Journal of Infection and Chemotherapy最新文献

Successful treatment of an intra-abdominal abscess caused by KPC-2-producing hypervirulent Klebsiella pneumoniae sequence type 11 with imipenem/cilastatin/relebactam in a Japanese patient

IF 1.9 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-04-22 DOI: 10.1016/j.jiac.2025.102717

Kazuhiro Ishikawa , Koko Shibutani , Yumiko Mikami , Sohei Harada , Kohji Komori , Nobuyoshi Mori

KPC-producing K. pneumoniae is rare in Japan. In China, KPC-2-producing sequence type (ST)11 K. pneumoniae isolates have been rapidly increasing, and a subset of these isolates have acquired hypervirulence. We report a case of a 39-year-old Japanese male who developed bacteremia and intra-abdominal abscesses caused by hypervirulent carbapenem-resistant K. pneumoniae. The patient sustained abdominal injuries following a traffic accident in Xinjiang Uygur Autonomous Region and underwent abdominal surgery before being transferred to our hospital. Abscess drainage was performed, and he was initially treated with meropenem (2 g every 8 hours, prolonged infusion over 3 hours), gentamicin (5 mg/kg/day), and tigecycline (200 mg as a loading, followed by 100 mg every 12 hours). KPC carbapenemase was detected using the NG-Test® CARBA 5 (NG Biotech, France), and the minimum inhibitory concentration for imipenem/cilastatin/relebactam was 1 μg/mL, indicating susceptibility. His treatment was switched to imipenem/cilastatin/relebactam (1 g every 6 hours) for 7 weeks, resulting in clinical improvement. Whole-genome sequencing analysis revealed that the causative strain was hypervirulent KPC-2-producing K. pneumoniae (capsular type K64, ST 11) carrying bla_KPC-2 and bla_CTX-M-65 on a multireplicon plasmid (pMTY24772_IncFII-R), which was a fusion of IncFII and IncR. Additionally, rmpA and iucABCD genes associated with hypervirulence were detected. The strain carried a resistance plasmid and a virulence plasmid similar to those carried by ST11-K64 KPC-producing strains reported from China. Imipenem/cilastatin/relebactam is potentially an option for treating infections caused by KPC-2-producing hypervirulent K, pneumoniae with porin mutations. Cross-border spread of pathogens that are both multidrug-resistant and hyperviirulent must be closely monitored.

{"title":"Successful treatment of an intra-abdominal abscess caused by KPC-2-producing hypervirulent Klebsiella pneumoniae sequence type 11 with imipenem/cilastatin/relebactam in a Japanese patient","authors":"Kazuhiro Ishikawa , Koko Shibutani , Yumiko Mikami , Sohei Harada , Kohji Komori , Nobuyoshi Mori","doi":"10.1016/j.jiac.2025.102717","DOIUrl":"10.1016/j.jiac.2025.102717","url":null,"abstract":"<div><div>KPC-producing <em>K. pneumoniae</em> is rare in Japan. In China, KPC-2-producing sequence type (ST)11 <em>K. pneumoniae</em> isolates have been rapidly increasing, and a subset of these isolates have acquired hypervirulence. We report a case of a 39-year-old Japanese male who developed bacteremia and intra-abdominal abscesses caused by hypervirulent carbapenem-resistant <em>K. pneumoniae</em>. The patient sustained abdominal injuries following a traffic accident in Xinjiang Uygur Autonomous Region and underwent abdominal surgery before being transferred to our hospital. Abscess drainage was performed, and he was initially treated with meropenem (2 g every 8 hours, prolonged infusion over 3 hours), gentamicin (5 mg/kg/day), and tigecycline (200 mg as a loading, followed by 100 mg every 12 hours). KPC carbapenemase was detected using the NG-Test® CARBA 5 (NG Biotech, France), and the minimum inhibitory concentration for imipenem/cilastatin/relebactam was 1 μg/mL, indicating susceptibility. His treatment was switched to imipenem/cilastatin/relebactam (1 g every 6 hours) for 7 weeks, resulting in clinical improvement. Whole-genome sequencing analysis revealed that the causative strain was hypervirulent KPC-2-producing <em>K. pneumoniae</em> (capsular type K64, ST 11) carrying <em>bla</em><sub>KPC-2</sub> and <em>bla</em><sub>CTX-M-65</sub> on a multireplicon plasmid (pMTY24772_IncFII-R), which was a fusion of IncFII and IncR. Additionally, <em>rmpA</em> and <em>iucABCD</em> genes associated with hypervirulence were detected. The strain carried a resistance plasmid and a virulence plasmid similar to those carried by ST11-K64 KPC-producing strains reported from China. Imipenem/cilastatin/relebactam is potentially an option for treating infections caused by KPC-2-producing hypervirulent <em>K, pneumoniae</em> with porin mutations. Cross-border spread of pathogens that are both multidrug-resistant and hyperviirulent must be closely monitored.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 6","pages":"Article 102717"},"PeriodicalIF":1.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluation of antibiotic de-escalation based on the DASON criteria by pharmacist-led post-prescription review and feedback: A retrospective study in a medium-sized Japanese hospital

