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Cryptococcal prostatitis in an immunocompromised patient with tocilizumab and glucocorticoid therapy: A case report. 一名接受托珠单抗和糖皮质激素治疗的免疫功能低下患者患上了隐球菌性前列腺炎:病例报告。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-08-15 DOI: 10.1016/j.jiac.2024.08.009
Kohei Oguni, Shinnosuke Fukushima, Hideharu Hagiya, Atsushi Kato, Atsuhito Suyama, Takehiro Iwata, Yoshia Miyawaki, Sawako Ono, Koji Iio, Fumio Otsuka

Cryptococcus prostatitis is an uncommon manifestation of cryptococcal infection that occurs mostly in immunocompromised patients. Tocilizumab, an anti-interleukin-6 receptor monoclonal antibody, has been associated with an increased risk of cryptococcal infections. However, there have been no documented cases of cryptococcal prostatitis in patients receiving tocilizumab therapy. We report a case of cryptococcal prostatitis in a 72-year-old man treated with glucocorticoids and tocilizumab for giant cell arteritis and granulomatosis with polyangiitis. The patient presented dysuria and his serum level of prostate-specific antigen was elevated. Magnetic resonance imaging revealed a prostate mass, and a prostate biopsy was performed, leading to a pathologic diagnosis of cryptococcal prostatitis. Fungal cultures for blood and urine were negative, while the cryptococcal antigen for both serum and urine showed positive results. There were no particular findings in the pulmonary and central nervous systems. The patient was successfully treated with oral fluconazole (400 mg/day) and was discharged. Although cryptococcal prostatitis is a rare entity, clinicians should note that an immunosuppressed patient may develop such a difficult-to-diagnose disease.

隐球菌前列腺炎是隐球菌感染的一种不常见表现,主要发生在免疫力低下的患者身上。抗白细胞介素-6 受体单克隆抗体 Tocilizumab 与隐球菌感染风险增加有关。然而,在接受托西珠单抗治疗的患者中还没有隐球菌前列腺炎病例的记录。我们报告了一例因巨细胞动脉炎和肉芽肿伴多血管炎而接受糖皮质激素和托珠单抗治疗的 72 岁男性隐球菌性前列腺炎病例。患者出现排尿困难,血清前列腺特异性抗原水平升高。磁共振成像检查发现前列腺肿块,于是进行了前列腺活检,病理诊断为隐球菌性前列腺炎。血液和尿液的真菌培养均呈阴性,而血清和尿液的隐球菌抗原均呈阳性。肺部和中枢神经系统没有特别的发现。患者接受了口服氟康唑(400 毫克/天)的成功治疗后出院。虽然隐球菌性前列腺炎非常罕见,但临床医生应该注意,免疫抑制患者可能会患上这种难以诊断的疾病。
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引用次数: 0
A questionnaire survey of infection control measures during the coronavirus infectious disease 2019 pandemic era 2019 年冠状病毒传染病大流行时期感染控制措施问卷调查。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-08-14 DOI: 10.1016/j.jiac.2024.08.005
Tetsuya Horino , Kazuyo Ono , Erisa Sugawara , Tetsuya Matsumoto , Hiroshi Yotsuyanagi , Masaki Yoshida

Objective

To clarify the infection control measures required in the event of a new infectious disease outbreak, we conducted a questionnaire survey on the infection control measures implemented against coronavirus disease 2019 (COVID-19).

Methods

An invitation to participate in this survey was sent to the heads of 2689 facilities affiliated with the members of the Japanese Society for Infection Prevention and Control in February 2023, requesting responses to the online survey using Google Forms by March 2023.

Results

Six hundred and forty-five facilities, including 20 clinics and 625 hospitals, participated in the survey. This survey revealed that various infection control measures were implemented, including universal masking in the non-COVID-19 ward (96.5 %), screening tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on scheduled admission (89.0 %), SARS-CoV-2 tests (98.7 %), and isolation in private rooms (76.5 %) for inpatients with fever. However, nosocomial infections and clusters of COVID-19 occurred in 94.4 % and 90.9 % of cases during the investigation period, respectively. One of the reasons for these results is that healthcare personnel (HCP) and patients were common index cases of nosocomial infections, and the most common cause of clusters was the work of symptomatic HCPs. These results suggest that HCPs should understand that they can be index cases or spreaders. On the other hand, the most common support from external facilities was healthcare centers, followed by physicians or nurses from other hospitals.

