記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Staphylococcus aureus (S. aureus) bloodstream infection (SAB) remains a major clinical challenge despite appropriate antimicrobial therapy. Recent studies have suggested the potential benefits of P2Y12 inhibitors in SAB treatment, but controversy persists regarding their optimal use. Moreover, the effects of P2Y12 inhibitors in Japanese patients remain unclear. This study aimed to evaluate the effects of using P2Y12 inhibitors before admission on outcomes in Japanese patients with SAB. METHODS: This retrospective study involved Japanese patients aged 18 years and older with S. aureus-positive blood cultures at Aichi Medical University Hospital in Japan from March 2015 to April 2023. The primary outcome was the rate of persistent bacteremia among patients with follow-up blood cultures within seven days. The secondary outcomes were 30-day and in-hospital mortality rates and bleeding events during hospitalization. RESULTS: During the study period, 238 patients with SAB (19 P2Y12 inhibitor users and 219 non-users) were enrolled. The median age was 77 years, and 38.7% of the patients were female individuals. The overall rate of methicillin-resistant S. aureus as a percentage of S. aureus was 37.9%, with no significant difference between the groups. The rate of persistent bacteremia was significantly lower in P2Y12 inhibitor users than in non-users (0% vs. 20.6%, p=0.03). The Kaplan-Meier survival curve for the 30-day and in-hospital mortality rates showed no significant difference between the groups (log-rank test, p=0.25 and p=0.20, respectively). No bleeding events occurred in either group. CONCLUSIONS: This retrospective study suggests that Japanese patients with SAB using P2Y12 inhibitors prior to admission as adjunctive therapy have a higher rate of microbiological clearance than non-users. However, further prospective studies are needed to determine the benefits of adding P2Y12 inhibitors to standard antimicrobial therapy for SAB.

DOI： 10.7759/cureus.71984

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A previous study reported that the incidence of hyponatremia after linezolid (LZD) use was higher than that with vancomycin (VCM ) use in adults. However, hyponatremia due to LZD in neonates and infants was not investigated. This study aimed to compare the incidence of hyponatremia between LZD and VCM use in neonates and infants. The retrospective study was conducted at the Aichi Medical University Hospital. All patients who were cared for in NICU or GCU and received ≥ 3 days of LZD or VCM were included in this study. Hyponatremia was defined as serum sodium level ≤ 134 mEq/L and ≥ 5% decrease from baseline after administration of LZD or VCM. A total of 76 patients (LZD, N=36; VCM, N=37) were included. There was no significant difference in the incidence of hyponatremia between the two groups (19.4% vs 16.2%, p = 0.72). The proportion of patients with a minimum value of serum sodium ≤ 134 mEq/L during treatment was 47.3% in the LZD group and 35.1% in the VCM group (p = 0.29), and the decrease in serum sodium level from baseline to the minimum value was 80.5% and 78.4%, respectively (p = 0.85). In conclusion, there was no significant difference in the incidence of hyponatremia between the LZD and VCM groups. Therefore, it is not necessary to avoid LZD use in neonates and infants because of the risk of hyponatremia.

DOI： 10.1016/j.jiac.2024.09.014

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The present study aimed to evaluate the impact of prospective audit and feedback (PAF) on the use of inpatient broad-spectrum antibiotics for more than 10 days using days of therapy (DOT) and a novel metric called days of antibiotic spectrum coverage (DASC) to assess whether the antimicrobial spectrum was narrowed. Conducted at Aichi Medical University Hospital in Japan, the study compared a six-month baseline period (April to September 2022) with a six-month intervention period (April to September 2023). The primary outcome measures were changes in DOT/patient and DASC/patient for broad-spectrum antibiotics. Propensity score matching was performed between two periods and a total of 172 patients were included in the study (pre-intervention, n = 86; intervention, n = 86). The DASC/patient of broad-spectrum antibiotics was statistically decreased in the intervention period compared to that in the baseline period (153.3 vs. 122.7, p < 0.05). Additionally, our PAF intervention led to a switch to narrow-spectrum antimicrobial therapy without increasing all-cause 30-day mortality (5.8% vs. 5.8%, p = 1.0). However, the DOT/patient, DASC/patient, and DASC/DOT of all antimicrobials were not significantly changed. Our study concluded that we should reconsider the timing of PAF intervention by evaluating the effort of PAF by using DOT and DASC.

DOI： 10.3390/antibiotics13090804

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: While respiratory syncytial virus (RSV) is one of the most common pathogens in adults admitted to the ICU due to respiratory diseases, no reports regarding the occurrence rate of RSV infections in adults in Japan during the COVID-19 pandemic exist. PATIENTS AND METHODS: We conducted this retrospective study to examine the exact occurrence rate of RSV infections in adults. We reviewed all patients (≥18 years) with any respiratory symptoms who received quantitative polymerase chain reaction (PCR) using nasopharyngeal samples for respiratory viruses by GeneLEAD at the Aichi Medical University Hospital between November 2022 and November 2023. RESULTS: A total of 541 adult patients who underwent PCR test were enrolled in this study. RSV was identified in 18 cases (3.3 %); 8 (1.5 %) upper and 10 (1.8 %) lower respiratory tract infections. Influenza A and SARS-CoV-2 were found in 10 (1.8 %) and 61 (11.3 %), respectively. Patients with RSV infections and COVID-19 had more comorbidities than those with Influenza virus infections. As for RSV-associated with lower respiratory tract infection cases, 10 developed acute respiratory failure, resulting in 1 fatal case due to pneumonia and 1 died of septic shock due to ileus. The 30-, 90-day mortality rates were 1 (6 %) and 2 (11 %) respectively. CONCLUSION: About 3 % of adults had RSV infections during the COVID-19 pandemic. The outcomes of RSV infections in adults were similar to those by COVID-19. Those with comorbidities should have a preventive method against RSV infections, the same as for COVID-19.

DOI： 10.1016/j.jiac.2024.05.004

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.heliyon.2024.e29811

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Despite advances in medical technology, lung cancer still has one of the highest mortality rates among all malignancies. Therefore, efforts must be made to understand the precise mechanisms underlying lung cancer development. In this study, we conducted lung and gut microbiome analyses and a comprehensive lipid metabolome analysis of host tissues to assess their correlation. Alternations in the lung microbiome due to lung cancer, such as a significantly decreased abundance of Firmicutes and Deferribacterota, were observed compared to a mock group. However, mice with lung cancer had significantly lower relative abundances of Actinobacteria and Proteobacteria and higher relative abundances of Cyanobacteria and Patescibacteria in the gut microbiome. The activations of retinol, fatty acid metabolism, and linoleic acid metabolism metabolic pathways in the lung and gut microbiomes was inversely correlated. Additionally, changes occurred in lipid metabolites not only in the lungs but also in the blood, small intestine, and colon. Compared to the mock group, mice with lung cancer showed that the levels of adrenic, palmitic, stearic, and oleic (a ω-9 polyunsaturated fatty acid) acids increased in the lungs. Conversely, these metabolites consistently decreased in the blood (serum) and colon. Leukotriene B4 and prostaglandin E2 exacerbate lung cancer, and were upregulated in the lungs of the mice with lung cancer. However, isohumulone, a peroxisome proliferator-activated receptor gamma activator, and resolvin (an ω-3 polyunsaturated fatty acid) both have anti-cancer effects, and were upregulated in the small intestine and colon. Our multi-omics data revealed that shifts in the microbiome and metabolome occur during the development of lung cancer and are of possible clinical importance. These results reveal one of the gut-lung axis mechanisms related to lung cancer and provide insights into potential new targets for lung cancer treatment and prophylaxis.

DOI： 10.1016/j.heliyon.2023.e23509

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Endometritis occurs frequently in humans and animals, which can negatively affect fertility and cause preterm parturition syndrome. Orally administered Clostridium butyricum, a butyrate-producing gram-positive anaerobe, exhibits anti-inflammatory effects. However, the precise mechanism by which Clostridium butyricum attenuates endometritis remains unclear. This in vivo study evaluated the anti-inflammatory effects of orally administered Clostridium butyricum on uterine tissues. In addition, we conducted uterine microbiome and lipid metabolome analyses to determine the underlying mechanisms. Female Balb/c mice were divided into the following four groups (n = 5-20): (1) mock group, (2) only operation group (mice only underwent operation to exposed uterine horns from the side), (3) control group (mice underwent the same operation with the operation group + perfusion of lipopolysaccharide solution from uterine horns), and (4) Clostridium butyricum administration group (mice underwent the same operation with the control group + oral Clostridium butyricum administration from days 0 to 9). Clostridium butyricum was administered via oral gavage. On day 10, we investigated protein expression, uterine microbiome, and lipid metabolism in uterine tissues. Consequently, orally administered Clostridium butyricum altered the uterine microbiome and induced proliferation of Lactobacillus and Limosilactobacillus species. The effects can contribute to show the anti-inflammatory effect through the interferon-β upregulation in uterine tissues. Additionally, oral Clostridium butyricum administration resulted in the upregulations of some lipid metabolites, such as ω-3 polyunsaturated fatty acid resolvin D5, in uterine tissues, and resolvin D5 showed anti-inflammatory effects. However, the orally administered Clostridium butyricum induced anti-inflammatory effect was attenuated with the deletion of G protein-coupled receptor 120 and 15-lipooxgenase inhibition. In conclusion, Clostridium butyricum in the gut has anti-inflammatory effects on uterine tissues through alterations in the uterine microbiome and lipid metabolism. This study revealed a gut-uterus axis mechanism and provided insights into the treatment and prophylaxis of endometritis.

DOI： 10.3389/fmicb.2024.1351899

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記述言語：日本語   出版者・発行元：日本嫌気性菌感染症学会  

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記述言語：日本語   出版者・発行元：日本嫌気性菌感染症学会  

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記述言語：日本語   出版者・発行元：日本嫌気性菌感染症学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Anaerobic bacteria, existing on human skin and mucous membranes, can cause severe infections with complications or mortality. We examined the clinical characteristics of patients infected with Fusobacterium spp. and assessed their antibiotic susceptibility. METHODS: Clinical data were collated from patients diagnosed with Fusobacterium infections in a Japanese university hospital between 2014 and 2023. Antibiotic susceptibility tests were conducted following the Clinical and Laboratory Standards Institute guidelines. RESULTS: We identified 299 Fusobacterium isolates. The median age was 61 years (range, 14-95 years), with females constituting 43.1% of the patients. Most infections were community-acquired (84.6%, 253/299). Multiple bacterial strains were isolated simultaneously in 74.6% of cases. One-fourth of the patients had solid organ malignancies (25.4%, 76/299), and 14.5% (11/76) of those had colorectal cancer. The 30-day mortality rate was 1.3%. Fusobacterium species were isolated from blood cultures in 6% (18/299) of the patients. Patients, aged 75 years or older, with cerebrovascular disease or hematologic malignancy exhibited significantly higher prevalence of blood culture isolates in univariate analysis. Each Fusobacterium species had its characteristic infection site. Approximately 5% F. nucleatum and F. necrophorum isolates showed penicillin G resistance. Moxifloxacin resistance was observed in varying degrees across strains, ranging from 4.6 to 100% of isolates. All isolates were sensitive to β-lactam/β-lactamase inhibitors, carbapenems, and metronidazole. CONCLUSION: We show a link between Fusobacterium species and solid organ malignancies. We observed resistance to penicillin, cefmetazole, clindamycin, and moxifloxacin, warranting caution in their clinical use. This study offers valuable insights for managing Fusobacterium infections and guiding empirical treatments.

DOI： 10.1007/s10096-023-04734-2

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担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）  

DOI： 10.2147/IDR.S442279

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記述言語：日本語   出版者・発行元：(一社)日本臨床微生物学会  

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担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）  

DOI： 10.2147/IDR.S433564

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Current models for predicting Clostridioides difficile infection (CDI) recurrence rates have a limited capacity to account for important risk factors. This study developed a clinical prediction rule for CDI recurrence. METHODS: This retrospective cohort study evaluated 209 patients with CDI at a university hospital in Japan. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify potential predictors (age, sex, underlying diseases, antibiotic use, acid suppressants, immunosuppressants, CDI history) of CDI recurrence. RESULTS: Forty-five patients developed recurrent CDI. Univariate analyses identified several significant recurrence predictors (enteral feeding, inflammatory bowel diseases [IBD], community-onset CDI, severe CDI). Enteral feeding (odds ratio [OR]: 3.87, 95% confidence interval [CI]: 1.75-8.56) and IBD (OR: 7.08, 95% CI: 1.28-39.06) were significant factors in the multivariate analysis. The CHIEF predictive scoring system was developed using five relevant variables (carbapenem use, hematologic malignancy, IBD, enteral feeding, fluoroquinolone use); the area under the ROC curve for the CHIEF score was 0.70. DISCUSSION: The CHIEF score incorporates useful, clinically available factors and could help identify patients at risk of recurrent CDI. CONCLUSIONS: These findings contribute to the understanding of risk factors associated with CDI recurrence and provide support for the development of prevention strategies.

DOI： 10.1016/j.ajic.2023.10.004

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記述言語：日本語   出版者・発行元：日本NP学会  

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

The coronavirus disease (COVID-19) pandemic continues to threaten global public health. Remdesivir and monoclonal antibodies have shown promise for COVID-19 treatment of patients who are immunocompromised, including those with cancer, transplant recipients, and those with autoimmune disorder. However, the effectiveness and safety of this combination therapy for patients who are immunosuppressed remain unclear. We compared the efficacy and safety of combination therapy and remdesivir monotherapy for patients with mild-to-moderate COVID-19 who were immunosuppressed. Eighty-six patients treated in July 2021-March 2023 were analyzed. The combination therapy group (CTG) showed a statistically significant reduction in viral load compared with the monotherapy group (MTG) (p < 0.01). Patients in the CTG also experienced earlier resolution of fever than those in the MTG (p = 0.02), although this difference was not significant in the multivariate analysis (p = 0.21). Additionally, the CTG had significantly higher discharge rates on days 7, 14, and 28 than the MTG (p < 0.01, p < 0.01, and p = 0.04, respectively). No serious adverse events were observed with combination therapy. These findings suggest that combination therapy may improve the clinical outcomes of immunosuppressed COVID-19 patients by reducing the viral load and hastening recovery. Further studies are required to fully understand the benefits of this combination therapy for immunocompromised COVID-19 patients.

DOI： 10.3390/v15091952

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記述言語：日本語   出版者・発行元：(株)南江堂  

＜文献概要＞はじめに 術後の注意すべき合併症の一つである人工関節周囲感染(periprosthetic joint infection:PJI)は,原因菌の同定率が比較的低いこと,挿入した金属には血管が通っていないため抗菌薬が届きにくいこと,金属表面にバイオフィルム(細菌塊)を形成して細菌が再増殖を起こすことから,治療に難渋し,人工関節抜去や入れ替えが必要となることも多い.本稿ではPJIの危険因子や原因微生物に加え,診断と治療,感染対策(主に周術期抗菌薬)について解説する.

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00764&link_issn=&doc_id=20230829300022&doc_link_id=issn%3D0030-5901%26volume%3D74%26issue%3D10%26spage%3D1103&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0030-5901%26volume%3D74%26issue%3D10%26spage%3D1103&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Clostridioides difficile infection (CDI) has significant implications for healthcare economics. Although clinical trials have compared fidaxomicin (FDX) and vancomycin, comparisons of FDX and oral metronidazole (MNZ) are limited. Therefore, we compared the therapeutic effects of FDX and oral MNZ. Patients diagnosed with CDI between January 2015 and March 2023 were enrolled. Those treated with oral MNZ or FDX were selected and retrospectively analyzed. The primary outcome was the global cure rate. Secondary outcomes included factors contributing to the CDI global cure rate; the rate of medication change owing to initial treatment failure; and incidence rates of clinical cure, recurrence, and all-cause mortality within 30 days. Of the 264 enrolled patients, 75 and 30 received initial oral MNZ and FDX treatments, respectively. The corresponding CDI global cure rates were 53.3% and 70% (p = 0.12). In multivariate analysis, FDX was not associated with the global cure rate. In the MNZ group, 18.7% of the patients had to change medications owing to initial treatment failure. The FDX group had a higher clinical cure rate and lower recurrence rate than the MNZ group, although not significant. However, caution is necessary owing to necessary treatment changes due to MNZ failure.

