Journal of Infection and Chemotherapy最新文献_第5页

Application of epithelial lining fluid drug concentrations to MICi-Based PK/PD modeling of cefepime/nacubactam in a murine model of CPE pneumonia 上皮内层液药物浓度在CPE肺炎小鼠模型中基于mici的头孢吡肟/纳库巴坦PK/PD模型中的应用

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-12-08 DOI: 10.1016/j.jiac.2025.102889

Yuki Mizukami , Mishu Takahashi , Kenta Suzuki , Shaoqing Duan , Shintaro Ikegami , Takuma Muraishi , Natsuki Satake , Yuko Okamoto , Yuki Igarashi , Yuki Enoki , Kazuaki Taguchi , Kazuaki Matsumoto

Introduction

Nacubactam is a novel β-lactamase inhibitor with intrinsic antibacterial activity that shows therapeutic potential against carbapenemase-producing Enterobacterales when administered with β-lactam antibiotics. Pharmacokinetics/pharmacodynamics (PK/PD) analyses based on drug concentrations at the site of infection are recommended to better evaluate antibiotic efficacy. A new PD index, the instantaneous minimum inhibitory concentration (MIC_i), which dynamically reflects the changing susceptibility of β-lactams during co-administration with β-lactamase inhibitors, has recently been proposed. This study aimed to assess the efficacy of cefepime combined with nacubactam in a murine model of pneumonia using MIC_i-based PK/PD analysis in the lung epithelial lining fluid (ELF).

Methods

In vitro pharmacodynamic testing using the checkerboard method was conducted with two β-lactamase-producing Klebsiella pneumoniae strains. In vivo PK and PD studies were performed in neutropenic mice using both β-lactamase-producing and non-producing strains. Drug concentrations in plasma and ELF were measured, and MIC_i-based PK/PD analysis was conducted.

Results

In vitro, the MIC of cefepime decreased in a concentration-dependent manner with increasing nacubactam. In the murine model of pneumonia, cefepime monotherapy resulted in bacterial changes of 0.12–4.30 log₁₀ CFU/lung, while the combination therapy reduced bacterial counts by −5.93 to −0.234 log₁₀ CFU/lung. The percentage of time that free cefepime concentrations exceeded MIC_i (T > MIC_i) was highly correlated with bacterial reduction. The target T > MIC_i for maximal effect was estimated to be 29.3 %.

Conclusions

These findings support the utility of MIC_i-based PK/PD analysis for optimizing combination antibiotic therapy in pneumonia.

纳库巴坦是一种新型的β-内酰胺酶抑制剂，具有内在的抗菌活性，当与β-内酰胺抗生素一起使用时，对产生碳青霉烯酶的肠杆菌显示出治疗潜力。建议根据感染部位的药物浓度进行药代动力学/药效学（PK/PD）分析，以更好地评估抗生素的疗效。最近提出了一种新的PD指标，即瞬时最小抑制浓度（瞬时最小抑制浓度，MICi），它动态地反映了β-内酰胺酶抑制剂与β-内酰胺酶抑制剂共同给药过程中β-内酰胺类药物敏感性的变化。本研究旨在通过肺上皮衬里液（ELF）基于mici的PK/PD分析，评估头孢吡肟联合纳库巴坦对小鼠肺炎模型的疗效。方法：采用棋盘法对2株产β-内酰胺酶肺炎克雷伯菌进行体外药效学试验。使用产生β-内酰胺酶和不产生β-内酰胺酶的菌株在中性粒细胞减少小鼠体内进行PK和PD研究。测定血浆药物浓度和ELF，并基于mici进行PK/PD分析。结果：体外头孢吡肟的MIC随纳库巴坦的增加呈浓度依赖性降低。在肺炎小鼠模型中，头孢吡肟单药治疗导致细菌数量变化0.12 ~ 4.30 log10 CFU/肺，而联合治疗使细菌数量减少-5.93 ~ -0.234 log10 CFU/肺。游离头孢吡肟浓度超过MICi （t> MICi）的时间百分比与细菌减少高度相关。达到最大效果的目标t> MICi估计为29.3%。结论：这些发现支持基于mici的PK/PD分析在优化肺炎联合抗生素治疗中的应用。

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引用次数: 0

Letermovir prophylaxis and risk of bacterial or fungal infection after allogeneic hematopoietic cell transplantation 莱特莫韦预防异基因造血细胞移植后细菌或真菌感染的风险。

