Journal of Infection and Chemotherapy最新文献

Purpose: To investigate the effect of studying abroad on catch-up vaccination coverage for measles, rubella, mumps, varicella, and tetanus during the pretravel consultation among young adult travelers.

Methods: This retrospective cohort study analyzed data from the Japan Pretravel Consultation Registry (J-PRECOR) on individuals aged 18-21 years with childhood vaccination records. Propensity score weighting was used to estimate the average treatment effect on the proportion of participants receiving catch-up vaccination.

Results: Among 1091 eligible participants, the catch-up vaccination need was highest for mumps (65.7 %) and varicella (49.0 %) and lowest for measles (9.9 %) and rubella (14.0 %). In the unadjusted analysis, the catch-up vaccination rate was 70.6 % for tetanus, 50.9 % for measles, 47.7 % for rubella, 40.0 % for mumps, and 23.9 % for varicella. In the weighted analysis, the study-abroad group had significantly higher catch-up vaccination rates for measles (54.6 % vs. 29.8 %, P = 0.039), rubella (53.0 % vs. 22.1 %, P < 0.001), and varicella (26.8 % vs. 10.9 %, P = 0.002), whereas the non-study-abroad group had a higher catch-up vaccination rate for tetanus (62.4 % vs. 78.4 %, P = 0.024).

Conclusion: Compared with other travelers, the catch-up vaccination rate among travelers studying abroad was higher for measles, rubella, and varicella, but lower for tetanus. In clients planning to study abroad, vaccinations required for travel should be recommended in addition to those required by the host institution, and vaccination against highly infectious diseases with potential for complications, such as measles, rubella, mumps, and varicella, should be recommended to clients traveling for reasons other than studying abroad.

Deep-seated mycoses are generally opportunistic infections that are difficult to diagnose and treat. They are expected to increase with the spread of advanced medical care and aging populations, thus highlighting the need for safe, effective, and rapid drug-based treatments. Depending on a patient's age, sex, underlying diseases, and immune system status, therapeutic drug monitoring (TDM) may be important for assessing variable pharmacokinetic parameters, as well as preventing drug-drug interactions, adverse events, and breakthrough infections caused by fungal resistance. Azole antifungal agents play an important role in the prevention and treatment of deep-seated fungal infections, with each azoles having its own unique pharmacokinetic properties and specific adverse events. Therefore, it is necessary to use national and international guidelines to build evidence for the expansion of TDM indications. This review focuses on the clinical utility and future perspectives of TDM using azole antifungal agents, in the context of recent evidence in the literature.

Background: Rapid identification of the causative organism in blood stream infections is essential for early initiation of appropriate antimicrobial therapy. Direct identification of bacteria in positive blood culture bottles using matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry is a promising application. A variety of direct identification methods have been reported; however, few studies have evaluated the impact of these methods on physician decision making regarding antimicrobial therapy.

Methods: We developed a simple method for direct bacterial identification and applied it to daily clinical practice to investigate the impact of direct identification of bacteria in positive blood culture bottles on physicians' choice of antimicrobial agents for treatment.

Results: From January 2016 to December 2022, we attempted direct identification in 98 cases and successfully acquired identification results in 88 cases. In three cases, no empiric antimicrobial agents were initiated at the time of venipuncture for blood culture but later initiated based on the direct identification results. In the remaining 85 cases, empiric antimicrobial therapy was initiated at the time blood cultures were performed, and in 29 cases, empiric antimicrobial therapy was changed after direct identification. In 17 of these 29 cases, the antimicrobial therapy was changed based on the direct identification of bacterial genus/species, resulting in a change to an effective antimicrobial therapy before the antimicrobial susceptibility testing results were available.

Conclusions: Direct identification of bacteria from positive blood culture bottles could contribute to earlier selection of or changes to antimicrobial therapies by attending physicians.

Background: Clostridioides difficile is a major cause of antimicrobial-associated colitis. While antimicrobial stewardship has reduced the incidence of C. difficile infection (CDI), managing CDI is challenging because knowledge about preventing it is limited among healthcare professionals. To address this, we examined associations between antimicrobial use and CDI development.

Methods: This observational, nested case-controlled study was conducted using the Shizuoka Kokuho Database (SKDB). Individuals with no record of CDI or antimicrobial-associated enterocolitis within 1 year after SKDB enrolment, but who subsequently developed CDI, were included as the Case group. The Control group comprised individuals selected via 1:4 matching sampling without replacement for sex, age, and month of CDI onset. Conditional logistic regression analysis was performed to assess associations between antimicrobial use (number and combination) and CDI development, controlling for matched variables, background factors, and underlying conditions.