DOI： 10.3390/antibiotics12081323

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Accurate diagnosis of prosthetic joint infection (PJI) enables early and effective treatment. However, there is currently no gold standard test for microbial detection of PJI and traditional synovial fluid culture is relatively insensitive. Recently, it has been reported that sonicating fluid culture and next-generation sequencing (NGS) improve microbial detection rates. Hence, we performed a systematic review and meta-analysis to compare microbial detection rates in microbial culture methods with and without sonication versus NGS. METHODS: We systematically searched EMBASE, PubMed, Scopus, CINAHL, and Ichushi databases and other sources (previous reviews) until August 2022. We evaluated the detection rates of pathogens in NGS and microbial cultures using samples of synovial or sonicated fluid. RESULTS: Of the 170 citations identified for screening, nine studies were included. Pooled analysis indicated that NGS had the highest detection rate among the microbial detection methods (NGS vs. sonicated, odds ratios [OR] 5.09, 95% confidential interval [CI] 1.67-15.50; NGS vs. synovial, OR 4.52, 95% CI 2.86-7.16). Sonicated fluid culture showed a higher detection rate than synovial fluid culture (OR 2.11, 95% CI 1.23-3.62). CONCLUSION: NGS might be useful as a screening tool for culture-negative patients. In clinical settings, sonicated fluid culture is a practical method for diagnosing PJI.

DOI： 10.1186/s13018-023-03973-5

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記述言語：日本語   出版者・発行元：(株)総合医学社  

症例は8歳男児で,呼吸困難のために入院した。来院時に著明な努力呼吸と陥没呼吸を認めたが,嗄声や犬吠様咳嗽は確認できなかった。聴診では呼気時と吸気時に喘鳴を認めたが,心音は整で心雑音は認めなかった。静脈血液ガス分析では,pH7.132,PaCO2 65.5mmHg,HCO3-21.2mmol/Lと呼吸性アシドーシスを認めた。鼻咽頭ぬぐい液のSARS-CoV-2 PCRは陽性だった。頸部単純CTで上部気管の狭窄を,胸部単純CTで両肺野に浸潤影とすりガラス影を認め,喉頭気管炎による陰圧性肺水腫を疑った。気管挿管して人工呼吸を開始した後に呼吸状態は速やかに改善し,34時間後には肺野の浸潤影とすりガラス影は改善した。入院4日目に抜管し,後障害なく退院した。COVID-19は喉頭気管炎を合併することがあり,陰圧性肺水腫を呈することがあることに注意を要する。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00643&link_issn=&doc_id=20230823330010&doc_link_id=%2Fag1snrsd%2F2023%2F007604%2F003%2F0525-0528%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fag1snrsd%2F2023%2F007604%2F003%2F0525-0528%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：日本臨床腸内微生物学会  

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記述言語：日本語   出版者・発行元：(株)総合医学社  

症例は8歳男児で,呼吸困難のために入院した。来院時に著明な努力呼吸と陥没呼吸を認めたが,嗄声や犬吠様咳嗽は確認できなかった。聴診では呼気時と吸気時に喘鳴を認めたが,心音は整で心雑音は認めなかった。静脈血液ガス分析では,pH7.132,PaCO2 65.5mmHg,HCO3-21.2mmol/Lと呼吸性アシドーシスを認めた。鼻咽頭ぬぐい液のSARS-CoV-2 PCRは陽性だった。頸部単純CTで上部気管の狭窄を,胸部単純CTで両肺野に浸潤影とすりガラス影を認め,喉頭気管炎による陰圧性肺水腫を疑った。気管挿管して人工呼吸を開始した後に呼吸状態は速やかに改善し,34時間後には肺野の浸潤影とすりガラス影は改善した。入院4日目に抜管し,後障害なく退院した。COVID-19は喉頭気管炎を合併することがあり,陰圧性肺水腫を呈することがあることに注意を要する。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background Clostridioides difficile infection (CDI) recurrence is a public health concern as well as a health economic burden. Bezlotoxumab treatment is one way to prevent recurrence; however, its clinical results have not been reported in Japan. Therefore, we investigated the efficacy and safety of bezlotoxumab in patients with CDI at a university hospital in Japan and compared them with previously reported findings. Methodology We retrospectively examined all patients with some risk factors for recurrent CDI who received bezlotoxumab at the discretion of physicians at the Aichi Medical University Hospital, Aichi, Japan, between July 2018 and July 2022. The primary outcome was the three-month CDI recurrence rate. The secondary outcomes were an initial clinical cure and the six-month CDI recurrence rate. The safety of the administration was also assessed. Results A total of nine patients who received bezlotoxumab were included during the study period. The rate of CDI recurrence within three months was 28.5% (2/9). Two patients died due to other causes before their diarrhea improved. None of the patients experienced CDI recurrence between three and six months after the initial clinical cure of the baseline episode. Patients showed good tolerability to bezlotoxumab with no adverse effects. Two patients with a single episode of CDI recurrence before bezlotoxumab administration showed no recurrence. Conclusions In this Japanese case-series study, the efficacy of bezlotoxumab in preventing CDI recurrence in elderly patients with CDI and multiple underlying diseases was inferior to that reported in previous studies that analyzed real-world data. It is possible that bezlotoxumab may not be fully effective in elderly patients with CDI.

DOI： 10.7759/cureus.42779

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

As bone and joint infections (BJIs) require long-term treatment, identifying their causative pathogens is vital. However, the detection rate of conventional culturing remains inadequate. This study aimed to evaluate the usefulness of the FilmArray blood culture identification (BCID) panel for identifying causative pathogens in patients with BJIs. We tested a BCID panel using collected samples, in addition to conventional cultures. The primary outcome was to evaluate the diagnostic performance of the BCID panel, calculated using conventional culturing methods. A total of 44 patients who underwent BJI-related specimen collection were enrolled. Of the 44 patients, 22 were diagnosed with a BJI. Conventional culture identified 15 of 22 organisms (68.2%), whereas the BCID panel identified 14 of 22 organisms (63.4%). The overall sensitivity and specificity of the BCID panel were 73.3% and 57.1%, respectively, compared to those of the conventional culture. However, the sensitivity reached 100% when only pathogens included in the BCID panel were considered. In seven culture-negative cases, the BCID panel identified three organisms (42.9%). The BCID panel also indicated the appropriate therapy against a BJI caused by methicillin-resistant Staphylococcus aureus by detecting the mecA gene. This study demonstrated that the BCID panel has the potential for early and accurate diagnosis of the causative organism of BJI using specimens such as joint fluid and bone tissue. Our results suggest that BCID panels, in addition to routine culture, may improve our ability to diagnose the causative microorganisms of BJI in clinical practice, thereby contributing to the selection of appropriate antimicrobial agents.

DOI： 10.1016/j.jiac.2023.04.011

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Isavuconazole is a novel triazole antifungal agent. However, the previous outcomes were highlighted by statistical heterogeneity. This meta-analysis aimed to validate the efficacy and safety of isavuconazole for the treatment and prophylaxis of invasive fungal infections (IFIs) compared with other antifungal agents (amphotericin B, voriconazole and posaconazole). METHODS: Scopus, EMBASE, PubMed, CINAHL and Ichushi databases were searched for relevant articles that met the inclusion criteria through February 2023. Mortality, IFI rate, discontinuation rate of antifungal therapy and incidence of abnormal hepatic function were evaluated. The discontinuation rate was defined as the percentage of therapy discontinuations due to adverse events. The control group included patients who received other antifungal agents. RESULTS: Of the 1784 citations identified for screening, 10 studies with an overall total of 3037 patients enrolled. Isavuconazole was comparable with the control group in mortality and IFI rate in the treatment and prophylaxis of IFIs, respectively (mortality, odds rate (OR) 1.11, 95% confidential interval (CI) 0.82-1.51; IFI rate, OR 1.02, 95% CI 0.49-2.12). Isavuconazole significantly reduced the discontinuation rate in the treatment (OR 1.96, 95% CI 1.26-3.07) and incidence of hepatic function abnormalities in the treatment and prophylaxis, compared with the control group (treatment, OR 2.31, 95% CI 1.41-3.78; prophylaxis, OR 3.63, 95% CI 1.31-10.05). CONCLUSIONS: Our meta-analysis revealed that isavuconazole was not inferior to other antifungal agents for the treatment and prophylaxis of IFIs, with substantially fewer drug-associated adverse events and discontinuations. Our findings support the use of isavuconazole as the primary treatment and prophylaxis for IFIs.

DOI： 10.1111/myc.13622

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Proteus spp. are widespread in the environment and comprise a part of the normal flora of the human gastrointestinal tract. Only six species in this genus, including Proteus mirabilis, Proteus vulgaris, Proteus terrae, Proteus penneri, Proteus hauseri, and Proteus faecis, have been isolated from human clinical specimens. However, there are no reports of Proteus alimentorum isolated from humans, and the clinical characteristics of P. alimentorum infection are unknown. CASE PRESENTATION: An 85-year-old female patient with peritoneal cancer was hospitalized for complicated pyelonephritis and bacteremia caused by P. alimentorum. The patient received antimicrobial therapy and was discharged on day 7 of hospitalization. No recurrence was observed 14 days after the treatment. Various methods were used to identify the Proteus sp. Furthermore, the VITEK-2 GN ID card resulted in low discrimination between P. hauseri and P. penneri. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry showed P. hauseri with a spectral score of 2.22 as the best match. Nevertheless, the pathogen was identified as P. alimentorum based on genetic investigation using 16 S rRNA gene sequencing and biochemical tests. CONCLUSION: Proteus alimentorum is a human pathogen, and its infection has an excellent therapeutic response to antimicrobials based on antimicrobial susceptibility. Genomic methods may be helpful for the precise identification of P. alimentorum.

DOI： 10.1186/s12879-023-08296-8

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.ejim.2023.04.027

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Recombinant human soluble thrombomodulin (rhTM) is used to treat sepsis-induced disseminated intravascular coagulation (DIC). However, no consistent clinical guidelines exist regarding the administration of rhTM in patients with sepsis-induced DIC. Therefore, we conducted this meta-analysis to evaluate the efficacy and safety of rhTM therapy in patients with sepsis-induced DIC. METHODS: EMBASE, PubMed, Scopus, Ichushi, and CINAHL databases were used to search for relevant articles that met the inclusion criteria of patients with sepsis-induced DIC treated with and without rhTM through November 2022. Mortality, DIC resolution, and incidence of bleeding complications were evaluated. DIC resolution was defined as the recovery from DIC after the start of DIC treatment. RESULTS: Of the 1697 citations identified for screening, 17 studies involving 2296 patients were included. Administering rhTM significantly reduced mortality (odds ratio (OR) 0.54, 95 % confidence interval (CI) 0.42-0.71) and improved DIC resolution (OR 2.88, 95 % CI 1.83-4.52). There were no significant differences in the incidence of bleeding complications between the rhTM and control groups (OR 0.92, 95 % CI 0.66-1.28). CONCLUSIONS: Our meta-analysis revealed that rhTM could reduce mortality and improve DIC resolution without increasing the risk of bleeding in patients with sepsis-induced DIC. Our findings suggest that rhTM is a relatively effective and safe anticoagulant for the treatment of sepsis-induced DIC. SUMMARY: Recombinant human soluble thrombomodulin reduced mortality without increasing the bleeding risk in the treatment of sepsis-induced disseminated intravascular coagulation.

DOI： 10.1016/j.thromres.2023.05.009

PubMed

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担当区分：筆頭著者,　責任著者   記述言語：英語  

Necrotizing pneumonia (NP) can occur as a secondary infection even if the clinical course of COVID-19 pneumonia is favorable, particularly in patients on mechanical ventilation and under immunosuppression.

DOI： 10.1002/ccr3.7164

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/cid/ciad153

PubMed

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担当区分：筆頭著者,　責任著者   記述言語：英語  

Currently, atovaquone is not recommended for treating severe Pneumocystis jirovecii pneumonia (PCP) due to insufficient evidence in clinical studies. This report describes a case of severe PCP in a human immunodeficiency virus (HIV)-negative immunosuppressed patient who was successfully treated with oral atovaquone and corticosteroids. A 63-year-old Japanese woman complained of fever and dyspnea for 3 days. She had been treated with oral prednisolone (30 mg/day) for interstitial pneumonia for 3 months without PCP prophylaxis. Although we could not confirm P. jirovecii from the respiratory specimen, a diagnosis of PCP was indicated by marked elevation of serum beta-D-glucan levels and bilateral ground-glass opacities in the lung fields. Based on the arterial blood gas test results (alveolar-arterial oxygen difference >45 mmHg), the disease status of PCP was defined as severe. Trimethoprim-sulfamethoxazole (SXT) is the first-line drug for treating severe PCP. However, given the patient's history of SXT-induced toxic epidermal necrolysis, she was administered atovaquone instead of SXT. Her clinical symptoms and respiratory condition gradually improved, with a 3-week treatment showing a good clinical course. Previous clinical studies on atovaquone have only been conducted in HIV-positive patients with mild or moderate PCP. Accordingly, the clinical efficacy of atovaquone for severe PCP cases or PCP in HIV-negative patients remains unclear. There is a rising incidence of PCP among HIV-negative patients, given the increasing number of patients receiving immunosuppressive medications; moreover, atovaquone has less severe side effects than SXT. Therefore, there is a need for further clinical investigation to confirm the efficacy of atovaquone in cases of severe PCP, especially among HIV-negative patients. In addition, it also remains unclear whether corticosteroids are beneficial for severe PCP in non-HIV patients. Thus, the use of corticosteroids in cases of severe PCP in non-HIV patients should also be investigated.