IF 1.9 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-04-21 DOI: 10.1016/j.jiac.2025.102716

Atsuhiro Mizushima , Satoru Mitsuboshi , Seiya Kobayashi , Kaori Hara , Yoshiaki Ara , Toshihiko Agatsuma

Introduction

Among antimicrobial stewardship team (AST) activities, de-escalation, which is aimed at optimizing antibiotic use, lacks a standardized evaluation method. The Duke Antimicrobial Stewardship Outreach Network (DASON) criteria provide a framework for assessing de-escalation; however, their applicability in small to medium-sized hospitals in Japan has remained unclear. We aimed to evaluate the effectiveness of AST pharmacist-led post-prescription review and feedback (PPRF) using multiple indicators, including de-escalation based on the DASON criteria, to determine whether these indicators are also applicable in medium-sized hospitals.

Methods

A retrospective study was conducted at a 330-bed hospital, comparing pre-PPRF (April 2021 to March 2022) and post-PPRF (April 2022 to March 2023) periods. The effectiveness of AST pharmacist-led PPRF was evaluated using the de-escalation rate determined by the DASON criteria, inappropriate antibiotic use in definitive therapy, days of therapy (DOT), and days of antibiotic spectrum coverage (DASC) per DOT.

Results

The de-escalation rate significantly increased from 20 % to 45 % (P < 0.01), and inappropriate antibiotic use in definitive therapy decreased from 7 % to 0 % after AST pharmacist-led PPRF. While DOT significantly increased from 11 days to 13 days (P = 0.02), no significant change was observed in the DASC/DOT ratio.

Conclusion

This study suggests that de-escalation based on the DASON criteria can be an effective quantitative indicator for evaluating AST pharmacist-led PPRF in medium-sized hospitals. The findings also suggest that incorporating multiple indicators tailored to each hospital's conditions can provide a more comprehensive framework for evaluating AST pharmacist-led PPRF.

{"title":"Evaluation of antibiotic de-escalation based on the DASON criteria by pharmacist-led post-prescription review and feedback: A retrospective study in a medium-sized Japanese hospital","authors":"Atsuhiro Mizushima , Satoru Mitsuboshi , Seiya Kobayashi , Kaori Hara , Yoshiaki Ara , Toshihiko Agatsuma","doi":"10.1016/j.jiac.2025.102716","DOIUrl":"10.1016/j.jiac.2025.102716","url":null,"abstract":"<div><h3>Introduction</h3><div>Among antimicrobial stewardship team (AST) activities, de-escalation, which is aimed at optimizing antibiotic use, lacks a standardized evaluation method. The Duke Antimicrobial Stewardship Outreach Network (DASON) criteria provide a framework for assessing de-escalation; however, their applicability in small to medium-sized hospitals in Japan has remained unclear. We aimed to evaluate the effectiveness of AST pharmacist-led post-prescription review and feedback (PPRF) using multiple indicators, including de-escalation based on the DASON criteria, to determine whether these indicators are also applicable in medium-sized hospitals.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted at a 330-bed hospital, comparing pre-PPRF (April 2021 to March 2022) and post-PPRF (April 2022 to March 2023) periods. The effectiveness of AST pharmacist-led PPRF was evaluated using the de-escalation rate determined by the DASON criteria, inappropriate antibiotic use in definitive therapy, days of therapy (DOT), and days of antibiotic spectrum coverage (DASC) per DOT.</div></div><div><h3>Results</h3><div>The de-escalation rate significantly increased from 20 % to 45 % (<em>P</em> < 0.01), and inappropriate antibiotic use in definitive therapy decreased from 7 % to 0 % after AST pharmacist-led PPRF. While DOT significantly increased from 11 days to 13 days (<em>P</em> = 0.02), no significant change was observed in the DASC/DOT ratio.</div></div><div><h3>Conclusion</h3><div>This study suggests that de-escalation based on the DASON criteria can be an effective quantitative indicator for evaluating AST pharmacist-led PPRF in medium-sized hospitals. The findings also suggest that incorporating multiple indicators tailored to each hospital's conditions can provide a more comprehensive framework for evaluating AST pharmacist-led PPRF.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 6","pages":"Article 102716"},"PeriodicalIF":1.9,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Post-vaccinal seronegative autoimmune encephalitis following recombinant zoster vaccination in two immunocompetent patients

IF 1.9 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-04-18 DOI: 10.1016/j.jiac.2025.102713

Tariq A. Madani , Abeer A. Khoja , Ahmad R. Abuzinadah , Ghada M. Abbas , Alaa A. Alotaibi , Ziad I. Alshehri , Salman T. Madani

Background

Varicella Zoster Virus (VZV) causes varicella as a primary infection and establishes latency in sensory ganglia. Reactivation in adults leads to herpes zoster (HZ). A highly effective recombinant zoster vaccine (Shingrix®) was recently developed to prevent HZ. While vaccine safety data is reassuring, we report two cases of post-vaccinal seronegative autoimmune encephalitis (AE) following the first dose of the Shingrix® vaccine.

