An Investigation of the Male Genitourinary Abscess Originated from Urinary Tract in a Tertiary Hospital, Shanghai, China, from 2004 to 2019

Abstract

Background: Male genitourinary abscess is one of the serious complications of urinary tract infections (UTIs). There were few researches on the clinical and pathogenic characteristics of male genitourinary abscess. Patients and Methods: A retrospective observational study was conducted between January 2004 and April 2019. Male patients with genitourinary abscess originated from urinary tract, including sites of scrotum, testis, epididymis, spermatic cord, and prostate, were enrolled. Clinical and microbial records were collected and analyzed, and antimicrobial susceptibility testings were performed according to CLSI standard. Whole-genome sequencing was applied to detect the β-lactamase genes and virulence genes, as well as to determine the multilocussequence typing (MLST) of the collected Klebsiella pneumoniae (K. pneumoniae) isolates. Results: A total of 22 male patients were included. The main clinical symptoms were fever (86.4%), scrotal swelling (68.2%), local skin warmth (59.1%) and ulceration (45.5%). Urinary irritation was often presented in prostate involved abscess. Ultrasound features had a 94.7% positive rate. Surgical treatment, including abscess drainage, was helpful to the prognosis. No matter where the specimens obtained from, including blood, urine or pus, multidrug-resistant K. pneumoniae was the dominant (11 cases, 50.0%) microorganism in positive cultures. Nine of eleven K. pneumoniae isolates had been preserved and recovered. As for MLST typing, all the nine available isolates of K. pneumoniae belonged to the ST11 type and characterized with bla KPC-2 carbapenemase gene. Virulence genes rmpA2, ybtS, kfuC, wzi, aerobactin genes (iucABCD and iutA) and type 3 fimbriae genes (mrkAD) were identified in all the K. pneumoniae isolates. Conclusion:It seemed that more patients under 35 years old were vulnerable to genitourinary abscess. There was an increasing trend that multidrug-resistant K. pneumoniae isolates with multiple virulence genes were involved in male genitourinary abscess. Prompt and proper antibiotic use, combined with adequate drainage of the abscess, was important to prognosis.

Pulmonary Abscess Secondary to Epididymitis Caused by Extended Spectrum β-Lactamase- Producing Hypervirulent Klebsiella pneumoniae: A Case Report

“…Acute epididymitis is a common urological emergency characterized by redness, swelling, and pain in the scrotum, often accompanied by fever and chills. In recent years, K. pneumoniae infections causing epididymitis and epididymal abscesses have been increasingly reported [1]. Acute epididymitis can occur through retrograde, hematogenous, lymphatic, and other routes, and is frequently secondary to urinary tract infections, long-term indwelling urinary catheters, invasive urethral procedures, urethral strictures, and obstructions.…”

Clinical characteristics, management, and treatment outcomes of epididymo-orchitis among patients in a referral hospital in Southern Saudi Arabia

“…Enteric Gram-negative bacteria have been well-documented as infectious agents responsible for EO in adult patients, with E. coli being the most commonly implicated pathogen [1]. The hematogenous route, originating from the bladder or ascending from the urethra, vas deferens, prostate and ejaculation duct, is considered a potential path of infection in cases of infective EO or testicular abscess [30]. Therefore, routine urinalysis and culture hold significant diagnostic value in identifying infectious causes of EO [28,31].…”