Yasuda,
Soichi Arakawa, Kazushi Tanaka,
Kiyohito Ishikawa,
Hiroshi Kiyota,
Hiroshi Hayami,
Shingo Yamamoto,
Tatsuhiko Kubo,
Tetsuro Matsumoto
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ABSTRACT: We examined the rate of relapse, as a variable index, in patients with urinary tract infection (UTI) who suffered from multiple relapses when using cranberry juice (UR65). A randomized, placebo-controlled, double-blind study was conducted from October 2007 to September 2009 in Japan. The subjects were outpatients aged 20 to 79 years who were randomly divided into two groups. One group received cranberry juice (group A) and the other a placebo beverage (group P). To keep the conditions blind, the color and taste of the beverages were adjusted. The subjects drank 1 bottle (125 mL) of cranberry juice or the placebo beverage once daily, before going to sleep, for 24 weeks. The primary endpoint was relapse of UTI. In the group of females aged 50 years or more, there was a significant difference in the rate of relapse of UTI between groups A and P (log-rank test; p = 0.0425). In this subgroup analysis, relapse of UTI was observed in 16 of 55 (29.1 %) patients in group A and 31 of 63 (49.2 %) in group P. In this study, cranberry juice prevented the recurrence of UTI in a limited female population with 24-week intake of the beverage.
Journal of Infection and Chemotherapy 09/2012; · 1.80 Impact Factor
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ABSTRACT: Fluoroquinolone (FQ) resistance in Pseudomonas aeruginosa has spread. The purpose of this study was to investigate the correlation between representative FQ, i.e. levofloxacin (LVX), resistance and mutations in the gyrA and parC genes of P. aeruginosa clinical isolates from the urine of urinary tract infection patients and their rapid detection by denaturing high-performance liquid chromatography (DHPLC). The susceptibility to LVX of 114 clinical isolates was measured and the quinolone resistance-determining regions (QRDRs) in the gyrA and parC genes of these isolates were sequenced. DHPLC was undertaken to correlate the distinctive chromatograms with their DNA mutation patterns. Among 114 isolates tested, 22 isolates (19.3%) were resistant to LVX. Six amino acid mutations were detected (Thr83Ile, Asp87Tyr and Asp87Asn in gyrA and Ser87Leu, Ser87Trp and Glu91Arg in parC), existing alone or in combination. There were 10 kinds of mutation patterns. The presence of two or more kinds of mutation significantly correlated with LVX resistance compared with the wild-type or a single mutation (P<0.0001). DHPLC data identified the number of amino acid mutations with reproducibility distinguishable by peak number and profile of the DHPLC chromatogram. In conclusion, two or more mutations in gyrA and parC were significantly related to LVX resistance in P. aeruginosa. DHPLC facilitated the detection of resistant alleles, providing a rapid (5min per sample), economical (96 samples per run) and reliable technique for characterising LVX resistance in P. aeruginosa. This rapid detection system could forecast LVX resistance by the DHPLC profile.
