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Murakami Y, Nozaki Y, Morosawa M, Toyama M, Ogashiwa H, Ueda T, Nakajima K, Tanaka R, Takesue Y. Difference in the impact of coinfections and secondary infections on antibiotic use in patients hospitalized with COVID-19 between the Omicron-dominant period and the pre-Omicron period. J Infect Chemother 2024:S1341-321X(24)00067-9. [PMID: 38428674 DOI: 10.1016/j.jiac.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION This study evaluated the effect of coinfections and/or secondary infections on antibiotic use in patients hospitalized with coronavirus disease 2019 (COVID-19). METHOD Days of therapy per 100 bed days (DOT) in a COVID-19 ward were compared between 2022 (Omicron period) and 2021 (pre-Omicron period). Antibiotics were categorized as antibiotics predominantly used for community-acquired infections (CAIs) and antibiotics predominantly used for health care-associated infections (HAIs). Bacterial and/or fungal infections which were proved or assumed on admission were defined as coinfections. Secondary infections were defined as infections that occurred following COVID-19. RESULTS Patients with COVID-19 during the Omicron period were older and had more comorbidities. Coinfections were more common in the Omicron period than in the pre-Omicron period (44.4% [100/225] versus 0.8% [2/257], respectively, p < 0.001), and the mean DOT of antibiotics for CAIs was significantly increased in the Omicron period (from 3.60 to 17.84, p < 0.001). Secondary infection rate tended to be higher in the Omicron period (p = 0.097). Mean DOT of antibiotics for HAIs were appeared to be lower in the COVID-19 ward than in the general ward (pre-Omicron, 3.33 versus 6.37, respectively; Omicron, 3.84 versus 5.22, respectively). No multidrug-resistant gram-negative organisms were isolated in the COVID-19 ward. CONCLUSION Antibiotic use for CAIs was limited in the pre-Omicron period but increased in the Omicron period because of a high coinfection rate on admission. With the antimicrobial stewardship, excessive use of antibiotics for HAIs was avoided in the COVID-19 ward during both periods.
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Affiliation(s)
- Yasushi Murakami
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Yasuhiro Nozaki
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Mika Morosawa
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Masanobu Toyama
- Department of Pharmacy, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Hitoshi Ogashiwa
- Department of Clinical Technology, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Ryoya Tanaka
- Department of Clinical Infectious Diseases, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, 479-8510, Japan.
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan; Department of Clinical Infectious Diseases, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, 479-8510, Japan.
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Asaeda T, Ueda T, Nozaki Y, Murakami Y, Morosawa M, Inaba H, Ogashiwa H, Doi M, Nakajima K, Shirakawa M, Nakamura A, Ikeda N, Sugiyama Y, Wada Y, Ito T, Takesue Y. Clinical features of pasteurellosis without an animal bite or scratch in comparison with bite/scratch pasteurellosis. J Infect Chemother 2024:S1341-321X(24)00032-1. [PMID: 38373634 DOI: 10.1016/j.jiac.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/20/2023] [Accepted: 02/04/2024] [Indexed: 02/21/2024]
Abstract
Pasteurellosis is a common zoonotic infection that occurs after an animal bite or scratch (B/S). We compared the clinical features of six patients with non-B/S pasteurellosis with those of 14 patients with B/S infections. Pasteurella multocida was identified with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry in all six non-B/S infections, whereas 13 of the 14 B/S infections were identified with diagnostic kits. The non-B/S infections were pneumonia (n = 3), skin and soft tissue infections (n = 2), and bacteremia (n = 1). Pneumonia occurred in two patients with underlying pulmonary disease, whereas ventilator-associated pneumonia developed in one patient with cerebral infarction. Pasteurella multocida was isolated from a blood specimen and nasal swab from a patient with liver cirrhosis (Child-Pugh class C) and diabetes. Cellulitis developed in one patient with diabetes and normal-pressure hydrocephalus, who had an open wound following a fall, and in one patient with diabetes and a foot ulcer. Three patients with non-B/S infections had no pet and no episode of recent animal contact. The rate of moderate-to-severe comorbidities was significantly higher in patients with non-B/S infections than in those with B/S infections (100% and 14.3%, respectively, p < 0.001). In conclusion, non-B/S infections can develop in patients with chronic pulmonary disease, invasive mechanical ventilation, or open wounds, or who are immunocompromised, irrespective of obvious animal exposure. In contrast to B/S infections, non-B/S pasteurellosis should be considered opportunistic.
