Pub Date : 2025-02-01DOI: 10.1016/j.jiac.2024.09.001
Alex Berman , Samuel C.O. Opara , Yun F. Wang , Michael H. Woodworth , Danielle Barrios Steed
Erysipelothrix rhusiopathiae is a common zoonotic pathogen that rarely causes diseases in humans. It has three main disease manifestations: a localized cutaneous, a disseminated cutaneous, and a systemic form of infection, typically characterized as bacteremia with or without endocarditis. Human infections are often associated with occupational exposure to animals, animal products, or their excreta. We present a case of a 60-year-old woman found to have E. rhusiopathiae bacteremia associated with a leg laceration sustained after she fell into a sewer drain. Germane animal exposures were not identified; thus, the source of bacterium was attributed to sewage or sewage-contaminated water. She was initially treated with intravenous penicillin with clinical improvement. However, given the patient's social factors, prolonged oral antimicrobial therapy was considered. E. rhusiopathiae is routinely susceptible to penicillin, cephalosporins, and fluoroquinolones but resistant to vancomycin. The data on alternatives to beta-lactam therapy are limited. We report a case of E. rhusiopathiae bacteremia successfully treated with oral linezolid.
{"title":"Erysipelothrix rhusiopathiae bacteremia treated with linezolid","authors":"Alex Berman , Samuel C.O. Opara , Yun F. Wang , Michael H. Woodworth , Danielle Barrios Steed","doi":"10.1016/j.jiac.2024.09.001","DOIUrl":"10.1016/j.jiac.2024.09.001","url":null,"abstract":"<div><div><em>Erysipelothrix rhusiopathiae</em> is a common zoonotic pathogen that rarely causes diseases in humans. It has three main disease manifestations: a localized cutaneous, a disseminated cutaneous, and a systemic form of infection, typically characterized as bacteremia with or without endocarditis. Human infections are often associated with occupational exposure to animals, animal products, or their excreta. We present a case of a 60-year-old woman found to have <em>E. rhusiopathiae</em> bacteremia associated with a leg laceration sustained after she fell into a sewer drain. Germane animal exposures were not identified; thus, the source of bacterium was attributed to sewage or sewage-contaminated water. She was initially treated with intravenous penicillin with clinical improvement. However, given the patient's social factors, prolonged oral antimicrobial therapy was considered. <em>E. rhusiopathiae</em> is routinely susceptible to penicillin, cephalosporins, and fluoroquinolones but resistant to vancomycin. The data on alternatives to beta-lactam therapy are limited. We report a case of <em>E. rhusiopathiae</em> bacteremia successfully treated with oral linezolid.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 2","pages":"Article 102510"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132954","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 : 2025-02-01DOI: 10.1016/j.jiac.2024.09.020
Tomoki Mizuno , Jun Suzuki , Shota Takahashi , Haruka Imai , Hideya Itagaki , Makiko Yoshida , Shiro Endo
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.
{"title":"The effect of baricitinib and corticosteroid compared to that of corticosteroid monotherapy in severely and critically ill patients with COVID-19: A Japanese multicenter inpatient database study","authors":"Tomoki Mizuno , Jun Suzuki , Shota Takahashi , Haruka Imai , Hideya Itagaki , Makiko Yoshida , Shiro Endo","doi":"10.1016/j.jiac.2024.09.020","DOIUrl":"10.1016/j.jiac.2024.09.020","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 2","pages":"Article 102531"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348238","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}
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.
