Language：English   Publishing type：Research paper (scientific journal)  

Carbapenemase-producing Enterobacterales (CPE) raise concerns about the treatment options for infectious diseases and infection control. We conducted a multicenter study to clarify the molecular epidemiology of CPE in the Aichi Prefecture during the first 3-month period from 2015 to 2019. Carbapenemase production was screened using a modified carbapenem inactivation method, and the genotypes of the carbapenemase genes were determined by polymerase chain reaction sequencing. Genetic relatedness was analyzed using multilocus sequence typing (MLST). Twenty-four hospitals participated in this study. Of the 56,494 Enterobacterales strains detected during the study period, 341 (0.6%) that met the susceptibility criteria were analyzed. Sixty-five of the 341 strains were determined to be CPE, with an incidence rate of 0.12% (65/56,494). The bacterial species responsible for CPE were Klebsiella pneumoniae (n = 24), Enterobacter cloacae complex (n = 23), Klebsiella oxytoca (n = 10), and Escherichia coli (n = 8). Most of the carbapenemase genotypes were IMP-1 (58/65), and only three were IMP-6 types. Three E. coli strains that produced NDM-5 were detected. MLST analysis showed that Sequence type (ST) 78 was predominant in E. cloacae complex CPE (14/23, 60.9%). Meanwhile, various STs were detected in carbapenemase-producing (CP) K. pneumoniae, of which ST37 and ST517 were the most common. The incidence rate of CPE in this region was comparable to national data. This 3-month surveillance revealed the spread of ST78 of CP E. cloacae complex and ST517 and ST592 of CP K. pneumoniae across hospitals, indicating the need to strengthen regional infection control programs.

DOI： 10.18999/nagjms.84.3.630

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Malassezia furfur is a lipophilic, yeast-like fungus that forms part of the normal human skin microflora and is associated with a wide range of infections, such as pityriasis versicolor, folliculitis, and systemic infections in immunocompromised patients. Although matrix-assisted laser desorption/ionization time-of-flight mass spectrometry has enabled rapid identification of Malassezia species, it is still a challenge to diagnose systemic infections because Malassezia fungemia can often be missed by automated blood culture systems. We report a case in which M. furfur in blood was detected by the presence of yeast-like fungi in blood smears. Yeast-like organisms were observed in the blood smears of a 3-year-old boy, taken over 2 weeks without any symptoms. He had undergone several courses of chemotherapy for neuroblastoma via an indwelling central venous catheter (CVC) that was placed in his right anterior chest for 11 months. Although the blood cultures obtained from an automated blood culture system were negative, M. furfur growth was detected in the subcultured blood taken from the CVC. The CVC was removed, and the scheduled chemotherapy was postponed. No systemic M. furfur bloodstream infection occurred; the infection resolved spontaneously without any specific treatment; only prophylactic fluconazole was administered. M. furfur fungemia may not be diagnosable by an automated blood culture system. Further, M. furfur may not cause infections in humans even when administered intravenously. This report may lead to the discovery of factors related to human infectivity of this disease in the future.

DOI： 10.1016/j.jiac.2022.02.026

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.jiac.2022.02.012

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: The dissemination of difficult-to-treat carbapenem-resistant Enterobacterales (CRE) is of great concern. We clarified the risk factors underlying CRE infection mortality in Japan. METHODS: We conducted a retrospective, multicentre, observational cohort study of patients with CRE infections at 28 university hospitals from September 2014 to December 2016, using the Japanese National Surveillance criteria. Clinical information, including patient background, type of infection, antibiotic treatment, and treatment outcome, was collected. The carbapenemase genotype was determined using PCR sequencing. Multivariate analysis was performed to identify the risk factors for 28-day mortality. RESULTS: Among the 179 patients enrolled, 65 patients (36.3%) had bloodstream infections, with 37 (20.7%) infections occurring due to carbapenemase-producing Enterobacterales (CPE); all carbapenemases were of IMP-type (IMP-1: 32, IMP-6: 5). Two-thirds of CPE were identified as Enterobacter cloacae complex. Combination therapy was administered only in 46 patients (25.7%), and the 28-day mortality rate was 14.3%. Univariate analysis showed that solid metastatic cancer, Charlson Comorbidity Index ≥3, bloodstream infection, pneumonia, or empyema, central venous catheters, mechanical ventilation, and prior use of quinolones were significant risk factors for mortality. Multivariate analysis revealed that mechanical ventilation (OR: 6.71 [1.42-31.6], P = 0.016), solid metastatic cancers (OR: 5.63 [1.38-23.0], P = 0.016), and bloodstream infections (OR: 3.49 [1.02-12.0], P = 0.046) were independent risk factors for 28-day mortality. CONCLUSION: The significant risk factors for 28-day mortality in patients with CRE infections in Japan are mechanical ventilation, solid metastatic cancers, and bloodstream infections.

