Non-O1 and non-O139 Vibrio cholerae (NOVC) strains rarely harbor the cholera toxin gene and are typically associated with mild, self-limiting gastroenteritis. However, an increasing number of reports in recent years have described severe gastroenteritis or extraintestinal infections with fatal outcomes, particularly in immunocompromised individuals, such as those with underlying conditions including cirrhosis. Here, we describe a case of severe gastroenteritis caused by V. cholerae serogroup O24, following the consumption of seafood during prolong prednisolone treatment for systemic lupus erythematosus. Stool culture upon admission yielded yellow colonies on thiosulfate-citrate-bile salt-sucrose agar, and Gram staining of the colonies revealed Gram-negative, curved, comma-shaped rods, suggestive of Vibrio species. Although matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) yielded low-confidence identifications, suggesting either Vibrio mimicus or Vibrio albensis, the isolate was ultimately identified as NOVC based on its biochemical characteristics and salt tolerance. Subsequent genetic analysis confirmed the isolate as V. cholerae serogroup O24, a strain not included in the MALDI-TOF MS identification database. This case underscores the diagnostic value of conventional methods, such as biochemical profiling, in identifying V. cholerae strains not detectable by current mass spectrometry-based systems.
{"title":"Severe gastroenteritis caused by Vibrio cholerae serogroup O24 in an immunocompromised patient: A case report","authors":"Tomoko Azuma , Yoshinori Takahashi , Megumi Oshima , Megumi Ikeda , Daiki Hayasi , Hatsumi Otani , Akiko Maekawa , Hiroyasu Oe , Aya Noguchi , Mika Mori , Hajime Kanamori","doi":"10.1016/j.jiac.2026.102906","DOIUrl":"10.1016/j.jiac.2026.102906","url":null,"abstract":"<div><div>Non-O1 and non-O139 <em>Vibrio cholerae</em> (NOVC) strains rarely harbor the cholera toxin gene and are typically associated with mild, self-limiting gastroenteritis. However, an increasing number of reports in recent years have described severe gastroenteritis or extraintestinal infections with fatal outcomes, particularly in immunocompromised individuals, such as those with underlying conditions including cirrhosis. Here, we describe a case of severe gastroenteritis caused by <em>V. cholerae</em> serogroup O24, following the consumption of seafood during prolong prednisolone treatment for systemic lupus erythematosus. Stool culture upon admission yielded yellow colonies on thiosulfate-citrate-bile salt-sucrose agar, and Gram staining of the colonies revealed Gram-negative, curved, comma-shaped rods, suggestive of <em>Vibrio</em> species. Although matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) yielded low-confidence identifications, suggesting either <em>Vibrio mimicus</em> or <em>Vibrio albensis</em>, the isolate was ultimately identified as NOVC based on its biochemical characteristics and salt tolerance. Subsequent genetic analysis confirmed the isolate as <em>V. cholerae</em> serogroup O24, a strain not included in the MALDI-TOF MS identification database. This case underscores the diagnostic value of conventional methods, such as biochemical profiling, in identifying <em>V. cholerae</em> strains not detectable by current mass spectrometry-based systems.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 2","pages":"Article 102906"},"PeriodicalIF":1.5,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928990","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}
Pub Date : 2026-01-05DOI: 10.1016/j.jiac.2026.102904
Fatih Çubuk , Caner Öksüz , Murtaza Öz
Objective
A substantial proportion of urine cultures in patients with suspected urinary tract infections (UTIs) yield negative results. This study aimed to evaluate whether parameters from automated urinalysis could predict the likelihood of significant bacterial growth, thereby aiding in reducing unnecessary cultures.
Methods
A total of 696 patients (402 females, 294 males) undergoing urinalysis with the FUS-200 automated analyzer were evaluated. Urine cultures were processed using the BD Phoenix 100 system. Demographic data and urinalysis parameters were compared according to culture results.
Results
Among culture-negative patients, females were younger (median age: 45 vs. 58 years, p = 0.000) and had significantly higher leukocyte, erythrocyte, and bacterial counts (p = 0.000). In culture-positive cases, females were younger than males (55 vs. 72.5 years, p = 0.000), though they had lower leukocyte counts (p = 0.029). Gram-negative infections were associated with significantly higher leukocyte and bacterial counts compared to gram-positive infections (p < 0.05), along with increased nitrite and leukocyte esterase positivity. ROC analysis identified optimal cut-off values for predicting significant culture growth: leukocyte count ≥16.5 (sensitivity, 79.5 %; specificity, 79.9 %) and bacterial count ≥2.5 (sensitivity, 77.6 %; specificity, 79.3 %). Cut-off values were higher in females (leukocytes: 23.5, bacteria: 5.5) than in males (leukocytes: 11.5, bacteria: 0.5).
