Journal of Infection and Chemotherapy最新文献

We have previously reported a clinical case in which a hospitalized patient with a history of hematopoietic stem cell transplantation for acute myeloid leukemia was persistently infected with SARS-CoV-2. This study investigated the neutralizing activity of patient sera against cultured viruses isolated at each time point. We also continued to decipher and analyze the whole-genome sequence of the virus. The results showed that the neutralizing activity against the cultured virus at each time point was higher in the sera collected in the late stage of infection. However, the cultured virus collected in the late stage of infection was less likely to be neutralized not only by the sera collected in the early stage of infection but also by the sera collected in the late stage. Moreover, the virus mutated in a manner that allowed it to escape neutralizing antibodies in a host vulnerable to prolonged infection, such as immunocompromised patients.

Background: Teicoplanin (TEIC) is a nephrotoxic agent. However, little is known about the effects of concomitant medications on nephrotoxicity. In this study, we investigated the effects of concomitant drugs on nephrotoxicity.

Methods: A retrospective observational case-control study was conducted on patients (≥18 years) who started TEIC at the Tokyo Dental College, Ichikawa General Hospital, between January 2013 and April 2023. The primary outcome was nephrotoxicity, defined as an increase in serum creatinine levels of ≥50 % or ≥0.5 mg/dL from baseline. Logistic regression analysis was used to determine the risk factors for nephrotoxicity associated with TEIC. In addition, we investigated the relationship between nephrotoxicity and predicted free TEIC concentrations.

Results: Of 305 patients, 43 (14.1 %) developed nephrotoxicity. The multivariate logistic regression analysis identified that serum albumin (odds ratio [OR] = 0.50, 95 % confidence interval [CI] 0.27-0.89, p = 0.02), concomitant use of loop diuretics (OR = 2.22, 95 % CI 1.10-4.59, p = 0.03), antivirals (OR = 3.24, 95 % CI 1.32-7.62, p < 0.01), and vasopressors (OR = 2.57, 95 % CI 1.10-5.78, p = 0.03) were the associated risk factors for nephrotoxicity in patients administered with TEIC. In 216 patients, predicted TEIC concentrations were 3.6 [interquartile range (IQR), 2.6-4.9] μg/mL in the nephrotoxicity group versus 3.6 [IQR, 2.5-4.7] μg/mL in the non-nephrotoxicity group, with no significant difference (p = 0.69).

Conclusion: Our results indicate the importance of modifying the concomitant use of loop diuretics, antivirals, and vasopressors.

Background: Cord blood transplantation (CBT) is associated with a high risk of cytomegalovirus (CMV) infection. Letermovir (LTV) is a prophylactic agent against CMV reactivation after CBT, but data on its effectiveness and the incidence of late CMV reactivation after LTV discontinuation are limited.

Methods: A single-center retrospective observational study was conducted in 79 adult CMV-seropositive CBT recipients who received their first transplant for acute myeloid leukemia, acute lymphoblastic leukemia, or myelodysplastic syndrome from February 2016 to September 2022. Outcomes were compared between 45 patients who received LTV prophylaxis and 34 patients who did not.

Results: The cumulative incidence of CMV reactivation was significantly lower in patients who received LTV prophylaxis at both day 100 (11.1 % vs. 82.4 %, p < 0.001) and 1 year (45.3 % vs. 82.4 %, p < 0.001). The incidence of late CMV reactivation after LTV discontinuation was 34.2 %. The cumulative incidence of CMV disease was comparable between patients who received and those who did not (0 % vs. 8.8 % at day 100, 2.3 % vs. 8.8 % at 1 year; p = 0.181). Multivariate analysis showed that LTV prophylaxis reduced the cumulative incidence of CMV reactivation (hazard ratio 0.20, 95 % confidence interval 0.09 to 0.42, p < 0.001).

Conclusion: LTV prophylaxis is strongly associated with prevention of CMV reactivation after CBT. Due to the high incidence of late CMV reactivation, close monitoring is required after LTV discontinuation and extension of LTV prophylaxis beyond day 100 should be considered.

Objective: The duration of viral shedding and criteria for de-isolation in the hospital among immunocompromised patients with coronavirus disease 2019 (COVID-19) remain unclear. This study aimed to evaluate viral shedding duration in immunocompromised patients infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2.

Methods: A prospective cohort study was performed at 2 tertiary medical centers in Japan during the Omicron epidemic waves from July 2022 to January 2023. Nasopharyngeal swabs were serially collected from immunocompromised patients with COVID-19, including those with hematological malignancies, solid tumors, autoimmune diseases, and human immunodeficiency virus infection. Patients were classified as severely or moderately immunocompromised according to the Japanese national guidelines for tixagevimab-cilgavimab. The relationship between patient characteristics, immune status, duration of viral RNA presence, and infectious virus shedding were assessed using Mann-Whitney U and Fisher's exact tests.

Results: Among 41 patients (163 samples), 9 (47 samples) were severely and 32 (116 samples) were moderately immunocompromised. In the severely and moderately immunocompromised groups, 87.2% and 75.0% of the samples were viral RNA-positive, while 36.2% and 35.3% were culture-positive, respectively. Five culture-positive samples after day 20 were from 2 severely immunocompromised patients on B cell depletion therapy. No culture-positive samples were found for the moderately immunocompromised patients after day 10.

Conclusions: Long-term viral shedding should be closely monitored in severely immunocompromised patients with COVID-19.