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-12-08 DOI: 10.1016/j.jiac.2025.102888

Shun-ichi Kimura , Shunto Kawamura , Takashi Toya , Keiji Okinaka , Hiroki Hosoi , Naoyuki Uchida , Noriko Doki , Tetsuya Nishida , Masatsugu Tanaka , Yuta Hasegawa , Yoshinobu Kanda , Noboru Asada , Naoki Kurita , Hirohisa Nakamae , Tetsuya Eto , Makoto Yoshimitsu , Makoto Onizuka , Takahiro Fukuda , Marie Ohbiki , Yoshiko Atsuta , Kimikazu Yakushijin

Background

Previous reports have suggested an association between cytomegalovirus (CMV) infection and bacterial or fungal infections after allogeneic hematopoietic cell transplantation (HCT). This study aimed to examine the relationship between letermovir (LTV) prophylaxis and the incidence of bacteremia and invasive fungal infections.

Methods

Using a Japanese transplant registry database, we analyzed 19,531 patients who underwent their first allogeneic HCT from 2011 to 2022. Patients who initiated LTV prophylaxis within the first week post-transplantation were classified as the LTV group.

Results

A total of 4915 patients in the LTV group and 14,616 in the No LTV group were analyzed. The incidence of bacteremia by day 100 was significantly lower in the LTV group compared to the No LTV group (17.4 % vs. 21.7 %, P < 0.001). In the multivariate analysis, LTV prophylaxis (HR 0.75, 95 %CI: 0.69–0.81) was found to be significantly associated with a reduced risk of bacteremia, along with neutrophil engraftment. Age >50 years, male, non-remission status, alternative donors, higher values of the hematopoietic cell transplantation-comorbidity index, poor performance status, and grade II–IV acute graft-versus-host disease were associated with an increased risk of bacteremia. LTV was associated with a reduced risk of bacteremia both within 30 days (HR 0.74, 95 %CI: 0.68–0.81) and beyond 30 days (HR 0.76, 95 %CI: 0.66–0.89) after HCT. Conversely, it was not associated with the risk of invasive aspergillosis or candidemia.

Conclusions

LTV prophylaxis significantly reduced the risk of bacteremia. However, it was not associated with the risk of invasive fungal infections.

背景：先前的报道表明，同种异体造血细胞移植（HCT）后巨细胞病毒（CMV）感染与细菌或真菌感染之间存在关联。本研究旨在探讨利特莫韦（LTV）预防与菌血症和侵袭性真菌感染的关系。方法：使用日本移植登记数据库，我们分析了2011年至2022年首次接受同种异体HCT的19531例患者。移植后第一周内开始LTV预防的患者被归类为LTV组。结果：LTV组共4915例，无LTV组共14616例。与无LTV组相比，LTV组第100天的菌血症发生率显著降低（17.4%比21.7%,P < 0.001）。在多变量分析中，发现LTV预防（HR 0.75, 95%CI: 0.69 - 0.81）与降低菌血症风险以及中性粒细胞植入显著相关。年龄bb - 50岁，男性，非缓解状态，替代供体，较高的造血细胞移植合并症指数，较差的状态和II-IV级急性移植物抗宿主病与菌血症的风险增加相关。LTV与HCT后30天内（HR 0.74, 95%CI: 0.68-0.81）和30天后（HR 0.76, 95%CI: 0.66-0.89）菌血症风险降低相关。相反，它与侵袭性曲霉病或念珠菌病的风险无关。结论：LTV预防可显著降低菌血症的发生风险。然而，它与侵袭性真菌感染的风险无关。

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引用次数: 0

A cluster of 11 cases of Listeria monocytogenes bacteremia in Kyoto, Japan 日本京都11例单核增生李斯特菌菌血症聚集性报告

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-12-05 DOI: 10.1016/j.jiac.2025.102887

Hajime Tsuboi , Shin Matsubara , Yoshiyuki Kawahara , Kenji Konaka , Kaori Tamai , Daisuke Yokoi , Yoshihiro Tanabe , Naohisa Fujita , Satoru Shikata

Background

Listeria monocytogenes infection, known as listeriosis, is relatively uncommon. However, in elderly or immunocompromised patients, it can lead to severe manifestations such as meningitis and bacteremia, making it a clinically important disease. The primary route of transmission is through ingestion of contaminated food, and since a wide range of food items may be involved, close collaboration with public health authorities is essential for effective source identification.