DOI： 10.1016/j.jgar.2022.04.004

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: The spread of third-generation cephalosporin-resistant Gram-negative bacteria is a serious concern in acute and post-acute care settings. This study aimed to understand the epidemiology and molecular background of fecal colonization of resistant Enterobacterales in elderly people. METHODS: In December 2015-December 2017, stool or rectal swab samples were collected from 101 elderly patients receiving home care, using long-term care facilities (LTCF), and living in nursing homes repeatedly at 3-9-month intervals. Patient clinical background data were collected from medical records. After phenotypic screening for extended-spectrum β-lactamase (ESBL), AmpC-type β-lactamase or carbapenemase production, drug resistance genes of isolates were analyzed using polymerase chain reaction (PCR). ESBL-producing Escherichia coli isolates obtained from the same patients in repetitive screenings were analyzed using PCR-based ORF typing. Risk factors for persistent carriage of resistant Enterobacterales were analyzed using multivariate analysis. RESULTS: Resistant Enterobacterales isolates were detected in 37 of 101 (36.6%) and 29 of 80 (36.3%) residents in first and second screenings, respectively. ESBL-producing E. coli accounted for 80% isolates, the most common being CTX-M-9-group β-lactamase producers. Molecular epidemiological analysis revealed probable transmissions of ESBL-producing E. coli; 58% of ESBL-producing E. coli colonizers were persistent colonizers at least after 3 -month intervals. Age > 87 years and LTCF residence were independent risk factors for persistent carriage of ESBL-producing E. coli. CONCLUSIONS: We showed, for the first time, high persistent colonization rate of ESBL-producing E. coli among elderly people in post-acute care settings with probable horizontal transmission. We also identified significant risk factors for persistent colonization.

DOI： 10.1016/j.jiac.2021.12.033

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

A 93-year-old woman was diagnosed with Lysinibacillus fusiformis bacteremia complicated with coma blisters. Initial gram staining for L. fusiformis indicated the presence of gram-negative rods; however, subsequent staining of colonies from Mueller-Hinton agar revealed the presence of gram-positive and gram-negative rods with spherical endospores, and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (VITEK ® MS and microflex® LT/SH) definitively identified the organism as L. fusiformis. The two-week administration of piperacillin/tazobactam and ampicillin resulted in an improvement of the patient's general condition, and the skin lesions gradually improved.

DOI： 10.1016/j.jiac.2021.10.030

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PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society of Internal Medicine  

We herein report a 59-year-old woman with a 2-year history of chronic bursitis of the hand who took 50 mg/day prednisolone for several autoimmune diseases. Mycobacteroides abscessus subsp. massiliense was isolated from the abscess and blood culture. Combination therapy (imipenem/cilastatin, amikacin, and clarithromycin) was administered for a month. Two months later, M. massiliense was detected from a blood culture again, and disseminated lesions were found. Clarithromycin and sitafloxacin were administered following eight weeks of the same regimen. Six months after the diagnosis, M. massiliense was isolated from a blood culture, and she expired due to multiple organ failure.

DOI： 10.2169/internalmedicine.6189-20

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PubMed

Language：Japanese   Publisher：(一社)日本環境感染学会  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.infpip.2021.100151

PubMed

Language：Japanese   Publishing type：Research paper (conference, symposium, etc.)   Publisher：(一社)日本環境感染学会  

Language：English   Publishing type：Research paper (scientific journal)  

Prolonged treatment with linezolid (LZD) is known to cause thrombocytopenia. However, some patients do not develop thrombocytopenia despite long-term administration of LZD. To determine the risk factors for LZD-associated thrombocytopenia in patients undergoing long-term LZD therapy, we conducted a retrospective cohort study among 212 patients receiving LZD treatment between December 2011 and June 2014 at a tertiary referral university hospital in Nagoya, Japan. Of the 217 patients who received LZD, 37 were treated with LZD for more than 14 days and were enrolled in the study. We compared data on demographic characteristics, underlying disease, microbiology, concomitant drugs, and laboratory tests between the thrombocytopenia group and the non-thrombocytopenia group. Thrombocytopenia was defined as having a platelet count < 100 × 103/μL or a ≥ 50% reduction in platelet count compared to baseline. Among the 37 patients who received LZD for more than 14 days, 17 (45.9%) developed thrombocytopenia. Multivariate logistic regression revealed that both the number of concomitant drugs with thrombocytopenic adverse effects (DTADE) (OR = 1.690; 95% CI = 1.037-2.754; P = 0.035) and a small decrease in the level of C-reactive protein (CRP) 14 days post-administration (OR = 0.965; 95% CI = 0.939-0.993; P = 0.013) were associated with thrombocytopenia during long-term LZD therapy. Therefore, the number of concomitant DTADE and a small decrease in CRP on the 14th day of treatment were key factors for the appearance of LZD-associated thrombocytopenia in patients with long-term LZD therapy. Our findings may be useful for preventing thrombocytopenia in patients treated with LZD for longer than 14 days.