Conclusion

In response to the emergence of infections, it is important to consider implementing infection control measures for HCPs and patients.

目的为了明确在爆发新传染病时所需要采取的感染控制措施,我们对 2019 年冠状病毒病(COVID-19)的感染控制措施进行了问卷调查:方法:2023 年 2 月,我们向日本感染预防与控制协会会员所属的 2 689 家医疗机构的负责人发出了参与调查的邀请,要求他们在 2023 年 3 月之前使用谷歌表格回答在线调查:结果:包括 20 家诊所和 625 家医院在内的 645 家机构参与了调查。调查显示,医院采取了各种感染控制措施,包括在非 COVID-19 病房普遍使用口罩(96.5%)、在预定入院时进行严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)筛查(89.0%)、SARS-CoV-2 检测(98.7%)以及对发烧住院病人进行单间隔离(76.5%)。然而,在调查期间,分别有 94.4% 和 90.9% 的病例发生了院内感染和 COVID-19 聚集。造成这些结果的原因之一是,医护人员(HCP)和患者是常见的院内感染指标病例,而造成集群的最常见原因是有症状的 HCP 的工作。这些结果表明,医护人员应该明白他们可能是病例或传播者。另一方面,最常见的外部机构支持是医疗保健中心,其次是其他医院的医生或护士:结论:为应对感染的出现,必须考虑对医护人员和患者实施感染控制措施。
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引用次数: 0
Fluoroquinolone resistance and clinical characteristics of acute bacterial prostatitis in Japan: A multicenter study by the Japanese research group for urinary tract infection. 日本急性细菌性前列腺炎的氟喹诺酮耐药性和临床特征:日本尿路感染研究小组的一项多中心研究。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-08-14 DOI: 10.1016/j.jiac.2024.08.012
Masahiro Matsumoto, Ryoichi Hamasuna, Koichiro Wada, Takuya Sadahira, Katsumi Shigemura, Kouki Maeda, Yoshiki Hiyama, Yoshikazu Togo, Seiji Nagasawa, Kazuaki Yamanaka, Kazuyoshi Shigehara, Kanao Kobayashi, Haruki Tsuchiya, Jun Miyazaki, Tohru Nakagawa, Kiyohito Ishikawa, Satoshi Takahashi, Naohiro Fujimoto, Shingo Yamamoto

Objective: This multicenter study aimed to analyze the risk factors for fluoroquinolone (FQ) resistance and to clarify the clinical characteristics of acute bacterial prostatitis (ABP) in Japan.

Methods: A total of 124 patients clinically diagnosed with ABP at 13 medical institutions participating in the Japanese Research Group for Urinary Tract Infection between January and December 2017 were retrospectively reviewed.

Results: Of the 124 patients included in this study, 37 were outpatients, and 87 were inpatients. The main underlying medical conditions before the onset of ABP were severe dysuria, urinary retention, transurethral manipulation, indwelling urinary catheter, and transrectal prostate biopsy (TRBx). The main symptoms were fever (≥37.5 °C), prostate tenderness, dysuria, micturition pain, urinary retention, and macrohematuria. Bacteremia was observed in 14 patients. Prostatic abscess was observed in three patients. Escherichia coli was the predominant organism, accounting for 48 % (51/106). FQ-resistant E. coli was detected in 33 % (17/51), and extended-spectrum beta-lactamase-producing E. coli in 12 % (6/51). TRBx (odds ratio [OR] = 48.60, 95 % confidence interval [CI]: 5.49-430.00, p < 0.001) and inpatient status (OR = 29.00, 95 % CI: 1.95-430.00, p = 0.014) were risk factors for the detection of FQ-resistant bacteria.

Conclusions: The detection rate of FQ-resistant bacteria was significantly higher with TRBx ABP and inpatient status. These findings have important implications for the management of ABP and antimicrobial treatment, especially for TRBx ABP, which should be considered a separate category.