Case report

We encountered 11 cases of Listeria monocytogenes bacteremia within a limited region over the course of one month. Whole-genome sequencing revealed that the isolates were highly genetically related. Notably, the patients resided in different municipalities, suggesting exposure to a widely distributed food source. However, under the current Japanese legal framework, bacteremia is not a notifiable condition, which hindered timely identification of the infection source.

Conclusion

This case series underscores challenges in both clinical practice and the public health system in Japan, highlighting how such rare, genetically related clusters of bacteremia, occurring within a short period and across multiple municipalities, can easily be overlooked under the current surveillance framework.

背景：单核细胞增生李斯特菌感染，又称李斯特菌病，是相对罕见的。然而，在老年人或免疫功能低下的患者中，可导致脑膜炎和菌血症等严重表现，使其成为临床上重要的疾病。主要传播途径是通过摄入受污染的食物，由于可能涉及多种食品，因此与公共卫生当局密切合作对于有效查明来源至关重要。病例报告：在一个月内，我们在有限的区域内遇到了11例单核细胞增生李斯特菌血症。全基因组测序结果显示，分离株具有高度的遗传相关性。值得注意的是，患者居住在不同的城市，这表明他们接触过广泛分布的食物来源。然而，在目前的日本法律框架下，菌血症不是一种必须报告的疾病，这阻碍了及时识别感染源。该系列病例凸显了日本临床实践和公共卫生系统面临的挑战，突出了在短时间内发生并跨越多个城市的这种罕见的、遗传相关的菌血症聚集性病例在当前的监测框架下很容易被忽视。

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引用次数: 0

Nutrition in nontuberculous mycobacterial pulmonary disease: A narrative review 非结核性分枝杆菌肺病的营养：综述。

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-12-05 DOI: 10.1016/j.jiac.2025.102886

Makoto Hayashi , Takuya Yokoe , Satoshi Matsukura

The clinical outcomes of nontuberculous mycobacterial pulmonary disease (NTM-PD) are largely influenced by nutritional status. However, specific nutritional intervention strategies for NTM-PD have not been established, making management challenging. This narrative review summarizes the immunopathology associated with mycobacterial infection and the effects of malnutrition on immune responses. It further examines the clinical impact of malnutrition and the nutritional characteristics of patients with NTM-PD, highlighting the significance of nutritional intervention. Additionally, we review the current knowledge on nutritional therapy for NTM-PD, drawing insights from approaches used in related conditions. Although nutritional support may improve patient outcomes and is clearly needed, evidence regarding its effectiveness remains limited. Consequently, incorporating nutritional assessment and individualized intervention into comprehensive care currently represents the best clinical practice.

非结核性分枝杆菌肺病（NTM-PD）的临床结果在很大程度上受营养状况的影响。然而，NTM-PD的具体营养干预策略尚未建立，这使得管理具有挑战性。本文综述了与分枝杆菌感染相关的免疫病理以及营养不良对免疫反应的影响。进一步探讨营养不良的临床影响及NTM-PD患者的营养特征，强调营养干预的重要性。此外，我们回顾了目前关于NTM-PD营养治疗的知识，从相关条件下使用的方法中吸取见解。虽然营养支持可以改善患者的预后，并且显然是必要的，但关于其有效性的证据仍然有限。因此，将营养评估和个性化干预纳入综合护理是目前最佳的临床实践。

引用次数: 0

Antibiotic-associated encephalopathy induced by cefmetazole in a hemodialysis patient: Case report 头孢美唑致血液透析患者抗生素相关性脑病1例报告。

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-12-04 DOI: 10.1016/j.jiac.2025.102882

Toshiyuki Nakanishi , Taku Harada , Satoshi Kutsuna

Antibiotic-associated encephalopathy (AAE) is a rare but significant neurological complication of β-lactam antibiotics, particularly in patients with renal impairment. While cefepime, ceftazidime, and ceftriaxone are well-documented causes, cefmetazole (CMZ) has not been widely recognized for neurotoxicity. We report an 82-year-old Japanese man with end-stage renal disease on chronic hemodialysis who developed altered mental status and myoclonus five days after starting intravenous CMZ for prostatic abscess. Electroencephalography (EEG) revealed triphasic waves consistent with non-convulsive status epilepticus. Neuroimaging and cerebrospinal fluid analysis showed no evidence of infection or stroke. Symptoms resolved within 48 hours of CMZ discontinuation. A Naranjo score of 5 supported a diagnosis of CMZ-induced AAE. This case underscores the potential neurotoxicity of CMZ and emphasizes the importance of early recognition of AAE in patients with renal dysfunction.