大肠杆菌是一种兼性厌氧细菌，可引起尿路和血液感染。一般来说，大肠杆菌很容易在常规临床微生物实验室中被鉴定出来。在此，我们报告了一例由产广谱β-内酰胺酶（ESBL）大肠杆菌引起的肾盂肾炎并伴有菌血症的病例，由于大肠杆菌表现出二氧化碳（CO2）依赖性生长，因此延误了对分离菌的鉴定。患者是一名 62 岁的男性，出现恶心和精神状态改变。对比增强计算机断层扫描显示左肾有多处脓肿。两组血液培养的厌氧瓶均呈阳性，但常规需氧培养的生长很弱。由于分离菌只在 5% CO2 环境下培养的琼脂平板上生长，因此鉴定工作被推迟。根据抗菌药敏感性检测结果，怀疑该分离菌株为产 ESBL 菌株，聚合酶链反应分析证实了这一点。通过使用美罗培南和肾切除术，患者得到了成功治疗。据我们所知，这是首例报告的由产 ESBL 二氧化碳依赖性大肠杆菌引起的人类感染病例。
{"title":"Carbon dioxide-dependent, extended-spectrum β-lactamase producing Escherichia coli bacteremia associated with pyelonephritis: A case-report","authors":"Shinya Yamamoto , Tatsuya Kobayashi , Mahoko Ikeda , Yusuke Nomura , Takeru Morishige , Katsuhiro Makino , Hiroshi Ito , Marie Yamashita , Daisuke Jubishi , Yoshiaki Kanno , Koh Okamoto , Yoshimi Higurashi , Shu Okugawa , Kyoji Moriya , Haruki Kume , Takeya Tsutsumi","doi":"10.1016/j.jiac.2024.10.010","DOIUrl":"10.1016/j.jiac.2024.10.010","url":null,"abstract":"<div><div><em>Escherichia coli</em> is a facultative anaerobic bacterium that causes urinary tract and bloodstream infections. Generally, <em>E. coli</em> 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 <em>E. coli</em>, which delayed the identification of the isolate as it exhibited carbon dioxide (CO<sub>2</sub>)-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 % CO<sub>2</sub> 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 <em>E. coli</em>.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 2","pages":"Article 102542"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467555","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 : 2025-02-01DOI: 10.1016/j.jiac.2024.11.006
Olugbenga Akinola , Oluwapelumi O. Afolabi , Gbemisola O. Adebisi-Jose , Abiodun I. Amusan , Hidayah A. Olumoh-Adbul , Olawale Olabanji , Olayinka Teslim , Grace O. Gbotosho
Background
Evident detection of artemisinin resistance markers in patient isolates of Plasmodium falciparum from East Africa threatens the efficacy of artemisinin-based combination therapies (ACTs) as first-line treatment of malaria in sub-Saharan Africa. Repositioning previously used antimalarials as complementary addition to ACTs has been suggested as a viable option to mitigating this threat. This study evaluated the potential benefit of chloroquine (CQ) as a complementary partner to dihydroartemisinin/piperaquine (DHA/PQ) in the treatment of malaria in a mice model.
Methods
The comparative efficacy of the combination of DHA/PQ/CQ and DHA/PQ against two strains of Plasmodium berghei ANKA (MRA 311 and 671) with different levels of sensitivities to chloroquine was evaluated in separate experiments. Parasitological activities including; parasite suppression time, parasite clearance time, recrudescence time, and parasite reduction ratio were evaluated in vivo. The mean survival time was also monitored throughout the duration of the study.
Results
In both parasite lines, 99.99 % chemo-suppression was observed on day 4 in the drug treatment groups (CQ alone, DHA/PQ and DHA/PQ/CQ). In the curative test, there were significant differences between DHA/PQ/CQ and DHQ/PQ treatment, highlighted by reduced parasite clearance time (4.75 ± 0.3 Vs 5.5 ± 0.3 days, P < 0.05), significantly delayed recrudescence time (28.5 ± 1.04 Vs 13.3 ± 0.48 days, P < 0.01), a 1.5-fold change in parasite reduction ratio, and a prolonged mean survival time (34.5 ± 1.04 Vs 26.7 ± 0.48 days, P < 0.05).
Conclusion
The addition of chloroquine to dihydroartemisinin-piperaquine may be beneficial in the treatment of malaria, especially in areas where malaria parasite sensitivity to chloroquine is predominant.