Case 1

A 67-year-old male surgeon presented one week after receiving the vaccine with a one-day history of dizziness, fatigue, and insomnia, followed the next day by confusion, agitation, terrifying visual hallucinations, paraphasic errors, and echolalia. Brain imaging and cerebrospinal fluid (CSF) analysis were unremarkable. The CSF multiplex polymerase chain reaction (PCR) panel targeting 14 bacterial and viral pathogens associated with meningitis/encephalitis was negative. All known AE antibodies were also negative. The patient initially improved with empiric anti-meningitis/encephalitis therapy, including a two-day course of steroids but he relapsed shortly after stopping the steroids, necessitating re-admission. Pulse steroid therapy followed by plasmapheresis led to full recovery.

Case 2

A 50-year-old female pediatrician presented with acute confusion nine days after the Shingrix® vaccination. CSF analysis showed lymphocytic-predominant mild pleocytosis and elevated protein, but brain imaging was unremarkable. The CSF meningitis/encephalitis PCR panel and AE antibodies were negative. Pulse steroid therapy and plasmapheresis led to full recovery.

Conclusions

These two cases highlight the potential for AE following the administration of the Shingrix® vaccine and underscore the importance of prompt recognition and aggressive immunotherapy to prevent morbidity and mortality.

{"title":"Post-vaccinal seronegative autoimmune encephalitis following recombinant zoster vaccination in two immunocompetent patients","authors":"Tariq A. Madani , Abeer A. Khoja , Ahmad R. Abuzinadah , Ghada M. Abbas , Alaa A. Alotaibi , Ziad I. Alshehri , Salman T. Madani","doi":"10.1016/j.jiac.2025.102713","DOIUrl":"10.1016/j.jiac.2025.102713","url":null,"abstract":"<div><h3>Background</h3><div>Varicella Zoster Virus (VZV) causes varicella as a primary infection and establishes latency in sensory ganglia. Reactivation in adults leads to herpes zoster (HZ). A highly effective recombinant zoster vaccine (Shingrix®) was recently developed to prevent HZ. While vaccine safety data is reassuring, we report two cases of post-vaccinal seronegative autoimmune encephalitis (AE) following the first dose of the Shingrix® vaccine.</div></div><div><h3>Case 1</h3><div>A 67-year-old male surgeon presented one week after receiving the vaccine with a one-day history of dizziness, fatigue, and insomnia, followed the next day by confusion, agitation, terrifying visual hallucinations, paraphasic errors, and echolalia. Brain imaging and cerebrospinal fluid (CSF) analysis were unremarkable. The CSF multiplex polymerase chain reaction (PCR) panel targeting 14 bacterial and viral pathogens associated with meningitis/encephalitis was negative. All known AE antibodies were also negative. The patient initially improved with empiric anti-meningitis/encephalitis therapy, including a two-day course of steroids but he relapsed shortly after stopping the steroids, necessitating re-admission. Pulse steroid therapy followed by plasmapheresis led to full recovery.</div></div><div><h3>Case 2</h3><div>A 50-year-old female pediatrician presented with acute confusion nine days after the Shingrix® vaccination. CSF analysis showed lymphocytic-predominant mild pleocytosis and elevated protein, but brain imaging was unremarkable. The CSF meningitis/encephalitis PCR panel and AE antibodies were negative. Pulse steroid therapy and plasmapheresis led to full recovery.</div></div><div><h3>Conclusions</h3><div>These two cases highlight the potential for AE following the administration of the Shingrix® vaccine and underscore the importance of prompt recognition and aggressive immunotherapy to prevent morbidity and mortality.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 6","pages":"Article 102713"},"PeriodicalIF":1.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Treatment satisfaction and needs among people living with HIV who have incomplete viral load suppression in Japan: A multicenter, cross-sectional, observational study 日本病毒载量未完全抑制的艾滋病病毒感染者对治疗的满意度和需求：一项多中心、横断面观察研究

IF 1.9 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-04-17 DOI: 10.1016/j.jiac.2025.102711

Takeshi Kimura , Shinichi Hikasa , Masashi Ishihara , Mariko Tsukiji , Yusuke Kunimoto , Kazuko Nobori , Kenta Onishi , Yuuki Yamamoto , Kyohei Haruta , Yohei Kashiwabara , Kenji Fujii , Kazuhiro Yamamoto , Tomohiro Omura , Kei Ebisawa , Goh Ohji , Kentaro Iwata , Ikuko Yano

Objective

This study aimed to evaluate the association between viral-load (VL)-suppression status and treatment satisfaction, depression, anxiety, and treatment needs in people living with HIV (PLWH).

Methods

A multicenter, cross-sectional study was conducted from April to December 2021. Eligible patients were classified into two groups based on their VL in the year prior to answering the questionnaires: those with all VL < 50 copies/mL (complete-VL-suppression group) and those with at least one VL ≥ 50 copies/mL (incomplete-VL-suppression group). The HIV Treatment Satisfaction Questionnaire: Status (HIVTSQs), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), and the drug formulation needs were compared between the two groups.