抗生素相关性脑病（AAE）是一种罕见但显著的β-内酰胺类抗生素神经系统并发症，尤其是肾损害患者。虽然头孢吡肟、头孢他啶和头孢曲松是有充分证据证明的原因，但头孢美唑（CMZ）尚未被广泛认为具有神经毒性。我们报告一名82岁日本男性慢性血液透析终末期肾脏疾病患者，在开始静脉注射CMZ治疗前列腺脓肿5天后出现精神状态改变和肌阵挛。脑电图显示三相波符合非惊厥性癫痫持续状态。神经影像学和脑脊液分析显示没有感染或中风的证据。停用CMZ后48小时内症状消失。Naranjo评分为5分支持cmz诱导的AAE的诊断。本病例强调了CMZ潜在的神经毒性，并强调了肾功能不全患者早期识别AAE的重要性。

引用次数: 0

Reducing the daily infusion time of peripheral parenteral nutrition to prevent bloodstream infection in hospitalized patients 减少外周肠外营养每日输注时间预防住院患者血流感染

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-12-04 DOI: 10.1016/j.jiac.2025.102884

Masafumi Shimoda, Yoshiaki Tanaka, Hiroyuki Kokutou, Takashi Yoshiyama, Kozo Morimoto, Kozo Yoshimori, Shoji Kudoh

Introduction

Peripheral parenteral nutrition (PPN), administered via a peripheral intravenous catheter (PVC), can occasionally lead to bloodstream infections (BSIs). We previously reported that a prolonged daily infusion time of PPN and all intravenous fluids were risk factors for BSI development. In response, our institution implemented a recommendation to limit the average daily infusion time of PPN to <12 h and that of all intravenous fluids to <18 h. The aim of this study was to investigate whether the incidence of BSI in patients receiving PPN decreased following the implementation of these recommendations.

Methods

We retrospectively collected data from 714 patients who underwent PPN therapy via PVC at Fukujuji Hospital from August 2022 to July 2025. We compared the incidence of BSI during PPN therapy between the preintervention and postintervention periods.

Results

Among the 714 patients, 507 were in the preintervention group, and 207 were in the postintervention group. The proportion of patients who developed BSIs was significantly lower in the postintervention group than in the preintervention group (n = 2 [1.0 %] vs. n = 27 [5.3 %], p = 0.006). The crude BSI incidence rate decreased from 3.59 to 0.73 per 1000 infusion days. A multivariable Poisson regression model revealed that the postintervention period was associated with a significantly lower BSI incidence rate (adjusted incidence rate ratio: 0.190; 95 % confidence interval: 0.045–0.804; p = 0.024), corresponding to an approximately 81 % reduction in BSI incidence.

Conclusion

Shortening the average daily infusion time of PPN and all intravenous fluids may help prevent the development of BSIs.

外周静脉营养（PPN）通过外周静脉导管（PVC）给予，偶尔会导致血流感染（bsi）。我们之前报道过PPN每日输注时间延长和所有静脉输液是BSI发展的危险因素。作为回应，我们的机构实施了一项建议，将PPN的平均每日输注时间限制在12小时，所有静脉输液的平均每日输注时间限制在18小时。本研究的目的是调查在实施这些建议后，接受PPN的患者BSI的发生率是否降低。方法回顾性收集2022年8月至2025年7月在福大医院经PVC行PPN治疗的714例患者的资料。我们比较了干预前和干预后PPN治疗期间BSI的发生率。结果714例患者中干预前组507例，干预后组207例。干预后组发生脑梗死的患者比例显著低于干预前组（n = 2 [1.0%] vs. n = 27 [5.3%], p = 0.006）。粗BSI发生率从每1000天3.59下降到0.73。多变量泊松回归模型显示，干预后期间BSI发病率显著降低（调整后的发病率比：0.190；95%可信区间：0.045-0.804;p = 0.024），相当于BSI发病率降低了约81%。结论缩短PPN及所有静脉输液的平均每日输注时间有助于预防脑梗死的发生。