International journal of antimicrobial agents 08/2012; 40(5):440-4. · 3.03 Impact Factor
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Tetsuro Matsumoto,
Ryoichi Hamasuna,
Kiyohito Ishikawa,
Satoshi Takahashi,
Mitsuru Yasuda,
Hiroshi Hayami, Kazushi Tanaka,
Tetsuro Muratani,
Koichi Monden,
Soichi Arakawa,
Shingo Yamamoto
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ABSTRACT: We investigated whether the presence of menopause influenced the species and distribution of causative bacteria isolated from patients with acute uncomplicated cystitis (the most common urinary tract infection), and we also investigated the sensitivity of the isolated species to antibacterial agents. Using multivariate analysis, we also investigated risk factors for infection with quinolone-resistant Escherichia coli, because its frequency has increased and it is now a clinical problem in Japan. Six hundred and thirty-four strains were isolated from 489 premenopausal patients (mean age 32.3 ± 10.1 years). Major causative bacteria detected were Escherichia coli (65.0 %), Enterococcus faecalis (12.0 %), Streptococcus agalactiae (5.5 %), and Klebsiella pneumoniae (1.6 %). From 501 postmenopausal patients (mean age 68.7 ± 10.29 years), 657 strains were isolated, and the major causative bacteria detected were E. coli (61.5 %), E. faecalis (13.7 %), K. pneumoniae (5.2 %), and S. agalactiae (4.0 %). The sensitivities to fluoroquinolones (FQs) and cephems of E. coli isolated from premenopausal patients were both ≥90 %, while the sensitivities to FQs of E. coli isolated from postmenopausal patients were about 5 % lower. In regard to infection with quinolone-resistant E. coli (minimal inhibitory concentration of levofloxacin [LVFX] ≥4 μg/mL), significant risk factors were observed in patients with more than two episodes of cystitis within a year (p = 0.0002), patients to whom antibacterial agents were used previously for this episode of cystitis (p = 0.0175), and patients who had a history of FQ administration within 1 month. Although the species and distribution of causative bacteria of acute uncomplicated cystitis were the same regardless of the presence of menopause, the sensitivities to FQs of E. coli detected in postmenopausal patients were significantly lower than those in the premenopausal women. The major risk factors for infection with quinolone-resistant E. coli were a history of FQ administration and the morbidity of cystitis rather than the menopausal status. It was considered that taking an appropriate history including the morbidity of cystitis and history of FQ administration, and the appropriate selection of an antibacterial agent, would be important when empirical therapy is required.
Journal of Infection and Chemotherapy 05/2012; 18(4):597-607. · 1.80 Impact Factor
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ABSTRACT: The purpose of this study was to investigate the association between prophylactic antibiotic administration (PAA) and post-operative infection in radical cystectomy with orthotopic neobladder urinary diversion carried out for patients with bladder cancer. Fifty-seven consecutive cases were analyzed retrospectively. Post-operative infections were categorized as urinary tract, wound, and remote infections. We used the antibiotics tazobactam/piperacillin (TAZ/PIPC), sulbactam/ampicillin (SBT/ABPC), flomoxef (FMOX), cefazolin (CEZ), cefotiam (CTM), and cefmetazole (CMZ). Twenty-five (43.9%) patients had post-operative infections. Five of these (8.77%) patients had wound infections, 22 (38.6%) patients had urinary tract infections, and 2 (3.51%) had remote infections. Our statistical analysis demonstrated that the patients with TAZ/PIPC used for PAA (5/18: 27.8%) had a significantly lower post-operative infection rate than patients with other antibiotics (24/39: 61.5%) (p = 0.0442). In addition, the patients with a shorter-duration PAA (within 72 h after the operation (48-72 h)) had a significantly lower rate of post-operative infections (12/33: 36.4%) than those with longer-duration PAA (longer than 72-96 h after the operation) (16/24: 66.7%) (p = 0.0239). Taken together, these results suggest that TAZ/PIPC with shorter PAA duration (within 72 h) might lead to a lower rate of post-operative infections. In conclusion, our data showed that PAA with TAZ/PIPC with a shorter duration PAA (within 72 h) might be recommended for radical cystectomy with orthotopic neobladder reconstruction. A prospective study based on our data is desirable to establish or revise guidelines for prophylactic medication for preventing post-operative infection after radical cystectomy with orthotopic neobladder urinary diversion.
Journal of Infection and Chemotherapy 01/2012; 18(4):479-84. · 1.80 Impact Factor
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ABSTRACT: Urinary tract infections (UTIs) can be hard to treat and treatment plans need to include accurate categorization such as uncomplicated or complicated UTI, or catheterized or uncatheterized UTI. We investigated the antibiotic susceptibilities of representative uropathogens in UTI categories.
We isolated uropathogens and analyzed their antimicrobial susceptibilities according to UTI categorization such as: (1) urology outpatients, urology inpatients, or other department inpatients; (2) uncomplicated or complicated UTIs; (3) upper or lower UTIs, and (4) non-catheterized or catheterized UTIs.
