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

Jiaying Tan; Mi Tian; Feng Zhao; Shuixiang Deng; Peng Jin; Yao Wang; Huimei Wen; Xiaohua Qin; Ye Gong

doi:10.2147/IDR.S298250

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

Infect Drug Resist. 2021 May 14:14:1795-1803. doi: 10.2147/IDR.S298250. eCollection 2021.

Authors

Jiaying Tan^#¹, Mi Tian^#¹, Feng Zhao¹, Shuixiang Deng¹, Peng Jin¹, Yao Wang¹, Huimei Wen¹, Xiaohua Qin^{2

3}, Ye Gong^{1

4}

Affiliations

¹ Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China.
² Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China.
³ Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, 200040, People's Republic of China.
⁴ Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China.

^# Contributed equally.

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: MLST type; carbapenem-resistant Klebsiella pneumoniae; male genitourinary abscess; virulence genes.

Grants and funding

The present study was supported by National Natural Science Foundation of China (Grant No. 81401699), National Key R&D Program of China (Grant No. 2018YFC1312600 and 2018YFC1312604 to YG), Scientific Research Project from Shanghai Municipal Health Commission (Grant No. 202040422) and The Scientific Research Project supported by Huashan Hospital, Fudan University (Grant No. Y845).