DOI： 10.18999/nagjms.82.3.407

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jhin.2018.10.005

Web of Science

Language：English   Publishing type：Research paper (scientific journal)  

Background: To clarify the molecular epidemiology of carbapenem-resistant Enterobacter cloacae complex (CREC) and the risk factors for acquisition of carbapenemase-producing E. cloacae complex (CPEC). Methods: Using clinical CREC isolates detected in a Japanese university hospital over 4 years, carbapenemase production was screened with phenotypic methods. Carbapenemase genes were analysed by PCR and sequencing. Molecular epidemiological analyses were conducted with repetitive extragenic palindromic (REP)-PCR and multilocus sequence typing (MLST). CRECs were identified to the subspecies level by hsp60 sequencing. Whole-genome sequencing of plasmids was conducted. A case-control study was performed to identify risk factors for acquisition of CPEC among patients with CREC. Results: Thirty-nine CRECs including 20 CPECs carrying blaIMP-1 were identified. Patients with CPEC had longer hospital stay before detection (26.5 days vs. 12 days, p = 0.008), a urinary catheter (odds ratio [OR], 5.36; 95% confidence interval [CI], 1.14-30.9; p = 0.023), or intubation (OR, 7.53; 95% CI, 1.47-53.8; p = 0.008) compared to patients without CPEC. Four genetically closely related CPEC clusters were observed, which showed that three of four CPEC clusters corresponded to E. asburiae (ST 53), E. hormaechei subsp. steigerwaltii (ST 113 and ST 1047) and E. cloacae subsp. cloacae (ST 513) by MLST and hsp60 sequencing. Seven representative plasmids shared structures with class I integron containing blaIMP-1 and IncHI2A replicon type. Conclusions: A longer hospital stay, presence of a urinary catheter, and intubation are risk factors for CPEC acquisition. In addition to horizontal transmission of genetically indistinguishable CPECs, IncHI2A plasmid carrying blaIMP-1 appeared to be transferred among genetically different ECs.

DOI： 10.1186/s13756-019-0578-3

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

This report described the experience of active surveillance culture implemented in response to the identification of a single carbapenemase-producing Escherichia coli in a Japanese university hospital. It revealed a horizontal transmission event and an additional asymptomatic carrier of carbapenemase-producing Escherichia coli with unique drug susceptibility and resistance gene profiles. Early implementation of active surveillance culture as a part of multifaceted infection control measures appeared to be useful to control further transmission of carbapenemase-producing Escherichia coli even in the low endemic facility. Further investigations on the timing and usefulness of active surveillance culture in the control of carbapenemase-producing Enterobacteriaceae would be warranted.

DOI： 10.1016/j.jiac.2018.05.013

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jiac.2018.08.017

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jhin.2018.03.005

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Language：English   Publishing type：Research paper (scientific journal)  

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

Web of Science

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: This study examined the risk factors for, and molecular mechanisms underlying, the increase in carbapenem minimum inhibitory concentrations (MICs) in clinical isolates of Pseudomonas aeruginosa. METHODOLOGY: Consecutive clinical isolates of P. aeruginosa were collected. The MicroScan WalkAway system detected more than fourfold increases in the MICs of carbapenems in P. aeruginosa isolates serially recovered from some patients during their clinical course. The clinical risk factors associated with this increase were examined by multiple logistic regression analysis. Western blot analysis and nucleotide sequencing of the oprD gene of 19 clonally related and paired P. aeruginosa isolates from the same patients were undertaken to examine the mechanisms underlying the increase in MICs. RESULTS: The results showed that prior use of carbapenems (OR, 2.799; 95 % CI, 1.088-7.200; P=0.033) and the use of ventilators or tracheostomies (OR, 2.648; 95 % CI, 1.051-6.671; P=0.039) were risk factors for increased carbapenem MICs. Analysis of the underlying mechanisms revealed that loss of functional OprD protein due to mutation of the oprD gene tended to occur in P. aeruginosa isolates with imipenem MICs of more than 8 µg ml-1; a reduction in OprD expression was observed in P. aeruginosa isolates with imipenem MICs of 4 or 8 µg ml-1. This difference in the resistance mechanism was not correlated with the MICs of meropenem. CONCLUSION: This difference in the resistance mechanism of P. aeruginosa indicates a critical breakpoint at an imipenem MIC of 8 µg ml-1, in accordance with EUCAST criteria. Reducing carbapenem use will prevent P. aeruginosa clinical isolates from developing resistance to carbapenems.