DOI： 10.2147/IDR.S406904

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

【序文】Verigene BC-GN(VBG)の性能評価,抗菌薬選択への影響を評価した。【方法】グラム陰性桿菌血液培養検体で,従来法とVBG細菌核酸同定の一致率,VBG薬剤耐性遺伝子の感度/特異度を評価した。また,(1)耐性遺伝子検出群,(2)カルバペネム投与群,(3)結果不一致群の3群で抗菌薬投与推移を評価した。【結果】対象81検体において,細菌核酸同定の一致率/薬剤耐性遺伝子の感度/特異度(%)は97.7/72.7/98.6であった。(1):経過良好1例を除きVBG後に標的治療化された。(2)耐性遺伝子未検出時のde-escalation率は37.5%であった。(3):VBG検出対象外の獲得耐性菌が3例あり2例で無効抗菌薬に変更されていた。【結論】VBGは薬剤耐性遺伝子検出時に早期標的治療化に貢献していたが,同遺伝子未検出時の抗菌薬変更は慎重に行う必要があり,de-escalationへの効果は低かった。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J04188&link_issn=&doc_id=20230414600006&doc_link_id=10.24679%2Fgekakansen.20.1_34&url=https%3A%2F%2Fdoi.org%2F10.24679%2Fgekakansen.20.1_34&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

【序文】Verigene BC-GN(VBG)の性能評価,抗菌薬選択への影響を評価した。【方法】グラム陰性桿菌血液培養検体で,従来法とVBG細菌核酸同定の一致率,VBG薬剤耐性遺伝子の感度/特異度を評価した。また,(1)耐性遺伝子検出群,(2)カルバペネム投与群,(3)結果不一致群の3群で抗菌薬投与推移を評価した。【結果】対象81検体において,細菌核酸同定の一致率/薬剤耐性遺伝子の感度/特異度(%)は97.7/72.7/98.6であった。(1):経過良好1例を除きVBG後に標的治療化された。(2)耐性遺伝子未検出時のde-escalation率は37.5%であった。(3):VBG検出対象外の獲得耐性菌が3例あり2例で無効抗菌薬に変更されていた。【結論】VBGは薬剤耐性遺伝子検出時に早期標的治療化に貢献していたが,同遺伝子未検出時の抗菌薬変更は慎重に行う必要があり,de-escalationへの効果は低かった。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J04188&link_issn=&doc_id=20230414600006&doc_link_id=10.24679%2Fgekakansen.20.1_34&url=https%3A%2F%2Fdoi.org%2F10.24679%2Fgekakansen.20.1_34&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：日本感染症学会・日本化学療法学会  

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記述言語：日本語   出版者・発行元：日本感染症学会・日本化学療法学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Introduction: A randomized control trial (RCT) is considered to be the highest level in the Evidence-Based Medicine (EBM) pyramid. While EBM is essential to make a practical tool such as a prognostic guideline, it has been unclear how many patients in the real world can be eligible for a randomized control trial (RCT). Patients and method: This study was performed to clarify if there is a difference in patients' profiles and clinical outcomes between the patients eligible and not eligible for any RCT. We reviewed all IE patients at our institute between 2007 and 2019. The patients were divided into two groups: those eligible for RCTs (RCT appropriate group) and those who were not (RCT inappropriate group). Exclusion criteria for clinical trials were set based on previous clinical trials. Results: A total of 66 patients were enrolled in the study. The median age was 70 years (range 18 to 87 years), and 46 (70%) were male. Seventeen (26%) of the patients were eligible for RCTs. Comparing the two groups, patients in the RCT appropriate group were younger and had fewer comorbidities. The disease severity was milder in the RCT appropriate groups than in the RCT inappropriate groups. Patients in the RCT appropriate group showed significantly longer overall survival times than those in the RCT inappropriate group (Log-Rank test, p < 0.001). Conclusions: We found a significant gap in patients' characteristics and clinical outcomes between the groups. Physicians should be aware that RCT can never reflect the real-world population.

DOI： 10.3390/jcm12041566

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Linezolid (LZD) and Tedizolid (TZD) are oxazolidinone antibiotic for meticillin-resistant Staphylococcus aureus (MRSA). Severe hyponatremia after LZD administration have been reported. Severe hyponatremia cause seizures, unconsciousness, and even death. Therefore, we conducted a study to assess the change of serum sodium level after LZD and TZD therapy. We enrolled 67 patients treated with LZD and 28 treated with TZD. We monitored the serum sodium level from the administration to 14 days after administration of oxazolidinone drug. Hyponatremia was defined a sodiuln level ≤134 mmol/L after the initiation of oxazolidinone drug. The frequency of hyponatremia in the LZD group was significantly higher than that in the TZD group (39.7% vs. 11.1%, p < 0.05). The rate of patients administered by injection was significantly higher than in the LZD group than in the TZD group (52.9% vs. 14.8%, p < 0.01). Multiple logistic regression analyses identified the albumin level before the oxazolidinone drug therapy as the independent variables associated with the development of hyponatremia. We revealed that TZD is safer than LZD in terms of hyponatremia. Therefore, cases that LZD is administered by injection should be used more carefully with hyponatremia in patients with low albumin level.

DOI： 10.3390/antibiotics12020345

PubMed

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記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

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記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

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記述言語：日本語   出版者・発行元：日本嫌気性菌感染症学会  

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記述言語：日本語   出版者・発行元：日本嫌気性菌感染症学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The human body is host to a large number of commensal microbial species such as bacteria, fungi, and viruses. Among these, the human mycobiome is often neglected as a potential cause of disease, as it is thought to be comparatively much less abundant and less diverse than the human bacteriome. Additionally, most fungi are not easily cultured, even in specific media. Hence, their study has been limited to date, mainly because of the unavailability of methods used for their detection. However, the utilization of a novel metagenomic methodology will enable the identification of well-characterized mycobiomes in several parts of the human body and broaden our knowledge of their contribution to human health and disease. In this article, we review the role of the human mycobiome in the gut, respiratory organs, skin, genital tract, and carcinogenesis, highlighting the correlations between the human mycobiome and mycobiome-associated diseases.

DOI： 10.3314/mmj.23-002

PubMed

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記述言語：英語  

Kalamiella piersonii is rare pathogen, and its pathogenicity to humans has been unknown. We describe an infant with bacteremia caused by Kalamiella piersonii. The patient was a 2-month-old girl presented with diarrhea, poor oral intake, and vomiting. The patient was tentatively diagnosed with acute enterocolitis. After admission, the patient developed a fever and blood culture yielded Gram-negative cocci, first determined to be Pantoea septica by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. However, genetic analysis of 16S rRNA allowed its identification as Kalamiella piersonii (GenBank accession number is OQ547240). Other housekeeping genes such as gyrB, rpoB, and atpD also identified the isolated strain as Kalamiella piersonii. The patient was successfully treated with cefotaxime without sequelae. Later, the patient was diagnosed as non-IgE-mediated gastrointestinal food allergy. Our experience indicated that Kalamiella piersonii is a potential human pathogen that can cause invasive infections even in infants and children. Identification of Kalamiella piersonii is difficult with routine conventional tests, and detailed studies including genetic analyses are necessary to clarify the pathogenicity of Kalamiella piersonii in humans.

DOI： 10.2147/IDR.S402364

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.idcr.2023.e01696

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The precise mechanism by which butyrate-producing bacteria in the gut contribute to resistance to respiratory viral infections remains to be elucidated. Here, we describe a gut-lung axis mechanism and report that orally administered Clostridium butyricum (CB) enhances influenza virus infection resistance through upregulation of interferon (IFN)-λ in lung epithelial cells. Gut microbiome-induced ω-3 fatty acid 18-hydroxy eicosapentaenoic acid (18-HEPE) promotes IFN-λ production through the G protein-coupled receptor (GPR)120 and IFN regulatory factor (IRF)-1/-7 activations. CB promotes 18-HEPE production in the gut and enhances ω-3 fatty acid sensitivity in the lungs by promoting GPR120 expression. This study finds a gut-lung axis mechanism and provides insights into the treatments and prophylaxis for viral respiratory infections.

DOI： 10.1016/j.celrep.2022.111755

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2169/internalmedicine.9484-22

PubMed

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記述言語：日本語   出版者・発行元：日本嫌気性菌感染症学会  

Clostridioides difficile感染症(CDI)は,日本では,その発症率の高さに相反し,CDIに対する認識度・理解度は依然として低く,医療関連感染対策は欧米に比較し後れを取っていることは否めない.CDIは,患者の動線を中心とした高頻度接触部位(ベッド,手すりなど)がC.difficileの汚染源となり,環境や人を介して伝播し,宿主側因子(抗菌薬投与等による消化管微生物叢の撹乱,加齢や基礎疾患など)と相まって発症する.用手法的な環境消毒では,拭き残し等により感染リスクが残存してしまう危険性が挙げられる.本研究では,加湿器を用い病室内全域に次亜塩素酸水を噴霧することで,C.difficile芽胞に対する殺芽胞効果が得られるか否かを検討した.C.difficile芽胞をプラスチックシャーレ上へ固着させた検体を,モデル病室内の各箇所へ設置し,次亜塩素酸水噴霧による殺芽胞効果を評価した.40ppmおよび300ppm濃度では,8時間噴霧において明確な殺芽胞効果は確認されなかった.一方で,1,000ppm濃度では,8時間噴霧において,25℃および37℃条件下で形成させたC.difficileに対し,各々2.32～2.61および1.10～1.65の対数減少を示した.この結果から,次亜塩素酸水噴霧が,用手法的な環境消毒法に代わる有効な消毒手段となる可能性が示唆された.(著者抄録)

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記述言語：日本語   出版者・発行元：日本嫌気性菌感染症学会  

【緒言】過酸化水素ドライミストは環境消毒に用いられている.院内感染で問題となっている細菌による環境汚染に対する過酸化水素ドライミストの有用性について実験的な検討を行った.【対象と方法】Clostridioides difficileの芽胞液を塗布・乾燥させたスライドグラス,カルバペネム耐性腸内細菌目細菌(Providencia rettgeri)と多剤耐性アシネトバクターの菌液それぞれ各50μLを代替キャリアとしてモデル病室内の複数箇所に設置し,過酸化水素ドライミストを15分間噴霧後,90分間エアレーションを行った.その後,代替キャリアから回収した菌体を培養し,生菌の有無を確認した.【結果】過酸化水素ドライミスト使用後は,検討した全ての設置箇所で何れの被検菌の発育も認められなかった.床頭台の引き出し内部のような場所であってもミストが侵入し,殺菌されていた.【結論】患者環境は患者由来の微生物で汚染されているが,手の行き届かない細部については十分に清掃ができず,微生物が残存している可能性がある.過酸化水素ドライミストは,狭い隙間にも侵入することができるため,清掃が困難な箇所の消毒をすることが可能であった.特に多剤耐性菌や芽胞菌検出患者退院後の退院時清掃に過酸化水素ドライミストによる環境消毒を追加することは最終清掃に有効であると考えられた.(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

While acute empyema is a critical infectious disease showing a high mortality rate, there are no prognostic tools to evaluate the disease severity and prognosis for patients. We conducted a retrospective cohort to determine whether quick Sequential Organ Failure Assessment (qSOFA) and SOFA score can predict the disease severity and prognosis of acute empyema. A total of 53 patients were enrolled in the study. The mean age was 69 years and 41 patients (77%) were male. Twenty-two patients (42%) had multiple underlying diseases with the Charlson comorbidity index ≥3. The-30 days, and in-hospital deaths were 7 (13%) and 10 (19%), respectively. The area under the ROC curve of SOFA score and CCI for 30-day and in-hospital deaths were 0.814 (p = 0.073) and 0.752 (p = 0.082), 0.848 (p = 0.07) and 0.762 (p = 0.011), respectively. Univariate analysis showed that qSOFA ≥2 and SOFA score ≥2, isolation of potentially drug-resistant (PDR) pathogen, high CCI (≥3), performance status of 2-4, surgical intervention, and anaerobic bacteria involvement were prognostic factors. Of these, multivariate logistic regression analysis showed that qSOFA ≥2 and SOFA score ≥2 (p = 0.011), isolation of PDR pathogen (p = 0.005), and high CCI (≥3) (p = 0.015) were independently poor prognostic factors. We concluded that qSOFA and SOFA scores could predict the disease severity and prognosis in acute empyema. Additionally, isolation of PDR pathogens and high CCI could be poor prognostic factors for patients.

DOI： 10.1016/j.jiac.2022.08.001

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記述言語：日本語   出版者・発行元：日本嫌気性菌感染症学会  

Clostridioides difficile感染症(CDI)は,日本では,その発症率の高さに相反し,CDIに対する認識度・理解度は依然として低く,医療関連感染対策は欧米に比較し後れを取っていることは否めない.CDIは,患者の動線を中心とした高頻度接触部位(ベッド,手すりなど)がC.difficileの汚染源となり,環境や人を介して伝播し,宿主側因子(抗菌薬投与等による消化管微生物叢の撹乱,加齢や基礎疾患など)と相まって発症する.用手法的な環境消毒では,拭き残し等により感染リスクが残存してしまう危険性が挙げられる.本研究では,加湿器を用い病室内全域に次亜塩素酸水を噴霧することで,C.difficile芽胞に対する殺芽胞効果が得られるか否かを検討した.C.difficile芽胞をプラスチックシャーレ上へ固着させた検体を,モデル病室内の各箇所へ設置し,次亜塩素酸水噴霧による殺芽胞効果を評価した.40ppmおよび300ppm濃度では,8時間噴霧において明確な殺芽胞効果は確認されなかった.一方で,1,000ppm濃度では,8時間噴霧において,25℃および37℃条件下で形成させたC.difficileに対し,各々2.32～2.61および1.10～1.65の対数減少を示した.この結果から,次亜塩素酸水噴霧が,用手法的な環境消毒法に代わる有効な消毒手段となる可能性が示唆された.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J06611&link_issn=&doc_id=20230221400003&doc_link_id=%2Ffc2kenki%2F2022%2F005202%2F003%2F0078-0089%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffc2kenki%2F2022%2F005202%2F003%2F0078-0089%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：日本嫌気性菌感染症学会  

【緒言】過酸化水素ドライミストは環境消毒に用いられている.院内感染で問題となっている細菌による環境汚染に対する過酸化水素ドライミストの有用性について実験的な検討を行った.【対象と方法】Clostridioides difficileの芽胞液を塗布・乾燥させたスライドグラス,カルバペネム耐性腸内細菌目細菌(Providencia rettgeri)と多剤耐性アシネトバクターの菌液それぞれ各50μLを代替キャリアとしてモデル病室内の複数箇所に設置し,過酸化水素ドライミストを15分間噴霧後,90分間エアレーションを行った.その後,代替キャリアから回収した菌体を培養し,生菌の有無を確認した.【結果】過酸化水素ドライミスト使用後は,検討した全ての設置箇所で何れの被検菌の発育も認められなかった.床頭台の引き出し内部のような場所であってもミストが侵入し,殺菌されていた.【結論】患者環境は患者由来の微生物で汚染されているが,手の行き届かない細部については十分に清掃ができず,微生物が残存している可能性がある.過酸化水素ドライミストは,狭い隙間にも侵入することができるため,清掃が困難な箇所の消毒をすることが可能であった.特に多剤耐性菌や芽胞菌検出患者退院後の退院時清掃に過酸化水素ドライミストによる環境消毒を追加することは最終清掃に有効であると考えられた.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J06611&link_issn=&doc_id=20230221400004&doc_link_id=%2Ffc2kenki%2F2022%2F005202%2F004%2F0090-0099%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffc2kenki%2F2022%2F005202%2F004%2F0090-0099%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本臨床微生物学会  

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Cefazolin (CFZ) is the first-line treatment for beta-lactamase-producing methicillin-sensitive Staphylococcus aureus (BP-MSSA) infection. In 2019, Japan experienced a CFZ shortage because of foreign object inclusion in a batch. Ampicillin/sulbactam (SAM) was preferred in many cases as definitive therapy for the treatment of BP-MSSA bacteremia to preserve broad-spectrum antibiotic stock. However, there are no previous studies reporting the clinical efficacy of SAM for BP-MSSA bacteremia. We aimed to compare the clinical efficacy and adverse effects of SAM versus CFZ in patients with BP-MSSA bacteremia. In total, 41 and 30 patients treated with SAM and CFZ, respectively, were identified. The baseline characteristics were similar in both groups. No significant differences were observed in length of hospital stay and all 30-day mortality between the two groups (p = 0.270 and 0.643, respectively). Moreover, no intergroup difference in 90-day mortality was found (hazard ratio 1.02, 95% confidential interval 0.227-4.53). Adverse effects, such as liver dysfunction, were less in the CFZ group than in the SAM group (p = 0.030). Therefore, in cases of poor CFZ supply or in patients allergic to CFZ and penicillinase-stable penicillins, SAM can be an effective therapeutic option for bacteremia due to BP-MSSA with attention of adverse effects, such as liver dysfunction.