Results: Of the 2,398,393 individuals, 4917 were assigned to the Case group and 19,668 to the Control group. The adjusted odds ratios (ORs) for CDI were 3.65 for one antimicrobial and 8.58, 17.3, and 38.9 for combinations of two, three, or four or more agents (all p < 0.001). Penicillins, fourth-generation cephems, and carbapenems exhibited high ORs. Similar results were observed in certain demographic and comorbidity-free subgroups. Several combinations (penicillins + carbapenems, penicillins + cephems + carbapenems, cephems + fluoroquinolones, and penicillins + cephems + carbapenems) were notably associated with CDI development.

Conclusion: CDI prevalence increased with the number of antimicrobial classes used in combination. Certain types or combinations of antimicrobials may increase the OR for CDI.

Background: The vaccination rate for HPV (Human Papillomavirus) has remained significantly low in Japan because of the administrative suspension of active recommendation. This study investigates the awareness and uptake of the HPV vaccine among healthcare students in Japan following the reinstatement of active recommendation for young women in April 2022.

Methods: A web-based survey was administered to 2567 healthcare students from Okayama and Shujitsu Universities in Japan in July 2023. The survey assessed participants' backgrounds, immunization status, awareness of vaccine recommendations, and knowledge of cervical cancer across various demographics, including sex, academic year, and department (Medicine, Health Science, Pharmaceutical, and Dentistry).

Results: The response rate was 36.3 % (933 students; 181 male, 739 female, and 13 unspecified gender). The overall immunization rate among female students was 55.6 %, with higher rates observed in medical (73.8 %) and dental (63.0 %) students. Awareness of the government's change in vaccine recommendation was notably high among female and senior male students. Over half of the female students (54.7 %) reported receiving vaccinations based on their parents' advice. Among those unvaccinated but interested in future immunization, concerns about adverse reactions (47.4 %) and challenges in scheduling vaccinations (29.1 %) were predominant.

Conclusion: Healthcare students exhibited a higher HPV vaccination rate than the general population. Ongoing education to improve vaccine literacy is crucial for augmenting HPV vaccination rates in Japan.

We present a case of spondylodiscitis caused by Aspergillus fumigatus, which we successfully treated with isavuconazole after voriconazole severe intolerance. Aspergillus spondylodiscitis is a severe and relatively rare form of extra-pulmonary invasive aspergillosis. Typically, voriconazole is the first-choice antifungal drug for treating Aspergillus osteomyelitis or spondylodiscitis. However, isavuconazole, a new antifungal medication, has been demonstrated as non-inferior to voriconazole in cases of invasive aspergillosis. It has the added benefits of fewer hepatobiliary, ocular, and cutaneous side effects. It generally does not demand serum level monitoring and poses fewer risks of drug interactions. Nonetheless, there are no studies yet that support its use in spondylodiscitis, and published experiences are very limited and based on isolated cases, albeit mainly positive. The case we present here aims to provide additional evidence on the efficacy and tolerability of isavuconazole in treating this condition.

Objective: The mechanism of aminoglycoside resistance due to abnormal hemin synthesis remains unclear. We investigate an Escherichia coli strain with a single amino acid substitution at position 85 of HemC.

Methods: An aminoglycoside-resistant Escherichia coli DH5α was selected by passaging in Lysogeny Broth (LB) medium containing amikacin. Whole genome sequencing was performed to determine the genetic profile of the strain. An isogenic strain of E. coli DH5α was created. Growth rates, drug susceptibilities and expressions of the heme synthetic genes were compared between the original strain and the isogenic strain.

Results: Whole genome sequencing revealed a nucleotide substitution at position 254 of hemC from adenine (A) to thymine (T), resulting in an amino acid substitution at position 85 of HemC from histidine (H) to leucine (L). There were no mutations in other heme synthetic genes, including hemA, hemB, hemC, hemD, hemE, hemF, hemG, hemH, hemL, hemN, hemX and hemY. The isogenic strain of E. coli DH5α with H85L in HemC was less susceptible to aminoglycosides, and its growth was slower than that of E. coli DH5α before passage. Quantitative real-time PCR showed that the expression of hemA was higher and the expressions of hemL, hemG and hemX lower in the isogenic strain than before passage.

Conclusion: This is the first report of aminoglycoside resistance due to an amino acid substitution in HemC. These findings suggested that mutations in the heme synthetic genes may indirectly affect the growth rates of E. coli strains and their susceptibilities to aminoglycosides.