Results

Of the 534 patients included in the analysis, 467 and 67 were classified into the complete and incomplete-VL-suppression groups, respectively. The total HIVTSQs scores (median [interquartile range (IQR)]) were 59.0 [53.0–64.0] and 56.0 [52.0–62.5] in the complete and incomplete-VL-suppression groups, respectively, with no significant difference. The incomplete-VL-suppression group scored significantly lower on the individual question for HIV control than the complete-VL-suppression group (5.0 [5.0–6.0] vs. 6.0 [5.0–6.0], P = 0.001). The total PHQ-9 and GAD-7 scores were not significantly different between the groups. The proportion of patients who preferred the once-every-month subcutaneous formulation was higher in the incomplete-VL-suppression group compared to the complete-VL-suppression group (16.4 % vs. 7.5 %, P = 0.028).

Conclusions

The association between VL-suppression status and overall treatment satisfaction, depression, or anxiety was not detected. However, satisfaction with HIV control and treatment needs may differ in PLWH with incomplete VL-suppression.

{"title":"Treatment satisfaction and needs among people living with HIV who have incomplete viral load suppression in Japan: A multicenter, cross-sectional, observational study","authors":"Takeshi Kimura , Shinichi Hikasa , Masashi Ishihara , Mariko Tsukiji , Yusuke Kunimoto , Kazuko Nobori , Kenta Onishi , Yuuki Yamamoto , Kyohei Haruta , Yohei Kashiwabara , Kenji Fujii , Kazuhiro Yamamoto , Tomohiro Omura , Kei Ebisawa , Goh Ohji , Kentaro Iwata , Ikuko Yano","doi":"10.1016/j.jiac.2025.102711","DOIUrl":"10.1016/j.jiac.2025.102711","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the association between viral-load (VL)-suppression status and treatment satisfaction, depression, anxiety, and treatment needs in people living with HIV (PLWH).</div></div><div><h3>Methods</h3><div>A multicenter, cross-sectional study was conducted from April to December 2021. Eligible patients were classified into two groups based on their VL in the year prior to answering the questionnaires: those with all VL < 50 copies/mL (complete-VL-suppression group) and those with at least one VL ≥ 50 copies/mL (incomplete-VL-suppression group). The HIV Treatment Satisfaction Questionnaire: Status (HIVTSQs), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), and the drug formulation needs were compared between the two groups.</div></div><div><h3>Results</h3><div>Of the 534 patients included in the analysis, 467 and 67 were classified into the complete and incomplete-VL-suppression groups, respectively. The total HIVTSQs scores (median [interquartile range (IQR)]) were 59.0 [53.0–64.0] and 56.0 [52.0–62.5] in the complete and incomplete-VL-suppression groups, respectively, with no significant difference. The incomplete-VL-suppression group scored significantly lower on the individual question for HIV control than the complete-VL-suppression group (5.0 [5.0–6.0] vs. 6.0 [5.0–6.0], <em>P</em> = 0.001). The total PHQ-9 and GAD-7 scores were not significantly different between the groups. The proportion of patients who preferred the once-every-month subcutaneous formulation was higher in the incomplete-VL-suppression group compared to the complete-VL-suppression group (16.4 % vs. 7.5 %, <em>P</em> = 0.028).</div></div><div><h3>Conclusions</h3><div>The association between VL-suppression status and overall treatment satisfaction, depression, or anxiety was not detected. However, satisfaction with HIV control and treatment needs may differ in PLWH with incomplete VL-suppression.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 6","pages":"Article 102711"},"PeriodicalIF":1.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Long-term functional prognosis with tocilizumab in severe COVID-19 infection: A multicenter prospective observational study on mechanically ventilated ICU patients in the COVID-19 recovery study II 使用托西珠单抗治疗 COVID-19 重症感染的长期功能预后：多中心前瞻性观察研究：COVID-19康复研究II中的机械通气ICU患者

IF 1.9 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-04-17 DOI: 10.1016/j.jiac.2025.102708

Junji Hatakeyama , Kensuke Nakamura , Naoki Kanda , Akira Kawauchi , Shigeki Fujitani , Taku Oshima , Hideaki Kato , Kohei Ota , Hiroshi Kamijo , Tomohiro Asahi , Yoko Muto , Miyuki Hori , Arisa Iba , Mariko Hosozawa , Hiroyasu Iso

Background

Tocilizumab, an IL-6 receptor antagonist, may prevent functional impairments in critically ill patients by attenuating the cytokine storm. This study investigated a potential effect of tocilizumab on preventing functional impairments in patients with severe coronavirus infection 2019 (COVID-19).

Methods

In a multicenter prospective observational study, patients with COVID-19 ≥ 20 years requiring mechanical ventilation admitted to the intensive care unit between April 2021 and September 2021 and discharged alive were followed for one year. A self-administered questionnaire on sequelae and functional impairments was mailed in August 2022, and data were collected. A multivariate logistic regression was used to assess the impact of tocilizumab on physical function, mental health, and Long COVID.