DOI： 10.3390/antibiotics11111505

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(株)総合医学社  

【緒言】髄液漏を伴う頭蓋底骨折は細菌性髄膜炎のリスクがあり,迅速な起炎菌の同定が必要である。我々は全自動多項目遺伝子検査によって頭部外傷後の肺炎球菌性髄膜炎を迅速に診断した症例を経験したので報告する。【症例】症例は交通外傷による頭蓋底骨折および髄液鼻漏で入院した6歳男児である。13価の肺炎球菌ワクチンは接種済みであった。アンピシリン/スルバクタムを予防的に投与したが,入院8日目に意識障害が出現した。髄液検査結果から細菌性髄膜炎と診断し,2時間後に全自動多項目遺伝子検査によって肺炎球菌が検出された。院内アンチバイオグラムに基づいてセフトリアキソンとバンコマイシンに変更した。髄液培養から20時間後に肺炎球菌が検出された。入院10日目に意識障害は改善した。入院22日目に抗菌薬を中止し,神経学的後障害はなく退院した。【考察】全自動多項目遺伝子検査は,迅速な起炎菌の同定と治療方針の決定に有用であった。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00643&link_issn=&doc_id=20221024480012&doc_link_id=%2Fag1snrsd%2F2022%2F007505%2F005%2F0807-0810%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fag1snrsd%2F2022%2F007505%2F005%2F0807-0810%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Current guidelines recommend the use of ceftriaxone and sulbactam-ampicillin for the initial treatment of community-acquired pneumonia (CAP). However, there are no clear data on these guidelines. Therefore, this systematic review and meta-analysis aims to evaluate the effectiveness of ceftriaxone and sulbactam-ampicillin in the initial treatment of CAP. The Embase, Scopus, PubMed, Ichushi, and Cumulative Index to Nursing and Allied Health Literature databases were systematically searched from inception to July 2022. The studies included patients who received ceftriaxone or sulbactam-ampicillin as the initial antibiotic therapy for CAP. The mortality and clinical cure rates were evaluated. Of the 2152 citations identified for screening, four studies were included. Results of the pooled analysis indicated no significant differences in the mortality and clinical cure rates between patients treated with ceftriaxone and those treated with sulbactam-ampicillin (mortality, odds ratio [OR]: 1.85, 95% confidence interval [CI]: 0.57-5.96; clinical cure rate, OR: 1.08, 95% CI: 0.18-6.44). This study supports the guidelines for CAP treatment, though further studies are needed to obtain a deeper understanding.

DOI： 10.3390/antibiotics11101291

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Although combination therapy using trimethoprim-sulfamethoxazole (TMP-SMX) plus echinocandins has been reported to reduce the mortality of patients with pneumocystis pneumonia (PCP), it remains unclear whether it is more effective than TMP-SMX monotherapy, the current first-line treatment for this disease. Hence, we performed a systematic review and meta-analysis to compare the efficacies of these treatment options for PCP. The Scopus, EMBASE, PubMed, CINAHL, and Ichushi databases were searched for studies (up to January 2022) reporting the mortality and positive response rates (fewer clinical symptoms, improved partial pressure of arterial oxygen, and resolution of pneumonitis on chest imaging) of PCP patients receiving monotherapy or combination therapy. Four studies met the inclusion criteria. All four presented mortality data and one had positive response rates. Compared with the monotherapy, the combination therapy resulted in significantly lower mortality and higher positive response rates (mortality: odds ratio (OR) 2.20, 95% confidence interval (CI) 1.46-3.31; positive response rate: OR 2.13, 95%CI 1.41-3.23), suggesting it to be an effective and promising first-line therapy for PCP. However, further safety evaluations are needed to establish this as a fact.

DOI： 10.3390/antibiotics11060719

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Vancomycin or daptomycin is administered to hemodialysis patients infected with methicillin-resistant Staphylococcus and Enterococcus species. Although serious concerns regarding nephrotoxicity due to vancomycin have been raised, it might not be a critical issue in hemodialysis patients. Moreover, very few studies have investigated the effectiveness of vancomycin versus daptomycin in patients undergoing hemodialysis. Hence, we retrospectively evaluated the effectiveness and safety of vancomycin and daptomycin in patients undergoing hemodialysis. We investigated the following measures: mortality, clinical and microbiological effectiveness, and incidence of adverse events in hemodialysis patients who received vancomycin or daptomycin from 2014 to 2019. Moreover, we evaluated the covariates related to 30-day mortality. We found that 73 patients received vancomycin, while 34 received daptomycin for the treatment of infections due to methicillin-resistant Staphylococcus aureus, methicillin-resistant coagulase-negative Staphylococci, and Enterococcus faecium. Mortality after vancomycin treatment was significantly lower than daptomycin treatment (4.1% vs. 26.5%, p &lt; 0.01). The clinical and microbiological effectiveness as well as the safety were not significantly different between the two treatments. Although daptomycin treatment with a loading dose was associated with lower mortality, the mortality of the treatment (8.3%) did not differ significantly compared to that of the vancomycin treatment (4.1%). Therefore, our findings suggest that vancomycin remains the first-line treatment for hemodialysis patients; however, a loading dose may be beneficial for patients receiving daptomycin.

DOI： 10.3390/antibiotics11060710

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Chronic endometritis is a persistent inflammatory condition of the endometrium that negatively affects pregnancy outcomes. The Centers for Disease Control and Prevention guidelines recommend oral antibiotic treatment for chronic endometritis. However, a recent randomized controlled trial concluded that it was unclear whether antibiotic treatment improved pregnancy outcomes. Hence, we performed a systematic review and meta-analysis to validate the impact of oral antibiotic treatments on pregnancy outcomes among patients with chronic endometritis. METHODS: We systematically searched the PubMed, Scopus, Ichushi, CINAHL, and EMBASE databases until May 2021. We compared the pregnancy outcomes in patients with chronic endometritis with and without antibiotic treatment. We then focused on the implantation rate, intrauterine pregnancy rate, and live birth rate to evaluate pregnancy outcomes. RESULTS: Seven studies were included in the meta-analysis. Three hundred seventy-two patients were treated with antibiotics, while 1024 patients were not treated with antibiotics. Various antibiotic regimens were administered during the study period [14-21 days]. Antibiotic treatments for chronic endometritis did not increase the implantation rate (odds ratios [OR] 1.02, 95% confidence interval [CI], 0.78-1.33), intrauterine pregnancy rate (OR 1.08, 95% CI 0.72-1.63), or live birth rate (OR 1.13, 95% CI 0.65-1.97). CONCLUSIONS: Our meta-analysis proved that oral antibiotic treatment did not improve pregnancy outcomes in patients with chronic endometritis. Accordingly, further studies are needed to elucidate the treatment to improve pregnancy outcomes.

DOI： 10.1016/j.jiac.2022.01.001

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

There is increasing evidence regarding the optimal therapeutic strategies for multidrug-resistant (MDR) bacteria that cause common infections and are resistant to existing antibiotics. Combination therapies, such as β-lactam combined with β-lactamase inhibitors or combination antibiotics, is a therapeutic strategy to overcome MDR bacteria. In recent years, the therapeutic options have expanded as certain combination drugs have been approved in more countries. However, only a handful of guidelines support these options, and the recommendations are based on low-quality evidence. This review describes the significance and efficacy of combination therapy as a therapeutic strategy against Gram-negative MDR pathogens based on previously reported meta-analyses.

DOI： 10.3390/antibiotics11040524

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Mycoplasma genitalium is recognized as a remarkable pathogen since azithromycin-resistant strains and treatment failure have been increasingly reported. Nevertheless, international guidelines still recommend azithromycin as a first-line treatment and moxifloxacin as a second-line treatment. We performed a systematic review and meta-analysis to validate the efficacy and safety of both drugs in the initial treatment of M. genitalium. We systematically searched the EMBASE, PubMed, Scopus, Ichushi, and CINAHL databases up to December 2021. We defined efficacy as clinical and microbiologic cure, and safety as persistent diarrhea. Overall, four studies met the inclusion criteria: one showed clinical cure (azithromycin treatment, n = 32; moxifloxacin treatment, n = 6), four showed microbiologic cure (n = 516; n = 99), and one showed safety (n = 63; n = 84). Moxifloxacin improved the microbiologic cure rate compared with azithromycin (odds ratio [OR] 2.79, 95% confidence interval [CI], 1.06-7.35). Clinical cure and safety did not show a significant difference between azithromycin and moxifloxacin treatments (OR 4.51, 95% CI 0.23-88.3; OR 0.63, 95% CI 0.21-1.83). Our meta-analysis showed that moxifloxacin was more effective than azithromycin at eradicating M. genitalium infections and supports its preferential use as a first-line treatment.

DOI： 10.3390/antibiotics11030353

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記述言語：日本語   出版者・発行元：日本嫌気性菌感染症学会  

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記述言語：日本語   出版者・発行元：日本嫌気性菌感染症学会  

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担当区分：筆頭著者,　責任著者   記述言語：英語  

Staphylococcus argenteus is a new species classified as part of the Staphylococcus aureus-related complex in 2015 and has been recognized to be as pathogenic as S. aureus. We describe the first case of endocarditis caused by S. argenteus. A 51-year-old man presented with chief complaints of fever and headaches. On admission, he showed a slight decrease in consciousness level (Glasgow Coma Scale, E4V4M6). Careful physical examination and imaging revealed a systolic heart murmur, Janeway lesions, and complicating convexity subarachnoid hemorrhage (cSAH) of the left frontal lobe. Ceftriaxone 4 g/day was administered immediately after blood cultures were obtained. The next day, all blood cultures grew Gram-positive cocci, identified as Staphylococcus aureus or Staphylococcus argenteus by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). However, the version of MALDI-TOF MS used could not distinguish these bacteria. Although we could not find valvular vegetation, he was clinically diagnosed with infective endocarditis according to the modified Duke's criteria. Meropenem 6 g/day and linezolid 1.2 g/day were started to cover S. aureus and methicillin-resistant S. aureus. Finally, ampicillin was selected based on drug susceptibility, and the patient was treated for 8 weeks and recovered without permanent damage. The isolated strain formed white colonies on blood agar plates, characteristic of S. argenteus, and differs from golden colony-forming S. aureus. Genetic analysis revealed the isolated strain as S. argenteus (sequence type 1223). Although distinguishing S. argenteus from S. aureus using routine conventional laboratory tests is difficult, the updated library version of MALDI-TOF MS is useful in identifying S. argenteus. Interestingly, all published cases of infection caused by ST1223 have been reported in Japan. Therefore, the trend of infections from the ST1223 strain should be carefully monitored, particularly in Japan. Further investigation is needed to clarify the epidemiology and clinical characteristics of S. argenteus infection, as there are few studies regarding this pathogen.

DOI： 10.2147/IDR.S373352

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担当区分：筆頭著者,　責任著者   記述言語：英語  

Although Dialister pneumosintes is a commensal microorganism of the oral cavity, it may sometimes cause severe systemic infections. We report a case of Lemierre syndrome (LS), which developed after D. pneumosintes infection, in a 73-year-old Japanese woman who was admitted to the hospital for throat pain, neck swelling, and fever for 3 days. She had a 3-month history of neglected dental caries, gingivitis, and periodontitis. Physical examination revealed right tonsillar erythema and swelling, and computed tomography (CT) showed peritonsillar and retropharyngeal abscesses. Ampicillin/sulbactam was promptly administered after collecting two sets of blood cultures. Surgical drainage for peritonsillar and retropharyngeal abscesses was also conducted on the second hospital day. Although only commensal oral microflora grew in the culture from the drained pus, Gram-negative bacilli were confirmed in the anaerobic blood cultures. Metronidazole was administered intravenously; however, the fever and neck swelling persisted. Repeat CT performed on the fifth hospital day revealed right internal jugular vein thrombosis, a known complication of tonsillitis and pharyngitis once the infection extends beyond the oropharynx. We diagnosed she had coexisting LS, and anticoagulant therapy was added to her treatment regimen. Her condition improved, and she was discharged after completing 3 weeks of antibiotics. Conventional methods failed to identify the isolated bacterium, and 16S rRNA sequencing ultimately identified it as D. pneumosintes. In a literature review of bacteremia due to D. pneumosintes, poor oral hygiene was considered a probable risk factor for invasive D. pneumosintes infection. We consider this to be the case in our patient who presented with dental caries, gingivitis, and periodontitis. In addition, all cases revealed that the 16S rRNA gene sequencing is useful for identifying this species. Although the diagnosis of LS by physical examination is difficult, physicians should always consider it as a potential complication of infections in the pharyngeal area.

DOI： 10.2147/IDR.S359074

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記述言語：日本語   出版者・発行元：日本嫌気性菌感染症学会  

2019年から始まった新型コロナウイルス感染症(COVID-19)の世界的な流行は、我々の生活を一変させた。現在までに、COVID-19に関する研究は多数なされており、COVID-19を引き起こす新型コロナウイルス(SARS-CoV-2)は、呼吸器官だけでなく、消化器官も感染経路となることが明らかになっている。一方、近年、次世代シーケンサーの登場によって、細菌叢解析が盛んに実施されている。その結果、人体には多くの細菌が生息しており、腸管だけでなく、呼吸器官にも好気性菌だけでなく嫌気性菌が多数存在することが明らかになった。これまでの研究によって、嫌気性菌が呼吸器官の粘膜層においてムチンの産生に関わり、ウイルスと宿主の接触を防ぎ、感染の回避や重症化を抑えていることや、臨床試験において嫌気性菌を含むProbioticsの経口投与がCOVID-19の予防や重症化の回避につながる可能性が示されている。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J06611&link_issn=&doc_id=20220302350001&doc_link_id=%2Ffc2kenki%2F2021%2F005101%2F001%2F0001-0008%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffc2kenki%2F2021%2F005101%2F001%2F0001-0008%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Carbapenem-resistant Enterobacterales (CRE) and carbapenemase-producing Enterobacterales (CPE) have become global threats. CRE- and CPE- derived infections have been associated with high mortality due to limited treatment options. Nacubactam is a β-lactamase inhibitor and belongs to the new class of diazabicyclooctane. The agent has an in vitro antimicrobial activity against several classes of β-lactamase-producing Enterobacterales. This study evaluated antimicrobial activity of combination therapies including β-lactams (aztreonam, cefepime, and meropenem) and nacubactam against four Enterobacter cloacae and six Klebsiella pneumoniae isolates with murine pneumonia model. Based on changes in bacterial quantity, antimicrobial activities of some regimens were assessed. Combination therapies including β-lactams (aztreonam, cefepime, and meropenem) with nacubactam showed enhanced antimicrobial activity against CRE E. cloacae (-3.70 to -2.08 Δlog10 CFU/lungs) and K. pneumoniae (-4.24 to 1.47 Δlog10 CFU/lungs) with IMP-1, IMP-6, or KPC genes, compared with aztreonam, cefepime, meropenem, and nacubactam monotherapies. Most combination therapies showed bacteriostatic (-3.0 to 0 Δlog10 CFU/lungs) to bactericidal (<-3.0 Δlog10 CFU/lungs) activities against CRE isolates. This study revealed that combination regimens with β-lactams (aztreonam, cefepime, and meropenem) and nacubactam are preferable candidates to treat pneumonia due to CRE and CPE.