Overwhelming post-splenectomy infection (OPSI) is a severe and potentially life-threatening condition that can occur in patients undergoing splenectomy. We report a case of a patient who had a splenectomy approximately 30 years ago during prosthetic valve insertion for infective endocarditis (IE). The patient later developed prosthetic valve endocarditis caused by Streptococcus pneumoniae associated with OPSI. Although IE due to Streptococcus pneumoniae is rare, the presence of a prosthetic valve may increase the risk of IE in splenectomized patients. This case highlights the need for increased vigilance in managing these patients. Additionally, this case represents a missed opportunity for vaccination, as the splenectomy was performed before the approval of the 23-valent pneumococcal polysaccharide vaccine in Japan. This underscores the importance of establishing a system to ensure appropriate vaccine catch-up and to provide educational opportunities for patients who have undergone splenectomy.

Herein, we present the case of a 64-year-old woman diagnosed with left calculous pyelonephritis. Gram-positive cocci in clusters were isolated from two sets of her blood culture. These cocci were later identified as Staphylococcus saprophyticus. Although S. saprophyticus is a common causative pathogen of urinary tract infection (UTI) among young women, coagulase-negative staphylococci including S. saprophyticus isolated from UTI patients' blood samples were often considered a result of contamination because of their rareness. Considering the high percentage of methicillin-resistant strains of S. saprophyticus, accurate strain identification and antimicrobial susceptibility testing are necessary to detect true bacteremia and its appropriate treatment.

Non-typhoid Salmonella (NTS) includes many serotypes that differ in host, geographic distribution, and virulence. We report the case of a 64-year-old man who developed enteritis caused by Salmonella Kedougou without bacteremia after returning from Thailand. The patient stayed in Chiang Mai, Thailand, for 10 days to play golf and was hospitalized with fever, chills, watery diarrhea, and vomiting on the day the patient returned to Japan. The patient was treated with intravenous azithromycin followed by ceftriaxone for 6 days. NTS was detected in the patient's stool culture, and additional strain analyses were performed. Polymerase chain reaction for the O-antigen and sequence analysis of fliC and fliB genes determined the serotype of the strain to be O13: i: l,w. The strain was assigned to sequence type 1543 using multilocus sequence typing. These results confirmed that the strain was S. Kedougou. Considering the incubation period of salmonellosis, the patient was most likely infected with S. Kedougou in Thailand, which is consistent with the epidemiological information that S. Kedougou is frequently detected in northern Thailand. The identification of NTS serovars may not affect clinical management; however, we believe that it is important to accumulate epidemiological information to understand the interactions between the environment, animals, and humans.

Introduction: Febrile urinary tract infections are major complications of radical cystectomy; however, their characteristics after robot-assisted radical cystectomy remain unclear. Thus, we investigated the rate, severity, pathogens, and risk factors of febrile urinary tract infections after robot-assisted radical cystectomy.

Patients and methods: Patients who underwent robot-assisted radical cystectomy at three institutions between April 2018 and March 2022 were retrospectively analyzed. The febrile urinary tract infections occurring within 90 days of surgery were evaluated.

Results: Overall, 191 patients were included. Of the 157 patients with ileal urinary diversions, 138 and 19 received ileal conduit and ileal neobladder, respectively; 42 febrile urinary tract infections were observed in 36 patients (22.9%). Of the 32 patients who underwent cutaneous ureterostomy, four patients had febrile urinary tract infections (12.5%). The incidence of postoperative febrile urinary tract infections was significantly higher in patients with ileal neobladder (52.9%) than in those with an ileal conduit (18.8%) (p < 0.05, log-rank test). Gram-positive strains were the dominant pathogen (60.0%), followed by gram-negative strains (37.1%) and fungi (2.9%). The blood culture was positive in 28.6% for febrile urinary tract infections. The primarily isolated strains were Enterococcus faecalis, Staphylococcus aureus, and Staphylococcus epidermidis, Escherichia coli and Pseudomonas aeruginosa. Female was the only risk factor for febrile urinary tract infections in those with an ileal conduit.

Conclusions: Gram-positive strains account for 60% of pathogens causing febrile urinary tract infections after robot-assisted radical cystectomy, that may cause severe complications, rendering management of febrile urinary tract infections paramount.

The BioFire FilmArray® Gastrointestinal (GI) Panel, a widely used diagnostic tool, is designed to detect the genetic material of 22 common pathogens responsible for gastroenteritis, including viruses, bacteria, and parasites. It can detect human adenovirus (HAdV) species F, particularly serotypes F40 and F41, which are the major causes of diarrhea and mortality in children. However, its potential shortcomings in detecting other HAdV species limit its effectiveness in broader HAdV detection in clinical settings and outbreak investigations. The aim of this study was to evaluate the ability of the GI Panel to detect three clades of HAdV-F41 and other HAdV species (viz., A31, B3, C1, C2, C5, C2/6, and D56) in Japan. Eighteen stool samples were analyzed, five of which contained HAdV-F41, and 13 contained other HAdV species, as confirmed via PCR and sequencing. Although the GI Panel reliably detected all clades of HAdV-F41, it failed to detect any other species, highlighting its limited diagnostic utility beyond F40/41 serotypes. Considering the high false-negative rate for non-F40/41 species, integrating complementary diagnostic methods such as PCR is crucial for comprehensive HAdV detection. These findings underscore the limitations of the GI Panel in detecting non-F40/41 species, such as HAdV-C (commonly associated with pediatric gastroenteritis) and other species that are important in immunocompromised patients. Complementary diagnostic methods, such as PCR or immunochromatographic assays, are essential to ensure accurate HAdV detection, especially in vulnerable populations.