DOI： 10.1099/jmm.0.000601

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

RATIONALE: Clostridium difficile bacteremia (CDB) and liver abscess is a quite rare presentation of C. difficile infection. PATIENTS CONCERNS: A 74-year-old male with primary biliary cirrhosis and hepatocellular carcinoma who underwent transarterial chemoembolization (TACE) developed a high fever on post-TACE day 14. Intravenous ceftriaxone and following meropenem were administered, however, his clinical response was poor. On post-TACE day 24, 2 sets of blood culture were taken due to elevation of C-reactive protein levels. DIAGNOSIS: CDB, caused by bacterial translocation. INTERVENTIONS: Intravenous vancomycin and oral metronidazole were administered for two weeks. OUTCOMES: One month after recurrent CDB, the patient was re-admitted due to a liver abscess at the same site of TACE. C. difficile was isolated from the liver abscess and the patient received 6 weeks of oral metronidazole treatment. CDB and liver abscess have not recurred since completion of antibiotic treatment. LESSONS: The spore-forming ability of C. difficile may contributed to the recurrent CDB episodes and liver abscess formation in necrotic liver tissue following TACE, and long-term metronidazole therapy was considered to be effective to C. difficile liver abscess.

DOI： 10.1097/MD.0000000000007969

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Pneumococcal biliary tract infections (PBTIs) were reported as rare due to the bacterium's bile solubility. The purpose of this study was to determine the occurrence and clinical characteristics of PBTIs. A retrospective case series review was conducted from January 2006 to August 2014 at a tertiary referral university hospital in Japan. Patients with a blood or bile culture positive for Streptococcus pneumoniae diagnosed with definite cholangitis or cholecystitis according to Tokyo Guideline 2013 were enrolled in this study. Data on clinical information, treatments, and outcomes were collected. During 104 months, 48 cases of positive blood cultures and 13 cases of positive bile cultures were recorded, and after excluding 43 and 5 of these, respectively, a total of 10 patients were diagnosed with PBTI. Most patients (9/10) had biliary tract problems and biliary devices in place. PBTIs were not rare; conversely, they were a relatively common cause of pneumococcal bacteremia in this center treating a high volume of biliary tract illnesses.

DOI： 10.1016/j.jiac.2016.11.008

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PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society of Intensive Care Medicine  

<B>Objectives:</B> To evaluate the usefulness of procalcitonin (PCT) in differential diagnosis for bacteremia or blood culture contamination and predicting either Gram-positive or Gram-negative bacteremia. <B>Methods:</B> We retrospectively reviewed a total of 132 cases in which PCT and C-reactive protein (CRP) were examined and blood cultures were found to be positive from November 2012 to June 2013. <B>Results:</B> The PCT concentrations were significantly higher in bacteremia cases (n=102) than in contamination cases (n=30) (median: 2.8 ng/m<I>l</I> vs. 0.3 ng/m<I>l</I>, <I>P</I><0.001). The receiver operating characteristics-areas under the curve (ROC-AUCs) of PCT and CRP for discriminating bacteremia from contamination were 0.76 and 0.64, respectively. PCT concentrations of Gram-positive cases (n=48) were not significantly different from those of Gram-negative cases (n=54) (median: 2.1 ng/m<I>l</I> vs. 3.7 ng/m<I>l</I>, <I>P</I>=0.123). <B>Conclusions:</B> Compared with CRP, PCT could be useful in the differential diagnosis between bacteremia and contamination. However, we may not estimate either Gram-positive or Gram-negative bacteremia using CRP and PCT.

DOI： 10.3918/jsicm.24_115

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)   Publisher：南江堂  

DOI： 10.15106/j00974.2017009426

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Point prevalence surveys (PPSs) in Japanese hospitals have not yet been reported. The purpose of this pilot PPS study was to evaluate the epidemiology of health care-associated infections (HAIs) and antimicrobial use in a Japanese tertiary university hospital. METHODS: A 1-day, cross-sectional PPS was performed at a Japanese university hospital. Data on demographics, active HAIs, and antimicrobial use of all inpatients were collected using a data collection form. RESULTS: Of 841 patients, 85 (10.1%) had 90 active HAIs, and 308 patients (36.6%) were administered 494 antimicrobials. Among the 90 HAIs and 58 pathogens, the most frequent infection and isolated pathogen were pneumonia (20.0%) and Enterobacteriaceae (27.6%), respectively. Of the 118 antimicrobials used for treatment of HAIs, carbapenems were the most frequently administered category of antimicrobials (22.9%). In regard to antimicrobials for surgical prophylaxis, 37 of 119 (31.1%) were administered to patients on postoperative day 3 or later, and 48 of 119 (40.3%) were administered orally. CONCLUSIONS: The incidence of HAIs is higher than in other developed countries. The social and medical situation in Japan may affect patient demographics, active HAIs, and antimicrobial use. Multicenter PPSs are necessary to uncover the real epidemiology of HAIs and antimicrobial use in Japan.