目的:这项多中心研究旨在分析氟喹诺酮类药物(FQ)耐药性的风险因素,并阐明日本急性细菌性前列腺炎(ABP)的临床特征:这项多中心研究旨在分析氟喹诺酮(FQ)耐药性的风险因素,并明确日本急性细菌性前列腺炎(ABP)的临床特征:对2017年1月至12月期间参与日本尿路感染研究小组的13家医疗机构临床诊断为急性细菌性前列腺炎的124例患者进行回顾性研究:在纳入本研究的 124 例患者中,37 例为门诊患者,87 例为住院患者。ABP发病前的主要基础疾病为严重排尿困难、尿潴留、经尿道操作、留置导尿管和经直肠前列腺活检(TRBx)。主要症状为发热(≥ 37.5°C)、前列腺触痛、排尿困难、排尿疼痛、尿潴留和大血尿。14 名患者出现菌血症。3 名患者出现前列腺脓肿。大肠埃希菌是主要病原菌,占 48%(51/106)。33%的患者(17/51)检出耐氟喹大肠杆菌,12%的患者(6/51)检出产扩谱β-内酰胺酶大肠杆菌。TRBx(几率比 [OR] = 48.60,95% 置信区间 [CI]:5.49-430.00, p < 0.001)和住院病人状态(OR = 29.00, 95% CI: 1.95-430.00, p = 0.014)是检出耐 FQ 细菌的风险因素:结论:耐 FQ 细菌的检出率明显高于 TRBx ABP 和住院患者。这些发现对 ABP 的管理和抗菌治疗具有重要意义,尤其是 TRBx ABP,应将其视为一个独立的类别。
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引用次数: 0
Cryptococcus neoformans fungemia in a liver transplant patient: Case report and literature review. 肝移植患者的新生隐球菌真菌血症:病例报告和文献综述。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-08-14 DOI: 10.1016/j.jiac.2024.08.011
Kübra Evren, Fatma Mutlu-Sarıgüzel, Ayşe Nedret Koç

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。
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引用次数: 0
Reliability of superficial swab culture results compared with deep wound culture results in Fournier's gangrene: A retrospective study. 在 Fournier 坏疽病例中,浅层拭子培养结果与深层伤口培养结果的可靠性比较:回顾性研究。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-08-14 DOI: 10.1016/j.jiac.2024.08.010
Jun Kamei, Kaori Endo, Hiroto Kishino, Atsushi Yanase, Risako Watanabe, Hirotaka Yokoyama, Masahiro Yamazaki, Toru Sugihara, Ei-Ichiro Takaoka, Satoshi Ando, Haruki Kume, Tetsuya Fujimura

Objectives: To compare isolates from deep wound and superficial swab cultures to evaluate the detectability of pathogens by each culture in Fournier's gangrene; and evaluate the association between microorganisms isolated from deep wounds and those isolated from blood or urine.

Methods: Patients with Fournier's gangrene who underwent debridement between October 2006 and January 2023 were retrospectively reviewed. In addition to comparing the isolates from deep wound cultures at initial debridement with those from superficial swab, blood, and urine cultures, the relationship between the traits of the organisms from deep wounds and patient disease severity and prognosis was examined.

Results: Among 25 patients, deep wound and superficial swab cultures were obtained from 25 to 18 patients, respectively. The frequency of anaerobic isolates was significantly lower in the superficial cultures than in the deep wound cultures (31/76 versus 13/56, p = 0.034). Bacteria not isolated from deep wounds were isolated from superficial cultures in 55.6 % of the patients; the concordance rate between deep and superficial cultures was 27.8 % (5/18). The positive rates of blood and urine cultures were 20.8 % and 35.7 %, respectively; all isolates from the urine and blood cultures reflected the results of the deep wound culture. No significant association was observed between the severity or mortality and the type of causative bacteria.

Conclusions: Superficial swab cultures cannot be substituted for deep wound cultures in Fournier's gangrene. Although the positivity rates for blood and urine cultures were not high, they were helpful in determining antibiotic de-escalation.