Conclusion
The practical utility of the defined normal range values for urinary leukocyte count is limited. The predictive power of urinalysis parameters for culture results is affected by patient gender. For predicting significant bacterial growth in males, we recommend leukocyte and bacteria cut-off values of 11.5/HPF and 0.5/HPF, respectively (with >85 % sensitivity and specificity). In females, leukocyte and bacterial counts in urine provide poor predictive value for culture positivity.
{"title":"Diagnostic utility of urinalysis parameters in predicting urine culture positivity: A gender-stratified evaluation","authors":"Fatih Çubuk , Caner Öksüz , Murtaza Öz","doi":"10.1016/j.jiac.2026.102904","DOIUrl":"10.1016/j.jiac.2026.102904","url":null,"abstract":"<div><h3>Objective</h3><div>A substantial proportion of urine cultures in patients with suspected urinary tract infections (UTIs) yield negative results. This study aimed to evaluate whether parameters from automated urinalysis could predict the likelihood of significant bacterial growth, thereby aiding in reducing unnecessary cultures.</div></div><div><h3>Methods</h3><div>A total of 696 patients (402 females, 294 males) undergoing urinalysis with the FUS-200 automated analyzer were evaluated. Urine cultures were processed using the BD Phoenix 100 system. Demographic data and urinalysis parameters were compared according to culture results.</div></div><div><h3>Results</h3><div>Among culture-negative patients, females were younger (median age: 45 vs. 58 years, p = 0.000) and had significantly higher leukocyte, erythrocyte, and bacterial counts (p = 0.000). In culture-positive cases, females were younger than males (55 vs. 72.5 years, p = 0.000), though they had lower leukocyte counts (p = 0.029). Gram-negative infections were associated with significantly higher leukocyte and bacterial counts compared to gram-positive infections (p < 0.05), along with increased nitrite and leukocyte esterase positivity. ROC analysis identified optimal cut-off values for predicting significant culture growth: leukocyte count ≥16.5 (sensitivity, 79.5 %; specificity, 79.9 %) and bacterial count ≥2.5 (sensitivity, 77.6 %; specificity, 79.3 %). Cut-off values were higher in females (leukocytes: 23.5, bacteria: 5.5) than in males (leukocytes: 11.5, bacteria: 0.5).</div></div><div><h3>Conclusion</h3><div>The practical utility of the defined normal range values for urinary leukocyte count is limited. The predictive power of urinalysis parameters for culture results is affected by patient gender. For predicting significant bacterial growth in males, we recommend leukocyte and bacteria cut-off values of 11.5/HPF and 0.5/HPF, respectively (with >85 % sensitivity and specificity). In females, leukocyte and bacterial counts in urine provide poor predictive value for culture positivity.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 2","pages":"Article 102904"},"PeriodicalIF":1.5,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903896","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}
Pub Date : 2026-01-01DOI: 10.1016/j.jiac.2025.102902
Nesrin Türker , Ozge Eren Korkmaz , Figen Kaptan Aydogmus , Nur Miray Ayhan Geniş , Tuba Müderris , Murat Aksun
Background
Carbapenem-resistant Gram-negative bloodstream infections (CR-GNB BSIs) are increasingly prevalent in intensive care units (ICUs) and associated with high mortality. Accurate early risk stratification tools are lacking.
Objectives
To develop and internally validate a nomogram-based model predicting 30-day mortality in ICU patients with CR-GNB BSIs.
Methods
We conducted a retrospective cohort study of adult ICU patients with CR-GNB BSIs at a tertiary hospital in western Turkey (January 2020–October 2024). Demographic, clinical, laboratory, and microbiological data were collected. Patients were randomly split into training (70 %) and validation (30 %) cohorts. Univariable and multivariable logistic regression analyses identified independent mortality predictors, which were incorporated into a nomogram. Model discrimination, calibration, and decision-curve utility were evaluated.