DOI： 10.3390/antibiotics10101179

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although Moraxella catarrhalis (M. catarrhalis) is a common cause of community-acquired pneumonia (CAP), studies investigating clinical manifestations of CAP due to M. catarrhalis (MC-CAP) in adults are limited. Since S. pneumoniae is the leading cause of CAP globally, it is important to distinguish between MC-CAP and CAP due to S. pneumoniae (SP-CAP) in clinical practice. However, no past study compared clinical characteristics of MC-CAP and SP-CAP by statistical analysis. We aimed to clarify the clinical characteristics of MC-CAP by comparing those of SP-CAP, as well as the utility of sputum Gram staining. METHODS: This retrospective study screened CAP patients aged over 20 years visiting or admitted to Okinawa Miyako Hospital between May 2013 and April 2018. Among these, we included patients whom either M. catarrhalis alone or S. pneumoniae alone was isolated from their sputum by bacterial cultures. RESULTS: We identified 134 MC-CAP and 130 SP-CAP patients. Although seasonality was not observed in SP-CAP, almost half of MC-CAP patients were admitted in the winter. Compared to those with SP-CAP, MC-CAP patients were older (p < 0.01) and more likely to have underlying pulmonary diseases such as asthma and bronchiectasis (p < 0.01). Approximately half of asthmatic MC-CAP and SP-CAP patients had asthma attacks. Although winter is an influenza season in Japan, co-infection with influenza virus was less common in MC-CAP compared to SP-CAP patients (3% vs. 15%, p < 0.01). Bronchopneumonia patterns on X-ray, as well as bronchial wall thickening, bilateral distribution, and segmental pattern on CT were more common in MC-CAP patients than in SP-CAP patients (p < 0.01). Sputum Gram stain was highly useful method for the diagnosis in both MC-CAP and SP-CAP (78.4% vs. 89.2%), and penicillins were most frequently chosen as an initial treatment for both pneumonias. CONCLUSIONS: This is the first study to show that MC-CAP occurred in older people compared to SP-CAP, influenza virus co-infection was less common in MC-CAP than SP-CAP, and that MC-CAP frequently caused asthma attacks. Gram stain contributed for the appropriate treatment, resulting in conserving broad-spectrum antibiotics such as cephalosporins and fluoroquinolones in both MC-CAP and SP-CAP patients.

DOI： 10.1186/s12879-020-05564-9

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：(一社)日本結核・非結核性抗酸菌症学会  

[目的]単一老健施設において肺結核のアウトブレイクを経験したため,寝たきり高齢者(入所者)と健常者(職員)における胸部CT画像所見の比較を行う。[対象]X年10月〜X+1年9月に,肺結核を発症し,胸部CTを撮影した入所者と職員。[方法]患者背景や胸部CT所見を後方視的に検討した。[結果]対象は入所者7例,職員9例の合計16例。職員との比較で,入所者は発熱や体重減少,炎症反応高値を示す傾向を認めた。胸部CTでは,入所者は気管支壁肥厚,気管支拡張症,結節影を全例に認め,職員は小葉中心性結節影を全例に認めた。入所者は全例で両側びまん性に陰影を呈し,職員よりも下葉に陰影を呈する傾向を認めた。[考察]本検討と過去の報告から,低栄養,PS不良の場合には,典型的な肺尖部優位の陰影は呈さず,下葉や両側びまん性に陰影を呈する傾向にあることが示唆された。また,高齢者の肺結核は高齢者の市中肺炎や医療介護関連肺炎と比べて,結節影やtreein-budの所見が多く,びまん性に陰影を示す傾向を認めた。[結論]寝たきり高齢者の肺結核は下葉にも高頻度で起こるため誤嚥性肺炎との鑑別を有し,細菌性肺炎と比較して多数の肺野に陰影を呈する傾向を示す。(著者抄録)

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：(一社)日本結核・非結核性抗酸菌症学会  

誤嚥性肺炎の診断でレボフロキサシン(LVFX)が投与された症例が初発患者と推測される介護施設での結核集団感染事例を経験したので報告する。80代男性(症例1)が発熱を主訴に受診。当初誤嚥性肺炎として治療されたが,最終的に肺結核と判明し抗結核薬で治療を行った。その1ヵ月後,症例1と同室の80代女性(症例2)が7ヵ月前から繰り返す発熱・咳嗽の精査で来院。胸部画像で多発空洞を認め,精査後に肺結核と診断された。症例2は過去7ヵ月間に複数回誤嚥性肺炎の診断でLVFX投与が行われていたことが判明し,臨床経過・画像などから初発患者と判断した。その後の接触者健診で,入所者11人,職員30人の結核感染が判明し,症例2を含む肺結核と診断された入所者3名に対し誤嚥性肺炎の診断でLVFXの投与が行われていた。LVFX投与により発熱・咳嗽などの症状が一時的に軽快し,結核感染の発見が遅れ集団感染へとつながったと推測された。本邦の新登録結核患者は80代以上で最も多い状況のため,特に高齢者が入所する施設においては安易にフルオロキノロン系薬剤(FQ)の使用は避けるべきであり,「FQを使用する際には必ず結核を除外する」ことを厳守する必要がある。(著者抄録)

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担当区分：筆頭著者,　責任著者   記述言語：英語  

Hypervirulent Klebsiella pneumoniae (HV-KP) typically causes pyogenic liver abscess and bacteremia with metastatic infections. Community-acquired pneumonia (CAP) due to HV-KP is uncommon and details of its clinical and microbiological features are limited. We report the first case of CAP due to capsular genotype K2-ST86 HV-KP in Okinawa, Japan and review infections caused by the K2-ST86 strain. A 79-year-old woman presenting with fever and productive cough persisting for the past three days was admitted to hospital. Her vital signs indicated septic shock. Lung examination by auscultation revealed holo-crackle and lobar pneumonia in chest radiography, and Streptococcus pneumoniae was suspected. However, sputum and blood cultures revealed Gram-negative coccus identified as K. pneumoniae. Genetic analysis identified the isolated strain as the K2 serotype harboring rmpA, iutA, entB, and mrkD. Therefore, we identified the isolated strain as hypervirulent. The isolate belonged to ST86 as determined by multilocus sequence typing. The case was not complicated by predisposing factors such as diabetes mellitus and malignancy related to HV-KP infection; thus, this CAP-causing HV-KP strain may differ from the typical HV-KP strain that induces liver abscess. A literature review identified only nine cases with CAP due to HV-KP. In all cases, the disease mainly occurred in older males with diabetes mellitus, which makes the present case unusual, and had high rates of septic shock and death. No case, including ours, was complicated by metastatic infection, suggesting that CAP due to HV-KP poses little distant metastasis risk, even in patients with bloodstream infection. In our review, consistent with our case, K2-ST86 was the most common strain of HV-KP in patients with CAP. Therefore, studies are needed to elucidate the clinical and microbiological features of HV-KP CAP, with a focus on the K2-ST86 strain. Physicians should always consider K. pneumoniae in cases of sepsis CAP with lobar pneumonia.

DOI： 10.2147/IDR.S252637

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担当区分：筆頭著者,　責任著者   記述言語：英語  

Hypervirulent Klebsiella pneumoniae (HV-KP) is typically associated with community-acquired liver abscess and bacteremia with metastatic infection; however, primary lung abscess (PLA) caused by HV-KP is rare, with only one such case report to date. A 69-year-old man with a history of diabetes mellitus (DM) was admitted to hospital complaining of slight bloody sputum. Chest imaging showed multiple consolidations with cavities in both lung fields. A culture of bronchoalveolar lavage fluid confirmed the presence of K. pneumoniae. Genetic analyses identified the isolate as serotype K2 and sequence type 375 (K2-ST375), and that it harbored the rmpA gene. The patient was an Asian middle-aged male with DM, all of which are risk factors for HV-KP infection. Although complicating DM and the presence of the rmpA gene are more likely to induce disseminated infection, metastatic infections were not found in this patient. The clinical and microbiological characteristics of our patient were different from those of a previous reported case, although in both cases the patient was from Asia and had DM. Therefore, DM appears to be one of the predisposing factors for HV-KP lung abscesses and physicians should pay attention to emerging HV-KP lung abscess infection, particularly in Asian countries. Previous studies have also revealed that K2-ST375 is one of the major clones causing HV-KP infection, and that it is mainly isolated from patients with liver abscess. Interestingly, including the present case, most of the infectious cases caused by K2-ST375 have been reported from Okinawa Prefecture in Japan. Therefore, the trend of the K2-ST375 strain should be carefully monitored, particularly in Okinawa, Japan. The serotype of HV-KP that causes PLA is still unknown and further study is needed to elucidate the etiology of PLA due to HV-KP and the relationship between the strain K2-ST375 and PLA.

DOI： 10.2147/IDR.S252251

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担当区分：筆頭著者,　責任著者   記述言語：英語  

Streptococcus agalactiae, also known as Group B Streptococcus (GBS), is the leading cause of bacteremia and meningitis in neonates; however, it also causes meningitis in adults, although much less frequently. After the detection of penicillin-non-susceptible GBS (PRGBS) for the first time in 2008 by Japanese researchers, clinical PRGBS isolates have been reported worldwide. These isolates need to be given due attention for being non-susceptible to multiple drugs. Herein, we present the first clinical report of meningitis caused by PRGBS. A 41-year-old Japanese male receiving an immunosuppressant visited hospital complaining of fever. Although he did not have meningitis-related symptoms or physical findings, determination of the cause of fever by Gram-staining of the spinal fluid revealed gram-positive cocci in pairs and chains. Initially, he was hospitalized on the diagnosis of cerebral meningitis caused by Streptococcus pneumoniae. However, culture of the spinal fluid revealed the β-hemolytic colonies on blood agar. Biochemical testing and mass spectrometry revealed the isolated organism as GBS (serotype Ib). The minimum inhibitory concentration (MIC) of penicillin G for the isolated strain was 0.5 μg/mL, which is greater than the MIC criteria for "susceptibility" to penicillin G for beta-hemolytic streptococci according to Clinical and Laboratory Standards Institute standards. The isolated strain was also resistant to macrolide (MIC ≥ 8 μg/mL) and fluoroquinolone (MIC ≥ 8 μg/mL). The patient recovered without neurologic sequelae upon treatment with ceftriaxone, vancomycin, and corticosteroids for 4 days, and subsequently with ampicillin for 17 days. The rate of isolation of PRGBS in the clinics has gradually increased, particularly in Japan. Although PRGBS isolated in the present case was susceptible to ampicillin and cephalosporins, strains not susceptible to ampicillin, cefotaxime, and ceftriaxone have already been isolated, indicating the prospects for limited range of effective antibiotics against PRGBS infections, including meningitis, in the near future.

DOI： 10.2147/IDR.S251250

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Determination of ceftriaxone (CTRX) concentration in human cerebrospinal fluid (CSF) is required to clarify whether a high concentration of CTRX in CSF is associated with CTRX-induced encephalopathy (CIE). In our study, in order to perform an accurate analysis of CSF sample from CIE patient, we proposed HPLC with UV detection (HPLC-UV) using an octadecylsilica (ODS) column, a methanol and 10 mM phosphoric acid (25:75, v/v) mixture solution as a mobile phase, and a detection wavelength at 280 nm. The linear range was from 0.1 to 100 μg/mL (r = 0.999) in the present HPLC-UV. In the recovery tests using blank samples of human CSF and control serum spiked with CTRX, the recoveries of CTRX were >95.3%, and the RSD (n = 3) was <5.8%. We applied the proposed HPLC-UV system to determine CTRX in the CSF and serum samples obtained from a patient diagnosed as having CIE, and it was revealed that the CTRX concentrations in the CSF sample and the serum were 2.61 and 37.35 μg/mL, respectively. To the best of our knowledge, this is the first report describing the determination of CTRX concentration in a CSF sample obtained from a peritoneal dialysis patient diagnosed as having CIE.

DOI： 10.1016/j.jchromb.2019.06.008

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective From November 24 to December 9, 2013, an outbreak of the influenza (flu) A (H3) virus occurred in a tertiary-care university hospital (1,014 beds). We herein report the prophylactic effect of anti-flu agents for controlling the flu outbreak. Methods We administered pre- or post-exposure prophylaxis with anti-flu agents in flu outbreak. To test the effectiveness of prophylaxis in a flu outbreak, we used the posterior mean of the reproductive value during the pre- and post-intervention period. We also simulated the probability distribution of new flu cases. We performed an analysis to quantify the strength of the intervention effect. Results A total of 97 people were diagnosed with flu before the intervention, and 7 were diagnosed after the intervention. A molecular analysis of the flu virus revealed that this outbreak was due to the flu A (H3) virus. A total of 3,702 people received prophylaxis. There was a significant reduction in the reproductive value from 1.89 [95% confidence interval (CI), 1.59 to 2.24] to 0.65 (95% CI, 0.02 to 1.00) after the intervention (p<0.001). Conclusion Prophylaxis with anti-flu agents, along with prompt identification and isolation of infected individuals, was effective in reducing the impact of a flu outbreak in a hospital.

DOI： 10.2169/internalmedicine.8854-17

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 67-year-old Japanese female with back pain and severe cachexia visited our hospital. The diagnosis was disseminated Mycobacterium avium complex infection (dMAC) with multiple bone involvement. Anti-mycobacterial chemotherapy was started, but fever persisted and dislocation of cervical vertebrae has made her bedridden. Because anti-interferon (IFN)-γ autoantibody was positive, four doses of rituximab 375 mg/m2, every 7 day, were administered. Soon after treatment, progression of osteolytic lesions and wasting has stopped. We proved that rituximab has recovered IFN-γ signaling as shown by IFN-γ-induced STAT1 phosphorylation. It can be a promising option for dMAC cases with anti-IFN-γ autoantibody.

DOI： 10.1007/s10875-017-0425-3

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

We present the first case report of osteomyelitis due to Clostridium hydrogeniformans in a previously healthy 18-year-old male. He was admitted to our hospital because of an open contaminated fracture of the right arm after being blown into a drain in a motorbike accident. He underwent surgical debridement and treatment course of cefazolin. Although he responded well to these initial treatments, subcutaneous abscess and ulnar osteomyelitis developed 1 month after discharge. Second debridement was performed and specimens were collected from both the abscess and bone tissues. Only anaerobic culture showed a gas-producing Gam-positive rod. Conventional methods and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry could not accurately identify this organism. However, 16S rRNA gene sequence analysis determined the isolate as C. hydrogeniformans with 99.79% homology. The patient recovered after 90 days of antibiotic treatment, and had no evidence of recurrence. Anaerobic bacteria are more common as causative pathogens in osteomyelitis related to traumatic wounds and Clostridium spp. are particularly associated with open fractures, which is consistent with our case. Although the epidemiology and clinical characteristics of C. hydrogeniformans infection is poorly understood because of the limitations of currently available conventional methods of identification, clinicians need to consider this organism as a causative pathogen in a patient with osteomyelitis in traumatic wounds, especially contaminated by sewer water.

DOI： 10.1016/j.anaerobe.2017.02.013

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: One of the major adverse events of caspofungin and micafungin is hepatotoxicity, however, there are few reports compared the incidence of hepatotoxicity between caspofungin and micafungin. Herein, the primary objective of this study was to compare the incidence of hepatotoxicity between caspofungin and micafungin treatments for patients with fungal or suspected fungal infection. METHODS: In total, 201 patients [caspofungin group: 66 patients; micafungin group: 135 patients] treated with echinocandins from April 2014 to November 2015 at Aichi Medical University Hospital. Investigation item were as follows; sex, age, weight, height, duration of treatment, total dose, disease type, clinical isolates, liver enzyme levels, concomitant medications. Liver function was assessed in accordance with Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. We divided into two groups depend on their liver enzyme levels before treated with echinocandins; normal group (liver enzyme levels ≤ CTCAE Grade 1), abnormal group (liver enzyme levels ≥ CTCAE Grade 2). RESULTS: The overall incidence of serious hepatotoxicity (Grade 3 or higher) was 6.1% (4/66) in the caspofungin group and 7.4% (10/135) in the micafungin group. The proportion of patients used caspofungin and micafungin showed serious hepatotoxicity were 0% (0/47) and 6.5% (7/108) in normal group (p = 0.17), and 21.1% (4/19) and 10.7% (3/28) in abnormal group (p = 0.42). CONCLUSION: There was no notable difference in serious hepatotoxicity between the caspofungin group and the micafungin group, even though in patients with abnormal liver enzyme levels (CTCAE grade 2 or higher).