{"title":"Triple artemisinin-based combination therapy (TACT): Efficacy of dihydroartemisinin-piperaquine plus chloroquine against Plasmodium berghei ANKA strains with different drug sensitivities in a murine malaria model","authors":"Olugbenga Akinola , Oluwapelumi O. Afolabi , Gbemisola O. Adebisi-Jose , Abiodun I. Amusan , Hidayah A. Olumoh-Adbul , Olawale Olabanji , Olayinka Teslim , Grace O. Gbotosho","doi":"10.1016/j.jiac.2024.11.006","DOIUrl":"10.1016/j.jiac.2024.11.006","url":null,"abstract":"<div><h3>Background</h3><div>Evident detection of artemisinin resistance markers in patient isolates of <em>Plasmodium falciparum</em> from East Africa threatens the efficacy of artemisinin-based combination therapies (ACTs) as first-line treatment of malaria in sub-Saharan Africa. Repositioning previously used antimalarials as complementary addition to ACTs has been suggested as a viable option to mitigating this threat. This study evaluated the potential benefit of chloroquine (CQ) as a complementary partner to dihydroartemisinin/piperaquine (DHA/PQ) in the treatment of malaria in a mice model.</div></div><div><h3>Methods</h3><div>The comparative efficacy of the combination of DHA/PQ/CQ and DHA/PQ against two strains of <em>Plasmodium berghei</em> ANKA (MRA 311 and 671) with different levels of sensitivities to chloroquine was evaluated in separate experiments. Parasitological activities including; parasite suppression time, parasite clearance time, recrudescence time, and parasite reduction ratio were evaluated <em>in vivo</em>. The mean survival time was also monitored throughout the duration of the study.</div></div><div><h3>Results</h3><div>In both parasite lines, 99.99 % chemo-suppression was observed on day 4 in the drug treatment groups (CQ alone, DHA/PQ and DHA/PQ/CQ). In the curative test, there were significant differences between DHA/PQ/CQ and DHQ/PQ treatment, highlighted by reduced parasite clearance time (4.75 ± 0.3 Vs 5.5 ± 0.3 days, P < 0.05), significantly delayed recrudescence time (28.5 ± 1.04 Vs 13.3 ± 0.48 days, P < 0.01), a 1.5-fold change in parasite reduction ratio, and a prolonged mean survival time (34.5 ± 1.04 Vs 26.7 ± 0.48 days, P < 0.05).</div></div><div><h3>Conclusion</h3><div>The addition of chloroquine to dihydroartemisinin-piperaquine may be beneficial in the treatment of malaria, especially in areas where malaria parasite sensitivity to chloroquine is predominant.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 2","pages":"Article 102556"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622057","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 : 2025-02-01DOI: 10.1016/j.jiac.2024.10.014
Yasemin Çakır Kıymaz , Serkan Bolat , Bilge Katırcı , Özlem Aldemir , Işık Altınkaya , Merdan Mustafa Özcan , Serhat Murat Hopoğlu , Murtaza Öz , Ertuğrul Keskin , Caner Öksüz , Kübra Fırtına Topçu , Mürşit Hasbek , Halef Okan Doğan , Seyit Ali Büyüktuna , Nazif Elaldı
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.
{"title":"Evaluation of the clinical characteristics, laboratory parameters, and antibiotic treatment in patients diagnosed with tularemia","authors":"Yasemin Çakır Kıymaz , Serkan Bolat , Bilge Katırcı , Özlem Aldemir , Işık Altınkaya , Merdan Mustafa Özcan , Serhat Murat Hopoğlu , Murtaza Öz , Ertuğrul Keskin , Caner Öksüz , Kübra Fırtına Topçu , Mürşit Hasbek , Halef Okan Doğan , Seyit Ali Büyüktuna , Nazif Elaldı","doi":"10.1016/j.jiac.2024.10.014","DOIUrl":"10.1016/j.jiac.2024.10.014","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>The study included 190 adult patients diagnosed with tularemia between November 2023 and June 2024.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 2","pages":"Article 102546"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558064","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 nationwide survey conducted by the Japanese Society of Chemotherapy and the Japanese Association for Infectious Diseases in 2020 provided insights into antimicrobial prescription practices among clinic doctors. This study aimed to investigate factors influencing changes in antimicrobial prescriptions post-implementation of the National Action Plan on Antimicrobial Resistance (NAPAR) and doctors' inclination to prescribe antimicrobials for common cold cases.
Methods
In September 2020, randomly selected questionnaires were distributed to 3000 community-based medical clinics in Japan. The primary objective was to assess the reduction in antimicrobial prescriptions post-NAPAR implementation. Multivariate linear regression analysis was employed to identify associated factors.
