The Japanese journal of antibiotics最新文献

Treatment for pulmonary nontuberculous mycobacteriosis is difficult. Since current treatment has limitation, new application is needed. Fluoroquinolone is one of candidates. We have investigated the feasibility of sitafloxacin (STFX). At first, the drug of MIC (minimum inhibitory concentration) was determined by the methods based on BrothMIC NTM. The MICs of STFX, moxifloxacin (MFLX), gatifloxacin (GFLX) were low. On contrast, the MICs of garenoxacin (GRNX) and tosufloxacin (TFLX) were high. Two cases of pulmonary Mycobacterium avium-intracellulare complex (MAC) disease were treated by STFX-contained regimen. In all cases of pulmonary MAC disease, improve of symptoms and chest CT images were attained. Adverse events were slight. These MIC studies and case reports suggest that STFX might have excellent in vitro and in vivo antimicrobial activities against MAC and is considered to be a candidate for the medication against pulmonary MAC disease.

Recently, the community pandemic infections of cefotaxime (CTX)-M type extended-spectrum β-lactamase (ESBL) producing bacteria, which is mostly resistant to CTX, has been well-known as major problems. When the ESBL-confirmation test cannot be done, CTX-resistant Escherichia coli might be used as the alternation method of infectious control. We investigated tendency of third-generation cephalosporin resistant E. coli and the clinical features of bloodstream infections (BSI) due to ESBL producing E. coli in our hospital, which has no department of microbial examination. We examined the trend of detection of CTX-resistant E. coli isolates from clinical samples from January 2009 to November 2013, and antimicrobial use density (AUD) of third-generation cephalosporins in the same period, and the clinical features of BSI of ESBL-producing E. coli. As a result, the percentages of CTX-resistant E. coli in all E. coli were 5.4% in inpatient and 3.9% in outpatient in 2009, but 32.8% and 17.8% in 2013, respectively. Additionally, AUD had increased from 20.6 in 2009 to 28.9 in 2013. In BSI due to E. coli, the clinical features which were male, bedridden patient and using urethral catheter, central venous catheter, chronic renal failure were significantly in the cases of ESBL-producing E. coli (n=8), compared to non-ESBL producing E. coli (n=32).

Bacteria isolated from surgical infections during the period from April 2010 to March 2011 were investigated in a multicenter study in Japan, and the following results were obtained. In this series, 631 strains including 25 strains of Candida spp. were isolated from 170 (81.7%) of 208 patients with surgical infections. Four hundred and twenty two strains were isolated from primary infections, and 184 strains were isolated from surgical site infection. From primary infections, anaerobic Gram-negative bacteria were predominant, followed by aerobic Gram-negative bacteria, while from surgical site infection aerobic Gram-positive bacteria were predominant, followed by anaerobic Gram-negative bacteria. Among aerobic Gram-positive bacteria, the isolation rate of Enterococcus spp. such as Enterococcus faecalis, Enterococcus faecium, and Enterococcus avium was highest, followed by Streptococcus spp. such as Streptococcus anginosus and Staphylococcus spp. such as Staphylococcus aureus, in this order, from primary infections, while Enterococcus spp. such as E. faecalis and E. faecium was highest, followed by Staphylococcus spp. such as S. aureus from surgical site infection. Among aerobic Gram-negative bacteria, Escherichia coli was the most predominantly isolated from primary infections, followed by Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter cloacae, and Pseudomonas aeruginosa in this order, and from surgical site infection, E. coli and R aeruginosa were most predominantly isolated, followed by E. cloacae and K. pneumoniae. Among anaerobic Gram-positive bacteria, the isolation rates of Parvimonas micra, Eggerthella lenta, Streptococcus constellatus, Gemella morbillorum, and Collinsella aerofaciens were the highest from primary infections, and the isolation rate from surgical site infection was generally low. Among anaerobic Gram-negative bacteria, the isolation rate of Bilophila wadsworthia was the highest from primary infections, followed by, Bacteroides fragilis and Bacteroides ovatus, and from surgical site infection, B. fragilis was most predominantly isolated, followed by Bacteroides thetaiotaomnicron, in this order. In this series, vancomycin-resistant MRSA (methicillin-resistant S. aureus), vancomycin-resistant Enterococcus spp. and multidrug-resistant P. aeruginosa were not observed.

Voriconazole (VRCZ), a broad-spectrum triazole, is served in two dosage forms-injection and oral. VRCZ is difference dosage of oral and intravenous administration writing a medical package insert in Japan. 6 mg/kg intravenous injection (IV) twice daily for first day as initial loading dose, followed by 3-4 mg/kg IV twice daily between meals is recommended. 300 mg orally twice daily for first day as initial loading dose, followed by 150-200 mg orally twice daily between meals is recommended. Patients weighing over 40 kg, 200 mg orally twice daily between meals is recommended. Patients weighing under 40 kg, 100 mg orally twice daily between meals is recommended, increase to 150 mg twice daily if inadequate response. This study evaluated VRCZ trough concentration and oral dosage in the 23 cases which administered VRCZ to analysis for TDM in Aichi University Hospital. Spearman rank correlation coefficient was calculated to examine relationships among variables. The level of statistical significance was set at p=0.05. All data were analyzed and processed on JMP 8 (SAS Institute Japan). There was a significant positive correlation between VRCZ trough concentration and dose/weight (r=0.47 p<0.05). In this result, VRCZ oral dosage is appropriate to administer dose/weight (mg/kg) twice a day as same as IV.

