Journal of Infection and Chemotherapy最新文献

Patients with acute myeloid leukemia (AML) are at high risk of developing invasive fungal disease (IFD) with high morbidity and attributable mortality, including those who were received Venetoclax treatment. Venetoclax, a new oral Bcl-2 inhibitor, targets tumor cells' ability to induce apoptosis. It is the only one which is approved by Food and Drug Administration (FDA) for treating newly diagnosed AML patients who are 75 years of age or older and are ineligible for intensive induction chemotherapy due to existing comorbidities. It has been shown that venetoclax-based regimens raise the risk of invasive fungal diseases (IFD) for AML patients in clinical practice. Because it can lead to prolonged and profound neutropenia in AML patients, with IFD incidence rates ranging from 5.1 % to 32 %, resulting in higher mortality rates. Because of drug-drug interactions between Venetoclax and partial antifungal agents, to choose anti-fungal prophylaxis and to adjust the dosage of agents rationally for AML patients seems crucial to physicians to those who are undergoing venetoclax-based chemotherapy. Therefore, this review aims to summary the mechanism and characteristic of IFD in AML patients and provide practical clinical suggestions and details for the prophylaxis of IFD in AML patients suffering Venetoclax-based treatment.

Introduction: Subcutaneous (SC) administration is typically used for pediatric inactivated vaccines in Japan, whereas intramuscular (IM) administration is used outside Japan. We previously reported the safety and immunogenicity of V114, a 15-valent pneumococcal conjugate vaccine (PCV), administered subcutaneously and intramuscularly in a Japanese phase 1 study (V114-028). Here, we report secondary descriptive analyses on V114 groups of the study to further assess the safety and immunogenicity profiles of V114 between the administration routes.

Methods: A total of 133 healthy Japanese infants were randomized to receive V114-SC (n = 44), V114-IM (n = 45), or PCV13-SC (n = 44) at approximately 3, 4, 5, and 12-15 months of age. Adverse events (AEs) from Days 1-14 post-vaccination and vaccine-related serious AEs from Day 1 to 1-month post-dose 4 were reported. Serotype-specific immunoglobulin G (IgG) responses were measured across the vaccination series.

Results: Proportions of participants with solicited systemic AEs (irritability, somnolence, decreased appetite, and urticaria) and pyrexia were generally comparable between the groups. Compared with V114-SC, patients receiving V114-IM had a lower incidence of irritability and somnolence, and higher incidence of decreased appetite. Proportion of participants with solicited injection-site erythema was lower with V114-IM (82.2%) than V114-SC (100.0%). Those with other solicited injection-site AEs (induration, swelling, and pain) were generally comparable between the groups, with lower observed proportions with V114-IM. Serotype-specific IgG responses were also generally comparable between the groups, including at pre-toddler dose.

Conclusions: These results suggest the utility of IM administration as an option for V114 vaccination in Japanese infants.

Background: More than 200 symptoms of post coronavirus disease (COVID-19) condition (PCC) impacting patients' quality of life have been reported. This study describes the symptoms of well-known PCC and diseases/conditions diagnosed after COVID-19 and analyzes the trends in well-known PCC according to the epidemic waves in the Japanese population.

Methods: Patients with a COVID-19 diagnosis in the JMDC claims database were matched 1:1 with individuals without COVID-19 diagnosis (controls) based on sex, year and month of birth, and risk factors for aggravation. The first month of COVID-19 diagnosis from January 2020-March 2022 was the index month, and the observation period was from July 2019 to 6 months from the index month (patients) and July 2019-September 2022 (controls).

Results: Of 263,456 each of patients and controls after matching, 51.8 % were aged 18-49 years, 56.3 % were male, and 24.5 % had risk factors for aggravation. One in 18 patients experienced well-known PCC 2-3 months after severe acute respiratory syndrome cornonavirus 2 infection, with the highest odds ratio (OR) being for pulmonary thromboembolism (29.37), followed by smell/taste disorder (13.34) and respiratory failure (8.28). Some of the common diseases/conditions diagnosed after COVID-19 comprised those of the genitourinary system, eye and adnexa, and ear and mastoid process and certain infectious and parasitic diseases. Overall, the risk difference decreased from the first to the sixth wave, but the OR was >1.00 for most symptoms even during the sixth wave.

Conclusions: PCC symptoms showed a declining trend over time but persisted. Physicians and patients need to recognize PCC symptoms.

