Heteroresistant Bacteria Detected by an Extended Raman-Based Antibiotic Susceptibility Test.

Worldwide, multiresistant bacterial strains are emerging at unprecedented rates. This development seriously threatens the ability of humanity to treat even common infections, resulting in disability and death. Furthermore, this development endangers all medical achievements including cancer therapy or organ transplantations. Therefore, the World Health Organization has endorsed antimicrobial resistance as a great threat to humanity. To still allow effective treatment of patients, rapid, automated, and reliable antibiotic susceptibility testing (AST) of bacterial pathogens is essential. Thereby, speed and sensitivity of the AST results are crucial for improving patient care. Here, Raman spectroscopy as a nondestructive technique providing chemical-specific information is employed to monitor the deuterium uptake of metabolically active bacteria during antibiotic treatment, enabling fast and reliable AST. For this purpose, a bulk sample-preparation method was developed, allowing a high-throughput analysis of a significant number of cells. A protocol was developed for Gram-positive (Enterococcus faecalis) and Gram-negative (Escherichia coli) reference strains and was tested on 51 clinical isolates with well-characterized resistance phenotypes against ampicillin, ciprofloxacin, meropenem, and vancomycin. Borderline resistant and heteroresistant phenotypes were observed and further investigated. This is of critical importance as the sensitive detection of low-frequency heteroresistance in bacterial populations is a huge challenge. Such isolates seem susceptible but are resistant to treatment in vivo. Automatable analysis detects strong phenotypes within 3 h. On the basis of experimental and modeled data, heteroresistance is estimated to be detectable down to frequencies of 10-6 and investigated on clinical isolates as a proof-of-concept study, but requiring longer incubation time.

[Urinary tract infections : What has been confirmed in therapy?] / Harnwegsinfektionen : Was ist gesichert in der Therapie?

Urinary tract infections (UTIs) affect approximately 150 million people worldwide per year, causing annual health costs of over three billion dollars just in the USA. Every second woman experiences at least one UTI in her lifetime, with every one in four experiencing recurrence. Uncomplicated infections like single or recurrent cystitis and pyelonephritis can be distinguished from complicated disease. UTIs in men can spread to the male glands, causing prostatitis and epididymitis. Antibiotic therapy is the standard procedure for UTIs. However, the extensive and sometimes irrational use of antibiotics for the treatment of infections has led to an increase in the incidence of multiresistant pathogens in recent years. Therefore, preventive nonantibiotic approaches are of great interest. This article provides an overview of the current management of urological infections as well as an outline of nonantibiotic preventive treatment modalities.

[Chronic prostatitis/chronic pelvic pain syndrome]. / Chronische Prostatitis/chronisches Beckenschmerzsyndrom.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is defined as chronic pain or discomfort in the pelvic region for at least 3 of the past 6 months. It is variably associated with lower urinary tract symptoms, psychosocial consequences, and sexual dysfunction. Specific test systems or biomarkers for a definitive diagnosis are still not available. The purposes of the basic diagnostic assessment are to determine the individual spectrum of symptoms and to rule out differential diagnoses of pelvic pain. Patient-reported outcome measures (PROMs) like the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) are valuable instruments for the initial diagnostic assessment and to evaluate treatment response. Classification systems like UPOINTS (urinary, psychosocial, organ specific, infection, neurologic/systemic, tenderness of skeletal muscles, sexual dysfunction) are valuable tools to determine the individual spectrum of symptoms, to guide the adapted diagnostic assessment, and to identify relevant targets for a multimodal and tailored treatment. Close urological monitoring of CP/CPPS patients is usually necessary, especially to minimize the unwarranted use of antibiotics in the case of undulating complaints.

[Urinary diversion for acute epididymitis : Transurethral or suprapubic catheter?] / Harnableitung bei akuter Epididymitis : Transurethraler oder suprapubischer Katheter?

Acute infective epididymitis is the most common cause for scrotal pain in adults. The severe course of the disease requires immediate antimicrobial management, comprised antibiotic treatment and supportive measures. Patients with chronic indwelling catheters and developing epididymitis show a more severe clinical course compared to patients without a catheter. Although it is common clinical practice to place a catheter for the treatment of a systemic infectious condition of the genitourinary tract, there is only limited evidence of support due to the absence of clinical trials.

[Viral infections in urology]. / Virusinfektionen in der Urologie.