Results
Analysis of 632 responses (response rate: 21.1 %) revealed determinants of decreased antimicrobial prescriptions, including familiarity with the Guide to Antimicrobial Stewardship (β = .482, t = 3.177, p = 0.002) and awareness of NAPAR (β = .270, t = 2.301, p = 0.022).
Conclusion
Interventions such as the Guide to Antimicrobial Stewardship may have contributed to the reduction in antimicrobial prescriptions among Japanese physicians. However, targeted strategies are needed to address high-prescription groups. Enhancing awareness and education on appropriate antimicrobial use should be integral components of future initiatives to combat antimicrobial resistance effectively.
{"title":"Factors associated with the change of antimicrobial prescription before and after the national action plan on antimicrobial resistance: Additional analysis of a nationwide survey conducted by the Japanese Society of Chemotherapy and the Japanese Association for Infectious Diseases","authors":"Shinichiro Morioka , Shinya Tsuzuki , Yoshiaki Gu , Yumiko Fujitomo , Hiroshi Soeda , Chikara Nakahama , Naoki Hasegawa , Shigefumi Maesaki , Masayuki Maeda , Tetsuya Matsumoto , Isao Miyairi , Norio Ohmagari","doi":"10.1016/j.jiac.2024.09.021","DOIUrl":"10.1016/j.jiac.2024.09.021","url":null,"abstract":"<div><h3>Background</h3><div>A nationwide survey conducted by the Japanese Society of Chemotherapy and the Japanese Association for Infectious Diseases in 2020 provided insights into antimicrobial prescription practices among clinic doctors. This study aimed to investigate factors influencing changes in antimicrobial prescriptions post-implementation of the National Action Plan on Antimicrobial Resistance (NAPAR) and doctors' inclination to prescribe antimicrobials for common cold cases.</div></div><div><h3>Methods</h3><div>In September 2020, randomly selected questionnaires were distributed to 3000 community-based medical clinics in Japan. The primary objective was to assess the reduction in antimicrobial prescriptions post-NAPAR implementation. Multivariate linear regression analysis was employed to identify associated factors.</div></div><div><h3>Results</h3><div>Analysis of 632 responses (response rate: 21.1 %) revealed determinants of decreased antimicrobial prescriptions, including familiarity with the Guide to Antimicrobial Stewardship (β = .482, t = 3.177, p = 0.002) and awareness of NAPAR (β = .270, t = 2.301, p = 0.022).</div></div><div><h3>Conclusion</h3><div>Interventions such as the Guide to Antimicrobial Stewardship may have contributed to the reduction in antimicrobial prescriptions among Japanese physicians. However, targeted strategies are needed to address high-prescription groups. Enhancing awareness and education on appropriate antimicrobial use should be integral components of future initiatives to combat antimicrobial resistance effectively.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 2","pages":"Article 102532"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cryptococcus neoformans is an environmental fungus that can frequently cause life-threatening meningitis and fungemia in acquired immunodeficiency syndrome patients. In recent years, cases of these fungal infections are increasingly identified in HIV-negative patients especially in solid organ transplantation (SOT) patients. Cryptococcal fungemia can often clinically present as life-threatening disseminated disease from subclinical colonization. This is a factor that affects survival, especially in patients with decompensated liver cirrhosis and SOT recipients. Early diagnosis and appropriate treatment are important for the course of the disease. This report describes the cryptococcal fungemia that developed in an HIV-negative patient after SOT due to alcohol-related liver cirrhosis.
