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 multilocus-sequence 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.

Keywords:

• male genitourinary abscess
• carbapenem-resistant Klebsiella pneumoniae
• virulence genes
• MLST type

Abbreviations

UTI, urinary tract infection; K. pneumoniae, Klebsiella pneumoniae; E. coli, Escherichia coli; ESBL, extended spectrum β-lactamase; EO, essential oil; CLSI, Clinical and Laboratory Standards Institute; PCR, polymerase chain reaction; bp, base pair; MLST, multilocus-sequence typing; cUTI, complicated UTI; SOFA, Sequential Organ Failure Assessment; AIDS, acquired immune deficiency syndrome; CRKP, carbapenem-resistant Klebsiella pneumoniae; SD, standard deviation; IQR, interquartile range; PLA, pyogenic liver abscess; ALO, Actinomyces-like organism; BSI, bloodstream infection; hvKP, hypervirulent Klebsiella pneumoniae; CT, computed tomography; MRI, magnetic resonance imaging.

Data Sharing Statement

All data generated or analyzed during this study are included in this published article.

Ethics Approval and Consent to Participate

The present study was approved by the Institutional Review Board (IRB) of Huashan Hospital, Fudan University. Specific patient consent to review their medical records, which contained in their consent form for admission, was not required by the IRB. The raw data were accessed from the photocopy medical record browser, which was granted by the director of Medical Record Administration through routine application procedure. The IRB approval included the statement covering patient data confidentiality and compliance with the Declaration of Helsinki.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.