目标比较伤口深部培养物和浅表拭子培养物中的分离物,评估每种培养物对福尼尔坏疽病原体的检出率;评估从伤口深部分离的微生物与从血液或尿液中分离的微生物之间的关联:方法: 对 2006 年 10 月至 2023 年 1 月期间接受清创术的 Fournier 坏疽患者进行回顾性研究。除了比较初次清创时伤口深部培养物与浅表拭子、血液和尿液培养物中的分离物外,还研究了伤口深部培养物的特征与患者病情严重程度和预后之间的关系:结果:在 25 名患者中,分别从 25 名和 18 名患者的伤口深部和表层拭子中获得了培养物。表层培养物中厌氧菌分离的频率明显低于伤口深层培养物(31/76 对 13/56,p = 0.034)。55.6%的患者从浅层培养物中分离出了未从伤口深部分离出的细菌;深层和浅层培养物的一致率为 27.8%(5/18)。血液和尿液培养的阳性率分别为 20.8% 和 35.7%;尿液和血液培养中分离出的所有细菌都反映了伤口深部培养的结果。伤口严重程度或死亡率与致病菌类型之间没有明显关联:结论:在治疗福尼尔坏疽时,不能用浅表拭子培养代替伤口深部培养。虽然血液和尿液培养的阳性率不高,但它们有助于确定抗生素的降级。
{"title":"Reliability of superficial swab culture results compared with deep wound culture results in Fournier's gangrene: A retrospective study.","authors":"Jun Kamei, Kaori Endo, Hiroto Kishino, Atsushi Yanase, Risako Watanabe, Hirotaka Yokoyama, Masahiro Yamazaki, Toru Sugihara, Ei-Ichiro Takaoka, Satoshi Ando, Haruki Kume, Tetsuya Fujimura","doi":"10.1016/j.jiac.2024.08.010","DOIUrl":"https://doi.org/10.1016/j.jiac.2024.08.010","url":null,"abstract":"<p><strong>Objectives: </strong>To compare isolates from deep wound and superficial swab cultures to evaluate the detectability of pathogens by each culture in Fournier's gangrene; and evaluate the association between microorganisms isolated from deep wounds and those isolated from blood or urine.</p><p><strong>Methods: </strong>Patients with Fournier's gangrene who underwent debridement between October 2006 and January 2023 were retrospectively reviewed. In addition to comparing the isolates from deep wound cultures at initial debridement with those from superficial swab, blood, and urine cultures, the relationship between the traits of the organisms from deep wounds and patient disease severity and prognosis was examined.</p><p><strong>Results: </strong>Among 25 patients, deep wound and superficial swab cultures were obtained from 25 to 18 patients, respectively. The frequency of anaerobic isolates was significantly lower in the superficial cultures than in the deep wound cultures (31/76 versus 13/56, p = 0.034). Bacteria not isolated from deep wounds were isolated from superficial cultures in 55.6 % of the patients; the concordance rate between deep and superficial cultures was 27.8 % (5/18). The positive rates of blood and urine cultures were 20.8 % and 35.7 %, respectively; all isolates from the urine and blood cultures reflected the results of the deep wound culture. No significant association was observed between the severity or mortality and the type of causative bacteria.</p><p><strong>Conclusions: </strong>Superficial swab cultures cannot be substituted for deep wound cultures in Fournier's gangrene. Although the positivity rates for blood and urine cultures were not high, they were helpful in determining antibiotic de-escalation.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995860","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
Impact of long-term macrolide therapy on the evaluation indicator of outpatient oral antimicrobial use according to the AWaRe classification. 根据 AWaRe 分类,长期大环内酯类药物治疗对门诊口服抗菌药物使用评价指标的影响。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-08-08 DOI: 10.1016/j.jiac.2024.08.006
Daisuke Yamasaki, Shiho Ito, Natsuki Ochiai, Takanori Yamaguchi, Kei Suzuki, Masaki Tanabe