DOI： 10.1016/j.jiac.2017.02.008

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Here we report six cases of daptomycin (DAP)-induced eosinophilic pneumonia (DIEP) encountered at two medical centers and present a review of 43 DIEP patients from 26 studies to compare the clinical characteristics and radiographic findings of acute and chronic eosinophilic pneumonia (AEP; CEP). Four of the six patients did not exhibit respiratory symptoms, and one patient with only fever was misdiagnosed with DAP-induced fever. According to our literature review and the present findings, male sex and old age were dominant risk factors for DIEP. Fever and fine crackles were the most common clinical manifestations. The DAP dose and duration of administration were not significant risk factors for DIEP, and we also could not find any association between allergic predisposition and DIEP. Among the reviewed patients, 51.8% did not show more than 25% eosinophils in bronchoalveolar lavage, which is a criterion for the diagnosis of drug-induced eosinophilic pneumonia. Chest images of all patients showed CEP patterns such as multiple reticulonodular infiltrates in the subpleural region and diffuse bilateral pulmonary infiltrates with ground-glass opacities. However, 66.7% of patients also exhibited pleural effusion, a feature specific to AEP. All patients showed prompt recovery after DAP withdrawal. Our results suggest that clinicians should consider DIEP as a differential diagnosis when patients receiving DAP therapy, particularly men and elderly patients, present with fever, even in the absence of respiratory symptoms. Furthermore, they should be aware that the occurrence of DIEP is independent of the DAP dose and administration duration, and allergic reaction.

DOI： 10.1016/j.jiac.2016.09.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Amikacin has been one of the important antimicrobial agents against Gram-negative pathogens. However, there is discrepancy regarding the amikacin initial dosage, with some reports recently recommending ≥25 mg/kg and others the conventional dosage (15-20 mg/kg). Hence, we evaluated the optimal initial dosing regimen of amikacin. Pharmacokinetic (PK) parameters were estimated using a population PK analysis. The pharmacodynamic (PD) target was a ratio of ≥8 between the concentration achieved 1 h after beginning the infusion (C peak) and the minimal inhibitory concentration (MIC) of the liable bacteria. Based on the population PK parameters, we simulated individual C peak for several dosing regimens by Monte Carlo method and analyzed the C peak/MIC ratio for MICs from 0.5 to 32 μg/mL. This study included 35 infected patients (25 males), with a median (range) age and body weight of 70 (15-95) years and 49.5 (32.5-78) kg, respectively. A two-compartment model was used, and total body clearance (CL) significantly correlated with creatinine clearance, and volume of distribution (V d) with body weight. Regarding the probability to achieve a C peak/MIC of ≥8, the 15 mg/kg regimen was sufficient to achieve the PK/PD target in ≥90% of patients for a MIC of 4 μg/mL or less. The cumulative fraction of response in Pseudomonas aeruginosa was that 76% of patients achieved a C peak/MIC of 8 with the amikacin dosage of 15 mg/kg/day. We suggest that the 15-mg/kg once-daily dosage of amikacin be recommended as the initial dosage. As its maintenance dosage, the 15 mg/kg/day amikacin dosage is needed for a MIC of ≤4 μg/mL, and amikacin monotherapy for a MIC of ≥8 μg/mL should be avoided.

DOI： 10.1007/s40268-016-0165-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

This is the first report to test the loading dosage of colistin against Pseudomonas aeruginosa, including MDRP. Using in vivo murine thigh infection model, in the loading dosage regimen (Day 1:50 mg/kg q12 h, Day 2-3: 25 mg/kg q12 h) group, 5 to 6 log10 CFU/ml reduction compared with control were observed for both strains of P. aeruginosa with colistin MIC 0.5 and 1 μg/mL at 72 h. But, similar reduction was observed for the strains with colistin MIC 0.5 μg/mL only in normal dosage regimen (Day 1-3: 25 mg/kg q12 h) group. For P. aeruginosa with colistin MIC 1 μg/mL, colistin loading dosage regimens showed greater antimicrobial activity than that of without loading dosage group (p < 0.05). These data suggest that the colistin loading regimen would be one of the useful options for P. aeruginosa with antimicrobial resistance infection treatment.

DOI： 10.1016/j.jiac.2016.09.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Among the different serotypes of Streptococcus pneumoniae, serotype 3 has received global attention. We report the fatal case of a 76-year-old Japanese man who had an invasive pneumococcal disease associated with pneumonia caused by serotype 3 S. pneumoniae. CASE PRESENTATION: The patient had a history of hypertension, laryngeal cancer, chronic obstructive pulmonary disease, and type 2 diabetes mellitus. Following a cerebral arteriovenous malformation hemorrhage, he underwent surgery to remove the hematoma and began rehabilitation. On day 66 of hospitalization, he suddenly developed a fever, and coarse crackles and wheezes were heard in his right lung. A diagnosis of hospital-acquired aspiration pneumonia was made, and initial treatment with piperacillin/tazobactam was started. Teicoplanin was added after S. pneumoniae was isolated from the blood culture, however, the patient died 5 days later. The S. pneumoniae detected in the sputum smear was serotype 3, showed mucoid colonies and susceptibility to penicillins, cephalosporins, carbapenems, and levofloxacin, but resistance to erythromycin. CONCLUSION: We experienced a fatal case of pneumonia caused by mucoid serotype 3 S. pneumoniae with a thick capsule. Serotype 3-associated pneumonia may develop a wider pulmonary infiltrative shadow, a prolonged therapeutic or hospitalization course, and a poor outcome. Careful observation and intervention are required, and the use of additional antibiotics or intravenous immunoglobulins should be considered in such cases. Pneumococcal immunization is also an important public health measure to minimize the development of severe infections caused by serotype 3 strains.

DOI： 10.1186/s13104-016-2353-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Reports of Pseudomonas aeruginosa with high antimicrobial resistance have steadily emerged, threatening the utility of a mainstay in antipseudomonal therapy. This study evaluated the antimicrobial activities of various combination therapies against P. aeruginosa with high antimicrobial resistance, including multidrug-resistant P. aeruginosa (MDRP) using an in vitro and in vivo study. METHODS: We evaluated 24 combination therapies, including colistin, aztreonam, meropenem, ceftazidime, ciprofloxacin, amikacin, rifampicin, arbekacin and piperacillin against 15 MDRP isolates detected at Aichi Medical University Hospital with the break-point checkerboard method. Based on the results of the in vitro study, we evaluated antimicrobial activity against highly antimicrobial-resistant P. aeruginosa with an in vivo murine thigh infection model. RESULTS: The combination regimens including colistin and aztreonam showed higher antimicrobial activity against the 15 MDRP isolates. In the in vivo study, the high-dose colistin monotherapy (16 mg/kg every 12 h) achieved greater log10 CFU changes than the normal-dose colistin regimen (8 mg/kg every 12 h) against 5 P. aeruginosa isolates, including 2 MDRP isolates (p < 0.05). Aztreonam monotherapy (400 mg every 8 h) yielded bacterial densities similar to untreated control mice for the MDRP isolate evaluated. The combination therapy with a higher dose of colistin had superior antimicrobial activity against 5 P. aeruginosa with colistin (MIC 0.5 μg/ml) and aztreonam (MIC ≥128 μg/ml) than colistin monotherapy. CONCLUSION: The data suggest that the combination treatment of colistin and aztreonam could be the most useful for treating highly resistant P. aeruginosa with a higher susceptibility to colistin, including MDRP infections.

DOI： 10.1159/000449367

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Neisseria meningitidis often causes meningitis and meningococcemia; however, meningococcal pneumonia is quite rare. Herein, we report a case of non-invasive meningococcal pneumonia initially misdiagnosed as pneumonia due to Moraxella catarrhalis on the basis of a Gram stain in a 43-year-old woman with asthma, type 2 diabetes mellitus, and schizophrenia. She visited our hospital following a 3-day history of fever, productive cough, and shortness of breath. Since her sputum smear revealed Gram-negative diplococcus and the chest radiograph showed infiltration in the lower right lung field, her initial diagnosis was pneumonia caused by M. catarrhalis. However, the next day, the sputum culture colonies were unlike those of M. catarrhalis, and matrix-assisted laser desorption/ionization time of flight mass spectrometry analysis revealed the pathogen to be N. meningitidis. As a result, we administered the appropriate treatment and ensured adequate infection prevention and control measures including, droplet precautions and prophylaxis provided to close contacts. Secondary infection did not occur. Although meningococcal pneumonia is not common, physicians should consider N. meningitidis when Gram-negative diplococci are observed in respiratory specimens, as N. meningitidis cannot be distinguished from M. catarrhalis with Gram staining alone. Moreover, it is also important to monitor the appearance of the pathogenic colonies and to closely coordinate with laboratory technicians to determine appropriate treatments. In this article, we review the previous case reports of meningococcal pneumonia reported in 1984-2015 in Japan, summarizing the clinical characteristics and comparing previous reviews of the literature.

DOI： 10.1016/j.jiac.2016.07.014

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND OBJECTIVE: In recent years, Streptococcus anginosus group (SAG) bacteria are becoming increasingly recognized as important pneumonia-causing pathogens. Although several small studies have been reported, the features of SAG pneumonia remain unclear, because the identification of SAG from sputum cultures is not routinely performed in most microbiology laboratories. The aim of this study was to elucidate the clinical characteristics of SAG pneumonia. PATIENT AND METHODS: This was a retrospective case-control study utilizing data obtained in our hospital between September 2009 and June 2016. We investigated 31 patients with SAG pneumonia (PWP), and also assessed the difference between the 31 PWP and 37 patients without pneumonia (PWOP) in whose sputum SAG was detected. RESULTS: Seventy-one percent of the patients were men and the median age was 78 years in the PWP. Univariate analysis indicated that the PWP were significantly more often a bed-ridden (p < 0.01) with comorbid aspiration than were the PWOP (p < 0.05). Among the PWP, nursing and healthcare-associated pneumonia (NHCAP) was the more common type of pneumonia (54.8%). S. anginosus was detected significantly more frequently in sputum cultures of PWP than PWOP (p < 0.01), and multiple pathogens were detected more frequently in PWP (p < 0.01). Streptococcus constellatus was the most frequently detected pathogen in patients with a single bacterial infection. Empyema was observed only in patients with multiple bacteria. CONCLUSIONS: SAG should be recognized as important causative pathogens of pneumonia, particularly among elderly patients with underlying disease associated with aspiration. NHCAP was the more common type of SAG pneumonia in this study.

DOI： 10.1016/j.jiac.2016.08.014

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Among the Citrobacter genus, the most commonly isolated bacteria from human specimens are Citrobacter freundii and Citrobacter koseri, and previous cases of infection due to Citrobacter braakii have been rarely reported. We present a case of bacteremia due to C. braakii in a 38-year-old woman with cervical cancer. She was admitted to our hospital with complaints of a fever, chills, and nausea. Blood culture results showed gram-negative bacilli identified as C. braakii via matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analysis, although biochemical testing findings were suggestive of C. freundii. Since a rare pathogen was detected in the present case and the results of additional biochemical studies were suggestive of both C. braakii and Citrobacter farmeri, genetic analysis was conducted. Finally, the gram-negative bacilli were confirmed as C. braakii, a member of the C. freundii complex since 1993, by 16S ribosomal RNA gene sequencing analysis. The gastrointestinal tract was considered the portal of entry, because the patient had a rectal fistula and other cultures such as urine and vaginal discharge incubated species other than C. braakii. The patient recovered after receiving treatment with ciprofloxacin for 14 days. The epidemiology and clinical characteristics of C. braakii infection are still unknown because of the limitations in accurate identification by using currently available commercial biochemical testing and previously, only 6 cases of C. braakii infection have been reported. Physicians should focus on this species, because it causes community-acquired infections, although further studies are needed to clarify the clinical characteristics of C. braakii infections.

DOI： 10.1016/j.jiac.2016.07.003

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Gene sequence analysis methods, including 16S rRNA identification, allows accurate identification of Streptococcus species, which include phenotypically closely related species that are difficult to differentiate using conventional chemical methods. We report a case of bacteremia due to Streptococcus tigurinus, identified by 16S rRNA, in a 72-year-old woman with gastrointestinal cancer and ascites. She was hospitalized to undergo elective tumor-related surgery. Five days prior to undergoing surgery, she developed a fever with no obvious source of infection. Blood cultures identified gram-positive cocci. The patient's bacteremia was initially thought to be caused by an Enterococcus species, given her underlying gastrointestinal disease. However, alpha-hemolytic, mucoid, circular colonies were observed on sheep blood agar the following day. Although matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and biochemical testing suggested Streptococcus pneumoniae, we conducted further investigation to identify the bacterium, as the patient had no symptoms of infections usually related with S. pneumoniae such as pneumonia, meningitis, or sinusitis, and the bacteremia occurred 30 days after hospitalization. Finally, the gram-positive cocci were identified as S. tigurinus, assigned to the Streptococcus mitis group in 2012. Although the origin of infection was unclear, it was suspected that peritonitis or bacterial translocation from the gastrointestinal tract caused the bacteremia. This novel species was recently reported as being extremely pathogenic and different from other Streptococcus species. It has been reported to occur in cases of infectious endocarditis and bacteremia. In this article, we reviewed previous reports of S. tigurinus infection and summarized the clinical and pathogenetic features.

DOI： 10.1016/j.jiac.2016.04.011

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Colistin is a polypeptide antibiotic of the polymyxin family (polymyxin E) which has been reported to be active against many multidrug-resistant (MDR) Gram-negative aerobic bacteria collected across the globe. While this agent was not currently licensed in Japan, the emergence of MDR organisms has necessitated its off-label used in the country. However, colistin was approved in March, 2015. This retrospective observational report includes nine patients with MDR Gram-negative infections due to Pseudomonas aeruginosa (n=6) and Klebsiella spp. (n=3) who received intravenous colistin therapy as part of their antimicrobial regimen. The median age and duration of administration were 40 years (range 7-90) and 8 days (range 1-19). Clinical success was observed in all eight patients for whom efficacy could be evaluated. Two patients encountered colistin related adverse effects 22.2% (2/9). In both cases the nephrotoxicity and dysgeusia resolved after discontinuation of colistin therapy. In vitro studies conducted with these clinical isolates of P aeruginosa displayed synergy with the combination of colistin plus ceftazidime, rifampicin, meropenem or aztreonam. This report provides early evidence that colistin is generally safe, effective and demonstrates in vitro synergy when used in combination for the management of MDR Gram-negative pathogens derived from Japanese patients.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The efficacy of arbekacin in patients with MRSA infections is influenced by the peak concentration (Cpeak)/MIC ratio (≧8). A daily arbekacin dose of 4-6 mg/kg is primarily used for the treatment of MRSA infection. However, clinical pharmacokinetic studies of arbekacin that evaluate changes in patients with different infectious diseases have been limited. This study was to evaluate the pharmacokinetics of arbekacin in different infectious diseases and to evaluate its dosing regimens. This work describes a single-centre, retrospective study. The pharmacokinetic parameters of arbekacin were calculated from individual serum-concentration data using WinNonlin ver. 6.3. A total of 331 serum samples were obtained from 170 patients. Our drug concentration-time data were well described by a two-compartment open model. The final model showed that drug clearance was related to creatinine clearance and that the total distribution volume (Vd) was related to actual body weight and the presence of bacteremia. The individual Vd in bacteremia patients was significantly higher than those of other patients (bacteremia: 29.7 ± 0.5 L, pneumonia: 20.8 ± 0.4 L, other infections: 21.4 ± 0.4 L; p < 0.05). Additionally, Monte Carlo simulation showed that target (Cpeak/MIC ≧ 8) attainment was only 10.1%, even at a dose of 6 mg/kg, especially for MRSA bacteremia patients with an arbekacin MIC = 2 μg/mL. In conclusion, our study revealed that the Vd may be higher in bacteremia patients than in patients with other infectious diseases. Therefore, an increase in the daily dose of arbekacin should be considered for bacteremia patients.