Results
A total of 281 patients were included (median age 66 years; 60.9 % male); 30-day mortality was 58 %. Acinetobacter spp. predominated (51.6 %), followed by Klebsiella spp. (42.3 %) and Pseudomonas spp. (6.1 %). Independent predictors of 30-day mortality included older age, immunosuppression, hypoalbuminemia, elevated white blood cell count, and absence of microbiological cure. The nomogram demonstrated excellent discrimination (AUC 0.895 training; 0.854 validation), good calibration (mean absolute error 0.022–0.059), and meaningful clinical net benefit across intermediate risk thresholds.
Conclusions
We developed and internally validated a nomogram using routine clinical and laboratory variables to predict 30-day mortality in ICU patients with CR-GNB BSIs. This tool may support early prognostic assessment at bedside and guide individualized management. Prospective multicenter validation is warranted.
{"title":"Carbapenem resistant gram negative bacteremia in intensive care unit patients: Development and validation of a nomogram-based 30-day mortality risk prediction model","authors":"Nesrin Türker , Ozge Eren Korkmaz , Figen Kaptan Aydogmus , Nur Miray Ayhan Geniş , Tuba Müderris , Murat Aksun","doi":"10.1016/j.jiac.2025.102902","DOIUrl":"10.1016/j.jiac.2025.102902","url":null,"abstract":"<div><h3>Background</h3><div>Carbapenem-resistant Gram-negative bloodstream infections (CR-GNB BSIs) are increasingly prevalent in intensive care units (ICUs) and associated with high mortality. Accurate early risk stratification tools are lacking.</div></div><div><h3>Objectives</h3><div>To develop and internally validate a nomogram-based model predicting 30-day mortality in ICU patients with CR-GNB BSIs.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of adult ICU patients with CR-GNB BSIs at a tertiary hospital in western Turkey (January 2020–October 2024). Demographic, clinical, laboratory, and microbiological data were collected. Patients were randomly split into training (70 %) and validation (30 %) cohorts. Univariable and multivariable logistic regression analyses identified independent mortality predictors, which were incorporated into a nomogram. Model discrimination, calibration, and decision-curve utility were evaluated.</div></div><div><h3>Results</h3><div>A total of 281 patients were included (median age 66 years; 60.9 % male); 30-day mortality was 58 %. <em>Acinetobacter spp</em>. predominated (51.6 %), followed by <em>Klebsiella spp</em>. (42.3 %) and <em>Pseudomonas spp</em>. (6.1 %). Independent predictors of 30-day mortality included older age, immunosuppression, hypoalbuminemia, elevated white blood cell count, and absence of microbiological cure. The nomogram demonstrated excellent discrimination (AUC 0.895 training; 0.854 validation), good calibration (mean absolute error 0.022–0.059), and meaningful clinical net benefit across intermediate risk thresholds.</div></div><div><h3>Conclusions</h3><div>We developed and internally validated a nomogram using routine clinical and laboratory variables to predict 30-day mortality in ICU patients with CR-GNB BSIs. This tool may support early prognostic assessment at bedside and guide individualized management. Prospective multicenter validation is warranted.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102902"},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145856988","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}
A man in his 50's with a history of acute lymphoblastic leukemia underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) over 20 years earlier and later developed bilateral giant pulmonary bullae, presumed secondary to pulmonary chronic graft-versus-host disease (cGVHD), requiring bilateral lung transplantation. Six months after lung transplantation, he developed rapid-onset severe normocytic anemia with reticulocytopenia. Cytomegalovirus (CMV) reactivation was initially suspected, and antiviral therapy was commenced, but the anemia persisted. Subsequent Polymerase chain reaction (PCR) testing revealed parvovirus B19 viremia, and bone marrow examination demonstrated erythroid hypoplasia with giant proerythroblasts, confirming parvovirus B19–associated pure red cell aplasia (PRCA). Treatment with intravenous immunoglobulin (IVIG) led to rapid hematologic improvement and complete recovery without recurrence.
This case underscores the importance of considering parvovirus B19 infection as a potential cause of anemia in immunocompromised individuals, especially following solid organ transplantation, where overlapping viral infections and immunosuppressive agents complicate diagnosis. Early recognition and prompt IVIG therapy can result in excellent outcomes and prevent unnecessary interventions.