DOI： 10.1016/j.ajic.2016.03.045

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.20825/amjsphcs.25.0_362_2

Language：English   Publishing type：Research paper (scientific journal)  

Web of Science

Language：English   Publishing type：Research paper (scientific journal)  

Web of Science

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本呼吸器学会  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/j.1469-0691.2012.03762.x

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2340/00015555-1385

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PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：株式会社医学書院  

DOI： 10.11477/mf.1402106478

CiNii Research

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society for Parenteral and Enteral Nutrition  

[Objectives] Our nutritional screening for the inpatients on admission consists of these four items; equal or less than 80% ideal body weight ratio, pressure sore, oral intake problem include enteral feeding, malnutrition with the appearance. If there are any inpatients with more than one item, we interpret them as malnourished and perform intervention of NST (nutritional support team). We report the utility of our nutritional simple screening on admission (NSSA).<br>[Methods] For all 245 inpatients hospitalized to our medical wards during two months, we independently performed NSSA and subjective global assessment (SGA). We reviewed whether we were able to detect patients with malnutrition by NSSA compared with SGA, physical measurement and blood examinations adequately.<br>[Results] By NSSA, we decided 61 patients needing NST intervention and 184 patients with NST intervention-free. Comparing NST intervention-free patients, NST intervention pivot patients were more undernourished by SGA significantly. Furthermore, serum albumin, % triceps skinfold thickness (%TSF) and % arm muscle circumference (%AMC) of the NST intervention pivot group were lower than NST intervention-free group significantly. The sensitivity and specificity for malnutrition judged by SGA patients of our NSSA were good, which was 87.2% and 86.5% respectively.<br>[Conclusion] Our NSSA shows clinical benefit for its simplicity, because malnutrition patients can be detected adequately.

DOI： 10.11244/jjspen.27.1079

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.20825/amjsphcs.22.0_420_1

Language：English   Publishing type：Research paper (scientific journal)   Publisher：株式会社医学書院  

DOI： 10.11477/mf.1402105119

CiNii Research

Total pages：viii, 203p   Language：Japanese Book type：Scholarly book

CiNii Books

Total pages：viii, 155p   Language：Japanese Book type：Scholarly book

CiNii Books

Language：Japanese   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：(一社)日本臨床微生物学会  

患者は70歳男性。リハビリテーション目的で前医入院中に発熱・血圧低下が出現し搬送された。右鼠径部には発赤を伴う痂皮と中枢側に伸びる索状物を触れた。造影CTで右大腿静脈内の造影欠損と血管周囲の炎症像を認め化膿性血栓性静脈炎と診断,meropenemが開始された。血液培養よりIMP-6 metallo-β-lactamase産生Klebsiella pneumoniaeを検出。aztreonam,amikacin,tigecyclineによる4週間の治療後sitafloxacinを2週間投与し治療を終了した。化膿性血栓性静脈炎は静脈壁に化膿性炎症を起こし血栓を形成する疾患で,持続性菌血症を呈し難治化しやすい。また,カルバペネマーゼ産生腸内細菌科細菌(CPE)による感染は治療薬の選択肢が限られ難治化のリスクとされている。本例ではカルバペネマーゼ産生を適切に検出し迅速に薬剤感受性検査結果を報告することで,適切な薬剤が選択され良好な転帰に繋がった。(著者抄録)

Authorship：Lead author,　Last author,　Corresponding author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Publisher：(株)にゅーろん社  

Authorship：Lead author,　Corresponding author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：(株)ヴァンメディカル  

Authorship：Lead author,　Last author,　Corresponding author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：(株)総合医学社  

＜point＞▼正しい敗血症診療には正しい感染症診療が必要。▼敗血症診療の質は、多職種の医療者による体制の整備と絶え間ない連携で向上させることができる。(著者抄録)

Authorship：Last author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：(株)全日本病院出版会  