新生隐球菌是一种环境真菌，在获得性免疫缺陷综合征患者中经常会引起危及生命的脑膜炎和真菌血症。近年来，在艾滋病病毒阴性患者，尤其是实体器官移植（SOT）患者中发现的真菌感染病例越来越多。隐球菌真菌血症在临床上通常表现为由亚临床定植引起的危及生命的播散性疾病。这是影响患者生存的一个因素，尤其是肝硬化失代偿期患者和实体器官移植受者。早期诊断和适当治疗对疾病的进程非常重要。本报告描述了一名因酒精相关性肝硬化而接受 SOT 治疗的 HIV 阴性患者发生的隐球菌真菌血症。
{"title":"Cryptococcus neoformans fungemia in a liver transplant patient: Case report and literature review","authors":"Kübra Evren , Fatma Mutlu-Sarıgüzel , Ayşe Nedret Koç","doi":"10.1016/j.jiac.2024.08.011","DOIUrl":"10.1016/j.jiac.2024.08.011","url":null,"abstract":"<div><div><em>Cryptococcus neoformans</em> is an environmental fungus that can frequently cause life-threatening meningitis and fungemia in acquired immunodeficiency syndrome patients. In recent years, cases of these fungal infections are increasingly identified in HIV-negative patients especially in solid organ transplantation (SOT) patients. Cryptococcal fungemia can often clinically present as life-threatening disseminated disease from subclinical colonization. This is a factor that affects survival, especially in patients with decompensated liver cirrhosis and SOT recipients. Early diagnosis and appropriate treatment are important for the course of the disease. This report describes the cryptococcal fungemia that developed in an HIV-negative patient after SOT due to alcohol-related liver cirrhosis.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 2","pages":"Article 102496"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995858","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}
Co-infection with other pathogens can alter the severity and clinical outcomes of viral infections. However, the information regarding viral co-infections in pediatric coronavirus disease 2019 (COVID-19) cases is still limited.
Methods
This is a nationwide, retrospective cohort study using the data from the COVID-19 Registry Japan. The pediatric (<18 years), laboratory confirmed, hospitalized COVID-19 patients in the Omicron variant of concern predominant period (January 2022 to January 2024) were included. Co-infection was investigated by multiplex PCR. We compared clinical characteristics, symptoms, severity, and outcomes between children with and without co-infection.
Results
Among 245 hospitalized pediatric COVID-19 patients, 78 (31.8 %) had co-infections. The patient backgrounds of the “co-infection” and “SARS-CoV-2 alone” groups were similar, although age distribution was different, with a lower number of patients over 12 years in the co-infection group (n = 2, 2.6 % vs. n = 29, 17.4 %; P < 0.001). Among the patients with co-infection, the most common pathogen was enterovirus/rhinovirus (51.3 %), followed by parainfluenza virus (23.1 %) and adenovirus (12.8 %). Patients with co-infection more commonly had respiratory symptoms, including SpO2 < 96 %, shortness of breath, runny nose, and wheezing. Requirement of non-invasive oxygen support was higher in the co-infection group (n = 27, 34.6 % vs. n = 28, 16.8 %, P = 0.006). By multivariable logistic regression analysis, co-infection and presence of any comorbidity were identified as significant risk factors for necessity of oxygen therapy (odds ratio [95 % confidence interval] 2.44 [1.29–4.63] and 3.99 [2.07–7.82], respectively).
Conclusions
Viral co-infection may increase the risk of respiratory distress in pediatric COVID-19 patients.
{"title":"Comparison of clinical characteristics and severity of COVID-19 with or without viral co-infection in hospitalized children","authors":"Kensuke Shoji , Yusuke Asai , Shinya Tsuzuki , Nobuaki Matsunaga , Setsuko Suzuki , Noriko Iwamoto , Takanori Funaki , Isao Miyairi , Norio Ohmagari","doi":"10.1016/j.jiac.2024.09.009","DOIUrl":"10.1016/j.jiac.2024.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Co-infection with other pathogens can alter the severity and clinical outcomes of viral infections. However, the information regarding viral co-infections in pediatric coronavirus disease 2019 (COVID-19) cases is still limited.</div></div><div><h3>Methods</h3><div>This is a nationwide, retrospective cohort study using the data from the COVID-19 Registry Japan. The pediatric (<18 years), laboratory confirmed, hospitalized COVID-19 patients in the Omicron variant of concern predominant period (January 2022 to January 2024) were included. Co-infection was investigated by multiplex PCR. We compared clinical characteristics, symptoms, severity, and outcomes between children with and without co-infection.</div></div><div><h3>Results</h3><div>Among 245 hospitalized pediatric COVID-19 patients, 78 (31.8 %) had co-infections. The patient backgrounds of the “co-infection” and “SARS-CoV-2 alone” groups were similar, although age distribution was different, with a lower number of patients over 12 years in the co-infection group (n = 2, 2.6 % vs. n = 29, 17.4 %; <em>P</em> < 0.001). Among the patients with co-infection, the most common pathogen was enterovirus/rhinovirus (51.3 %), followed by parainfluenza virus (23.1 %) and adenovirus (12.8 %). Patients with co-infection more commonly had respiratory symptoms, including SpO<sub>2</sub> < 96 %, shortness of breath, runny nose, and wheezing. Requirement of non-invasive oxygen support was higher in the co-infection group (n = 27, 34.6 % vs. n = 28, 16.8 %, <em>P</em> = 0.006). By multivariable logistic regression analysis, co-infection and presence of any comorbidity were identified as significant risk factors for necessity of oxygen therapy (odds ratio [95 % confidence interval] 2.44 [1.29–4.63] and 3.99 [2.07–7.82], respectively).</div></div><div><h3>Conclusions</h3><div>Viral co-infection may increase the risk of respiratory distress in pediatric COVID-19 patients.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 2","pages":"Article 102520"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262406","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}