The WHO recently proposed a new indicator for judging the appropriateness of antimicrobial selection according to the AWaRe classification. Although macrolides are often administered for long-term macrolide therapy, the impact of this therapy on the indicator remains unclear. This study examined the impact of this therapy on the indicator for outpatient oral antimicrobial use. Using the JMDC claims database, outpatients who were prescribed an oral antimicrobial at least once between January and December 2022 (n = 2.66 million) were included in the study. The ratio of patient numbers and antimicrobial usage (AMU) were calculated based on age group (<15, 15-64, and ≥65 years) and prescription days (1-15, 16-30, 31-60, 61-90, and ≥91 days), and AMU of each drug was corrected for defined daily doses and classified according to the AWaRe. Patients with chronic airway disease for whom macrolides were prescribed for 91 days and more were defined as long-term macrolide therapy. Macrolides accounted for more than 30 % of total oral AMU in all age groups. In the elderly, 11.2 % of patients were prescribed macrolides for 91 days or more, accounting for 66.4 % of macrolide use. With regard to diseases that were associated with macrolide prescriptions, the percentage of patients prescribed for chronic airway diseases increased as the number of days of prescription increased. These results suggest that the impact of long-term macrolide therapy should be considered when assessing the appropriateness of outpatient oral AMU according to the AWaRe classification.

世卫组织最近提出了一项新指标,用于根据 AWaRe 分类判断抗菌药物选择的适当性。虽然大环内酯类药物经常被用于长期大环内酯类药物治疗,但这种疗法对该指标的影响仍不明确。本研究考察了这种疗法对门诊口服抗菌药物使用指标的影响。本研究利用 JMDC 索偿数据库,将 2022 年 1 月至 12 月期间至少开过一次口服抗菌药的门诊患者(n=266 万)纳入研究范围。根据年龄组计算出患者人数与抗菌药物使用量(AMU)的比率((
{"title":"Impact of long-term macrolide therapy on the evaluation indicator of outpatient oral antimicrobial use according to the AWaRe classification.","authors":"Daisuke Yamasaki, Shiho Ito, Natsuki Ochiai, Takanori Yamaguchi, Kei Suzuki, Masaki Tanabe","doi":"10.1016/j.jiac.2024.08.006","DOIUrl":"10.1016/j.jiac.2024.08.006","url":null,"abstract":"<p><p>The WHO recently proposed a new indicator for judging the appropriateness of antimicrobial selection according to the AWaRe classification. Although macrolides are often administered for long-term macrolide therapy, the impact of this therapy on the indicator remains unclear. This study examined the impact of this therapy on the indicator for outpatient oral antimicrobial use. Using the JMDC claims database, outpatients who were prescribed an oral antimicrobial at least once between January and December 2022 (n = 2.66 million) were included in the study. The ratio of patient numbers and antimicrobial usage (AMU) were calculated based on age group (<15, 15-64, and ≥65 years) and prescription days (1-15, 16-30, 31-60, 61-90, and ≥91 days), and AMU of each drug was corrected for defined daily doses and classified according to the AWaRe. Patients with chronic airway disease for whom macrolides were prescribed for 91 days and more were defined as long-term macrolide therapy. Macrolides accounted for more than 30 % of total oral AMU in all age groups. In the elderly, 11.2 % of patients were prescribed macrolides for 91 days or more, accounting for 66.4 % of macrolide use. With regard to diseases that were associated with macrolide prescriptions, the percentage of patients prescribed for chronic airway diseases increased as the number of days of prescription increased. These results suggest that the impact of long-term macrolide therapy should be considered when assessing the appropriateness of outpatient oral AMU according to the AWaRe classification.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912967","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
Multicenter surveillance of the outcomes of and antimicrobial susceptibility to acute cystitis caused by Staphylococcussaprophyticus. 对由葡萄球菌引起的急性膀胱炎的结果和抗菌药敏感性进行多中心监测。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-08-08 DOI: 10.1016/j.jiac.2024.08.007
Toshiki Etani, Shuhei Kondo, Ryohei Azuma, Rika Banno, Teruki Isobe, Nobuhiko Shimizu, Keitaro Iida, Tatsuya Hattori, Takashi Nagai, Taiki Kato, Yoshinobu Moritoki, Takako Inoue, Atsushi Nakamura, Takahiro Yasui