Escherichia coli, Enterococcus faecalis, and Pseudomonas aeruginosa were representative uropathogens. Susceptibilities to levofloxacin (LVFX) in E. coli in urology outpatients (p = 0.0179), those to ceftadizime in E. coli in other department inpatients (p = 0.0327), and those to LVFX in E. faecalis in complicated UTI (p = 0.0137) significantly decreased in these 3 years compared with the previous 3 years. Susceptibilities of upper UTI to LVFX in E. coli were significantly lower in the recent 4 years compared to lower UTI (p = 0.0452) and those of catheterized UTI to LVFX in E. faecalis were significantly lower than in non-catheterized UTI (p = 0.0153).
Data demonstrated different tendencies of uropathogens' antibiotic susceptibilities according to UTI categorizations and they could be useful for planning UTI treatments.
Urologia Internationalis 01/2012; 88(2):198-208. · 0.99 Impact Factor
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ABSTRACT: Invasive upper urinary tract procedures such as retrograde pyelography (RP) or single (S-J) or double J (D-J) stenting are commonly performed to assess or treat ureteral strictures. Urinary tract infection (UTI) can result after such procedures, and prophylactic antimicrobial administration (PAA) may be necessary. This study investigated infectious complications and risk factors, focusing on PAA.
We studied antimicrobial prevention in 353 upper urinary tract examinations or treatments. Procedures included S-J or D-J installation or exchange, RP and percutaneous nephrostomy. We investigated PAA and the occurrence of febrile infectious complications with respect to each procedure and attempted to find the risk factors.
Levofloxacin was used in 149 subjects (42.2%) and cefcapene pivoxil in 114 cases (32.3%). There were 16 febrile infectious complication cases (4.5%) after procedures, and pyuria or hydronephrosis prior to examination or treatment was an independent risk factor for infectious complication (p < 0.05) as well.
These data showed that it is necessary to evaluate the risk factors before urological procedures of the upper urinary tract and to offer a definite preventive methodology according to these risk factors for the establishment and update of guidelines.
Urologia Internationalis 01/2012; 88(1):43-7. · 0.99 Impact Factor
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ABSTRACT: Radical cystectomy is associated with the highest morbidity and mortality of all commonly performed urological cancer treatment procedures. Postoperative infection remains a major problem. We herein report the results of an open prospective study involving radical cystectomies, undertaken to evaluate the efficacy of 0.5/2 g tazobactam-piperacillin (TAZ-PIPC) in the prevention of postoperative infectious complications. Antimicrobial prophylaxis was performed using 0.5/2 g TAZ-PIPC (2.5 g i.v.) every 3 h during surgery and then twice a day for 3 days postoperatively. The patients were monitored to detect any postoperative infections. During surgery, irrigation fluid from the total abdominal cavity was taken for bacterial culture just before closing the abdomen. Surveillance cultures of drain discharge and urine from ureteral stents were also performed. Other samples were taken for bacterial culture when an infection was suspected. The total postoperative bacterial infection rate was 20.0% (7/35), and surgical site infection rate was 5.7% (2/35). These rates are lower than those documented in other studies. This study, even though open and noncomparative, showed that a short-interval regimen containing 0.5/2 g TAZ-PIPC provides adequate antimicrobial prophylaxis in patients undergoing radical cystectomy.
