Acta Medica Okayama2001尿路感染症由来Enterococcus faecalisの病原性因子に関する分子疫学的検討ENAyanoIshiiNo potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155811312001尿路感染症由来 Enterococcus faecalis の病原性因子に関する分子疫学的検討1725ENAyanoIshiiEnterococcus faecalis is a frequent cause of hospital-acquired infection. Two hundred fifty one E. faecalis isolates from patients with urinary tract infection at Okayama University Hospital over an 8-year period from 1991 through 1998 were collected. The presence of the asaⅠ, cylA, aac (6')-aph (2''), and aph (3')-Ⅲgenes was analyzed by PCR methods. Of the 251 isolates, 205(81.7%) were positive for asaⅠ. The 81.5% (167/205) of asaⅠ-positive isolates also possessed either cylA or aminoglycoside resistance genes, compared to only 15.2% of (7/46) asaI-negative isolates (p<0.0001). The incidence of asaI gradually increased from 69.2% in 1991 to 90.7% in 1998. The number of isolates that contain asaI, cylA and asaI-positive and hemolysin-producing isolates revealed 22 different banding patterns, including 6 pairs with similar patterns. The plasmid analyses of these isolates showed different patterns except for 1 pair with similar PFGE pattern. These results suggest that E. faecalis possessing the asaⅠ gene may play an important role in the exchange of genetic information among enterococci in the urinary tract.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6612012Laparoscopic-Assisted Tension-free Vaginal Mesh: An Innovative Approach to Placing Synthetic Mesh Transvaginally for Surgical Correction of Pelvic Organ Prolapse2329ENToyohikoWatanabeMiyabiInoueAyanoIshiiToyokoYamatoMasumiYamamotoKatsumiSasakiYasuyukiKobayashiMotooArakiShinyaUeharaTakashiSaikaHiromiKumonOriginal Article10.18926/AMO/48078Polypropylene mesh implants for the correction of pelvic organ prolapse (POP) are now available in Japan. We developed an innovative approach for correcting POP by placing polypropylene mesh transvaginally with laparoscopic assistance. From June 2007 through March 2010, sixteen consecutive patients with symptomatic stage 2 or 3 pelvic organ prolapse underwent the laparoscopic-assisted tension-free vaginal mesh procedure at Okayama University Hospital. All patients were evaluated before and at 1, 3, 6, and 12 months after surgery. Female sexual function was also evaluated with the Female Sexual Function Index (FSFI). The procedure was performed successfully without significant complications. Fifteen of 16 patients were considered anatomically cured (93.8%) at 12 months postoperatively. One patient with a recurrent stage 3 vaginal vault prolapse required sacral colpopexy six months postoperatively. Total FSFI scores improved significantly from 10.3±1.3 at baseline to 18.0±1.2 at 12 months after surgery. The laparoscopic-assisted trans-vaginal mesh is a safe, effective, and simple procedure for POP repairs. The procedure not only restores anatomic relationships but also improves sexual function.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6822014Molecular Epidemiology and Clinical Implications of Metallo-β-Lactamase-Producing Pseudomonas aeruginosa Isolated from Urine8999ENShinichiSakoReikoKariyamaRitsukoMitsuhataMasumiYamamotoKoichiroWadaAyanoIshiiShinyaUeharaSusumuKokeguchiNobuchikaKusanoHiromiKumonOriginal Article10.18926/AMO/52405We conducted a study on molecular epidemiology and clinical implications of metallo-β-lactamase (MBL)-producing Pseudomonas aeruginosa isolated from urine. Over a 10-year period from 2001 through 2010, a total of 92 MBL-producing P. aeruginosa urine isolates were collected from patients (one isolate per patient) who were admitted to 5 hospitals in Okayama Prefecture, Japan. When cross-infection was suspected in the hospital, pulsed-field gel electrophoresis was performed. In the resulting dendrogram of 79 MBL-producing P. aeruginosa urine isolates, no identical isolates and 7 pairs of isolates with ≥80% similarity were found. The biofilm-forming capabilities of 92 MBL-producing P. aeruginosa urine isolates were significantly greater than those of 92 non-MBL-producing urine isolates in a medium of modified artificial urine. The imipenem resistance transferred in 16 of 18 isolates tested, and these frequencies were in the range of 10-3 to 10-9. All of 18 isolates tested belonged to internationally spread sequence type 235 and had 3 gene cassettes of antimicrobial resistance genes in the class 1 integron. The strong biofilm-forming capabilities of MBL-producing P. aeruginosa urine isolates could be seriously implicated in nosocomial infections. To prevent spread of the organism and transferable genes, effective strategies to inhibit biofilm formation in medical settings are needed.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7042016A Phase II Clinical Trial Evaluating the Preventive Effectiveness of Lactobacillus Vaginal Suppositories in Patients with Recurrent Cystitis299302ENKoichiroWadaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShinyaUeharaDepartment of Urology, Kawasaki Hospital, Kawasaki Medical SchoolAyanoIshiiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakuyaSadahiraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMasumiYamamotoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesRitsukoMitsuhataDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesAtsushiTakamoto Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMotooArakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasuyukiKobayashiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMasamiWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToyohikoWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKatsuyukiHottaCenter for innovative Clinical Medicine, Okayama University HospitalYasutomoNasuDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesClinical Study Protocols10.18926/AMO/54508Urinary tract infections (UTIs) are the most common bacterial infections in women, and many patients experience frequent recurrence. The aim of this report is to introduce an on-going prospective phase II clinical trial performed to evaluate the preventive effectiveness of Lactobacillus vaginal suppositories for prevention of recurrent cystitis. Patients enrolled in this study are administered vaginal suppositories containing the GAI 98322 strain of Lactobacillus crispatus every 2 days or 3 times a week for one year. The primary endpoint is recurrence of cystitis and the secondary endpoints are adverse events. Recruitment began in December 2013 and target sample size is 20 participants.