{"title":"Parvovirus B19 infection induces pure red cell aplasia after lung transplantation","authors":"Yusuke Okamoto , Kenichi Ishiyama , Akira Matsumoto , Yusuke Tsuda , Miki Nagao , Masahiro Hirata , Masakazu Fujimoto , Hironori Haga , Yojiro Yutaka , Akifumi Takaori-Kondo","doi":"10.1016/j.jiac.2025.102901","DOIUrl":"10.1016/j.jiac.2025.102901","url":null,"abstract":"<div><div>A man in his 50's with a history of acute lymphoblastic leukemia underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) over 20 years earlier and later developed bilateral giant pulmonary bullae, presumed secondary to pulmonary chronic graft-versus-host disease (cGVHD), requiring bilateral lung transplantation. Six months after lung transplantation, he developed rapid-onset severe normocytic anemia with reticulocytopenia. Cytomegalovirus (CMV) reactivation was initially suspected, and antiviral therapy was commenced, but the anemia persisted. Subsequent Polymerase chain reaction (PCR) testing revealed parvovirus B19 viremia, and bone marrow examination demonstrated erythroid hypoplasia with giant proerythroblasts, confirming parvovirus B19–associated pure red cell aplasia (PRCA). Treatment with intravenous immunoglobulin (IVIG) led to rapid hematologic improvement and complete recovery without recurrence.</div><div>This case underscores the importance of considering parvovirus B19 infection as a potential cause of anemia in immunocompromised individuals, especially following solid organ transplantation, where overlapping viral infections and immunosuppressive agents complicate diagnosis. Early recognition and prompt IVIG therapy can result in excellent outcomes and prevent unnecessary interventions.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102901"},"PeriodicalIF":1.5,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786657","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}
We investigated the long-term impact of an antimicrobial stewardship program (ASP) led by a dedicated intensive care unit (ICU) pharmacist belonging to an antimicrobial stewardship team (AST) on trends in antimicrobial use and patient outcomes.
Methods
This was a single-center, retrospective study of patients admitted in an open ICU. Days of therapy (DOT) and number of patients receiving antimicrobial drug (NAD) of carbapenems, anti-pseudomonal β-lactams and non-anti-pseudomonal β-lactams, and all-cause mortality at 28 days were compared between the pre-ASP period (April 2012 to March 2016) and post-ASP period (April 2016 to March 2024). We divided patients into the sepsis, non-sepsis, and non-infection groups and compared outcomes. De-escalation rates and number of days until de-escalation of carbapenems and anti-pseudomonal β-lactams were investigated in sepsis and non-sepsis cases.
Results
DOT decreased significantly for carbapenems, anti-pseudomonal and non-anti-pseudomonal β-lactams post-ASP. In sepsis cases, the number of days until de-escalation of carbapenems and anti-pseudomonal β-lactams significantly decreased post-ASP; the ICU pharmacist intervened in all cases for sepsis and non-sepsis post-ASP. DOT of carbapenems and anti-pseudomonal β-lactams decreased significantly in non-sepsis and non-infection cases post-ASP. NAD significantly decreased in patients treated with carbapenems, anti-pseudomonal β-lactams and non-anti-pseudomonal β-lactams post-ASP. In non-infection cases, NAD significantly decreased in patients treated with carbapenems, anti-pseudomonal β-lactams post-ASP. No significant difference occurred in all-cause mortality rate between groups.
Conclusion
ASP led by a pharmacist belonging to an AST in the open ICU contributed to long-term appropriate antimicrobial use of carbapenems and anti-pseudomonal β-lactams, and DOT for non-pseudomonal β-lactams.