INTRODUCTION: The COVID (coronavirus disease 2019) pandemic has shown impressively that infectious diseases can have an enormous impact on the healthcare system and beyond. In the specialty of urology, patients present in daily practice with viral infections that are associated with numerous diseases. METHODOLOGY: The aim of this review is to describe viral infections relevant for urology, and in particular to emphasize vaccination prevention. A selective literature search was carried out on the subjects of "COVID and urology", "urogenital viral infections", "viral urological infections in transplant medicine", and "vaccination prevention of viral diseases". RESULTS: Coronaviruses have already caused two local epidemics: SARS (severe acute respiratory syndrome) epidemic and MERS (Middle East respiratory syndrome) epidemic. The fact that the SARS-CoV­2 (SARS coronavirus 2) disease is contagious even without symptoms has essentially led to the rapid spread and global pandemic. A large number of viruses, which can also induce viremia, have been detected in the ejaculate and are thus associated with a possible urogenital infection. These include the mumps virus, Coxsackie viruses or enteroviruses, among others. It has also been shown that a Zika virus infection can also be sexually transmitted via the sperm as a carrier. Viruses therefore also play an important role in reproduction. When performing kidney transplants, urologists are often confronted with viral infections. The most effective weapon against viruses is prevention by vaccination. CONCLUSION: In terms of ethiopathogenesis, the genitourinary tract is most often affected by viruses, in the context of viremia or through reactivation due to immunosuppression. Immunomodulation and vaccination prophylaxis play a leading role in therapy.

[The microbiome in benign prostatic hyperplasia]. / Das Mikrobiom beim benignen Prostatasyndrom.

The advent of new high throughput sequencing technologies has paved the way for microbiome research, opening up entirely new perspectives on the complex and diverse ecosystems of the human body. One of the main findings was that it became clear that in contrast to the widely held dogma the urinary tract is not a sterile environment. As for all niches of the human body, a well-balanced microbiome is an essential part for the physiological functioning of the urinary tract and therefore it must be considered a prerequisite for health. The dysbalance of the microbiome is now seen as having a considerable impact on the pathogenesis of a plethora of diseases. Its role in benign disorders, such as interstitial cystitis, urinary urge incontinence and chronic prostatitis/chronic pelvic pain syndrome as well as participation in malignant conditions, such as prostate cancer has recently been revealed. The contribution of the urinary microbiome to the pathogenesis and progression of lower urinary tract symptoms due to benign prostatic obstruction are currently under investigation.

[Chronic prostatitis/chronic pelvic pain syndrome]. / Chronische Prostatitis/chronisches Beckenschmerzsyndrom.

Chronic prostatitis (CP, or chronic pelvic pain syndrome, CPPS) is defined as chronic pain or discomfort in the pelvic region for at least 3 of the past 6 months, often accompanied by lower urinary tract symptoms, psychosocial impairments and sexual dysfunction. Currently, no biomarkers or clinical test procedures for a definitive diagnosis are available. The main objectives for the diagnostic assessment are to exclude differential diagnoses of pelvic pain and to determine the individual symptom profile of the patient. The UPOINTS classification identifies the individual clinical profile of the patient, provides guidance for the necessary diagnostic steps and is the foundation for a tailored multimodal, symptom-oriented and personalized treatment concept. Regular follow-up controls are needed to monitor the treatment response with the option to modify if necessary.

[The role of the microbiome in urology]. / Die Rolle des Mikrobioms in der Urologie.

With the advent of novel high throughput-sequencing technologies we gained greater insights into the complex and diverse interactions of the microbiome for health and disease in the human body. The concept of urinary sterility has long been dismissed and now we strive for deciphering various microbial signatures associated with a disease. A dysbalance of the microbiome appears to have a substantial impact on the pathogenesis of both malignant and benign conditions. Novel preventive and therapeutic approaches and biomarker systems have been proposed for prostate cancer, renal cell carcinoma and bladder cancer based on microbiome analyses. The exclusion of a microbial origin was always part of the diagnosis of benign disorders such as interstitial cystitis, urinary urge incontinence or chronic prostatitis/chronic pelvic pain syndrome. Now we are certain that an imbalanced microbial profile plays an essential role for the pathogenesis and disease management of these challenging conditions.