Results

Of 157 analyzed patients, 41 received tocilizumab. The tocilizumab group had more severe illness, but a lower prevalence of physical impairment (17.1 % vs. 23.3 %, p = 0.41) and mental disorders (19.5 % vs. 39.7 %, p = 0.009) than the non-tocilizumab group. The prevalence of Long COVID was higher in the tocilizumab group (92.7 % vs. 80.2 %, p = 0.06), whereas fatigue/malaise was significantly lower (19.5 % vs. 37.1 %, p = 0.039). Adjusted odds ratios (95 % confidence interval) for physical impairment, mental disorders, and Long COVID with tocilizumab were 0.70 (0.2–2.1), 0.40 (0.16–1.01), and 2.94 (0.7–12.3), respectively, with no significant difference.

Conclusions

Tocilizumab was associated with a lower prevalence of physical impairment and mental disorders at 1 year in patients with severe COVID-19. Furthermore, Long COVID had a weaker impact on physical and cognitive functions.

{"title":"Long-term functional prognosis with tocilizumab in severe COVID-19 infection: A multicenter prospective observational study on mechanically ventilated ICU patients in the COVID-19 recovery study II","authors":"Junji Hatakeyama , Kensuke Nakamura , Naoki Kanda , Akira Kawauchi , Shigeki Fujitani , Taku Oshima , Hideaki Kato , Kohei Ota , Hiroshi Kamijo , Tomohiro Asahi , Yoko Muto , Miyuki Hori , Arisa Iba , Mariko Hosozawa , Hiroyasu Iso","doi":"10.1016/j.jiac.2025.102708","DOIUrl":"10.1016/j.jiac.2025.102708","url":null,"abstract":"<div><h3>Background</h3><div>Tocilizumab, an IL-6 receptor antagonist, may prevent functional impairments in critically ill patients by attenuating the cytokine storm. This study investigated a potential effect of tocilizumab on preventing functional impairments in patients with severe coronavirus infection 2019 (COVID-19).</div></div><div><h3>Methods</h3><div>In a multicenter prospective observational study, patients with COVID-19 ≥ 20 years requiring mechanical ventilation admitted to the intensive care unit between April 2021 and September 2021 and discharged alive were followed for one year. A self-administered questionnaire on sequelae and functional impairments was mailed in August 2022, and data were collected. A multivariate logistic regression was used to assess the impact of tocilizumab on physical function, mental health, and Long COVID.</div></div><div><h3>Results</h3><div>Of 157 analyzed patients, 41 received tocilizumab. The tocilizumab group had more severe illness, but a lower prevalence of physical impairment (17.1 % vs. 23.3 %, p = 0.41) and mental disorders (19.5 % vs. 39.7 %, p = 0.009) than the non-tocilizumab group. The prevalence of Long COVID was higher in the tocilizumab group (92.7 % vs. 80.2 %, p = 0.06), whereas fatigue/malaise was significantly lower (19.5 % vs. 37.1 %, p = 0.039). Adjusted odds ratios (95 % confidence interval) for physical impairment, mental disorders, and Long COVID with tocilizumab were 0.70 (0.2–2.1), 0.40 (0.16–1.01), and 2.94 (0.7–12.3), respectively, with no significant difference.</div></div><div><h3>Conclusions</h3><div>Tocilizumab was associated with a lower prevalence of physical impairment and mental disorders at 1 year in patients with severe COVID-19. Furthermore, Long COVID had a weaker impact on physical and cognitive functions.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 6","pages":"Article 102708"},"PeriodicalIF":1.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Emergence of Japanese encephalitis in a previously non-reported area: Three consecutive annual cases from a tertiary center in Narita, Chiba, Japan

IF 1.9 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-04-15 DOI: 10.1016/j.jiac.2025.102706

Koki Yoshizawa , Emiri Muranaka , Ryota Hase , Masahiro Namiki , Satoki Hanayama , Yukiko Ozawa , Shogo Furukawa , Yuriko Kikkawa

The number of Japanese encephalitis (JE) cases dramatically decreased after implementing national vaccination program in Japan and the diagnosis requires specific tests in the reference laboratory in most cases. We report three consecutive cases of JE in a single hospital in Narita over three years. Although the PCR test confirmed the diagnosis in one case, the PCR was negative and IgM captured ELISA in the reference laboratory confirmed the diagnosis in the other two cases. These cases suggest that the number of JE patients may be underestimated in Japan. Physicians should consider JE as a differential diagnosis, when encountering the cases of encephalitis or meningitis with unknown etiology during the warm season even in the area where JE has not been reported.

引用次数: 0

Assessing the adequacy of blood culture collection in patients aged 80 years or older 评估 80 岁及以上患者血液培养采集的充分性

IF 1.9 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-04-14 DOI: 10.1016/j.jiac.2025.102705

Takehiro Hashimoto , Takaaki Yahiro , Sakirul Khan , Kazunori Kimitsuki , Hiroki Yoshikawa , Akira Nishizono , Kosaku Komiya , Kazufumi Hiramatsu

Introduction

Bloodstream infections (BSIs) are common and fatal conditions in hospitalized patients. Despite higher BSI mortality rates in older adult patients, predicting BSIs in this population remains challenging. This study aimed to assess whether blood culture (BC) collection is adequate for these patients.