{"title":"The effect of pharmacist-led antimicrobial stewardship on antimicrobial use in an intensive care unit: a single-center, retrospective, observational study","authors":"Yoshihiro Nishita , Natsuko Ishida , Masatoshi Taga , Ryoji Takata , Yoshitsugu Iinuma , Togen Masauji , Junko Ishizaki","doi":"10.1016/j.jiac.2025.102898","DOIUrl":"10.1016/j.jiac.2025.102898","url":null,"abstract":"<div><h3>Purpose</h3><div>We investigated the long-term impact of an antimicrobial stewardship program (ASP) led by a dedicated intensive care unit (ICU) pharmacist belonging to an antimicrobial stewardship team (AST) on trends in antimicrobial use and patient outcomes.</div></div><div><h3>Methods</h3><div>This was a single-center, retrospective study of patients admitted in an open ICU. Days of therapy (DOT) and number of patients receiving antimicrobial drug (NAD) of carbapenems, anti-pseudomonal β-lactams and non-anti-pseudomonal β-lactams, and all-cause mortality at 28 days were compared between the pre-ASP period (April 2012 to March 2016) and post-ASP period (April 2016 to March 2024). We divided patients into the sepsis, non-sepsis, and non-infection groups and compared outcomes. De-escalation rates and number of days until de-escalation of carbapenems and anti-pseudomonal β-lactams were investigated in sepsis and non-sepsis cases.</div></div><div><h3>Results</h3><div>DOT decreased significantly for carbapenems, anti-pseudomonal and non-anti-pseudomonal β-lactams post-ASP. In sepsis cases, the number of days until de-escalation of carbapenems and anti-pseudomonal β-lactams significantly decreased post-ASP; the ICU pharmacist intervened in all cases for sepsis and non-sepsis post-ASP. DOT of carbapenems and anti-pseudomonal β-lactams decreased significantly in non-sepsis and non-infection cases post-ASP. NAD significantly decreased in patients treated with carbapenems, anti-pseudomonal β-lactams and non-anti-pseudomonal β-lactams post-ASP. In non-infection cases, NAD significantly decreased in patients treated with carbapenems, anti-pseudomonal β-lactams post-ASP. No significant difference occurred in all-cause mortality rate between groups.</div></div><div><h3>Conclusion</h3><div>ASP led by a pharmacist belonging to an AST in the open ICU contributed to long-term appropriate antimicrobial use of carbapenems and anti-pseudomonal β-lactams, and DOT for non-pseudomonal β-lactams.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102898"},"PeriodicalIF":1.5,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786750","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}
A 69-year-old woman with hypertension had undergone total arch replacement with an open stent graft 7 years prior. She was referred to our hospital for evaluation after experiencing fever (>38 °C) and cough. Chest radiography revealed a prominent aortic arch, and contrast-enhanced computed tomography demonstrated aortic arch enlargement and peri-graft fluid collection containing air. These findings indicated graft infection and prompted immediate intervention. Blood cultures grew Streptococcus equi subspecies zooepidemicus, a zoonotic pathogen associated with horses. Notably, the patient worked as a horse trainer. On hospital day 6, she developed severe hemoptysis due to an aortobronchial fistula caused by stent graft infection and underwent emergency re-replacement of the aortic arch. Intraoperative specimens also yielded the same pathogen. Consequently, she was treated with ampicillin, and her postoperative course was uneventful. Although rare, zoonotic pathogens can cause vascular graft infections.
{"title":"Zoonotic aortic graft infection by Streptococcus equi","authors":"Haruka Karaushi , Akihiro Yoshitake , Yuta Kanazawa , Noriyuki Watanabe , Mieko Tokano , Masafumi Seki , Kotaro Mitsutake","doi":"10.1016/j.jiac.2025.102900","DOIUrl":"10.1016/j.jiac.2025.102900","url":null,"abstract":"<div><div>A 69-year-old woman with hypertension had undergone total arch replacement with an open stent graft 7 years prior. She was referred to our hospital for evaluation after experiencing fever (>38 °C) and cough. Chest radiography revealed a prominent aortic arch, and contrast-enhanced computed tomography demonstrated aortic arch enlargement and peri-graft fluid collection containing air. These findings indicated graft infection and prompted immediate intervention. Blood cultures grew <em>Streptococcus equi</em> subspecies <em>zooepidemicus</em>, a zoonotic pathogen associated with horses. Notably, the patient worked as a horse trainer. On hospital day 6, she developed severe hemoptysis due to an aortobronchial fistula caused by stent graft infection and underwent emergency re-replacement of the aortic arch. Intraoperative specimens also yielded the same pathogen. Consequently, she was treated with ampicillin, and her postoperative course was uneventful. Although rare, zoonotic pathogens can cause vascular graft infections.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102900"},"PeriodicalIF":1.5,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781349","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}
Group B Streptococcus (GBS), a commensal bacterium in the gastrointestinal tract, can cause invasive GBS (iGBS) infections, particularly in older adults with underlying comorbidities. We determined the relationship between mortality and host-related or virulence factors in older adults with iGBS infections.
Methods
We retrospectively analyzed 105 cases of iGBS infection treated between January 2016 and October 2023 at Tokyo Medical University Hospital and two affiliated hospitals. The association between patient outcomes and demographics, underlying diseases, clinical manifestations, medical treatment, biomarkers, antimicrobial agents used at admission, and capsular type of GBS isolates was examined.