We developed and evaluated of multiplex real-time PCR assay for detection of vancomycin-resistant genes (vanA, vanB, vanC1 and vanC2/C3) using the new, fully automated BD MAX platform. Ct value analyses of real-time PCR simultaneous repeatability test have showed the usefulness; coefficient of variation: CV (%) were determined 2.09%, 1.72%, 1.41% and 1.52% with vanA, vanB, vanC1 and vanC2/C3, respectively. We also evaluated with 43 strains of enterococci were characterized by conventional PCR method; 4/4 for vanA-positive, 14/14 for vanB-positive, 1/1 for vanB plus vanC1-positive, 6/6 for vanC1-positive, 4/4 for vanC2/C3- positive and 14/14 for all-van gene-negative strains were identified correctly. This assay was automatically performing before and after PCR operations previously done manually by operator, such as DNA extraction, sample dispensing and gel electrophoresis or the ethidium bromide dyeing. As a result, work burden and the risk of the contamination were largely reduced and were shortened to about half for measurement time. We conclude that this assay could greatly contribute to efficient and rapid detection of vancomycin-resistant genes.

We investigated the susceptibility of 400 Pseudomonas aeruginosa (P. aeruginosa) clinical isolates to 3 antipseudomonal carbapenems, namely, doripenem (DRPM), meropenem (MEPM), and imipenem (IPM). The test strains were isolated from the following specimens: respiratory (n = 194), urinary (n = 61), digestive (n = 38), pus (n = 36), skin (n = 21), blood (n = 9), upper respiratory tract and oral cavity (n = 8), and others (n = 33) at Osaka City University Hospital from July to October 2013. Test strains were categorized as susceptible, ≤ 2 μg/mL; intermediate, 4 μg/mL; and resistant, ≥ 8 μg/mL according to Clinical and Laboratory Standards Institute criteria (M100-S22), updated on January 2012. To compare the antimicrobial activities of these 3 carbapenems, the susceptibility rate for each agent was analyzed. Susceptibility to DRPM, MEPM, and IPM was 78.3%, 74.3%, and 64.8%, respectively, whereas resistance was 12.5%, 22.8%, and 28.5%, respectively. The frequency of strains resistant to DRPM was significantly lower than that for MEPM (p < 0.001) and IPM (p < 0.001). To compare the activities of the 3 carbapenems against the P. aeruginosa clinical isolates, we plotted the numbers of strains against each minimum inhibitory concentration (MIC) level. The MICs of DRPM were lower than those of MEPM in 19.8% of strains, and lower than those of IPM in 41.8% of strains, and the MICs of MEPM were lower than those of IPM in 33.0% of strains. Further, we found that 7.7% of the MEPM-resistant strains were susceptible to DRPM, 23.7% of the IPM-resistant strains were susceptible to DRPM, and 9.6% of the IPM-resistant strains were susceptible to MEPM; however, none of the MEPM-resistant strains was susceptible to IPM, and none of the DRPM-resistant strains was susceptible to MEPM or IPM. In conclusion, the in vitro activity of DRPM against the P. aeruginosa clinical isolates was superior to those of MEPM and IPM.

Antimicrobials are commonly used to treat acute respiratory tract infection in adults. Furthermore, their overuse has raised concern. We conducted a field survey study that included 170 medical institutions from January 2008 to June 2010. The purpose of this study was to clarify the relationship between the rate of antimicrobial use and patient outcomes with each indication. The study included 1753 patients diagnosed with acute respiratory tract infection. Antimicrobials were used for treatment of 1420 of these patients, whereas 333 cases were not treated with antimicrobials. After 3 days of treatment, patients administered antimicrobials experienced a higher improvement rate than those who did not receive antimicrobial treatment (92.2% vs. 83.3%, p < 0.0001). However, after 7 days of treatment, the rates of improvement for patients in both groups were similar (95.0% and 93.4%, respectively, p = 0.2391). In addition, according to the criteria for the usage of antimicrobials described in the Japanese Respiratory Society guidelines for the management of respiratory tract infection in adults, the patients were classified into the 3 categories (6 indication factors for antimicrobial use): Grade 1, ≤ 2 factors; Grade 2, 3-4 factors; Grade 3, 5-6 factors). The indication factors considered were the following: 1) temperature; 2) purulent sputum or nasal discharge; 3) tonsillar enlargement and tonsillolith/white puss; 4) middle otitis/sinusitis; 5) inflammatory reaction; and 6) high-risk patients. The results indicate that the improvement observed after 3 days of treatment in Grade 2 and Grade 3 patients was significantly higher with antimicrobial treatment than without antimicrobial treatment. In conclusion, the administration of antimicrobials is not recommended in younger patients with no underlying disease. However, the use of antimicrobials is required in patients with a higher relative risk that corresponds to the presence of ≥ 3 of the 6 indication factors for antimicrobial use.

We investigated the susceptibility of Candida species from clinical aseptic samples, including blood, at some hospitals in Saitama prefecture. Candida spp. detected from aseptic samples in the 6 institutes in Saitama prefecture from November 2007 to July 2011 were studied. The number of isolates was 85, which are 43 (50.6%) of Candida albicans, 24 (28.2%) of Candida parapsilosis, 5 (5.9%) of Candida glabrata, 5 (5.9%) of Candida tropicalis, 4 (4.7%) of Candida guilliermondii, 2 (2.4%) of Candida fermentati, 1 (1.2%) of Candida famata and Candida lusitaniae, respectively. All isolates were susceptible to amphotericin B. However, resistant isolates against micafungin were 3 in 5 of C. glabrata. We analyzed susceptibility of Candida spp. in Saitama prefecture in the article, and our study might be useful for the fungal therapy in the region.