Background: Hospital-acquired pneumonia (HAP) is a common nosocomial infection and is associated with high mortality. Despite advances in the understanding of the causes and prevention of HAP, it continues to be a frequent complication associated with hospital care. Presently, there are no large retrospective cohort studies on HAP in Japan.

Methods: A retrospective cohort study was conducted using the Medical Data Vision Co. Ltd. database for the study period (April 1, 2015 to May 31, 2018). The study population was defined based on ICD-10 codes for bacterial pneumonia, characteristics of hospitalization, and prescription of injection-only antibiotics. The study included patients ≥18 years of age with at least one episode of HAP during the identification period, where the episode was defined as hospitalization with HAP within the study identification period.

Results: A total of 2968 patients were included in this study contributing to 2979 HAP episodes. Patients with HAP were more likely to be male (64.9 %) and older than age 65 (86.5 %). The top three frequently prescribed antibiotics were sulbactam-ampicillin (39.7 %; 1183 episodes), tazobactam-piperacillin (28.4 %; 846 episodes) and ceftriaxone (23.2 %; 690 episodes). The mean (±SD) length of hospital stay during overall hospitalization and the HAP period were 49.9 (±34.2) days and 11.3 ± 7.3 days respectively. The HAP patient mortality at discharge was 22.0 %.

Conclusion: The present study provided insights regarding the characteristics, treatment patterns of HAP patients in Japan. Further, the study provided noteworthy information regarding antibiotic usage trends in the aging Japanese population.

Background: Invasive group A Streptococcus (iGAS) infections are rare but potentially fatal. Although the number of invasive group A Streptococcus (iGAS) infections decreased during the coronavirus disease (COVID-19) pandemic, it sharply increased worldwide following the pandemic due to the emergence of M1_UK strains. In Japan, non-fluminant iGAS infections have not been included in the national survey notification system. Therefore, the clinical and microbiological characteristics of iGAS infection are unknown. In this study, we aimed to clarify the clinical and microbiological characteristics of pediatric iGAS infections.

Methods: We conducted a case-series analysis of children aged 0-15 years with positive Streptococcus pyogenes cultures from otherwise sterile sites, diagnosed between July 2018 and June 2024. Clinical data were extracted from the electronic medical records. Samples of clinical isolates were sent to the Public Health Research Institute for further analysis.

Results: We identified 11 patients (median age, 5 years [interquartile range 1-8.5 years]; 6 girls). The incidence rate of the iGAS infections was highest in 2024, with 3 cases in 6 months. Primary bacteremia without focal infection was the predominant diagnosis, followed by skin and soft tissue infections with bacteremia. Among the 11 iGAS infections, 9 isolates were available for additional microbiological tests. M12 and M1 strains were predominant (four cases each). Three of the four M1 isolates were M1_UK strains.

Conclusions: In the present study, the increasing incidence of iGAS infection and clinical diagnoses are similar to those reported in other countries; however, M12 strains as well as M1 strains are predominant.

Background: Multiple myeloma (MM) is a common hematologic malignancy and immune dysfunction is a hallmark of the disease. It leads to an increased infection risk, which is still a major cause of mortality. The infection spectrum and characteristics have evolved with the introduction of novel agents. An understanding of risk factors that increasing susceptibility to infection is critical in fighting them. This retrospective study aimed to identify risk factors associated with infection and develop nomogram to qualify the risk of infection.

Methods: We retrospectively reviewed the data of patients who were diagnosed with MM between April 1, 2018 and December 31, 2021 in our department. Independent predictors for infection were determined by the univariate and multivariate logistic regression analysis. Nomogram was established and evaluated by receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA).

Results: A total of 230 MM patients who were diagnosed or treated in our department were included. Infections were identified in 37.4 % of MM patients in the first treatment course. The most common infection was the pulmonary infection. The first treatment course had the highest infection rate. With three or more comorbidities, anemia, high LDH level and high β2-MG level were independent risk factors for infection in MM patients during the induction period. The area under the curve (AUC) of nomogram was 0.746 (95 % CI: 0.679-0.814). The calibration curve and DCA indicated the good performance of the nomogram.

Conclusion: Multiple myeloma patients with one or more of these mentioned risk factors should be monitored with particular care in order to decrease the incidence and severity of infective complications. Nomogram was established to predict the incidence of infection in MM patients. Nomogram has satisfactory accuracy, and clinical utility may benefit for clinical decision-making.