Results
The median age of the patients was 78 years (interquartile range, 64–85 years), and 89.5 % had underlying comorbidities, such as diabetes, chronic kidney disease, and malignancies. Common clinical manifestations include skin and soft tissue infections, bacteremia, and urosepsis. The overall mortality rate was 11.4 %. White blood cell (WBC) counts (breakpoint,10 × 103/μL) on admission were significantly lower in fatal cases (P < 0.001; odds ratio, 9.6), but no significant differences were observed for other biomarkers. The Kaplan–Meier estimate of 28-day survival was associated with WBC count (P < 0.001). The most common capsular type was Ib, followed by type V. Levofloxacin resistance was predominantly identified in type Ib. No significant association was found between capsular type and mortality rates.
Conclusion
Effective prevention of iGBS infections in older individuals requires large-scale surveillance, including environmental factors, and the development of comprehensive and multifaceted prevention strategies for high-risk older populations.
{"title":"Characteristics of invasive group B streptococcal infections in adults and older individuals in a super-aging society in Japan, 2016–2023","authors":"Hideaki Takahashi , Haruko Miyazaki , Yuki Watanabe , Daisuke Kawahata , Yutaka Nasu , Misako Takata , Hidemasa Nakaminami , Hidehiro Watanabe , Yuji Hirai , Kimiko Ubukata , Shigeki Nakamura","doi":"10.1016/j.jiac.2025.102897","DOIUrl":"10.1016/j.jiac.2025.102897","url":null,"abstract":"<div><h3>Background</h3><div>Group B <em>Streptococcus</em> (GBS), a commensal bacterium in the gastrointestinal tract, can cause invasive GBS (iGBS) infections, particularly in older adults with underlying comorbidities. We determined the relationship between mortality and host-related or virulence factors in older adults with iGBS infections.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 105 cases of iGBS infection treated between January 2016 and October 2023 at Tokyo Medical University Hospital and two affiliated hospitals. The association between patient outcomes and demographics, underlying diseases, clinical manifestations, medical treatment, biomarkers, antimicrobial agents used at admission, and capsular type of GBS isolates was examined.</div></div><div><h3>Results</h3><div>The median age of the patients was 78 years (interquartile range, 64–85 years), and 89.5 % had underlying comorbidities, such as diabetes, chronic kidney disease, and malignancies. Common clinical manifestations include skin and soft tissue infections, bacteremia, and urosepsis. The overall mortality rate was 11.4 %. White blood cell (WBC) counts (breakpoint,10 × 10<sup>3</sup>/μL) on admission were significantly lower in fatal cases (<em>P</em> < 0.001; odds ratio, 9.6), but no significant differences were observed for other biomarkers. The Kaplan–Meier estimate of 28-day survival was associated with WBC count (<em>P</em> < 0.001). The most common capsular type was Ib, followed by type V. Levofloxacin resistance was predominantly identified in type Ib. No significant association was found between capsular type and mortality rates.</div></div><div><h3>Conclusion</h3><div>Effective prevention of iGBS infections in older individuals requires large-scale surveillance, including environmental factors, and the development of comprehensive and multifaceted prevention strategies for high-risk older populations.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102897"},"PeriodicalIF":1.5,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781369","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}
Cefiderocol, a novel β-lactam antibiotic, exhibits potent activity against carbapenemase-producing Enterobacterales (CPE). While its clinical efficacy has been reported for infections caused by KPC-type CPE and Stenotrophomonas maltophilia, evidence regarding its effectiveness against IMP-type CPE remains primarily derived from in vitro studies, with limited clinical data available. This is the first pediatric case successfully treated with cefiderocol for IMP-type CPE bacteremia. He was a 6-year-old boy with inherited glycosylphosphatidylinositol deficiency and acute lymphoblastic leukemia undergoing chemotherapy. He developed bacteremia that blood culture multiplex PCR identified Klebsiella pneumoniae with IMP gene. The combination therapy of cefiderocol 60mg/kg/dose every 8 hours and gentamicin 5mg/kg/dose once daily sterilized blood culture, and subsequent monotherapy with cefiderocol was continued for a total of 14 days. Additional molecular test in the strain detected IMP-1 carbapenemase, SHV extended spectrum β-lactamase and EBC-type AmpC β-lactamase. Cefiderocol was susceptible at minimum inhibitory concentration 0.5μg/mL. Further study is needed for cefiderocol treatment for IMP-type CPE infection in children.