国内外で薬剤耐性菌が問題となってきており、抗菌薬処方の適正化が強く求められてきている。このような状況下で、周術期に投与すべき薬剤・投与タイミング・投与期間などが記載された「術後感染予防抗菌薬適正使用のための実践ガイドライン」が作成され、周術期抗菌薬投与の指針として使用可能である。また、術後の内服抗菌薬として頻用される第3世代の経口セファロスポリン系薬剤は概して生体内利用率が低く、ガイドラインと照らし合わせても周術期抗菌薬としての投与は不要である。名古屋大学医学部附属病院では、周術期抗菌薬投与の適正化を行ったことで、2013年上半期と比較して、2017年の上半期では耳鼻咽喉科の処方量で71%の第3世代の経口セファロスポリン系薬剤の処方量の削減を行うことができた。本稿では、薬剤耐性対策アクションプランを含めた抗菌薬適正使用の必要性、耳鼻咽喉科での周術期抗菌薬投与の原則、名古屋大学医学部附属病院での取り組みについて概説する。(著者抄録)

Authorship：Lead author,　Corresponding author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：(株)ヴァンメディカル  

「カルバペネム耐性腸内細菌科細菌」の定義は複数あるため、データ解釈時は注意する。カルバペネマーゼ産生腸内細菌科細菌の検出に自施設で実施可能な検査の内容とその限界を把握しておくことが望ましい。カルバペネム耐性腸内細菌科細菌に普遍的に効果的な抗菌薬はなく、感受性検査結果を元に症例ごとに選択する。宿主因子・感染臓器から原因病原体を推定した上で抗菌薬を選択する基本的習慣を身につけることが、抗菌薬の適正使用に繋がる。(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J03177&link_issn=&doc_id=20180625070006&doc_link_id=10.34426%2FJ03177.2018256910&url=https%3A%2F%2Fdoi.org%2F10.34426%2FJ03177.2018256910&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Authorship：Lead author,　Corresponding author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：(株)じほう  

＜Key Points＞「カルバペネム耐性腸内細菌科細菌(CRE)」の定義が複数存在するため、データは注意して解釈する。特に「カルバペネマーゼ産生腸内細菌科細菌」に注意する。自施設で行っている感受性検査やカルバペネマーゼ検出検査について理解しておく。CREに対し一律に効果のある抗菌薬レジメンはなく、個々の感受性検査結果に応じてレジメンを選択する。CREを保菌するリスクを減らすためには、自施設の抗微生物薬の使用量をモニタリングしながら適切なフィードバックを行い、不適切な抗微生物薬投与の減少に努めるAntimicrobial Stewardshipが重要である。(著者抄録)

Language：Japanese   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：(一社)日本呼吸器学会  

症例は関節リウマチ治療中の69歳男性。2013年10月に胸部腫瘤様陰影で当科紹介され気管支鏡検査を行うも確定診断に至らず、11月初旬に発熱と胸部陰影の悪化あり精査加療目的に入院。CTガイド下経皮肺生検により肺ノカルジア症と診断、治療するも永眠された。治療前の検査で血中(1→3)-β-D-グルカン(βDG)値高値を認め各種検査を行うも深在性真菌感染症を疑う所見は認められず、肺ノカルジア症により血中βDG値が上昇していた可能性が考えられた。(著者抄録)

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Publisher：(一社)日本集中治療医学会  

【目的】菌血症におけるプロカルシトニン(procalcitonin、PCT)の初期診断での有用性について、後方視的に解析した。【方法】2012年11月から2013年6月までの8ヵ月間において当院で血液培養検査が陽性となりPCTが測定されていた132例を調査対象とし、検出菌、PCTおよびC反応性蛋白(CRP)との関連性を評価した。【結果】感染症専門医により、菌血症102例、contamination(擬陽性)30例と判断された。菌血症と擬陽性でPCT(ng/ml)とCRP(mg/dl)の中央値は、それぞれ2.8と0.3、13.2と7.0であり、菌血症で有意に高かった(P<0.001、P=0.020)。ROC-AUC(receiver operating characteristic-area under the curve)(95%CI)は、PCT 0.76(0.65〜0.86)、CRP 0.64(0.52〜0.76)だった。一方、菌血症の原因菌別でグラム陽性菌(n=48)とグラム陰性菌(n=54)のPCTは、それぞれ2.1と3.7で有意差を認めなかった(P=0.123)。【結論】PCTはCRPと比較して真の菌血症と擬陽性の鑑別に役立つと評価された。しかし、菌血症におけるグラム陽性菌とグラム陰性菌を鑑別できるものではなかった。(著者抄録)

Language：Japanese   Publisher：(一社)日本集中治療医学会  

Language：Japanese   Publisher：(一社)日本集中治療医学会  

Authorship：Last author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：メディカ出版  

CiNii Books

Authorship：Last author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：南江堂  

DOI： 10.15106/j00974.2017009426

CiNii Research

Authorship：Last author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：(株)南江堂  