DOI： 10.1016/j.jiac.2016.03.008

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The purpose of this study was to examine the pharmacokinetics/pharmacodynamics of rifampicin against methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA), and vancomycin-intermediate S. aureus (VISA) in a neutropenic murine thigh infection model. METHODS: Three S. aureus isolates (MSSA [ATCC 25923], MRSA and VISA [Mu50]) with rifampicin MIC 0.06 to >256 μg/mL were tested. The efficacy was calculated as the change in bacterial density. A maximum effect model was used to determine the PK/PD index that best described the dose-response data. RESULTS: The area under the curve (AUC)/MIC and maximum concentration of drug in serum (Cmax/MIC) were the best correlated with in vivo efficacy (AUC/MIC, R(2) = 0.96; Cmax/MIC, R(2) = 0.97) for S. aureus ATCC 25923 strain, and the dose fractionation-response study did not show significantly different antimicrobial activity (p = 0.10). The AUC/MIC values associated with stasis and 1-log kill for the S. aureus ATCC 25923 strain were 386 and 952, respectively. On the other hand, no antimicrobial efficacy was observed against two strains (MRSA and VISA) with MIC of 128 μg/mL or more. CONCLUSION: Rifampicin demonstrated concentration-dependent killing. The AUC/MIC was a predictive PK/PD index.

DOI： 10.1016/j.jiac.2016.02.011

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Previously, Veillonella species had been considered as nonpathogenic and rarely caused serious infections. We report a case of 25-year-old man with osteomyelitis caused by Veillonella species. He was admitted to the hospital due to an open fracture to the left radial bone caused by industrial washing machine accident, and emergency surgery was performed. However, wound infections occurred one week after the operation. Although Acinetobacter baumannii and Serratia marcescens were cultured from the pus, obligate anaerobic bacteria were not detected at that point. Debridement was repeated and antibiotics were changed according to the result of bacterial culture and drug sensitivity. Despite this, the infection was poorly controlled. On the 5th debridement, granulomatous bone tissues on pseudarthrosis were found for the first time at the infection site. Although no bacteria was detected with aerobic culture, anaerobic incubation revealed Gram-negative cocci which was later identified as Veillonella species by 16S rRNA gene sequence analysis. His condition improved without any additional debridement after adding effective antibiotics against Veillonella species. It is well known that prolonged infection with aerobes consumes oxygen in the infection site and leads the environment to more favorable conditions for anaerobic bacteria, thus we speculated that prolonged infection with bacteria such as S. marcescens induced the favorable environment for Veillonella species. Physicians should realize the importance of anaerobic culture method in routine practice, especially in complicated cases such as the present case. In this article, we reviewed case reports of Veillonella infection and summarized the clinical features of this organism.

DOI： 10.1016/j.jiac.2015.12.015

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: To study the clinical characteristics and associated risk factors of infections caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. METHODS: A case-control study at a large university hospital in Japan, comparing patients who were infected or colonized with ESBL-producing Enterobacteriaceae (n = 212) and non-ESBL-producing Enterobacteriaceae (n = 2089) in 2010-2013. Data were collected from medical charts, retrospectively. Multivariate logistic regression analysis was used to explore risk factors of ESBL-producing Enterobacteriaceae (Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Proteus mirabilis) infection or colonization for each pathogen, respectively. RESULTS: ESBL-producing Enterobacteriaceae [E. coli (n = 113), K. oxytoca (n = 46), K. pneumoniae (n = 41), P. mirabilis (n = 12)] were taken from patients were identified in 1409 outpatient and 892 inpatients. Infection or colonization caused by ESBL-producing Enterobacteriaceae was considered to be hospital-acquired, healthcare-associated and community-acquired in 60.4%, 17.9% and 21.7% patients, respectively. Independent risk factors for ESBL-producing Enterobacteriaceae infection or colonization were male sex, cerebrovascular disease, intubation/tracheostomy, major surgery within 60 days (p < 0.001). Moreover, antimicrobial usage (more than 4 days) during preceding 60 days, especially aminoglycoside, oxazolidinone, tetracycline, fluoroquinolone, trimethoprim/sulfamethoxazole, and second- and fourth-generation cephalosporin were risk factors (p < 0.001). However, acquisition location of infection (hospital-acquired and community-onset) was not a risk factor (p > 0.05). CONCLUSION: The problem of ESBL production is no longer limited to hospital-acquired infections. The presence of chronic illness, such as cerebrovascular disease, and recent antimicrobial use were independent risk factors for ESBL-producing Enterobacteriaceae infection or colonization.

DOI： 10.1016/j.jiac.2016.02.004

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: There are several studies of assessment for teicoplanin loading dose regimen. However, the optimal loading dose achieving the target range 15-30 μg/mL has been still unclear. We investigated the probability of target attachment as teicoplanin concentration 15-30 μg/mL at the 3rd day after teicoplanin therapy started, clinical efficacy and safety in retrospective study. METHODS: In total, 42 patients treated with teicoplanin from January 2010 to July 2014 at Aichi Medical University Hospital were divided into three groups; group 1 (about 40 mg/kg for 2 days), group 2 (about 35 mg/kg for 2 days) and group 3 (about 30 mg/kg for 2 days; the previous regimen). The probability of target attachment as teicoplanin concentration, efficacy and toxicity were compared among three groups. RESULTS: The proportion of patients achieving the target range was 100% in group 1, 57.9% in group 2, and 38.9% in group 3 (p = 0.05). The percentage of patients that showed hepatotoxicity and nephrotoxicity was not different from three groups (hepatotoxicity: group 1, 20%; group 2, 21.1%; group 3, 16.7%: p = 0.48; nephrotoxicity: group 1, 0%; group 2, 5.3%; group 3, 16.7%: p = 0.38). Finally, there were not significant differences of clinical efficacy among three regimens, but CRP 4-7 day after teicoplanin therapy in group 1 and group 2 exhibited a significant lower value, compared with group 3. CONCLUSIONS: We suggested that 35-40 mg/kg for 2 days as a loading does would be needed for the early achieving target range (15-30 μg/mL) and improvement of infection.

DOI： 10.1016/j.jiac.2016.01.019

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

86歳男性。前傾姿勢と右口角下垂が出現後、構音障害と嚥下障害を認めたため、著者らの施設へ受診となった。所見では右半身麻痺を認め、頭部MRIにて橋梗塞と診断、抗血小板薬による治療目的で入院となった。しかし、入院3日目より発熱が出現し、右下肺野にはfine cracklesを聴取された。また、喀痰塗抹では口腔内常在菌を疑う複数菌が認められた。以上、これらのことから本症例は誤嚥性肺炎の診断で血液培養採取後にSBT/ABPCの投与が開始された。その結果、血液培養からはグラム陰性桿菌が検出され、検出菌を質量分析器と迅速微生物分類同定装置を用いて分析したところ、O.intermediumが同定され、このO.intermediumによる菌血症の診断に至った。以後、抗菌薬をMEPMへ変更すると、速やかに解熱し、抗菌薬終了後の血液培養では陰性が確認された。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00276&link_issn=&doc_id=20160628420006&doc_link_id=1390001205047764864&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390001205047764864&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

手指衛生は感染防止技術の根幹をなす。今回、我々は当院において2013年2月から2014年3月までに手指消毒薬キャンペーンを実施し消毒薬の使用量とhealthcare-associated methicillin-resistant Staphylococcus aureus(HA-MRSA)検出率への影響を調査した。キャンペーン前の消毒量は5.8(L/1000patient-days)であったのに対し、キャンペーン後は11.6(L/1000patient-days)と有意に増大し(p<0.01)、MRSA検出率(%)は2.5から1.5に有意に低下した(p<0.01)。キャンペーンによる消毒薬の使用量の増大の結果、HA-MRSA検出率の低下に繋がった。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J05141&link_issn=&doc_id=20160205530005&doc_link_id=10.4058%2Fjsei.31.32&url=https%3A%2F%2Fdoi.org%2F10.4058%2Fjsei.31.32&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

One of the major adverse events associated with linezolid treatment is pancytopenia. However, there are few reports about the tolerability of linezolid among patients undergoing hemodialysis. This study retrospectively investigated the frequency of bicytopenia (thrombocytopenia and erythropenia) secondary to linezolid treatment in patients undergoing and not-undergoing hemodialysis. In total, 181 patients treated with linezolid from January 2010 to July 2012 at Aichi Medical University Hospital were divided into three groups; patients undergoing hemodialysis (HD group), those with creatinine clearance (CLCR) of <50 mL/min (CLCR < 50 group) and those with CLCR of ≥ 50 mL/min (CLCR ≥ 50 group). The incidence of thrombocytopenia, and changes in the platelet (PLT) counts during and after linezolid therapy were compared among three groups. Thrombocytopenia (<75% of the baseline level) occurred in 125 patients (69.1%). PLT reached its nadir 3-4 days after the end of linezolid therapy. In particular, the PLT nadir in HD group occurred earlier than that in non-HD groups (HD, 11.5 days [4-31 days]; CLCR < 50, 14 days [5-43 days]; CLCR ≥ 50, 15.5 days [4-49 days]; p = 0.11). HD group exhibited the greatest rate of reduction of PLT (HD, 24.0% [0.4-93.8%]; CLCR < 50, 23.8% [0.8-92.9%]; CLCR ≥ 50, 22.4% [0.92-92.9%]; p = 0.003). Finally, HD group exhibited the slowest recovery of PLT to its baseline level (HD, 10 days [5-29 days]; CLCR < 50, 9 days [2-16 days]; CLCR ≥ 50, 8 days [3-17 days]; p = 0.09). The incidence of erythropenia was not significantly different among three groups. These results indicate the need to monitor the PLT count during and after linezolid treatment in patients undergoing hemodialysis.

DOI： 10.1016/j.jiac.2015.06.007

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Liposomal amphotericin-B (Ambisome(®)) is widely used antifungal drug for treatments of invasive fungal infections. The use of liposomal amphotericin-B is increasing in medical setting because of its tolerability and potent antifungal activity. CASE PRESENTATION: In a case of a 76 year-old Japanese female was admitted with subarachnoid hemorrhage, the ethnicity of the patient is Asian, we experienced that liposomal amphotericin-B was the culprit drug for Drug-induced hypersensitivity syndrome, also known as drug rash with eosinophilia and systemic symptoms in view of a clear temporal relationship between liposomal amphotericin-B administration and the onset of symptoms, the remission of the symptomatological pattern after liposomal amphotericin-B withdrawal. CONCLUSION: The present case report shows that prolonged liposomal amphotericin-B treatment can be associated with drug rash with eosinophilia and systemic symptoms. We recommend careful monitoring of neutrophil counts in a prolonged treatment course with liposomal amphotericin-B.

DOI： 10.1186/s13104-015-1486-0

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

Methicillin-resistant Staphylococcus aureus(MRSA)は、院内感染を引き起こす極めて重要な原因菌である。我々は、2012年4月から2013年6月までに当院で分離された新規MRSA検出率と消毒量および抗菌薬使用量(AUD)について検討した。MRSA検出率は消毒量と負の相関(r=-0.34)があり、カルバペネム系薬のAUDと正の相関(r=0.61)があった。次いで、第一世代セファロスポリン(r=0.59)、キノロン系薬(r=0.48)と正の相関を示した。この結果を用いて主成分分析を行ったところ、MRSA検出率に対する寄与率は消毒量が20.7%、カルバペネム系薬のAUDが12.7%であった。そのMRSA検出率に対する累積寄与率は、消毒量とカルバペネム系薬のAUDの総和で86.7%であった。新規解析法により、MRSA検出率をビジュアル化することが可能となり、MRSA検出率の低下に繋がった。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J05141&link_issn=&doc_id=20150807380004&doc_link_id=10.4058%2Fjsei.30.262&url=https%3A%2F%2Fdoi.org%2F10.4058%2Fjsei.30.262&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

We herein describe the case of a 63-year-old man who died from relapsed epidermal growth factor receptor gene (EGFR) exon 19 deletion lung adenocarcinoma treated with erlotinib. According to the autopsy results, he was confirmed to have small cell carcinoma without the EGFR T790M mutation in his pancreas and left kidney metastatic specimens, while the adenocarcinoma metastatic lesion in his right kidney had the EGFR T790M mutation; both retained the somatic EGFR exon 19 deletion. We herein report an autopsy case of resistance to an EGFR tyrosine kinase inhibitor via small cell carcinoma transformation and the EGFRT790M mutation in separate metastatic organs.

DOI： 10.2169/internalmedicine.54.5481

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：(一社)日本内科学会  

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J01159&link_issn=&doc_id=20141120110003&doc_link_id=10.2169%2Fnaika.103.2657&url=https%3A%2F%2Fdoi.org%2F10.2169%2Fnaika.103.2657&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(公財)日本感染症医薬品協会  

経口剤ボリコナゾール(VRCZ)が投与された23名(男19名、女4名、平均64.04歳)を対象に、用量と目標血漿中濃度(1〜5μg/ml)達成度について検討した。目標達成は16名、非達成が7名で、両群間に性別、年齢、体重、用量、用量/体重の有意差はなかった。添付文書通りに投与した19名の達成率は68.4%、体重換算(3〜4mg/kg/回)投与とした11名は63.6%で、有意差はなかった。年齢、体重、用量とVRCZ血漿中トラフ濃度とは相関を認めず、用量/体重との間には正の相関を認め、濃度高値または低値を示した症例は回帰直線の信頼区間外であった。解析対象患者には100kgを超える過体重2名が存在し、当初の1名はVRCZ血漿中濃度が0.88μg/mlと低値であったため、次に経験した1名には体重当たりの用量設定とした結果、2.62μg/mlと目標範囲内に収まった。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00542&link_issn=&doc_id=20141031140001&doc_link_id=1520009409536394112&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1520009409536394112&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

記述言語：日本語   出版者・発行元：(公財)日本感染症医薬品協会  

肺炎に対してアルベカシン(ABK)の吸入療法を施行した6例について検討した。膿性喀痰を有し、画像にて肺炎と診断し、複数回に渡り同一耐性菌を検出した場合、起因菌とし、入院患者6例を対象とした。人工呼吸器管理が行われた肺炎症例4例、ジェットネブライザーによる吸入療法を実施した2例であった。検出した耐性菌は、MDRPが2例、2剤耐性緑膿菌2例、カルバペネム耐性緑膿菌1例、緑膿菌とMRSAの検出1例、その他混合検出菌としてC.striatum 2例、S.maltophilia 1例であった。ABK吸入療法を施行し、全例で臨床学的効果を認めた。ABK吸入療法中止後に同一耐性菌を6例中5例で検出した。ABK吸入療法後の初回陰性化までの日数の中央値は7日(4〜23日)であった。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00542&link_issn=&doc_id=20140901060003&doc_link_id=1520853834467148800&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1520853834467148800&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   出版者・発行元：The Japanese Society of Internal Medicine  

カルバペネム耐性腸内細菌科細菌（carbapenem-resistant Enterobacteriaceae：CRE）はカルバペネム系抗菌薬に耐性を獲得した腸内細菌科細菌の総称で，ヒトの腸管に生息する腸内細菌が耐性を持つという点が重要である．ほとんどの耐性遺伝子がプラスミド伝播性であるため，他の細菌や種を超えて薬剤耐性が伝播する可能性があり，治療には多剤耐性菌用の薬剤であるチゲサイクリンやコリスチンの使用が必要な症例もある．現時点では本邦での検出頻度は低いが，アウトブレイク事例も認めるため，今後の動向には注意する．

DOI： 10.2169/naika.103.2657

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その他リンク： https://jlc.jst.go.jp/DN/JALC/10041605720?from=CiNii

記述言語：日本語   出版者・発行元：(一社)日本結核・非結核性抗酸菌症学会  

61歳女。主訴は3ヵ月続く乾性咳嗽であった。胸部X線画像で右大量胸水を認め、胸部CTでは両側肺尖部の胸膜肥厚を認めた。胸膜生検組織のPCR法にて結核菌が同定され、結核性胸膜炎の診断で4剤による治療を開始した。治療開始後2ヵ月目の胸部CTにて、胸水の著明な減少にもかかわらず胸膜の腫瘤性病変と右中葉のすりガラス陰影が新たに出現した。CT下肺生検にて結核菌は検出されなかったが、類上皮肉芽腫を認めたため胸膜肺結核腫と診断した。抗結核薬の継続で胸膜腫瘤は縮小し、肺野の陰影も消退した。経過中、喀痰から結核菌は検出されず、肺病変も胸膜結核腫と同様な成因による肺内結核腫と判断した。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J00407&link_issn=&doc_id=20131120410003&doc_link_id=1523106604887561088&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1523106604887561088&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 66-year-old man with human immunodeficiency virus (HIV) infection was admitted for treatment of Pneumocystis pneumonia. Upon admission, a tumor mass adjacent to the thoracic descending aorta was revealed on computed tomography. Histology revealed an exudative granuloma with histiocytes packed with numerous acid-fast bacilli. Mycobacterium avium was isolated from the tissue. A genetic examination of the isolates demonstrated this strain to be located in the cluster consisting of strains that cause systemic infection. The patient's baseline CD4+ cell count was 9/μL and the HIV-RNA viral load was 43,800 copies/mL. This case suggests the possibility of a localized onset of disseminated M. avium infection.