{"title":"The first pediatric case successfully treated with cefiderocol for IMP-type carbapenemase-producing Enterobacterales bacteremia","authors":"Haruna Mori , Yuto Otsubo , Meiwa Shibata , Kyogo Suzuki , Yuho Horikoshi","doi":"10.1016/j.jiac.2025.102899","DOIUrl":"10.1016/j.jiac.2025.102899","url":null,"abstract":"<div><div>Cefiderocol, a novel β-lactam antibiotic, exhibits potent activity against carbapenemase-producing Enterobacterales (CPE). While its clinical efficacy has been reported for infections caused by KPC-type CPE and <em>Stenotrophomonas maltophilia</em>, evidence regarding its effectiveness against IMP-type CPE remains primarily derived from in vitro studies, with limited clinical data available. This is the first pediatric case successfully treated with cefiderocol for IMP-type CPE bacteremia. He was a 6-year-old boy with inherited glycosylphosphatidylinositol deficiency and acute lymphoblastic leukemia undergoing chemotherapy. He developed bacteremia that blood culture multiplex PCR identified <em>Klebsiella pneumoniae</em> with IMP gene. The combination therapy of cefiderocol 60mg/kg/dose every 8 hours and gentamicin 5mg/kg/dose once daily sterilized blood culture, and subsequent monotherapy with cefiderocol was continued for a total of 14 days. Additional molecular test in the strain detected IMP-1 carbapenemase, SHV extended spectrum β-lactamase and EBC-type AmpC β-lactamase. Cefiderocol was susceptible at minimum inhibitory concentration 0.5μg/mL. Further study is needed for cefiderocol treatment for IMP-type CPE infection in children.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102899"},"PeriodicalIF":1.5,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781415","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}
Prospective audit and feedback (PAF) is a key component of antimicrobial stewardship (AS) programs and has been shown to reduce the use of broad-spectrum antibiotics. However, the optimal timing of PAF intervention remains unclear.
This quasi-experimental, single-center study investigated the impact of changing PAF timing from day 3 to day 7 after initiating empirical broad-spectrum antibiotics. Monthly days of therapy (DOT) for carbapenems (CAR), piperacillin-tazobactam (PIP/TAZ), and cefepime (PEF) were extracted from 2016 to 2024. Annual susceptibility rates of Pseudomonas aeruginosa and the time from blood culture submission to susceptibility results were also evaluated. Interrupted time series analysis assessed changes in DOT, while other data were descriptively analyzed.
DOT for CAR and PIP/TAZ decreased significantly post-intervention (CAR: −0.68, P < 0.001; PIP/TAZ: −0.29, P = 0.031), despite no significant change in trend slopes. PEF showed no significant changes. Susceptibility rates of P. aeruginosa remained stable. Notably, 28.3 % of blood culture results exceeded 4 days to report, and 95 % were available by day 7.
As causality cannot be inferred from this observational design, the mechanism underlying the observed reduction in DOT remains uncertain. Nevertheless, adjusting PAF timing may be feasible in settings with limited stewardship resources. Further studies are needed to determine the most effective timing of PAF interventions and to assess generalizability to other institutions.
前瞻性审核和反馈（PAF）是抗菌药物管理（AS）计划的关键组成部分，已被证明可以减少广谱抗生素的使用。然而，PAF干预的最佳时机仍不清楚。这项准实验、单中心研究调查了在使用经验性广谱抗生素后第3天至第7天改变PAF时间的影响。提取2016 - 2024年碳青霉烯类药物（CAR）、哌拉西林-他唑巴坦（PIP/TAZ）和头孢吡肟（CEF）的月治疗天数（DOT）。同时对铜绿假单胞菌的年敏感性和血培养提交至药敏结果的时间进行了评价。中断时间序列分析评估DOT的变化，而其他数据进行描述性分析。干预后，尽管趋势斜率没有显著变化，但CAR和PIP/TAZ的DOT显著下降（CAR: -0.68, P < 0.001; PIP/TAZ: -0.29, P = 0.031）。CEF无明显变化。铜绿假单胞菌的敏感率保持稳定。值得注意的是，28.3%的血培养结果超过4天报告，95%的血培养结果在第7天报告。由于因果关系不能从这种观察设计中推断出来，因此观察到的DOT减少的机制仍然不确定。然而，在管理资源有限的情况下，调整PAF时间可能是可行的。需要进一步的研究来确定PAF干预的最有效时机，并评估对其他机构的推广。
{"title":"Impact of timing in prospective audit and feedback on broad-spectrum antibiotic use: a comparison between third-day and seventh-day interventions","authors":"Hisako Machida , Yoshiki Kusama , Daisuke Onozuka , Atsuko Sunada , Satoshi Kutsuna","doi":"10.1016/j.jiac.2025.102896","DOIUrl":"10.1016/j.jiac.2025.102896","url":null,"abstract":"<div><div>Prospective audit and feedback (PAF) is a key component of antimicrobial stewardship (AS) programs and has been shown to reduce the use of broad-spectrum antibiotics. However, the optimal timing of PAF intervention remains unclear.