{"title":"Reducing the daily infusion time of peripheral parenteral nutrition to prevent bloodstream infection in hospitalized patients","authors":"Masafumi Shimoda, Yoshiaki Tanaka, Hiroyuki Kokutou, Takashi Yoshiyama, Kozo Morimoto, Kozo Yoshimori, Shoji Kudoh","doi":"10.1016/j.jiac.2025.102884","DOIUrl":"10.1016/j.jiac.2025.102884","url":null,"abstract":"<div><h3>Introduction</h3><div>Peripheral parenteral nutrition (PPN), administered via a peripheral intravenous catheter (PVC), can occasionally lead to bloodstream infections (BSIs). We previously reported that a prolonged daily infusion time of PPN and all intravenous fluids were risk factors for BSI development. In response, our institution implemented a recommendation to limit the average daily infusion time of PPN to <12 h and that of all intravenous fluids to <18 h. The aim of this study was to investigate whether the incidence of BSI in patients receiving PPN decreased following the implementation of these recommendations.</div></div><div><h3>Methods</h3><div>We retrospectively collected data from 714 patients who underwent PPN therapy via PVC at Fukujuji Hospital from August 2022 to July 2025. We compared the incidence of BSI during PPN therapy between the preintervention and postintervention periods.</div></div><div><h3>Results</h3><div>Among the 714 patients, 507 were in the preintervention group, and 207 were in the postintervention group. The proportion of patients who developed BSIs was significantly lower in the postintervention group than in the preintervention group (n = 2 [1.0 %] vs. n = 27 [5.3 %], <em>p</em> = 0.006). The crude BSI incidence rate decreased from 3.59 to 0.73 per 1000 infusion days. A multivariable Poisson regression model revealed that the postintervention period was associated with a significantly lower BSI incidence rate (adjusted incidence rate ratio: 0.190; 95 % confidence interval: 0.045–0.804; <em>p</em> = 0.024), corresponding to an approximately 81 % reduction in BSI incidence.</div></div><div><h3>Conclusion</h3><div>Shortening the average daily infusion time of PPN and all intravenous fluids may help prevent the development of BSIs.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102884"},"PeriodicalIF":1.5,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145682332","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

Limitations of the AWaRe antibiotic classification during the 2024 Mycoplasma pneumoniae epidemic in Tokyo 2024年东京肺炎支原体流行期间AWaRe抗生素分类的局限性

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-12-04 DOI: 10.1016/j.jiac.2025.102885

Yuto Otsubo , Rentaro Oda , Yo Murata , Funato Sato , Shogo Akahoshi , Hiroshi Sakiyama , Yuho Horikoshi

Background

The utility of AWaRe antibiotic classification for evaluating antimicrobial stewardship in clinics during epidemics of specific, infectious diseases remains unknown. This study aimed to examine antibiotic prescribing patterns using the AWaRe classification during a Mycoplasma pneumoniae epidemic in Tokyo.

Methods

Oral antibiotic prescription data from January 2024 to June 2025 were obtained from the prescription surveillance system of 11 clinics in the Tama regional network (Tama cohort), a subset of all registered clinics in Tokyo (Tokyo cohort). For analysis, the pre-epidemic period, epidemic period, and post-epidemic period were defined as January–June 2024, July–December 2024, and January–June 2025, respectively. The primary outcome was the change in Access antibiotic proportions across the three periods. The secondary outcome was the difference in this change between cohorts.

Results

In total, 8,420 and 526,822 antibiotic prescriptions were issued by the Tama cohort and the Tokyo cohort, respectively. In the Tama cohort, Access antibiotic proportions were 64 %, 48 %, and 75 % during the pre-epidemic, epidemic, and post-epidemic periods, respectively; the corresponding values in the Tokyo cohort were 37 %, 32 %, and 40 %. Compared with the Tokyo cohort, estimated changes in Access proportions in the Tama cohort were −11.7 % (95 % CI: −14.2 to −9.2) from pre-epidemic to epidemic period, and +19.0 % (95 % CI: 16.6 to 21.5) from epidemic to post-epidemic period.

Conclusions

Access proportions temporarily decreased during the 2024 M. pneumoniae epidemic, particularly in the Tama cohort, where the baseline Access proportion was high, indicating potential limitation of AWaRe indicators under epidemic conditions.