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7562021Clinical Efficacy and Safety of Sitafloxacin 200 mg Once Daily for Refractory Genitourinary Tract Infections763766ENTakehiroIwataDepartment of Urology, Okayama University HospitalTakuyaSadahiraDepartment of Urology, Okayama University HospitalYukiMaruyamaDepartment of Urology, Okayama University HospitalTakanoriSekitoDepartment of Urology, Okayama University HospitalKasumiYoshinagaDepartment of Urology, Okayama University HospitalShogoWatariDepartment of Urology, Okayama University HospitalKentaroNagaoDepartment of Urology, Okayama University HospitalTatsushiKawadaDepartment of Urology, Okayama University HospitalYusukeTominagaDepartment of Urology, Okayama University HospitalShingoNishimuraDepartment of Urology, Okayama University HospitalAtsushiTakamotoDepartment of Urology, Okayama University HospitalTomokoSakoDepartment of Urology, Okayama University HospitalKoheiEdamuraDepartment of Urology, Okayama University HospitalYasuyukiKobayashiDepartment of Urology, Okayama University HospitalMotooArakiDepartment of Urology, Okayama University HospitalAyanoIshiiDepartment of Urology, Okayama University HospitalMasamiWatanabeDepartment of Urology, Okayama University HospitalToyohikoWatanabeDepartment of Urology, Okayama University HospitalYasutomoNasuDepartment of Urology, Okayama University HospitalKoichiroWadaDepartment of Urology, Okayama University HospitalClinical Study Protocol10.18926/AMO/62820The aim of this ongoing trial is to evaluate the clinical efficacy and safety of sitafloxacin (STFX) 200 mg once daily (QD) for 7 days in patients with refractory genitourinary tract infections, which include recurrent or complicated cystitis, complicated pyelonephritis, bacterial prostatitis, and epididymitis. The primary endpoint is the microbiological efficacy at 5-9 days after the last administration of STFX. Recruitment began in February 2021, and the target total sample size is 92 participants.No potential conflict of interest relevant to this article was reported.Frontiers MediaActa Medica Okayama1664-302X142023Etiology of recurrent cystitis in postmenopausal women based on vaginal microbiota and the role of Lactobacillus vaginal suppository1187479ENTakanoriSekitoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceKoichiroWadaDepartment of Urology, Shimane University Faculty of MedicineAyanoIshiiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceTakehiroIwataDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceTakehiroMatsubaraOkayama University Hospital Biobank, Okayama University HospitalShutaTomidaCenter for Comprehensive Genomic Medicine, Okayama University HospitalMasamiWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceMotooArakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceTakuyaSadahiraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceBackground: The vaginal microbiota can be altered by uropathogenic bacteria associated with recurrent cystitis (RC), and the vaginal administration of Lactobacillus have suggested certain effects to prevent RC. The relationship between vaginal microbiota and the development of RC has not been elucidated. We aimed to clarify the etiology of RC from vaginal microbiota and importance of vaginal Lactobacillus. <br>
Methods: Vaginal samples obtained from 39 postmenopausal women were classified into four groups: healthy controls; uncomplicated cystitis; RC; and prevention (prevented RC by Lactobacillus crispatus-containing vaginal suppositories). Principal coordinate analysis and beta-diversity analysis was used to assess 16S rRNA gene sequencing data from the vaginal microbiome. <br>
Results: Cluster analysis divided the vaginal bacterial communities among 129 vaginal samples into three clusters (A, B, and C). Fourteen of 14 (100%) samples from the RC group and 51 of 53 (96%) samples from the prevention group were in clusters B and C, while 29 of 38 (76%) samples from the healthy group and 14 of 24 (58%) samples from the uncomplicated cystitis group were in cluster A. The principal coordinate analysis showed that plots in the uncomplicated cystitis group were similar to the healthy group, indicating a large separation between the RC group and the uncomplicated cystitis group. On beta-diversity analysis, there were significant differences between the healthy group and the uncomplicated cystitis group (p = 0.045), and between the RC group and the uncomplicated cystitis group or the healthy group (p = 0.001, p = 0.001, respectively). There were no significant differences between the RC group and the prevention group (p = 0.446). The top six taxa were as follows: Prevotella, Lactobacillus, Streptococcus, Enterobacteriaceae, Anaerococcus, and Bifidobacterium. Among patients with RC, Lactobacillus was undetectable before administration of suppositories, while the median relative abundance of Lactobacillus was 19% during administration of suppositories (p = 0.0211), reducing the average cystitis episodes per year (6.3 vs. 2.4, p = 0.0015). <br>
Conclusion: The vaginal microbiota of postmenopausal women with RC is differed from healthy controls and uncomplicated cystitis in terms of lack of Lactobacillus and relatively dominant of Enterobacteriaceae. Vaginal administration of Lactobacillus-containing suppositories can prevent RC by stabilizing vaginal dysbiosis and causing a loss of pathogenic bacteria virulence.No potential conflict of interest relevant to this article was reported.