In this study, we aimed to investigate the antimicrobial susceptibility of Staphylococcus saprophyticus in Japan. Additionally, we evaluated the effectiveness of different therapeutic agents and compared the differences in their outcomes in treating S. saprophyticus-induced acute cystitis, considering that cephem antibiotics are standard treatments for acute cystitis in Japan. This retrospective study was conducted at ten hospitals housing urology departments, where urologists were dispatched from the Department of Nephro-Urology, Nagoya City University Graduate School of Medicine. Initially, we prepared a list of S. saprophyticus cases detected between January 2012 and December 2021, using the bacteriological testing system of each hospital. Subsequently, we reviewed the electronic medical records of the listed cases to investigate the causative diseases, treatments, and outcomes in patients with acute cystitis. The number of S. saprophyticus samples collected in this study was 289 from urine specimens, including 157 from women with acute cystitis. All antimicrobial agents demonstrated good therapeutic efficacy in all patients, except in those who did not return for follow-up visits (30 %). Furthermore, only one case of inadequate therapeutic efficacy was observed in a patient treated with a third-generation cephalosporin. All the other patients were cured. These findings revealed that the susceptibility of S. saprophyticus to different antimicrobials did not differ considerably between the specimens from patients with acute cystitis and those from other patients, suggesting a similar trend of therapeutic efficacies of the tested antimicrobials against S. saprophyticus-induced acute cystitis.

在这项研究中,我们旨在调查日本的肥厚葡萄球菌对抗菌药的敏感性。此外,考虑到头孢类抗生素是日本治疗急性膀胱炎的标准疗法,我们还评估了不同治疗药物的有效性,并比较了它们在治疗由葡萄球菌引起的急性膀胱炎方面的效果差异。这项回顾性研究在 10 家设有泌尿科的医院进行,由名古屋市立大学医学研究生院肾脏泌尿科派出泌尿科医生。首先,我们利用各医院的细菌检测系统编制了 2012 年 1 月至 2021 年 12 月期间发现的沙弗氏菌病例清单。随后,我们查阅了所列病例的电子病历,以调查急性膀胱炎患者的致病疾病、治疗方法和结果。本研究从尿液标本中收集到 289 份沙雷氏菌样本,其中 157 份来自急性膀胱炎女性患者。除未复诊的患者(30%)外,所有抗菌药物对所有患者均有良好疗效。此外,只有一例使用第三代头孢菌素治疗的患者疗效不佳。其他患者均已痊愈。这些研究结果表明,急性膀胱炎患者的标本与其他患者的标本对不同抗菌素的敏感性差别不大,这表明所测试的抗菌素对沙普氏菌引起的急性膀胱炎具有相似的疗效趋势。
{"title":"Multicenter surveillance of the outcomes of and antimicrobial susceptibility to acute cystitis caused by Staphylococcussaprophyticus.","authors":"Toshiki Etani, Shuhei Kondo, Ryohei Azuma, Rika Banno, Teruki Isobe, Nobuhiko Shimizu, Keitaro Iida, Tatsuya Hattori, Takashi Nagai, Taiki Kato, Yoshinobu Moritoki, Takako Inoue, Atsushi Nakamura, Takahiro Yasui","doi":"10.1016/j.jiac.2024.08.007","DOIUrl":"https://doi.org/10.1016/j.jiac.2024.08.007","url":null,"abstract":"<p><p>In this study, we aimed to investigate the antimicrobial susceptibility of Staphylococcus saprophyticus in Japan. Additionally, we evaluated the effectiveness of different therapeutic agents and compared the differences in their outcomes in treating S. saprophyticus-induced acute cystitis, considering that cephem antibiotics are standard treatments for acute cystitis in Japan. This retrospective study was conducted at ten hospitals housing urology departments, where urologists were dispatched from the Department of Nephro-Urology, Nagoya City University Graduate School of Medicine. Initially, we prepared a list of S. saprophyticus cases detected between January 2012 and December 2021, using the bacteriological testing system of each hospital. Subsequently, we reviewed the electronic medical records of the listed cases to investigate the causative diseases, treatments, and outcomes in patients with acute cystitis. The number of S. saprophyticus samples collected in this study was 289 from urine specimens, including 157 from women with acute cystitis. All antimicrobial agents demonstrated good therapeutic efficacy in all patients, except in those who did not return for follow-up visits (30 %). Furthermore, only one case of inadequate therapeutic efficacy was observed in a patient treated with a third-generation cephalosporin. All the other patients were cured. These findings revealed that the susceptibility of S. saprophyticus to different antimicrobials did not differ considerably between the specimens from patients with acute cystitis and those from other patients, suggesting a similar trend of therapeutic efficacies of the tested antimicrobials against S. saprophyticus-induced acute cystitis.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912968","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
Two cases of iatrogenic levofloxacin-resistant pre-XDR tuberculosis in Japan. 日本两例左氧氟沙星耐药的 XDR 前肺结核病例。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-08-06 DOI: 10.1016/j.jiac.2024.08.003
Tomohiko Ukai, Akihiro Ohkado, Masao Okumura, Takashi Yoshiyama