Bacterial contamination of plasma is unusual owing to frozen storage nevertheless reported. We report a case of transfusion transmitted infection due to Burkholderia cepacia contaminating fresh frozen plasma. A 31 year old male with decompensated chronic liver disease presented with breathlessness due to pleural effusion. Due to elevated prothrombin time, fresh frozen plasma was infused. After ten minutes of transfusion, he became febrile, tachypnoeic and transfusion was stopped. Plasma bag and blood cultures from patient grew B. cepacia. He became hemodynamically unstable due to underlying disease and died after a week.

Introduction: Staphylococcus aureus bacteremia (SAB), especially when caused by methicillin-resistant S. aureus (MRSA), is of considerable clinical importance. In recent years, the proportion of MRSA among S. aureus has decreased, and a relative increase in the proportion of methicillin-susceptible S. aureus (MSSA) has been observed. It is therefore necessary to consider both MRSA and MSSA when assessing the microbiological and clinical significance of SAB.

Materials and methods: We included SAB cases from the Nara Medical University Hospital between January 2015 and February 2017. We performed drug susceptibility testing, toxicity gene analysis, multilocus sequence typing (MLST), and polymerase chain reaction-based open reading frame typing (POT) of stored strains to integrate clinical and bacteriological characteristics.

Results: There were 90 cases during the experimental period (42 MRSA and 48 MSSA), with 30-day mortality rates of 19 % for MRSA and 10.4 % for MSSA. Deaths were more frequently complicated by septic shock and disseminated intravascular coagulation. MLST studies showed that ST8, ST764, ST1, and ST15 were prevalent in the MRSA group, whereas ST5, ST188, and ST12 were prevalent in MSSA. Infective endocarditis cases had a long time from onset to the initiation of effective antimicrobials and were all MSSA. MLST and POT results correlated well, and POT appeared to have better discriminatory power.

Conclusions: The severity and mortality of SAB, along with the microbiological characteristics of causative isolates, vary by location and time. Continued studies integrating clinical and microbiological investigations are thus needed.

Purpose: We aimed to evaluate the influence of easing COVID-19 preventive measures following its downgrading to a common infectious disease on COVID-19 occurrence among hospitalized patients.

Methods: Nosocomial occurrence of COVID-19 was compared between periods with national infectious disease category 5 versus the preceding category 2 equivalent. Changes in the revised manual included a shorter duration of work restrictions for infected health care practitioners (HCPs); no work restriction for HCPs exposed to SARS-CoV-2 with a negative test on days 1, 3 and 5; discontinuation of universal pre-admission screening; and pre-emptive isolation of patients without screening. Wearing an N95 mask and face shield was required in procedure/care with moderate-to high-risk contact.

Results: Although the mean monthly number of infected HCPs increased from 8.1 to 12.7 in the category 5 period (p = 0.034) and that of pre-admission screening decreased to one-fourth, the COVID-19 incidence in hospitalized patients remained similar between the two study periods (1.60 ± 5.59/month versus 1.40 ± 2.63/month, p = 0.358). Clusters, defined as ≥3 COVID-19 patients on the ward, were experienced twice in the preceding period and only once in the category 5 period. The index cases causing nosocomial SARS-CoV-2 transmission mostly involved rehabilitation therapists in the preceding period; five of six index cases were patients in the category 5 period. Following the expanded indication for N95 masks, neither SARS-CoV-2 transmission to patients nor transmission from infected patients was observed in HCPs for 1 year.

Conclusion: With sustained, enhanced standard precautions, easing prevention strategies could limit nosocomial SARS-CoV-2 infections.

Fasciolosis is a food-borne parasitic disease, caused by the large liver fluke, Fasciola. Humans acquire infection by ingesting fresh or undercooked water plants, on which infective metacercaria encyst. In spite of the rarity of the disease in Japan, we encountered four successive fasciolosis patients within a short period, who were all living in the same area. The patients were 70-82 years old, three females and the husband of one of the female patients. They started complaining of non-specific symptoms, such as fever, general fatigue, appetite loss, and abdominal pain, almost at the same time. All patients showed prominent peripheral blood eosinophilia, and the medical imaging indicated multiple hepatic lesions. No parasite eggs or worms were detected in any of the patients. Diagnosis was made serologically and they were treated with praziquantel and/or triclabendazole. No cattle or sheep were farmed in the area, but the wild sika deer, Cervus nippon, inhabited adjacent to the residential area. The intermediate host snail, Austropeplea ollula, were found near the residence of the patients, and one of the collected snails was positive for F. hepatica/gigantica hybrid type rediae. Our report should alarm the medical professionals for this rare and unfamiliar parasitic disease.

Blood culture-negative infective endocarditis (BCNE) has a poorer prognosis than culture-positive cases. Thus, it is crucial to determine the pathogenic microorganism using molecular diagnostic techniques, in addition to conventional techniques, including cultures of blood and/or resected valve tissue. Herein, we report a case of culture-negative infective endocarditis (IE) caused by Neisseria bacilliformis, as identified by 16S rRNA analysis of valve tissue. N. bacilliformis a non-gonococcal and non-meningococcal Neisseria species that partially comprises the oropharyngeal microbiome, and reports of invasive infections have increased recently. We conducted a literature review of IE caused by N. bacilliformis and found that beta-lactam antibiotics were effective with a relatively favorable prognosis. To the best of our knowledge, this is the first case of culture-negative IE in which N. bacilliformis was identified via 16S rRNA analysis.

Background: The optimal timing and selection for blood culture collection in patients with acute cholangitis remains unclear. The relationship between common bile duct (CBD) diameter and the incidence of bacteremia in patients with CBD stones was elucidated.

Methods: This single-center retrospective observational study included patients with symptomatic CBD stones who presented to the emergency department between January 2019 and December 2021. The primary endpoint was the incidence of bacteremia. The patients were divided into two groups based on bacteremia complications. The patient characteristics and CBD diameters were compared between the two groups to identify factors associated with bacteremia.

Results: In total, 270 patients were analyzed, with bacteremia identified in 134 patients (50 %), and the median CBD diameter was 10.7 mm (IQR, 8.7-13.7). The CBD diameter was significantly larger in patients with bacteremia (median 12.4 mm [IQR, 9.9-15.7] vs. 9.7 mm [IQR, 8.2-11.7], P < 0.001) in univariate analysis. Multivariable analysis revealed that the CBD diameter was significantly associated with bacteremia (OR: 1.25, 95 % CI: 1.14-1.38, P < 0.010). The area under the ROC curves, representing the diagnostic accuracy of CBD diameter for indicating bacteremia, was 0.72 (95 % CI, 0.66-0.78) with a cut-off value of 11.2 mm.

Conclusion: CBD dilation in patients with symptomatic CBD stones is significantly correlated with bacteremia. The CBD diameter cannot be assessed as the sole tool for detecting bacteremia; however, CBD dilation could be an indicator of bacteremia, assisting in the treatment strategy, regardless of the initial severity of cholangitis.

Background: Quality control (QC) of carbapenem susceptibility testing for Gram-negative bacteria faces challenges due to limited measuring ranges and the lack of suitable QC strains. This study aimed to select and evaluate QC strains for meropenem antimicrobial susceptibility testing (AST) through a pilot external quality assessment (EQA).

Methods: Candidate QC strains for meropenem AST were selected based on primary AST data and genomic information from the Japan Antimicrobial Resistant Bacterial Bank. Phenotype stability was verified through serial passaging and MIC comparison with original strains. The validated broth microdilution method was used to determine the target MIC value in a pilot EQA involving 47 clinical laboratories in Japan using ten different AST methods.

Results: Two strains, Citrobacter freundii JBBDAJB-19-0032 (Strain-A) and Enterobacter hormaechei subsp. steigerwaltii JBEBAAB-19-0102 (Strain-B), both carrying bla_IMP-1, were selected as candidate QC strains. The meropenem MICs for Strain-A and Strain-B were 4 mg/L and 2 mg/L, respectively. In the pilot EQA, 43 laboratories reported appropriate results for Strain-A and 40 laboratories reported appropriate results for Strain-B. The MIC range was 2-8 mg/L for Strain-A and 1-4 mg/L for Strain-B. However, 19 and 12 laboratories, respectively, reported out-of-range MICs using AST plates on the MicroScan WalkAway. Inappropriate results were reported by four and seven laboratories, respectively, using common methods for Strain-A and Strain-B, respectively.

Conclusions: The candidate QC strains selected for this study are suitable for meropenem AST EQA, except when the measuring range of certain methods does not match their QC range.