Materials and methods

We conducted a retrospective study of BCs collected from hospitalized patients between June 2020 and March 2024 at a tertiary care hospital in Japan.

Results

A total of 11,674 BC sets were collected from 5837 hospitalized patients. The true-positive rate was significantly higher in patients aged ≥80 years than in those aged <80 years (13.6 % vs. 10.6 %, p < 0.001). Additionally, the contamination rate was higher in patients aged ≥80 years than in those aged <80 years (3.1 % vs. 2.2 %, p = 0.016). However, chills were less frequent in patients aged ≥80 years. Additionally, the median temperature was lower in older adult patients than in those aged <80 years.

Conclusions

BCs may be insufficiently collected in patients aged ≥80 years. Furthermore, a bundled intervention approach is needed for proper BC collection among patients aged ≥80 years.

{"title":"Assessing the adequacy of blood culture collection in patients aged 80 years or older","authors":"Takehiro Hashimoto , Takaaki Yahiro , Sakirul Khan , Kazunori Kimitsuki , Hiroki Yoshikawa , Akira Nishizono , Kosaku Komiya , Kazufumi Hiramatsu","doi":"10.1016/j.jiac.2025.102705","DOIUrl":"10.1016/j.jiac.2025.102705","url":null,"abstract":"<div><h3>Introduction</h3><div>Bloodstream infections (BSIs) are common and fatal conditions in hospitalized patients. Despite higher BSI mortality rates in older adult patients, predicting BSIs in this population remains challenging. This study aimed to assess whether blood culture (BC) collection is adequate for these patients.</div></div><div><h3>Materials and methods</h3><div>We conducted a retrospective study of BCs collected from hospitalized patients between June 2020 and March 2024 at a tertiary care hospital in Japan.</div></div><div><h3>Results</h3><div>A total of 11,674 BC sets were collected from 5837 hospitalized patients. The true-positive rate was significantly higher in patients aged ≥80 years than in those aged <80 years (13.6 % vs. 10.6 %, p < 0.001). Additionally, the contamination rate was higher in patients aged ≥80 years than in those aged <80 years (3.1 % vs. 2.2 %, p = 0.016). However, chills were less frequent in patients aged ≥80 years. Additionally, the median temperature was lower in older adult patients than in those aged <80 years.</div></div><div><h3>Conclusions</h3><div>BCs may be insufficiently collected in patients aged ≥80 years. Furthermore, a bundled intervention approach is needed for proper BC collection among patients aged ≥80 years.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 6","pages":"Article 102705"},"PeriodicalIF":1.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143834305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Isavuconazole in chronic pulmonary aspergillosis: What is the evidence? 异武唑治疗慢性肺曲霉菌病：证据是什么？

IF 1.9 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-04-10 DOI: 10.1016/j.jiac.2025.102704

Vitor Falcão de Oliveira , Mariane Taborda , Jéssica Toshie Katayose , Bruno Victor dos Santos Prates , Isadora Cristina de Souza Ritter , Adriana Satie Gonçalves Kono Magri , Edson Abdala , Marcello Mihailenko Chaves Magri

Background

Newer drugs like isavuconazole have been more widely used for invasive aspergillosis, where they are included as first-line treatments in major guidelines, whereas their use in chronic pulmonary aspergillosis (CPA) remains limited. Therefore, the aim of this study is to conduct a systematic review of the literature on the use of isavuconazole in CPA.

Methods

We searched PubMed/MEDLINE and Embase on August 9th, 2024. Our inclusion criteria included patients with CPA who were treated with isavuconazole. We summarized binary variables with counts and percentages, and continuous variables with mean and SD.

Results

We found 15 articles on CPA using isavuconazole. These studies were published after 2017, with a high predominance in high-income countries, especially US (40 %, n = 6) and UK (33.3 %, n = 5). There were 10 case reports, the majority of which used isavuconazole as salvage therapy. Two articles compared isavuconazole with voriconazole. The overall response rates at the end of treatment for CPA patients were similar, and the incidence of adverse drug reactions was numerically lower in the isavuconazole group compared to voriconazole. We found five articles on blood levels of isavuconazole. The mean isavuconazole serum level was >1 mg/L in all studies, even at a 100-mg daily dose. In the retrospective studies, the rate of isavuconazole discontinuation ranged from 17 % to 36 %.

Conclusion

There is limited experience with isavuconazole in treating CPA. This study consolidates existing evidence on its use in CPA, highlighting its potential as a therapeutic option beyond invasive aspergillosis, though further research is needed.