This case report discusses two instances of iatrogenically induced pre-extensively drug-resistant tuberculosis (pre-XDR TB). In both cases, the patients were initially diagnosed with tuberculosis and hospitalized in university hospitals. Nucleic acid amplification tests identified rifampicin-resistant tuberculosis, leading to a deviation from clinical guidelines. Without prior verification of susceptibility to other drugs, levofloxacin was added to the standard antituberculosis regimen, which included isoniazid, pyrazinamide, ethambutol, and rifampicin. Subsequent phenotypic drug susceptibility tests (DST) revealed resistance to isoniazid but susceptibility to levofloxacin, thus reclassifying the condition as multidrug-resistant tuberculosis (MDR-TB). However, by the time these patients were transferred to our hospital and began MDR-TB treatment, they had already developed resistance to levofloxacin, escalating their condition to pre-XDR TB. These cases underscore the importance of rapid access to comprehensive DST upon the identification of rifampicin resistance and adherence to established clinical guidelines.

本病例报告讨论了两例由人为因素诱发的耐药前肺结核(XDR 前肺结核)。在这两个病例中,患者最初被诊断为肺结核,并在大学医院住院治疗。核酸扩增检测发现了耐利福平结核病,导致偏离了临床指南。在没有事先验证对其他药物的敏感性的情况下,在标准抗结核治疗方案(包括异烟肼、吡嗪酰胺、乙胺丁醇和利福平)中加入了左氧氟沙星。随后进行的表型药敏试验(DST)显示,患者对异烟肼产生耐药性,但对左氧氟沙星敏感,因此该病被重新归类为耐多药结核病(MDR-TB)。然而,当这些患者转到我院并开始接受 MDR-TB 治疗时,他们已经对左氧氟沙星产生了耐药性,病情升级为前 XDR TB。这些病例凸显了在发现利福平耐药性后迅速进行全面的 DST 检测并遵守既定临床指南的重要性。
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引用次数: 0
Trimethoprim-sulfamethoxazole combined with echinocandins versus trimethoprim-sulfamethoxazole alone for Pneumocystis pneumonia in patients without human immunodeficiency virus infection: A nationwide retrospective cohort study. 三甲氧苄啶-磺胺甲噁唑联合棘白菌素与单用三甲氧苄啶-磺胺甲噁唑治疗未感染人类免疫缺陷病毒患者的肺孢子虫肺炎:一项全国性回顾性队列研究。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-08-06 DOI: 10.1016/j.jiac.2024.08.004
Jumpei Taniguchi, Shotaro Aso, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga

Background: Although combination therapy of echinocandins with trimethoprim-sulfamethoxazole (TMP-SMX) has been reported for patients with Pneumocystis jirovecii pneumonia (PCP), the effectiveness of this combination therapy in patients with PCP without human immunodeficiency virus (HIV) infection remains unknown.

Methods: Data from the Japanese Diagnosis Procedure Combination inpatient database was used to identify non-HIV patients who underwent their first hospitalisation for PCP between April 2012 and March 2022. The patients were divided into those treated with TMP-SMX alone and those treated with TMP-SMX combined with echinocandins. We performed propensity-score overlap-weighting analysis to estimate in-hospital mortality.

Results: Among the 1324 eligible patients, 122 received TMP-SMX plus echinocandins, while 1202 received TMP-SMX alone. The propensity-score overlap-weighting analysis showed that the combination therapy was not associated with reduced in-hospital mortality in comparison with TMP-SMX alone (22.2 % vs. 26.9 %; risk difference, 4.6 %; 95 % confidence interval, -6.1 %-15.3 %; P = 0.398).

Conclusions: Echinocandins combined with TMP-SMX may not improve in-hospital mortality due to PCP in patients without HIV infection.