[Novel minimally invasive treatment options for male lower urinary tract symptom]. / Neue minimal-invasive Therapie des benignen Prostatasyndroms.

Novel minimally invasive treatment options strive for innovative approaches that are equally efficient to standard procedures with a superior safety profile. A true minimally invasive technique can be performed in an ambulatory setting under local anaesthesia and no need for postinterventional catheterization so that quick and problem-free return to everyday life is possible. Sexual dysfunction is a great concern of sexually active patients facing surgery. The novel techniques clearly demonstrate that relief of bothersome lower urinary tract symptoms (LUTS) is possible without compromising erectile and ejaculatory function. Urolift® is an attractive treatment option for carefully selected patients without a middle lobe who have special interest in the rapid and smooth return to daily activity and the complete preservation of sexual function. Rezum® and AquaBeam® are promising novel techniques that can be also performed in the presence of certain prostatic features like a middle lobe. iTIND® is still in its infancy of clinical evaluation and therefore, its true value still needs to be determined. According to current data the role of intraprostatic injectables for the treatment of male LUTS is still unclear.

[Pathogenesis of urinary tract infections : An update]. / Pathogenese der Harnwegsinfektion : Ein Update.

Urinary tract infections are among the most common bacterial infections worldwide. The management has become a public health concern of socioeconomic importance. Every second woman will experience at least one episode in her lifetime. Due to the emergence of multiresistant pathogens and the developmental void, treatment has become more challenging over the years. Deciphering the complex molecular interaction between host and pathogen is necessary to identify potent treatment targets for future approaches. The objective of this review is to present novel aspects on the pathogenesis of urinary tract infections and its relevance for clinical practice.

[MRI of the prostate]. / MRT der Prostata.

New clinical and technological advances in the field of magnetic resonance imaging (MRI) and targeted image-guided biopsy techniques have significantly improved the detection, localization and staging as well as active surveillance of prostate cancer in recent years. Multiparametric MRI (mpMRI) is currently the main imaging technique for the detection, characterization and diagnostics of metastasizing prostate cancer and is of high diagnostic importance for local staging within the framework of the detection of prostate cancer.

[Minimally invasive treatment of benign prostatic hyperplasia]. / Minimal-invasive Therapie des benignen Prostatasyndroms.

Novel minimally invasive treatment options for the management of male lower urinary tract symptoms (LUTS) due to bladder outlet obstruction (BOO) aim to provide equal efficacy compared to standard techniques with a more favourable safety profile. The preservation of all aspects of male sexual function including antegrade ejaculation is increasingly important to patients. It should be ideally performed in an outpatient setting under local anesthesia to assure a short recovery time. Novel injectables for intraprostatic application (botulinum neurotoxin A, NX-1207, PRX302) have emerged and first phase III results could not confirm the promising initial data. For mechanical devices like Urolift® the early and mid-term benefits demonstrate a rapid and durable symptom relief without compromising sexual function. Novel innovative procedures like aquablation (AquaBeam®) are entering the scene, but their feasibility, efficacy and safety still need to be addressed in randomized controlled trials.

[Current Aspects on the Pathogenesis of Urinary Tract Infections]. / Aktuelle Aspekte zur Pathogenese der Harnwegsinfektion.

Urinary tract infections are among the most common bacterial infectious diseases worldwide. Every second woman will experience at least one urinary tract infection in her lifetime. The administration of antibiotics has been a safe and efficient treatment modality so far. However, due to the emergence of multi-resistant pathogens and the developmental void of new antimicrobial drugs, the therapy of infections mighty become more challenging in the near future. So, knowledge of the complex host-pathogen interaction is of great importance. Common phenotypes observed in clinical practice suggest basic principles, which are relevant for the development of novel antimicrobial strategies. With invading pathogens forming intracellular bacterial communities they evade host response and provide a nidus for recurrent infection. A plethora of virulence factors allow uropathogenic bacteria to colonize and to establish infections in the urinary tract. In response, host responses seem to address specific virulence mechanisms that are essential to pathogenicity. Deciphering the molecular mechanisms underlying the complex host-pathogen interaction is critical to devise novel treatment options.

[Management of multiresistant pathogens in urology]. / Management multiresistenter Erreger in der Urologie.