{"title":"Isavuconazole in chronic pulmonary aspergillosis: What is the evidence?","authors":"Vitor Falcão de Oliveira , Mariane Taborda , Jéssica Toshie Katayose , Bruno Victor dos Santos Prates , Isadora Cristina de Souza Ritter , Adriana Satie Gonçalves Kono Magri , Edson Abdala , Marcello Mihailenko Chaves Magri","doi":"10.1016/j.jiac.2025.102704","DOIUrl":"10.1016/j.jiac.2025.102704","url":null,"abstract":"<div><h3>Background</h3><div>Newer drugs like isavuconazole have been more widely used for invasive aspergillosis, where they are included as first-line treatments in major guidelines, whereas their use in chronic pulmonary aspergillosis (CPA) remains limited. Therefore, the aim of this study is to conduct a systematic review of the literature on the use of isavuconazole in CPA.</div></div><div><h3>Methods</h3><div>We searched PubMed/MEDLINE and Embase on August 9th, 2024. Our inclusion criteria included patients with CPA who were treated with isavuconazole. We summarized binary variables with counts and percentages, and continuous variables with mean and SD.</div></div><div><h3>Results</h3><div>We found 15 articles on CPA using isavuconazole. These studies were published after 2017, with a high predominance in high-income countries, especially US (40 %, n = 6) and UK (33.3 %, n = 5). There were 10 case reports, the majority of which used isavuconazole as salvage therapy. Two articles compared isavuconazole with voriconazole. The overall response rates at the end of treatment for CPA patients were similar, and the incidence of adverse drug reactions was numerically lower in the isavuconazole group compared to voriconazole. We found five articles on blood levels of isavuconazole. The mean isavuconazole serum level was >1 mg/L in all studies, even at a 100-mg daily dose. In the retrospective studies, the rate of isavuconazole discontinuation ranged from 17 % to 36 %.</div></div><div><h3>Conclusion</h3><div>There is limited experience with isavuconazole in treating CPA. This study consolidates existing evidence on its use in CPA, highlighting its potential as a therapeutic option beyond invasive aspergillosis, though further research is needed.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 6","pages":"Article 102704"},"PeriodicalIF":1.9,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143828478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Role of continuous infusion in Bayesian-assisted vancomycin dosing guided by area under the concentration-time curve in adults: A scoping review with case series

IF 1.9 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-04-09 DOI: 10.1016/j.jiac.2025.102703

Kazutaka Oda , Tomomi Katanoda , Shoji Kondo , Hirofumi Jono , Hideyuki Saito

Introduction

Continuous infusion (CI) of vancomycin offers potential benefits in achieving therapeutic drug levels and reducing nephrotoxicity compared to intermittent infusion (IntI). However, no studies from Japan have evaluated CI in detail. This study presents a scoping review with the relevant case series to assess the role of CI in Bayesian-assisted AUC-guided vancomycin dosing.

Methods

The scoping review was performed using PubMed, Web of Science, and Cochrane Library to identify studies published between 2018 and 2024. Data included study design, dosing methods, AUC estimation techniques, outcomes of nephrotoxicity, and therapeutic target achievement. The retrospective analysis was conducted on 15 cases treated with CI at Kumamoto University Hospital. Demographics, nephrotoxicity, and mortality outcomes were analyzed.

Results

The scoping review identified 10 studies, including one randomized controlled trial. Most studies relied on trough concentrations as surrogates for AUC in IntI groups, despite guidelines recommending against this approach. Target exposures for CI varied, with few studies aligning with AUC-guided dosing ranges of 400–600 μg h/mL. Of 15 cases included, four required increased dosing due to high creatinine clearance (CCr), achieving therapeutic targets without nephrotoxicity or mortality. The remaining 11 cases demonstrated variable outcomes, with only 45.5 % achieving therapeutic targets and 54.5 % developing nephrotoxicity.

Conclusions

Although the scoping review highlighted the need for further studies to optimize dosing strategies and clarify the comparative benefits of CI versus Bayesian-assisted IntI, CI may offer potential advantages in achieving therapeutic targets, particularly for adults requiring higher doses, such as those exceeding 3–4 g/day.