背景：在特定传染病流行期间，AWaRe抗生素分类评估临床抗菌药物管理的效用尚不清楚。本研究旨在研究东京肺炎支原体流行期间使用AWaRe分类的抗生素处方模式。方法从东京所有注册诊所（东京队列）的Tama区域网络（Tama队列）的11家诊所的处方监测系统中获取2024年1月至2025年6月的口服抗生素处方数据。为进行分析，将流行前期、流行期和流行后期分别定义为2024年1 - 6月、2024年7 - 12月和2025年1 - 6月。主要结果是三个时期抗生素使用比例的变化。次要结果是队列间这种变化的差异。结果多摩队列和东京队列共发放抗生素处方8420张和526822张。在Tama队列中，在流行前、流行期和流行后，可获得抗生素的比例分别为64%、48%和75%；东京队列的相应值分别为37%、32%和40%。与东京队列相比，从流行前到流行期，Tama队列的可及性比例估计变化为- 11.7% (95% CI: - 14.2至- 9.2)，从流行期到流行后时期，估计变化为+ 19.0% （95% CI: 16.6至21.5）。结论在2024年肺炎支原体流行期间，可获取比例暂时下降，特别是在Tama队列中，基线可获取比例较高，表明AWaRe指标在流行条件下可能存在局限性。

{"title":"Limitations of the AWaRe antibiotic classification during the 2024 Mycoplasma pneumoniae epidemic in Tokyo","authors":"Yuto Otsubo , Rentaro Oda , Yo Murata , Funato Sato , Shogo Akahoshi , Hiroshi Sakiyama , Yuho Horikoshi","doi":"10.1016/j.jiac.2025.102885","DOIUrl":"10.1016/j.jiac.2025.102885","url":null,"abstract":"<div><h3>Background</h3><div>The utility of AWaRe antibiotic classification for evaluating antimicrobial stewardship in clinics during epidemics of specific, infectious diseases remains unknown. This study aimed to examine antibiotic prescribing patterns using the AWaRe classification during a <em>Mycoplasma pneumoniae</em> epidemic in Tokyo.</div></div><div><h3>Methods</h3><div>Oral antibiotic prescription data from January 2024 to June 2025 were obtained from the prescription surveillance system of 11 clinics in the Tama regional network (Tama cohort), a subset of all registered clinics in Tokyo (Tokyo cohort). For analysis, the pre-epidemic period, epidemic period, and post-epidemic period were defined as January–June 2024, July–December 2024, and January–June 2025, respectively. The primary outcome was the change in Access antibiotic proportions across the three periods. The secondary outcome was the difference in this change between cohorts.</div></div><div><h3>Results</h3><div>In total, 8,420 and 526,822 antibiotic prescriptions were issued by the Tama cohort and the Tokyo cohort, respectively. In the Tama cohort, Access antibiotic proportions were 64 %, 48 %, and 75 % during the pre-epidemic, epidemic, and post-epidemic periods, respectively; the corresponding values in the Tokyo cohort were 37 %, 32 %, and 40 %. Compared with the Tokyo cohort, estimated changes in Access proportions in the Tama cohort were −11.7 % (95 % CI: −14.2 to −9.2) from pre-epidemic to epidemic period, and +19.0 % (95 % CI: 16.6 to 21.5) from epidemic to post-epidemic period.</div></div><div><h3>Conclusions</h3><div>Access proportions temporarily decreased during the 2024 <em>M. pneumoniae</em> epidemic, particularly in the Tama cohort, where the baseline Access proportion was high, indicating potential limitation of AWaRe indicators under epidemic conditions.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102885"},"PeriodicalIF":1.5,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145682336","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

Pharmacokinetics of daptomycin during low-flow continuous renal replacement therapy in critically ill Japanese patients 日本危重病人低流量连续肾替代治疗期间达托霉素的药代动力学。

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-12-03 DOI: 10.1016/j.jiac.2025.102883

Kazuro Ikawa , Mana Taguchi , Takeshi Ide , Norifumi Morikawa , Kenta Takeda

Introduction

Daptomycin is used to treat systemic and life-threatening infections caused by methicillin-resistant Staphylococcus aureus in critically ill patients receiving continuous renal replacement therapy (CRRT). However, the pharmacokinetics of daptomycin during low-flow CRRT have not been examined; thus, the appropriate dosing adjustment in Japan remains uncertain.

Methods

The daptomycin concentrations in plasma and effluent samples of adult Japanese patients receiving continuous venovenous hemodiafiltration (n = 4) and continuous venovenous hemodialysis (n = 2) were measured by liquid chromatography. The data were analyzed and used to estimate pharmacodynamic exposure and concentrations to profile daptomycin regimens.