PubMed

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本呼吸器学会  

症例は55歳男性。54歳時に当院泌尿器科で夫婦間血液型不適合生体腎移植を施行され、外来でシクロスポリン、ミコフェノール、メチルプレドニゾロンを内服中であった。来院4日前より発熱が出現し、乾性咳嗽も認めたことから当院救急受診。室内気でSpO2 83%と低酸素血症を認め、胸部CTでびまん性にスリガラス陰影を認めた。β-D-グルカン値の上昇と、画像所見からニューモシスチス肺炎(Pneumocystis jirovecii pneumonia:PCP)が疑われ、気管支鏡検査でPCPと確定診断した。ST合剤投与開始後に、低酸素血症が進行したためプレドニン(prednisolone、PSL)60mgを併用したところ酸素飽和度や画像所見は徐々に改善した。その後PSLの減量を行ったが、酸素化および画像の悪化が認められたためPSLを30mgまで増量したところ速やかに症状や画像は改善し、その後も経過良好で治癒した。本症例は非HIV症例であるが、PSL減量がPCP増悪に関係しておりHIVにおける免疫再構築症候群と類似な経過を呈したと考えられた。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2011&ichushi_jid=J03150&link_issn=&doc_id=20110601250005&doc_link_id=1570854175042340352&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1570854175042340352&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

記述言語：日本語   出版者・発行元：(株)近代出版  

Streptococcus oralis subsp.tigurinusは、特に肝硬変や糖尿病などの基礎疾患がある患者に対して、感染性心内膜炎を引き起こす。生化学的性状による同定は困難であるため、16S rRNAなど遺伝子検査での同定が必要な菌種である。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：日本語   出版者・発行元：(株)ビー・エム・エル  

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記述言語：日本語   出版者・発行元：(一社)日本臨床微生物学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床微生物学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床微生物学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床微生物学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：日本語   出版者・発行元：(株)ヴァンメディカル  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：沖縄県医師会医学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：琉球医学会  

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記述言語：日本語   出版者・発行元：琉球医学会  

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記述言語：日本語   出版者・発行元：琉球医学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：日本臨床腸内微生物学会  

琉球大学医学部附属病院に於いて2014年1月1日から2016年6月30日までの期間に、カルバペネマーゼ非産生カルバペネム耐性E.cloacae(nonCP-CREC)を分離した35例(nonCP-CREC群)と、同時期にカルバペネマーゼ感性E.cloacae(CSEC)を分離した35例(CSEC群)の臨床的背景を比較検討した。患者背景・臨床経過においてnonCP-CRECの誘導に関連が示唆された因子は認めず、E.cloacaeによる感染症の発生率、死亡率に関してはnonCP-CREC群とCSEC群で差はなかった。今回の検討においてはnonCP-CREC分離が臨床に与える影響は限定的と考えられた。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本結核・非結核性抗酸菌症学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床微生物学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器学会  

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記述言語：日本語   出版者・発行元：日本嫌気性菌感染症学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(一社)日本結核・非結核性抗酸菌症学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床微生物学会  

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記述言語：日本語   出版者・発行元：(株)ヴァンメディカル  

重症のC.difficile感染症(Clostridium difficile infection:CDI)に対する外科的治療は、以前はショックや臓器不全の徴候が認められた際に選択されていたが、近年のメタ解析では昇圧剤使用前の早期の段階で結腸亜全摘を行うことが死亡率の改善を上昇させることが判明した。高い奏効率が得られ、かつ低侵襲の糞便移植(Fecal microbiota transplantation:FMT)やバンコマイシン(VCM)直腸投与は、投与量や投与方法、ドナーのスクリーニングなどに関して確立された方法がない状況ではあるものの、多数のエビデンスが蓄積されてきている領域である。また、重症CDIのthird lineの治療法としてチゲサイクリン(TGC)が推奨されてきている。(著者抄録)

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本結核・非結核性抗酸菌症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床微生物学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床微生物学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床微生物学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本医真菌学会  

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記述言語：日本語   出版者・発行元：(一社)日本医真菌学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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記述言語：日本語   出版者・発行元：(株)メディカルレビュー社  

Carbapenem-resistant Enterobacteriaceae(CRE)は、カルバペネム系抗菌薬に耐性を獲得した腸内細菌科の総称で、ヒトの腸管に生息する腸内細菌が耐性をもつという点が重要である。耐性遺伝子の多くがプラスミド伝播性であるため、他の細菌や種を超えて薬剤耐性が伝播する可能性があり、治療には多剤耐性菌用の薬剤であるチゲサイクリンやコリスチンが必要な場合もある。現時点では日本での検出頻度は決して高いものではないが、CREのアウトブレイク事例も認められるため、今後の動向には注意する。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)ヴァンメディカル  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(一社)日本TDM学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(株)南山堂  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本結核・非結核性抗酸菌症学会  

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記述言語：日本語   出版者・発行元：日本嫌気性菌感染症学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(株)メディカルレビュー社  

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J06002&link_issn=&doc_id=20150203130006&doc_link_id=%2Fai1kansd%2F2015%2F000401%2F007%2F0030-0036%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fai1kansd%2F2015%2F000401%2F007%2F0030-0036%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)ヴァンメディカル  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床微生物学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床微生物学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(株)診断と治療社  

＜Headline＞1.2012年4月の診療報酬改定により、Infection Control Team(ICT)に対する評価は、2012年3月までの診療報酬で認められていた医療安全対策加算とは別の評価体系に改められた。2.人的要因が確保されたICTを組織している医療機関と300床未満の医療機関との連携、ICTをもつ医療機関同士が相互に感染防止対策に関する評価を実施した場合、連携して院内感染対策にあたった場合の評価が認められた。これらは、2014年4月の診療報酬改定でも2012年4月に改訂された点数のまま存続することになった。3.医療関連感染制御には、ICTラウンドの充実化、マニュアルの定期的なアップデート、地域医療連携、感染症科の設立、微生物検査室の充実化が重要である。(著者抄録)

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(株)総合医学社  

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記述言語：日本語   出版者・発行元：(株)医学書院  

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00421&link_issn=&doc_id=20140416220020&doc_link_id=10.11477%2Fmf.1543104241&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1543104241&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

記述言語：日本語   出版者・発行元：(一社)日本呼吸器学会  

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記述言語：日本語   出版者・発行元：(株)南山堂  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：金原出版(株)  

気腫合併肺線維症(CPFE)症例の胸部単純X線およびBMIについて検討した。CPFE症例23例を対象とし、同時期に入院した慢性閉塞性肺疾患(COPD)症例20例、UIP pattarnの間質性肺炎(IP)症例23例を比較対象とした。IP症例では両側下葉の網状影と肺野の容量減少を認めた。CPFE症例では両側下葉の網状影を認めるが、肺野の容量減少は認めなかった。COPD症例では、肺野の容量増大と肺野の透過性亢進、横隔膜の平底化、肋間腔の拡大を認めた。縦横比はCOPD、CPFE、IPの順に低くなり、BMIはCOPD、CPFE、IPの順に大きくなる傾向を示し、縦横比とBMIの相関性は、COPD群とIP群では負の相関を示した。

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

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記述言語：日本語   出版者・発行元：大道学館出版部  

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J01556&link_issn=&doc_id=20131224410008&doc_link_id=%2Fam3daidc%2F2013%2F009012%2F008%2F1697-1704%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fam3daidc%2F2013%2F009012%2F008%2F1697-1704%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：医学図書出版(株)  

集中治療領域の感染症治療は、感染臓器や原因菌が判明するまでその死亡率の高さから広域スペクトルの抗菌薬を選択せざるを得ないことが多い。敗血症は、感染による全身症状を伴った感染症による症候と定義され、pharmacokinetics-pharmacodynamics(PK-PD)理論に基づいた適正な抗菌化学療法も重要となる。一方で、広域抗菌薬の長期使用は、耐性菌の選択に結びつく可能性があるため、原因菌が判明した時点で狭域な抗菌薬に変更するde-escalationを考慮することも重要である。(著者抄録)

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記述言語：日本語   出版者・発行元：(NPO)日本呼吸器内視鏡学会  

背景。巨大嚢胞の治療法としては一般的に手術療法が選択される。しかしながら残存肺機能が低かったり全身状態が悪かったりして手術が行えない症例も多い。近年、手術困難な重症肺気腫症例に対して気管支内視鏡を用いた気管支鏡的容量減少術が試みられているが、用いる器具や技術が特殊であり、種々の合併症の報告も見られ一般的には用いられていない。症例。症例は61歳男性。重症インフルエンザ肺炎後のARDSを背景に急速に増大し手術療法が困難と判断されたため、巨大嚢胞に対して気管支鏡下嚢胞内瘻術に気管支閉塞術を併用し、嚢胞を縮小し得た。結論。リスクの高い巨大肺嚢胞に対して、気管支内視鏡下嚢胞ドレナージは治療選択肢の1つとなる可能性がある。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)医学書院  

Clostridium difficile感染症(CDI)の治療抗菌薬として,軽症例や初回の再発例ではメトロニダゾール(MNZ),重症例や再発を繰り返す例ではバンコマイシン(VCM)が推奨される.プロバイオティクスによるCDIの予防は確立しているとは言い難いが,有用性が報告されているため併用を考慮する.また,プレバイオティクスとの併用も検討する.フィダキソマイシン(FDX)はC.difficileのRNA polymeraseを阻害することにより殺菌的に作用する薬剤で,正常な腸内細菌叢を破壊しにくく,C.difficileの芽胞形成抑制作用や毒素産生抑制作用も認められる.VCMと比較してCDIの再発率が低く,VREなどの耐性菌出現のリスクも低いことから,新たな治療選択肢として注目される.(著者抄録)

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記述言語：日本語   出版者・発行元：(株)医薬ジャーナル社  

近年、高齢化や医療の進歩にともなう免疫不全状態患者、生活習慣病としての糖尿病や高血圧などの基礎疾患を有する患者の増加に加え、各種耐性菌の出現、選択や増加により難治化あるいは重症化傾向を示す感染症が多くみられるようになった。臨床現場では、このような難治性の重症感染症の救命率をいかに向上させるかが大きな課題となっている。本稿では、重症細菌感染症に対してもっとも汎用されるカルバペネム系薬の適正使用を推進するためのPK-PD(薬物動態学-薬力学)理論の基本から応用と限界に言及し解説する。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(株)日本臨床社  

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記述言語：日本語   出版者・発行元：(一社)日本医真菌学会  

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記述言語：日本語   出版者・発行元：(一社)日本医真菌学会  

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記述言語：日本語   出版者・発行元：(一社)日本医真菌学会  

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記述言語：日本語   出版者・発行元：(株)メディカルレビュー社  

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J06002&link_issn=&doc_id=20130725290005&doc_link_id=%2Fai1kansd%2F2013%2F000203%2F006%2F0036-0040%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fai1kansd%2F2013%2F000203%2F006%2F0036-0040%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)日本臨床社  

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記述言語：日本語   出版者・発行元：(株)医薬ジャーナル社  

2009年に米国感染症学会(IDSA)から2004年の改訂版として「カンジダ症治療の実践的臨床ガイドライン2009」が公表され、2012年には欧州臨床微生物学会(ESCMID)から「カンジダ症の診断と治療に関するESCMIDガイドライン2012」が発表された。両ガイドラインで大きく異なる点は、エビデンスの評価方法、エンピリック治療と治療薬の考え方、さらにカテーテル関連感染に関する抗真菌薬の考え方である。IDSAガイドライン2009の経験的治療は、侵襲性カンジダ症のリスク因子を有する重症患者でカンジダ症以外に明らかな原因がない発熱を認める場合と記載され、カンジダ症確定診断例に対する治療と同様に初期治療としてFLCZ(フルコナゾール)またはキャンディン系薬を推奨している。具体的には、重症度による区分がなされ、アゾール系薬の投与歴があり、中等症ないし重症例やCandida glabrata、Candida kruseiにはキャンディン系薬が推奨されている。ESCMIDガイドライン2012のエンピリック治療では発熱に応じたアプローチとして記載され、キャンディン系薬が推奨されている。特記すべきことはFLCZの位置づけが異なり、IDSAガイドライン2009では初期治療で軽症であればFLCZを支持しているが、ESCMIDガイドライン2012ではCandida parapsilosisの場合を除きFLCZがほとんど推奨されていない点などである。本稿では、非好中球減少症患者に対する侵襲性カンジダ症治療を、ESCMIDガイドライン2012およびIDSAガイドライン2009の両ガイドラインを比較しながら解説する。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床医学リスクマネジメント学会  

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記述言語：日本語   出版者・発行元：(公社)日本化学療法学会  

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記述言語：日本語   出版者・発行元：沖縄県医師会医学会  

症例1:80歳男。軽度の乾性咳嗽を主訴とした。CTで左肺動脈近傍の前縦隔に結節影を認め、VATS腫瘍生検術で胸腺腫と診断された。患者が高齢のためシスプラチン使用は困難で、アルコールアレルギーのためパクリタキセルも使用できなかった。非血液毒性が少ないカルボプラチン+ゲムシタピンを使用したところ、Partial responseの効果が得られた。しかし、化学療法開始後10ヵ月に病変が増大し、現在は放射線治療中である。症例2:68歳女。軽度の湿性咳嗽を主訴とした。健診のCTで右胸水貯留、縦隔病変を指摘され、胸腔鏡下生検術で胸腺癌と診断された。3レジメンによる化学療法、放射線療法を行ったが、結節状に増大した胸膜播種、肺内転移病変が出現した。カルボプラチン+S-1を使用したところ、病変は縮小したが、血小板減少と好中球減少が遷延し、S-1単独療法に変更した。その後、Stable diseaseの効果が得られたが、血液毒性が遷延したため治療を中止した。現在、病変は増大しているが全身状態は良好である。

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記述言語：日本語   出版者・発行元：沖縄県医師会医学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(NPO)日本肺癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器学会  

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記述言語：日本語   出版者・発行元：(一社)日本呼吸器学会  

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