</div><div>This quasi-experimental, single-center study investigated the impact of changing PAF timing from day 3 to day 7 after initiating empirical broad-spectrum antibiotics. Monthly days of therapy (DOT) for carbapenems (CAR), piperacillin-tazobactam (PIP/TAZ), and cefepime (PEF) were extracted from 2016 to 2024. Annual susceptibility rates of <em>Pseudomonas aeruginosa</em> and the time from blood culture submission to susceptibility results were also evaluated. Interrupted time series analysis assessed changes in DOT, while other data were descriptively analyzed.</div><div>DOT for CAR and PIP/TAZ decreased significantly post-intervention (CAR: −0.68, P < 0.001; PIP/TAZ: −0.29, P = 0.031), despite no significant change in trend slopes. PEF showed no significant changes. Susceptibility rates of <em>P. aeruginosa</em> remained stable. Notably, 28.3 % of blood culture results exceeded 4 days to report, and 95 % were available by day 7.</div><div>As causality cannot be inferred from this observational design, the mechanism underlying the observed reduction in DOT remains uncertain. Nevertheless, adjusting PAF timing may be feasible in settings with limited stewardship resources. Further studies are needed to determine the most effective timing of PAF interventions and to assess generalizability to other institutions.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102896"},"PeriodicalIF":1.5,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774669","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}
We describe the first case of both a peritoneal abscess and a lumbar-peritoneal (LP) shunt infection related to Corynebacterium striatum (C. striatum). An 85-year-old Japanese male with a history of diabetes, hyperlipidemia, and a pulmonary vein isolation procedure for atrial fibrillation presented with urinary incontinence, gait disturbance, and cognitive decline. He was diagnosed with normal-pressure hydrocephalus (NPH) and underwent LP shunt surgery. Postoperatively, he developed pneumonia followed by an intra-abdominal abscess and bacterial meningitis. C. striatum was isolated from both cerebrospinal fluid (CSF) and intraperitoneal abscess. Despite antibiotic treatment including vancomycin, he developed septic shock and ultimately resulted in his death.
The LP shunt likely facilitated the entry of C. striatum into the CSF, resulting in meningitis and subsequent abscess formation. Despite appropriate antibiotic treatment including vancomycin, C. striatum infections can be resistant and lead to severe outcomes. This case highlights a new complication associated with C. striatum: bacterial meningitis and intraperitoneal abscesses via an LP shunt, expanding its clinical spectrum.
{"title":"Lumbar-peritoneal shunt-associated meningitis and peritoneal abscess due to Corynebacterium striatum: A case report and literature review","authors":"Akiho Maeda , Koji Hayashi , Rina Izumi , Yusuke Tsujigiwa , Yuka Nakaya , Yoshitomo Fukuoka , Kohei Ueda , Norichika Hashimoto","doi":"10.1016/j.jiac.2025.102895","DOIUrl":"10.1016/j.jiac.2025.102895","url":null,"abstract":"<div><div>We describe the first case of both a peritoneal abscess and a lumbar-peritoneal (LP) shunt infection related to <em>Corynebacterium striatum</em> (<em>C. striatum</em>). An 85-year-old Japanese male with a history of diabetes, hyperlipidemia, and a pulmonary vein isolation procedure for atrial fibrillation presented with urinary incontinence, gait disturbance, and cognitive decline. He was diagnosed with normal-pressure hydrocephalus (NPH) and underwent LP shunt surgery. Postoperatively, he developed pneumonia followed by an intra-abdominal abscess and bacterial meningitis. <em>C. striatum</em> was isolated from both cerebrospinal fluid (CSF) and intraperitoneal abscess. Despite antibiotic treatment including vancomycin, he developed septic shock and ultimately resulted in his death.</div><div>The LP shunt likely facilitated the entry of <em>C. striatum</em> into the CSF, resulting in meningitis and subsequent abscess formation. Despite appropriate antibiotic treatment including vancomycin, <em>C. striatum</em> infections can be resistant and lead to severe outcomes. This case highlights a new complication associated with <em>C. striatum</em>: bacterial meningitis and intraperitoneal abscesses via an LP shunt, expanding its clinical spectrum.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102895"},"PeriodicalIF":1.5,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145756992","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}
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