Mycobacterium bovis is one of the species belonging to the Mycobacterium tuberculosis complex; its attenuated form—Bacillus Calmette-Guérin (BCG)—is used as a live vaccine against tuberculosis. Besides its use as a vaccine, BCG is widely used for treating bladder cancer. However, complications related to its use can lead to disseminated infection with M. bovis, known as BCGosis. BCGosis has multiple manifestations, and its culture requires a long time and complex polymerase chain reaction (PCR), posing challenges to its diagnosis. Herein, we report a case of a 74-year-old man with bladder cancer in whom multiple new arterial aneurysms developed during spondylitis treatment following intravesical BCG administration. The patient presented with syncope and left neck swelling. His medical history included transurethral bladder tumor resection and intravesical BCG therapy for bladder cancer. Sixteen months before he visited our institution, he developed spondylitis (L5/S1), an epidural abscess (L5/S1), and an abscess on the right thigh. Biopsy cultures and PCR confirmed M. tuberculosis complex, leading to antituberculosis drug therapy. Upon admission, multiple aneurysms were identified, and drug therapy was continued. However, new multiple aneurysms developed with the rupture of the right femoral aneurysm, leading to surgical interventions and arterial biopsy. The biopsy showed no signs of mycobacterial infection. Other aneurysm etiologies were ruled out and M. bovis was confirmed by PCR in the specimen from the initial intervertebral disc biopsy; thus, a diagnosis of BCGosis was made. This case highlights the importance of a thorough follow-up to detect new complications, even during treatment.
{"title":"Multiple arterial aneurysms in a patient with spondylitis following intravesical Bacillus Calmette-Guérin administration for bladder cancer: A case report","authors":"Shun Yonezaki , Masumi Suzuki Shimizu , Tomomi Ota , Soichiro Ozasa , Shogo Akabame , Shotaro Ide , Kosuke Kosai , Katsunori Yanagihara , Koya Ariyoshi , Akitsugu Furumoto","doi":"10.1016/j.jiac.2024.10.017","DOIUrl":"10.1016/j.jiac.2024.10.017","url":null,"abstract":"<div><div><em>Mycobacterium bovis</em> is one of the species belonging to the <em>Mycobacterium tuberculosis</em> complex; its attenuated form—Bacillus Calmette-Guérin (BCG)—is used as a live vaccine against tuberculosis. Besides its use as a vaccine, BCG is widely used for treating bladder cancer. However, complications related to its use can lead to disseminated infection with <em>M. bovis</em>, known as BCGosis. BCGosis has multiple manifestations, and its culture requires a long time and complex polymerase chain reaction (PCR), posing challenges to its diagnosis. Herein, we report a case of a 74-year-old man with bladder cancer in whom multiple new arterial aneurysms developed during spondylitis treatment following intravesical BCG administration. The patient presented with syncope and left neck swelling. His medical history included transurethral bladder tumor resection and intravesical BCG therapy for bladder cancer. Sixteen months before he visited our institution, he developed spondylitis (L5/S1), an epidural abscess (L5/S1), and an abscess on the right thigh. Biopsy cultures and PCR confirmed <em>M. tuberculosis</em> complex, leading to antituberculosis drug therapy. Upon admission, multiple aneurysms were identified, and drug therapy was continued. However, new multiple aneurysms developed with the rupture of the right femoral aneurysm, leading to surgical interventions and arterial biopsy. The biopsy showed no signs of mycobacterial infection. Other aneurysm etiologies were ruled out and <em>M. bovis</em> was confirmed by PCR in the specimen from the initial intervertebral disc biopsy; thus, a diagnosis of BCGosis was made. This case highlights the importance of a thorough follow-up to detect new complications, even during treatment.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 2","pages":"Article 102549"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605034","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 : 2025-02-01DOI: 10.1016/j.jiac.2024.11.013
Norihiko Terada , Shigemi Hitomi , Hanako Kurai
Background
Prolonged installation of a nephrostomy tube causes colonization of various microorganisms within the lumen of the tube, leading to the development of nephrostomy tube-associated pyelonephritis (NTAP). Patients with malignancy, often necessitating long-term installation of a nephrostomy tube, are susceptible to NTAP. However, information regarding the characteristics of NTAP in this population is limited.