背景:尽管有报道称棘白菌素与三甲氧苄氨嘧啶-磺胺甲恶唑(TMP-SMX)联合疗法可用于治疗肺孢子菌肺炎(PCP)患者,但这种联合疗法对未感染人类免疫缺陷病毒(HIV)的PCP患者的疗效仍然未知:方法:利用日本诊断程序组合住院病人数据库中的数据,确定了在 2012 年 4 月至 2022 年 3 月期间首次因五型多氯联苯感染住院的非 HIV 患者。这些患者被分为单独接受 TMP-SMX 治疗的患者和接受 TMP-SMX 联合棘白菌素治疗的患者。我们进行了倾向分数重叠加权分析,以估算院内死亡率:在1324名符合条件的患者中,122人接受了TMP-SMX联合棘白菌素治疗,1202人接受了TMP-SMX单独治疗。倾向分数重叠加权分析显示,与单独使用TMP-SMX相比,联合疗法与降低院内死亡率无关(22.2% vs. 26.9%;风险差异,4.6%;95%置信区间,-6.1% to 15.3%;P = 0.398):结论:在未感染艾滋病毒的患者中,棘白菌素类药物与TMP-SMX联用可能无法改善五氯苯酚引起的院内死亡率。
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引用次数: 0
Comparative genomic and morphological analyses of capsular and capsular-deficient pneumococcal strains simultaneously isolated from a patient with invasive pneumococcal disease. 对从一名侵袭性肺炎球菌疾病患者体内同时分离出的有菌胶囊和无菌胶囊肺炎球菌菌株进行基因组和形态学比较分析。
IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Pub Date : 2024-08-05 DOI: 10.1016/j.jiac.2024.08.001
Noriko Takeuchi, Misako Ohkusu, Yoko Kusuya, Hiroki Takahashi, Masashi Yamaguchi, Yuko Omata, Tomoko Nakazawa, Naruhiko Ishiwada

Introduction: To understand the in-vivo dynamics in pneumococci, investigation into the carriage in patients with invasive pneumococcal disease (IPD) is extremely important.

Methods: To clarify genomic and morphological differences between pneumococcal strains simultaneously isolated from different sites in a patient with IPD, we conducted comparative analyses of two strains. A capsular strain isolated from the blood and a non-capsular strain isolated from the sputum of a patient with IPD were used.

Results: The strain isolated from blood was serotype 24B with capsule. The strain isolated from sputum with capsular type 24 genes was non-encapsulated, and genomic analysis revealed an insertion region in the wcxK gene. Its biofilm-forming capacity was higher than that of the capsular strain, as was that of the pspK-positive true non-encapsulated strain. Furthermore, observing the microbe using transmission electron microscopy revealed that the strain isolated from sputum lacked a capsule, like the pspK-positive true non-encapsulated strain.

Conclusions: Our analysis of the two strains isolated from the blood and sputum of a patient with IPD showed one possible in-vivo morphological change in Streptococcus pneumoniae.

简介:为了解肺炎球菌在体内的动态变化,对侵入性肺炎球菌疾病(IPD)患者的带菌情况进行调查至关重要:为了了解肺炎球菌的体内动态,对侵袭性肺炎球菌疾病(IPD)患者的携带情况进行调查极为重要:为了弄清同时从一名 IPD 患者的不同部位分离出的肺炎球菌菌株在基因组和形态上的差异,我们对两株菌株进行了比较分析。结果:从血液中分离的菌株为血清型,从 IPD 患者的痰中分离的菌株为非血清型:结果:从血液中分离出的菌株是带菌囊的血清型 24B。结果:从血液中分离出的菌株是带包囊的血清 24B 型,从痰中分离出的菌株是不带包囊的 24 型基因,基因组分析显示 wcxK 基因有一个插入区。它的生物膜形成能力高于有囊菌株,pspK 阳性的真正无囊菌株也是如此。此外,使用透射电子显微镜观察微生物发现,从痰中分离出的菌株与pspK阳性的真正无包囊菌株一样没有包囊:我们对从一名 IPD 患者的血液和痰中分离出的两株菌株进行的分析表明,肺炎链球菌在体内可能会发生形态变化。
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Journal of Infection and Chemotherapy
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