デバイス関連感染症は死亡率,入院期間,医療費の増加,薬剤耐性菌選択にもつながる医原性感染症である.デバイス関連感染予防のもっとも重要な点は,留置前にはデバイスの適応の有無を,留置後は抜去可能かどうかを日々検討することである.また,重要な点は,留置時の清潔操作,留置後のケアが重要であり,抗菌薬投与ではない.サーベイランスを行うことで,デバイス関連感染症の発生状況を把握することができ,対策に役立てることが可能である.(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00974&link_issn=&doc_id=20161104070007&doc_link_id=issn%3D0022-1961%26volume%3D118%26issue%3D5%26spage%3D885&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0022-1961%26volume%3D118%26issue%3D5%26spage%3D885&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Authorship：Lead author,　Last author,　Corresponding author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：(公社)愛知県医師会  

インフルエンザウイルスによって起こされる疾患である、季節性インフルエンザ、鳥インフルエンザ、新型インフルエンザに関して、それらを医学的および医療の観点からみた際の共通点と相違点について述べる。(著者抄録)

Language：Japanese   Publisher：(一社)日本集中治療医学会  

Language：Japanese   Publishing type：Research paper, summary (national, other academic conference)   Publisher：日本医療薬学会  

DOI： 10.20825/amjsphcs.25.0_362_2

CiNii Books

CiNii Research

Language：Japanese   Publishing type：Research paper, summary (national, other academic conference)   Publisher：(一社)日本感染症学会  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Publisher：(一社)日本病院薬剤師会  

ランソプラゾール口腔内崩壊錠(以下、LPZ OD錠)の経鼻胃管からの投与がチューブ閉塞に与える影響について臨床的に検討した。2008年1月〜2009年9月に、名古屋記念病院において経鼻胃管を挿入して栄養管理を施行した症例を対象に診療録から後ろ向きに調査した。LPZ OD錠投与群は39例(8Fr.27例、12Fr.12例)、非投与群は48例(8Fr.32例、12Fr.16例)で、閉塞件数は8Fr.使用患者の投与群が非投与群に比して有意に多かった(20.5%vs.8.1%、χ2検定、p<0.05)。経鼻胃管の閉塞率は、8Fr.使用患者は投与群8日目18.8%、15日目26.6%、非投与群8日目6.2%、15日目9.8%で、12Fr.使用患者は両日ともに投与群4.0%、非投与群5.3%で、8Fr.使用患者の投与群の閉塞率が有意に高かった(log-rank検定、p<0.05)。これらの検討よりLPZ OD錠の投与は細径経鼻胃管の閉塞に影響を与える可能性がある。(著者抄録)

Authorship：Last author   Language：Japanese   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：東海産科婦人科学会  

毒素性ショック症候群(TSS:toxic shock syndrome)はMRSAを含むStaphylococcus aureusなどが産生する毒素(TSST-1:toxic shock syndrome toxin-1)によりT細胞を活性化させ、炎症性サイトカインが分泌されることにより発熱・発疹・低血圧・多臓器不全などを呈し、重症例では死に至ることもある疾患である。今回我々は子宮筋腫に対する腹式単純子宮全摘術後に創感染からTSSに至ったと考えられる症例を経験したので報告する。症例は44歳2経産の有経女性、子宮筋腫による過多月経・貧血のため腹式単純子宮全摘術を施行した。術後2日目より発熱が出現、その後血圧低下・腎機能低下・落屑を伴う紅斑などを順に呈した。薬疹など鑑別に苦慮したが、CDC(Center for Disease Control and Prevention)の診断基準よりTSSの診断に至り、血液透析やバンコマイシン(VCM)などの抗菌薬投与により治療を行い軽快した。術後急速な経過で発熱・ショック・皮疹を呈する場合には、CDC(Center for Disease Control and Prevention)の診断基準に基づいて、早期よりTSSを疑い治療開始することが重要であると考えた。(著者抄録)

Language：Japanese   Publishing type：Research paper, summary (national, other academic conference)  

J-GLOBAL

Authorship：Lead author,　Last author,　Corresponding author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：株式会社医学書院  

DOI： 10.11477/mf.1402106478

CiNii Research

Authorship：Lead author,　Last author,　Corresponding author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：(株)医学書院  

Language：Japanese   Publishing type：Research paper, summary (national, other academic conference)   Publisher：一般社団法人 日本医療薬学会  