Results

The pharmacokinetics of daptomycin was described using two-compartment model. In the six CRRT patients (effluent flow rate, 0.825 ± 0.038 L/h), the parameter estimates were: volume of distribution of the central compartment, 8.09 ± 3.76 L; volume of distribution of the peripheral compartment, 6.23 ± 2.58 L; intercompartmental clearance, 4.63 ± 1.98 L/h; total clearance, 0.439 ± 0.172 L/h; sieving coefficient, 0.0995 ± 0.0295; extrinsic clearance by CRRT, 0.0815 ± 0.0223 L/h; intrinsic clearance of the patient, 0.357 ± 0.173 L/h; area under the concentration-time curve (AUC) for 24 h, 597.6 ± 196.1 mg‧h/L. Simulated daptomycin regimen for the exposure target (AUC ≥666 mg‧h/L) was 5.36 ± 2.46 mg/kg every 24 h, achieving the safety target (the minimum concentration ≤24.3 mg/L).

Conclusion

These results help to define the pharmacokinetics of daptomycin during low-flow CRRT, while also helping to consider dosing regimens for critically ill Japanese patients receiving CRRT.

简介：达托霉素用于治疗接受持续肾替代治疗（CRRT）的危重患者由耐甲氧西林金黄色葡萄球菌引起的全身和危及生命的感染。然而，达托霉素在低流量CRRT中的药代动力学尚未被研究；因此，日本适当的剂量调整仍不确定。方法：采用液相色谱法测定日本接受连续静脉静脉血液滤过（n = 4）和连续静脉静脉血液透析（n = 2）的成年患者血浆和流出液中达托霉素的浓度。对数据进行分析并用于估计药效学暴露和浓度，以描述达托霉素方案。结果：采用双室模型描述了达托霉素的药动学。6例CRRT患者（流出流速0.825±0.038 L/h），参数估计值为：中央室分布容积8.09±3.76 L；外周室分布容积，6.23±2.58 L；室间间隙：4.63±1.98 L/h；总间隙0.439±0.172 L/h；筛分系数，0.0995±0.0295；CRRT外清除率为0.0815±0.0223 L/h；患者本征清除率0.357±0.173 L/h；24 h浓度-时间曲线下面积（AUC）为597.6±196.1 mg·h/L。模拟达托霉素方案暴露目标（AUC≥666 mg·h/L）为5.36±2.46 mg/kg，达到安全目标（最低浓度≤24.3 mg/L）。结论：这些结果有助于确定低流量CRRT期间达托霉素的药代动力学，同时也有助于考虑日本危重患者接受CRRT的给药方案。

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引用次数: 0

RSV epidemiology in Italian adults over 60: a multicenter cross-sectional study 意大利60岁以上成年人RSV流行病学：一项多中心横断面研究。

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-12-02 DOI: 10.1016/j.jiac.2025.102881

Federica Novazzi , Laura Pellegrinelli , Federica A.M. Giardina , Carla Acciarri , Stefano Menzo , Elisa Vian , Valeria Biscaro , Giulia Piccirilli , Tiziana Lazzarotto , Sara Uceda Renteria , Annapaola Callegaro , Guglielmo Ferrari , Elisabetta Pagani , Elisa Masi , Cristina Galli , Claudia Tiberio , Martina Esposito , Alessandra Pierangeli , Guido Antonelli , Eleonora Lalle , Matteo Fracella

Objective

Respiratory syncytial virus (RSV) infections have a significant impact on public health, particularly among children and the elderly. However, the burden on older adults in Italy is underestimated due to a lack of comprehensive data.

Methods

Data on the molecular detection of RSV in respiratory samples from laboratories across Italy, from north to south, between September 2021 and May 2023 were collected and analyzed.

Results

A total of 138,783 tests were provided by 13 laboratories, with an overall RSV positivity rate of 6.4 %. Among adults aged ≥60 years (35.4 % of the total), the RSV positivity rate was 3.5 %. Two epidemic waves were observed, peaking in December 2021 and January 2023, with the second wave showing a higher number of cases. RSV subtyping revealed that RSV-B was the predominant subtype in both epidemic seasons, compared to RSV-A.

Conclusion

Analyses of RSV circulation in older adults highlight seasonal variability and underscore the importance of testing in this population. These findings may inform surveillance, clinical management, and the development of future preventive strategies, including vaccination.