Journal of Infection and Chemotherapy 10/2011; 18(2):175-9. · 1.80 Impact Factor
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ABSTRACT: We examined Enterococcus faecalis strains clinically isolated from 100 patients with urinary tract infections (UTIs) for their susceptibility to levofloxacin (LVX) by measuring the MIC and investigated amino acid mutations by direct DNA sequencing, which were then correlated with LVX resistance. Next, we studied risk factors for LVX resistance, such as age, gender, and previous fluoroquinolone use, and investigated the statistical correlation of these risk factors with each amino acid mutation and LVX resistance. Of the 100 isolates tested, 14 isolates showed LVX resistance and all of these isolates had amino acid mutations. We demonstrated that 2 out of 4 mutations (Ser83-to-Ile in gyrA and Ser80-to-Ile in parC) had a significant correlation with LVX resistance. There was a significant relationship between isolates with 2 or 3 amino acid mutations and LVX resistance. In addition, we found a significant correlation between the previous use of fluoroquinolones and LVX resistance or the presence of mutations and also demonstrated that previous use of other types of antibiotics was significantly related to the presence of mutations by multivariate analysis. In conclusion, we found significant correlation between amino acid mutations in E. faecalis, LVX resistance, and risk factors such as previous use of fluoroquinolones.
Journal of clinical microbiology 09/2011; 49(11):3912-6. · 4.16 Impact Factor
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Nippon rinsho. Japanese journal of clinical medicine 06/2011; 69 Suppl 5:379-83.
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ABSTRACT: Overuse of antibiotics can cause the emergence of resistant bacterial strains. This study retrospectively investigated recent trends in Escherichia coli causing urinary tract infections (UTIs), focusing on antibiotic use and antibiotic susceptibilities. Patients diagnosed with UTIs caused by E. coli in Akashi Municipal Hospital between April 2004 and March 2010 were enrolled in the study. A total of 858 UTI cases were examined. Antibiotics used in our hospital during that period and the antibiotic susceptibilities of E. coli in UTI cases were assessed. We analyzed the data on a yearly basis, with the year being defined as the period from April to the following March (e.g., in this study the period from April 2004 to March 2005 represents 2004). The first 3 years (2004-2006) were compared to the last 3 years (2007-2009). The use of piperacillin, cephazolin, amikacin, oral cefotiam, and levofloxacin decreased significantly and the use of imipenem, gentamicin (GM), cefcapene, and oral minocycline (MINO) increased significantly in the last 3 years compared to the previous 3 years. The susceptibilities of MINO in complicated cystitis significantly increased and those of GM in uncomplicated pyelonephritis significantly decreased in these 3 years (2007-2009) compared to the previous 3 years (2004-2006) (P < 0.05). Additionally, extended-spectrum β-lactamase (ESBL)-producing E. coli tended to be isolated more often; this was statistically significant in the last 3 years (2007-2009) compared to the previous 3 years (2004-2006) (P < 0.05). In conclusion, we found changes in our pattern of antibiotic use associated with changes in antibiotic susceptibilities and an increase in ESBL-producing E. coli isolated from our UTI cases. Monitoring of antibiotic use and emergence of resistant strains should be continued.
Journal of Infection and Chemotherapy 04/2011; 17(5):646-51. · 1.80 Impact Factor
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ABSTRACT: To investigate the efficacy of tazobactam/piperacillin (TAZ/PIPC) plus levofloxacin (LVFX) as a prophylactic administration in transrectal prostate biopsy (TPBX).
We investigated 201 consecutive patients who underwent TPBX in one Japanese hospital during the period of 2009-2010. The patients received TAZ/PIPC 4.5 g i.v. once just before and 3 hours after TPBX, plus oral LVFX 300 mg or 500 mg daily for 3 days. We examined the infectious adverse events and laboratory data (serum white blood cell [WBC] count and C-reactive protein [CRP]) before and 1 day after TPBX.
Only one patient (0.50%) in 201 cases had febrile complications after TPBX. Serum WBC and CRP did not rise significantly on the day after TPBX compared with before TPBX (p>0.05). There was no significant difference in the rise of serum WBC and CRP before and after TPBX in the comparison of LVFX 500 mg with LVFX 300 mg in the TAZ/PIPC plus LVFX regimen.
TAZ/PIPC plus LVFX can be considered as a prophylactic regimen for preventing infectious complications in TPBX.
Korean journal of urology 04/2011; 52(4):289-92.