DOI： 10.20825/amjsphcs.22.0_420_1

CiNii Books

CiNii Research

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Publisher：(株)ジェフコーポレーション  

【目的】当院では入院時簡易栄養スクリーニング(Nutritional Simple Screening on Admission;以下、NSSAと略)として、(1)標準体重比80%以下(2)褥瘡(3)経腸栄養も含めて食事摂取に問題(4)外見上栄養不良の4項目のうち1項目該当すれば栄養不良のリスクありとして栄養サポートチーム(Nutrition Support Team;以下、NSTと略)が介入している。今回、NSSAの精度を主観的包括的栄養評価(Subjective Global Assessment;以下、SGAと略)と比較した。【方法】内科系病棟において2ヵ月の全入院患者245例にNSSAとSGAをそれぞれ独立して行い、身体計測・血液検査も含めてNSSAが適切に栄養不良患者を抽出しているか検討した。【結果】NSSAによるNST介入要61例は、NST介入不要184例に比較して有意にSGAによる栄養不良の重症度が高く、%三頭筋皮下脂肪厚、%上腕筋囲および血清アルブミン値は介入要群で有意に低値であった。NSSAは、SGAで判定した栄養不良症例に対して、感度87.2%、特異度86.5%と良好であった。【結語】NSSAは適切に栄養不良患者を抽出しており、簡便さの点から臨床的に有用であると思われた。(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J03242&link_issn=&doc_id=20120801120010&doc_link_id=10.11244%2Fjjspen.27.1079&url=https%3A%2F%2Fdoi.org%2F10.11244%2Fjjspen.27.1079&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Authorship：Lead author,　Last author,　Corresponding author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：(株)羊土社  

(1)診断・治療の選択が論理的になされてはじめて、適切な『経過観察』が可能になる!(2)『経過観察』は1つのプランではない!(3)チェックすべきポイントを明確にして、1つずつアセスメントを行っていこう!(4)感染症の経過は「改善」か「悪化」かのどちらかで、「横ばい」はほとんどない!(5)『経過観察』には院内感染症の発症予防も含まれる!(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2011&ichushi_jid=J03286&link_issn=&doc_id=20110622020004&doc_link_id=%2Fai4resic%2F2011%2F001305%2F005%2F0823-0830%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fai4resic%2F2011%2F001305%2F005%2F0823-0830%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Authorship：Lead author,　Last author,　Corresponding author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：(株)へるす出版  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：医歯薬出版(株)  

＜栄養ケアのポイント＞・非代償性肝硬変に合併する静脈瘤や消化性潰瘍も含めた難治性消化管出血への対応。・経口分岐鎖アミノ酸(Branched Chain Amino Acids、以下BCAA)製剤投与とLate Evening Snack(以下LES)の有用性。(著者抄録)

Authorship：Lead author,　Corresponding author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：(株)シービーアール  

Authorship：Lead author,　Last author,　Corresponding author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：株式会社医学書院  

DOI： 10.11477/mf.1402105119

CiNii Research

Authorship：Lead author,　Last author,　Corresponding author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：(株)医学書院  

＜ポイント＞★救急診療は感染症の宝庫.★感染症を診断する=感染している「微生物」と「臓器」を推定すること.★感染症診断の主役は病歴聴取・身体診察と微生物学的検査→画像検査はあくまで脇役.★事前(検査前)確率の見積もりのない画像検査は非常に危険.★感染症診断において画像検査が有用となる場合で,造影CTが最も有用であることが多い.(著者抄録)

Authorship：Last author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：(株)メディカ出版  

＜Key Point＞人工呼吸管理の目的は、できる限り早く、そして問題なく自発呼吸に戻すことであり、そのためには人工呼吸管理の開始から常にウィーニングを考え、実践していくことが重要です。実際に、人工呼吸管理に費やす時間の41%はウィーニングともいわれており、急変などのリスク管理においても最も重要な過程といえます。今回は、ウィーニングにおける「人工呼吸器からの離脱」と「気管チューブの抜管」という局面において、急変を防ぐ「気付き力」について取り上げます。これらの状況では、患者の状態は変わりやすく、少しの油断が致命的な結果を招くこともあり、呼吸ケアスタッフの慎重できめ細やかな観察と対応が必須です。(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J03901&link_issn=&doc_id=20100528240008&doc_link_id=%2Fao7kyuci%2F2010%2F000806%2F011%2F0564-0570%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fao7kyuci%2F2010%2F000806%2F011%2F0564-0570%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Authorship：Last author,　Corresponding author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：(株)新興医学出版社  

Authorship：Lead author,　Last author,　Corresponding author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：(株)南山堂  

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J00821&link_issn=&doc_id=20100413240054&doc_link_id=%2Faf5thrpc%2F2010%2F0092s1%2F054%2F1104-1108%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faf5thrpc%2F2010%2F0092s1%2F054%2F1104-1108%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif