Journal of Infection and Chemotherapy最新文献

Aerococcus urinae, a gram-positive, catalase-negative coccus, has emerged as a notable pathogen in clinical microbiology. It is traditionally associated with urinary tract infections in elderly males with underlying urologic conditions. Recently, A. urinae has been implicated in severe invasive infections outside the genitourinary tract including infective endocarditis, vertebral osteomyelitis, peritonitis, lymphadenitis, and discitis. We present the case of 84-year-old male with a history of aortic graft replacement who presented with five days of fever and fatigue. Blood and urine cultures grew gram-positive cocci, identified as A. urinae. Thoracoabdominal contrast-enhanced CT revealed a slightly increased soft tissue shadowing around the prosthetic stent in the ascending aorta, indicating a possible aortic stent-graft infection. Gallium-67 scintigraphy demonstrated inflammation around the prosthetic stent in the ascending aorta consistent with an aortic stent-graft infection. The patient and family opted for conservative treatment and despite a six-week inpatient course of ampicillin, followed by oral amoxicillin, the patient died one week after discharge. This is the first published case of A. urinae causing an aortic stent-graft infection. Clinicians should remain cognizant of the disseminated source of infection in cases of A. urinae bacteremia.

Background: Liver disease remains a significant concern for people living with HIV (PLWH), especially in those with hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection. This study assessed the prevalence of viral hepatitis coinfections and evaluated the current state of hepatitis management by HIV care providers in Japan.

Methods: This single-center, retrospective, observational study analyzed data from PLWH treated with antiretroviral therapy between April 1, 2023 and March 31, 2024. Data included demographics, ART regimen, hepatitis status, and screening practices of 811 PLWH treated with antiretroviral therapy.

Results: The median age of the study population was 48 years, and 97.8 % were men. The HBV status was as follows: chronic HBV, 6.5 %; clinical remission, 34.0 %; uninfected, 30.9 %; unknown, 14.2 %. The HCV antibody positivity rate was 3.2 %. Substantial gaps in hepatitis screening and monitoring were identified. Specifically, we found inadequate rates of abdominal ultrasound examinations and HCC screening among patients with HIV and viral hepatitis coinfection. Moreover, only 71.7 % of patients chronically infected with HBV and 61.5 % with HCV underwent abdominal ultrasound examinations in the preceding 12 months-only 5.7 % and 3.8 % of the participants in these groups had had received tumor marker testing in the previous 12 months.

Conclusion: There are challenges in hepatitis and HCC screening and monitoring among patients with HIV and viral hepatitis coinfection in Japan. These findings underscore the need to improve adherence to clinical practice guidelines and implement integrated care models to enhance hepatitis management in PLWH.

Introduction: Ruminococcus gnavus is a microbiota-forming, gram-positive coccus reportedly associated with several diseases, such as Crohn's disease. The number of in vitro studies on it is increasing. However, its clinical information is lacking in the literature, with only a few case reports published to date. To elucidate the significance of this organism, we describe its clinical characteristics in this study.

Methods: During the study period (2013-2022), we identified 11 patients with R. gnavus bacteremia and conducted a retrospective chart review. Cases identified to be contaminated were excluded. We found 11 reports of R. gnavus bacteremia on PubMed and reviewed their clinical characteristics.

Results: Eleven R. gnavus bloodstream infection cases were identified in our facility. The median age of the patients was 83 years (interquartile range: 73.75-87.25). Seven cases had at least one documented intestinal lesion including three with malignancy cases, and two cases had uncompensated cirrhosis. In most cases, bacterial translocation was suspected as the entry mechanism. Among the 11 R. gnavus bloodstream infections, 7 (63.6 %) were associated with intestinal lesions, and 2 (18.2 %) had a history of suspected bacterial translocation without documented intestinal lesions.

Conclusion: To the best of our knowledge, this is the largest cohort study on R. gnavus bloodstream infections. Intestinal entry was suspected in more than 80 % of cases in both our cohort and the literature review cohort. For cases of bacteremia with an unknown etiology due to R. gnavus, a thorough examination of gastrointestinal lesions should be performed.

Introduction: Despite its importance for young women, the human papillomavirus (HPV) vaccination coverage remains low in Japan. Previous studies have examined behaviors related to HPV catch-up vaccination. Uniquely, this study aimed to investigate perceptions and factors influencing vaccination coverage among female university students in the catch-up program, focusing on both medical and non-medical undergraduates.

Methods: A web-based survey was conducted at Kochi University from January 16 to February 13, 2023, targeting female students born between April 2, 1997, and April 1, 2006. The survey collected demographic data and assessed knowledge of HPV infection, cervical cancer, and preventive measures. Chi-square tests and logistic regression analyses were used to identify differences between vaccinated and unvaccinated groups as well as factors related to HPV vaccination.

Results: Of the 310 participants, 39.0 % were vaccinated against HPV, 35.2 % were freshmen, and 75.2 % were in medical science programs. HPV vaccination was significantly associated with being in upper years of university (OR = 3.78-42.83), studying medical sciences (OR = 1.93), undergoing cervical cancer screening (OR = 4.04), and receiving free vaccination vouchers (OR = 2.03).

Conclusion: Knowledge and awareness of HPV and cervical cancer significantly contribute to higher vaccination uptake in the generation receiving catch-up vaccinations. Tailoring information and distributing free vaccination vouchers could enhance HPV vaccination rates and awareness in this group.

We report two cases of patients with extensively drug-resistant Salmonella Typhi infection who had recently traveled to Pakistan. These cases suggest that obtaining a detailed travel history and considering the epidemiology of drug-resistant S. Typhi in the suspected area of acquisition is crucial for managing patients with typhoid fever.

Background: Systemic baricitinib and corticosteroids play important roles in treating severely and critically ill patients with coronavirus disease 2019 (COVID-19). However, the efficacy of the combination of baricitinib and corticosteroids compared to that of corticosteroid monotherapy in severely and critically ill hospitalized patients with COVID-19 remains unclear.

Methods: We analyzed severely and critically ill hospitalized patients with COVID-19 aged >18 years between January 1, 2020 and May 31, 2023, using a Japanese multicenter inpatient database. We performed propensity score matching to analyze the effect of the combination of baricitinib and corticosteroids within 2 days of hospital admission (combination group) on the 28-day and in-hospital mortality rates compared with those of corticosteroid monotherapy within 2 days of hospital admission (control group). Sensitivity analysis was performed using inverse probability weighting analysis and the generalized estimating equation method.

Results: The eligible patients (n = 7433) were divided into a combination (n = 679) and a control group (n = 6754). One-to-four propensity score matching analyses included 566 combination and 2264 control group patients. There was no significant difference in 28-day (8.5 % vs. 8.8 %; risk difference, -0.3 % [95 % confidence interval, -2.9 to 2.3]) or in-hospital (11 % vs. 10 %; risk difference, 1.0 [-1.9 to 3.9]) mortality rates between 2 groups. The sensitivity analysis showed similar outcomes.

Conclusion: This observational study, using a Japanese multicenter inpatient database, found that the combination of baricitinib and corticosteroid therapy did not improve the 28-day or in-hospital mortality rates in severely and critically ill patients with COVID-19 compared to corticosteroid monotherapy.

Escherichia coli is a facultative anaerobic bacterium that causes urinary tract and bloodstream infections. Generally, E. coli is easily identified in routine clinical microbiology laboratories. Herein, we report a case of pyelonephritis with bacteremia due to extended-spectrum β-lactamase (ESBL) producing E. coli, which delayed the identification of the isolate as it exhibited carbon dioxide (CO₂)-dependent growth. The patient was a 62-year-old man who presented with nausea and an altered mental status. Contrast-enhanced computed tomography revealed multiple abscesses in the left kidney. The anaerobic bottles of the two sets of blood cultures were positive, but growth on a routine aerobic culture was weak. Identification of the isolate was delayed because it grew only on agar plates incubated in a 5 % CO₂ atmosphere. The isolate was suspected to be an ESBL-producing strain based on antimicrobial susceptibility testing, which was confirmed by polymerase chain reaction analysis. The patient was successfully treated with administering meropenem and nephrectomy. To the best-of-our-knowledge, this is the first reported case of a human infection caused by ESBL-producing carbon-dioxide-dependent E. coli.

Introduction: This retrospective, cross-sectional, multi-center study aimed to evaluate the impact of laboratory results and treatments on the treatment response in patients diagnosed with tularemia.

Methods: The study included 190 adult patients diagnosed with tularemia between November 2023 and June 2024.

Results: 67.9 % were female, mean age was 45.8 ± 14.9 years. The most frequently detected symptoms were sore throat (74.2 %), fatigue (71.6 %), and neck swelling (56.3 %). The most common form of tularemia was oropharyngeal (82.6 %) and glandular (14.2 %). The most used monotherapy was ciprofloxacin (80.5 %, n = 136), and combination therapy was streptomycin-ciprofloxacin (81.0 %, n = 17). Treatment failure was observed in 29 patients (15.2 %). No difference was found between patients who responded and didn't respond to treatment regarding laboratory parameters. Lymph node drainage or excision was performed in 47 patients (23 %). Suppurative lymphadenitis, abscess, necrosis, and conglomerate lymphadenopathy were more common in the lymph node drainage group. Reactive lymph nodes were more common in the group without lymph node drainage. There was no difference between the two groups regarding laboratory parameters of patients with and without lymph node drainage. The duration of antibiotic treatment was longer in patients who underwent lymph node drainage than in those who didn't.

Conclusion: Radiological evaluation of lymph nodes upon hospital admission, in addition to antibiotic therapy during treatment, may help predict which patients are more likely to require surgical drainage. Laboratory parameters may not provide significant benefits in predicting the need for lymph node drainage and long-term treatment did not affect the treatment response.

The WHO recently proposed a new indicator for judging the appropriateness of antimicrobial selection according to the AWaRe classification. Although macrolides are often administered for long-term macrolide therapy, the impact of this therapy on the indicator remains unclear. This study examined the impact of this therapy on the indicator for outpatient oral antimicrobial use. Using the JMDC claims database, outpatients who were prescribed an oral antimicrobial at least once between January and December 2022 (n = 2.66 million) were included in the study. The ratio of patient numbers and antimicrobial usage (AMU) were calculated based on age group (<15, 15-64, and ≥65 years) and prescription days (1-15, 16-30, 31-60, 61-90, and ≥91 days), and AMU of each drug was corrected for defined daily doses and classified according to the AWaRe. Patients with chronic airway disease for whom macrolides were prescribed for 91 days and more were defined as long-term macrolide therapy. Macrolides accounted for more than 30 % of total oral AMU in all age groups. In the elderly, 11.2 % of patients were prescribed macrolides for 91 days or more, accounting for 66.4 % of macrolide use. With regard to diseases that were associated with macrolide prescriptions, the percentage of patients prescribed for chronic airway diseases increased as the number of days of prescription increased. These results suggest that the impact of long-term macrolide therapy should be considered when assessing the appropriateness of outpatient oral AMU according to the AWaRe classification.