目的：呼吸道合胞病毒（RSV）感染对公众健康有重大影响，特别是在儿童和老年人中。然而，由于缺乏全面的数据，意大利老年人的负担被低估了。方法：收集和分析2021年9月至2023年5月期间意大利各地实验室呼吸样本中RSV分子检测数据，从北到南。结果：13个实验室共提供138,783份检测报告，RSV总阳性率为6.4%。60岁以上成人（35.4%）RSV阳性率为3.5%；观察到两次流行波，分别于2021年12月和2023年1月达到高峰，第二波病例数更高。RSV亚型分型结果显示，与RSV- a相比，RSV- b是两个流行季节的主要亚型。结论：对老年人RSV循环的分析强调了季节性变异，并强调了在该人群中进行检测的重要性。这些发现可为监测、临床管理和制定包括疫苗接种在内的未来预防策略提供信息。

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引用次数: 0

A comparative study of out-of-pocket expenditure and quality of life in chronic pulmonary aspergillosis and post-tuberculosis lung disease patients 慢性肺曲霉病与结核后肺病患者自费支出与生活质量的比较研究。

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy

Pub Date : 2025-12-01 DOI: 10.1016/j.jiac.2025.102873

Renuka Titiyal , Sanjukta Sarkar , Megha Priyadarshi , Ved Prakash Meena , Prayas Sethi , G. Rahul Krishnan , Bindu Prakash , Gagandeep Singh , Immaculata Xess , Surabhi Vyas , Neeraj Nischal , Manish Soneja , Sanjeev Sinha , Naveet Wig , Animesh Ray

Background

Chronic pulmonary aspergillosis (CPA) comprises a spectrum of conditions that frequently affect individuals with chronic lung diseases, particularly post-tuberculosis lung disease (PTLD). Both disorders contribute to significant morbidity and impaired quality of life (QoL). In addition, they impose financial burden, much of which is borne directly by patients in low- and middle-income countries. However, data on out-of-pocket expenditure (OOPE) and its relationship with QoL in these groups remain limited.

Methods

This cross-sectional study, conducted at a tertiary referral centre in India, aimed to estimate OOPE (direct and indirect costs) in patients with CPA and PTLD, identify determinants of expenditure, and assess associations with QoL. Data on OOPE, borrowing, and catastrophic health expenditure during the preceding year were collected through structured interviews. QoL was evaluated using the St. George's Respiratory Questionnaire (SGRQ). Results: Both the direct ($406.42 ± 543.95 vs $251.81 ± 245.42, p value: 0.0038) and indirect costs ($49.93 ± 72.07 vs $39.81 ± 123.32, p value: 0.001) were significantly higher in the CPA group compared with the PTLD group. Subgroup analyses revealed higher diagnostic, transport, and food-related expenses in CPA individuals. Catastrophic expenditure was comparable in both groups (CPA: 60.5 %; PTLD: 67.9 %; p:0.325). Hemoptysis independently predicted poorer QoL across groups. QoL was significantly worse in CPA than PTLD (SGRQ total: 37.32 vs 31.16, p: 0.0125) and significant correlation between OOPE and QoL.

Conclusion

CPA imposes a greater financial burden and is associated with a poorer QoL compared with PTLD, underscoring the need for financial protection measures to improve outcomes in these patients.

背景：慢性肺曲霉病（CPA）包括一系列经常影响慢性肺病患者的疾病，特别是结核后肺病（PTLD）。这两种疾病都会导致显著的发病率和生活质量（QoL）受损。此外，它们造成经济负担，其中大部分由低收入和中等收入国家的患者直接承担。然而，关于自费支出（OOPE）及其与这些群体生活质量关系的数据仍然有限。方法：这项横断面研究在印度的一家三级转诊中心进行，旨在估计CPA和PTLD患者的OOPE（直接和间接成本），确定支出的决定因素，并评估与生活质量的关系。通过结构化访谈收集了前一年的对外开放、借款和灾难性卫生支出数据。使用圣乔治呼吸问卷（SGRQ）评估生活质量。结果：CPA组的直接成本（$406.42 + 543.95 vs $251.81 + 245.42， p值：0.0038）和间接成本（$49.93 + 72.07 vs $39.81+ 123.32， p值：0.001）均显著高于PTLD组。亚组分析显示，CPA个体的诊断、运输和食品相关费用较高。两组的灾难性支出具有可比性（CPA: 60.5%; PTLD: 67.9%; p:0.325）。咯血独立预测各组较差的生活质量。CPA患者的生活质量明显差于PTLD患者（SGRQ总分：37.32 vs 31.16, p: 0.0125）， OOPE与生活质量之间存在显著相关性。结论：与PTLD相比，CPA患者的经济负担和生活质量负担更大，需要采取经济保护措施来改善这些患者的预后。

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