Methods
We reviewed 43 NTAP cases of patients with malignancy in a cancer center and examined causative and non-causative microorganisms among those detected in urine culture. Causative microorganisms were defined as (1) those detected simultaneously in urine and blood cultures or (2) those detected in monomicrobial urine culture and to which physicians administered active antimicrobials for ≥5 days. Non-causative microorganisms were defined as those to which active antimicrobials were given for a total of <5 days.
Results
Patients in 42 of the 43 NTAP cases recovered with antimicrobial therapy for ≥7 days. Causative microorganisms were identified in 25 cases, where Escherichia coli and Klebsiella pneumoniae were most frequent. All enterococci other than Enterococcus faecalis, Corynebacterium species, and Candida species other than Candida albicans and most of Stenotrophomonas maltophilia detected in urine culture were considered non-causative of NTAP.
Conclusion
E. coli was a common organism causing NTAP of this population. Several microorganisms resistant to cephalosporin were non-causative of NTAP, for which administration of antimicrobials may be unnecessary even if detected in urine culture.
{"title":"Identification of causative and non-causative microorganisms of nephrostomy tube-associated pyelonephritis among patients with malignancy","authors":"Norihiko Terada , Shigemi Hitomi , Hanako Kurai","doi":"10.1016/j.jiac.2024.11.013","DOIUrl":"10.1016/j.jiac.2024.11.013","url":null,"abstract":"<div><h3>Background</h3><div>Prolonged installation of a nephrostomy tube causes colonization of various microorganisms within the lumen of the tube, leading to the development of nephrostomy tube-associated pyelonephritis (NTAP). Patients with malignancy, often necessitating long-term installation of a nephrostomy tube, are susceptible to NTAP. However, information regarding the characteristics of NTAP in this population is limited.</div></div><div><h3>Methods</h3><div>We reviewed 43 NTAP cases of patients with malignancy in a cancer center and examined causative and non-causative microorganisms among those detected in urine culture. Causative microorganisms were defined as (1) those detected simultaneously in urine and blood cultures or (2) those detected in monomicrobial urine culture and to which physicians administered active antimicrobials for ≥5 days. Non-causative microorganisms were defined as those to which active antimicrobials were given for a total of <5 days.</div></div><div><h3>Results</h3><div>Patients in 42 of the 43 NTAP cases recovered with antimicrobial therapy for ≥7 days. Causative microorganisms were identified in 25 cases, where <em>Escherichia coli</em> and <em>Klebsiella pneumoniae</em> were most frequent. All enterococci other than <em>Enterococcus faecalis</em>, <em>Corynebacterium</em> species, and <em>Candida</em> species other than <em>Candida albicans</em> and most of <em>Stenotrophomonas maltophilia</em> detected in urine culture were considered non-causative of NTAP.</div></div><div><h3>Conclusion</h3><div><em>E. coli</em> was a common organism causing NTAP of this population. Several microorganisms resistant to cephalosporin were non-causative of NTAP, for which administration of antimicrobials may be unnecessary even if detected in urine culture.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 2","pages":"Article 102563"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681724","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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