{"title":"Role of continuous infusion in Bayesian-assisted vancomycin dosing guided by area under the concentration-time curve in adults: A scoping review with case series","authors":"Kazutaka Oda , Tomomi Katanoda , Shoji Kondo , Hirofumi Jono , Hideyuki Saito","doi":"10.1016/j.jiac.2025.102703","DOIUrl":"10.1016/j.jiac.2025.102703","url":null,"abstract":"<div><h3>Introduction</h3><div>Continuous infusion (CI) of vancomycin offers potential benefits in achieving therapeutic drug levels and reducing nephrotoxicity compared to intermittent infusion (IntI). However, no studies from Japan have evaluated CI in detail. This study presents a scoping review with the relevant case series to assess the role of CI in Bayesian-assisted AUC-guided vancomycin dosing.</div></div><div><h3>Methods</h3><div>The scoping review was performed using PubMed, Web of Science, and Cochrane Library to identify studies published between 2018 and 2024. Data included study design, dosing methods, AUC estimation techniques, outcomes of nephrotoxicity, and therapeutic target achievement. The retrospective analysis was conducted on 15 cases treated with CI at Kumamoto University Hospital. Demographics, nephrotoxicity, and mortality outcomes were analyzed.</div></div><div><h3>Results</h3><div>The scoping review identified 10 studies, including one randomized controlled trial. Most studies relied on trough concentrations as surrogates for AUC in IntI groups, despite guidelines recommending against this approach. Target exposures for CI varied, with few studies aligning with AUC-guided dosing ranges of 400–600 μg h/mL. Of 15 cases included, four required increased dosing due to high creatinine clearance (CCr), achieving therapeutic targets without nephrotoxicity or mortality. The remaining 11 cases demonstrated variable outcomes, with only 45.5 % achieving therapeutic targets and 54.5 % developing nephrotoxicity.</div></div><div><h3>Conclusions</h3><div>Although the scoping review highlighted the need for further studies to optimize dosing strategies and clarify the comparative benefits of CI versus Bayesian-assisted IntI, CI may offer potential advantages in achieving therapeutic targets, particularly for adults requiring higher doses, such as those exceeding 3–4 g/day.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 5","pages":"Article 102703"},"PeriodicalIF":1.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143823819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A case of primary meningococcal conjunctivitis in an older patient 一名老年患者的原发性脑膜炎球菌结膜炎病例

IF 1.9 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-04-09 DOI: 10.1016/j.jiac.2025.102702

Yu Matsuo , Yu Monden , Hiroshi Watanabe , Hideyuki Takahashi , Yukihiro Akeda , Hodaka Akune , Kensuke Sasaki , Daiki Ishio , Kohei Yamazaki , Naotaka Tashiro , Shigeo Yoshida

Primary meningococcal conjunctivitis (PMC) is rare, and it is particularly rare in older patients. Patients with PMC may develop invasive meningococcal disease (IMD), which has an overall mortality rate of 8 %–14 %. An 81-year-old man presented to us with complaints of decreased vision and persistent pain in his right eye after ocular trauma. He had copious purulent discharge, conjunctival injection, corneal edema and Descemet's membrane folds in the right eye. The best-corrected visual acuity (BCVA) was 0.02. Levofloxacin 1.5 % eye drops and fluorometholone 0.1 % eye drops, each four times daily, were initiated before the results of conjunctival culture were available. Neisseria meningitidis was isolated 2 days after the patient's first visit. Cefmenoxime hydrochloride 0.5 % eye drops eight times daily were added and a single dose of oral levofloxacin 500 mg was administered to prevent IMD. After treatment, his symptoms resolved and BCVA increased to 0.8. The frequency of instillation of eye drops was reduced, and all medications were stopped 21 days after the first visit. The patient did not develop IMD. Later, the serogroup and sequence type of our isolate was revealed to be non-groupable and 11026, which is unique to Japan. All ST-11026 isolates have been found to lack the ability to synthesize capsular polysaccharide, which is one of the meningococcal pathogenicity. If a patient presents with conjunctivitis with copious ocular purulent discharge, conjunctival culture should be performed promptly for early diagnosis of PMC regardless of the patient's age.

{"title":"A case of primary meningococcal conjunctivitis in an older patient","authors":"Yu Matsuo , Yu Monden , Hiroshi Watanabe , Hideyuki Takahashi , Yukihiro Akeda , Hodaka Akune , Kensuke Sasaki , Daiki Ishio , Kohei Yamazaki , Naotaka Tashiro , Shigeo Yoshida","doi":"10.1016/j.jiac.2025.102702","DOIUrl":"10.1016/j.jiac.2025.102702","url":null,"abstract":"<div><div>Primary meningococcal conjunctivitis (PMC) is rare, and it is particularly rare in older patients. Patients with PMC may develop invasive meningococcal disease (IMD), which has an overall mortality rate of 8 %–14 %. An 81-year-old man presented to us with complaints of decreased vision and persistent pain in his right eye after ocular trauma. He had copious purulent discharge, conjunctival injection, corneal edema and Descemet's membrane folds in the right eye. The best-corrected visual acuity (BCVA) was 0.02. Levofloxacin 1.5 % eye drops and fluorometholone 0.1 % eye drops, each four times daily, were initiated before the results of conjunctival culture were available. <em>Neisseria meningitidis</em> was isolated 2 days after the patient's first visit. Cefmenoxime hydrochloride 0.5 % eye drops eight times daily were added and a single dose of oral levofloxacin 500 mg was administered to prevent IMD. After treatment, his symptoms resolved and BCVA increased to 0.8. The frequency of instillation of eye drops was reduced, and all medications were stopped 21 days after the first visit. The patient did not develop IMD. Later, the serogroup and sequence type of our isolate was revealed to be non-groupable and 11026, which is unique to Japan. All ST-11026 isolates have been found to lack the ability to synthesize capsular polysaccharide, which is one of the meningococcal pathogenicity. If a patient presents with conjunctivitis with copious ocular purulent discharge, conjunctival culture should be performed promptly for early diagnosis of PMC regardless of the patient's age.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 6","pages":"Article 102702"},"PeriodicalIF":1.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143829380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0