Epidemiological data from recent years confirm the increasing problem of antimicrobial resistance not only for healthcare-associated, gram-positive pathogens but also for gram-negative bacteria. In particular, the progressive increase in resistance to third generation cephalosporins and carbapenems in Enterobacteriaceae is of great concern. With its contribution to infectious morbidity, mortality and financial costs to healthcare systems worldwide, multidrug-resistant pathogens emerge more and more as a public health issue of substantial socioeconomic importance. The Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute (RKI) decided to formulate novel definitions for multidrug-resistance in order to develop hygiene measures for infections and colonization with multidrug-resistant gram-negative bacilli.

[Perioperative antibiotic prophylaxis for major urological interventions]. / Perioperative Antibiotikaprophylaxe bei großen urologischen Eingriffen.

BACKGROUND: With the emergence of multidrug resistant bacteria reaching alarming levels and the year-long developmental void of new antimicrobial drugs, the rational and appropriate use of antibiotics is of paramount importance. The number of surgical interventions is still increasing so that surgical site infections represent the most frequent form of nosocomial infection. METHOD: Fundamental hygiene measures as well as aseptic and tissue-preserving surgical techniques are supported by perioperative antibiotic prophylaxis to prevent surgical site infections. This is accomplished by a single short-term antibiotic administration at the beginning of or at the latest during the operative intervention. Due to its contribution to the total consumption of antibiotics and when misused to the development of multidrug resistance, an appropriate and controlled perioperative antibiotic prophylaxis is mandatory. INDICATION: The indications for perioperative antibiotic prophylaxis depend on the type of surgical procedure, the classification of operative wounds as well as individual patient and operation-related risk factors.

[Antibiotic resistance and their significance in urogenital infections: new aspects]. / Antibiotikaresistenz und deren Bedeutung bei urogenitalen Infektionen : Neue Aspekte.

Urinary tract infections (UTI) are among the most frequent bacterial infections and therefore make a significant contribution to the widespread use and extensive misuse of antibacterial drugs. The amount of antibiotics used directly correlates with the emergence of antibiotic resistance. The World Health Organization (WHO) has recently issued a fact sheet highlighting the worldwide increase in antibiotic resistance. The spectrum of urological diseases affected by antibiotic resistance ranges from benign uncomplicated cystitis to severe life-threatening urosepsis and from urethritis to multidrug resistant tuberculosis. The European Section of Infections in Urology (ESIU) performs an annual surveillance study to evaluate antibiotic resistance in urology which revealed excessively high resistance rates, similar to other surveillance studies. In the light of these developments the World Alliance against Antibiotic Resistance (WAAAR) has advocated a 10-point action plan to combat the rapid rise of worldwide antibiotic resistance.

[Diagnostics of benign prostate syndrome]. / Diagnostik des benignen Prostatasyndroms.

The diagnostic work-up of lower urinary tract symptoms (LUTS) in the German guidelines consists of obligatory and optional diagnostic parameters. Recommendations for assessing LUTS include patient history, symptom questionnaires (IPSS international prostate symptoms score), physical examination, urine analysis, prostate-specific antigen, uroflowmetry, ultrasound examination of the urinary bladder, including postvoid residual urine and ultrasound examination of the upper urinary tract. Optional tests are voiding diary, pressure-flow studies, ultrasound measurement of detrusor wall thickness, urethrocystography and urethrocystoscopy. Ultrasound measurement of detrusor wall thickness in particular has a 95 % positive predictive value in diagnosing bladder outlet obstruction. With all diagnostic parameters it is possible to treat LUTS in a risk-adapted manner.

[Etiology and pathophysiology of benign prostate hyperplasia]. / Ätiologie und Pathophysiologie der benignen Prostatahyperplasie.

The pathogenesis of benign prostate hyperplasia (BPH) is still unclear. It is a common disease affecting exclusively humans in its full clinical appearance. There is a broad variety of possible underlying mechanisms which most likely interact in the pathogenesis of the disease: inflammatory processes taking place predominantly in the stroma and inducing proliferation of all tissues within the transitional zone, an imbalance of androgens and estrogens and their receptors, hyperinsulinemia and hypercholesterolemia (metabolic syndrome) as direct promoters of glandular growth and autosomal dominant inheritance. The detrusor muscle responds to the increased outflow resistance with muscular hypertrophy. Decreased compliance of the bladder wall results in voiding difficulties while electric instability of the hypertrophied detrusor muscle and increased recruiting of otherwise silent afferent fibres cause storage symptoms.