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Affiliation(s)
- Tsubasa Asaeda
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan.
| | - Yasuhiro Nozaki
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Yasushi Murakami
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Mika Morosawa
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Hiroko Inaba
- Department of Dermatology, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Hitoshi Ogashiwa
- Department of Clinical Technology, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Miki Doi
- Department of Clinical Technology, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan.
| | - Manabu Shirakawa
- Department of Neurosurgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan.
| | - Akifumi Nakamura
- Division of Thoracic Surgery, Department of Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan.
| | - Naoto Ikeda
- Division of Hepatobiliary and Pancreatic Diseases, Department of Gastroenterology, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan.
| | - Yuya Sugiyama
- Department of Plastic Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan.
| | - Yoshihiro Wada
- Department of Dermatology, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan.
| | - Takahiro Ito
- Department of Clinical Infectious Diseases, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, 479-8510, Japan.
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan; Department of Clinical Infectious Diseases, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, 479-8510, Japan.
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Hanai Y, Ueda T, Hamada Y, Oda K, Takahashi Y, Nakajima K, Miyazaki Y, Kiriyama M, Uekusa S, Matsuo K, Matsumoto K, Kimura T, Takesue Y. Optimal timing for therapeutic drug monitoring of voriconazole to prevent adverse effects in Japanese patients. Mycoses 2023; 66:1035-1044. [PMID: 37584173 DOI: 10.1111/myc.13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND The optimal timing for therapeutic drug monitoring (TDM) of voriconazole in Asians, who have higher rates of poor metabolisers than non-Asians, is unclear. This can cause unexpectedly high concentrations and delays in reaching steady-state levels. OBJECTIVES To determine the appropriate timing of TDM in Japanese patients receiving voriconazole. PATIENTS/METHODS Trough levels (Cmin ) were measured on days 3-5 (recommended timing, RT) and days 6-14 (delayed timing, DT) after starting voriconazole in patients receiving an appropriate dosage. Considering bioavailability, Cmin was only compared in patients receiving oral voriconazole. RESULTS A total of 289 and 186 patients were included in the safety and pharmacokinetic analyses, respectively. There was a significant difference in Cmin measured no later than and after day 5 (3.59 ± 2.12 [RT] vs. 4.77 ± 3.88 μg/mL [DT], p = .023), whereas no significant difference was observed on cutoff day 6 (3.91 ± 2.60 vs. 4.40 ± 3.94 μg/mL, p = .465), suggesting that Cmin close to the steady-state was achieved after day 5. DT causes a delay in achieving the therapeutic range. The hepatotoxicity rates were 21.5% and 36.8% in the RT and DT groups, respectively (p = .004); DT was an independent risk factor for hepatotoxicity. CONCLUSION Although steady-state concentrations may not be achieved by day 5, early dose optimisation using RT can prevent hepatotoxicity in Japanese patients. TDM should be performed on days 3-5 to ensure safety. However, subsequent TDM may be necessary due to a possible further increase in Cmin .
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Affiliation(s)
- Yuki Hanai
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yukihiro Hamada
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Kazutaka Oda
- Department of Pharmacy, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoshiko Takahashi
- Department of Pharmacy, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshitsugu Miyazaki
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo, Japan
| | - Mone Kiriyama
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Shusuke Uekusa
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Kazuhiro Matsuo
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Juntendo University Hospital, Tokyo, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
- Department of Clinical Infectious Diseases, Tokoname City Hospital, Tokoname, Japan
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Sugisawa T, Ishikawa H, Uchida K, Takesue Y, Mori J, Kinoshita T, Morikawa S, Okamoto F, Sawada T, Ohji M, Kanda T, Takeuchi M, Miki A, Kusuhara S, Ueda T, Ogata N, Sugimoto M, Kondo M, Yoshida S, Ogata T, Kimura K, Mitamura Y, Jujo T, Takagi H, Terasaki H, Sakamoto T, Komuku Y, Gomi F. Risk Factors for Legal Blindness in 77 Japanese Patients with Endogenous Endophthalmitis: A Multicenter Cohort Study from J-CREST. Ocul Immunol Inflamm 2023; 31:1505-1512. [PMID: 36007241 DOI: 10.1080/09273948.2022.2112237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/07/2022] [Accepted: 07/14/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE We investigated potential predictive factors for visual prognosis in Japanese patients with endogenous endophthalmitis. DESIGN Retrospective observational multicenter cohort study. METHODS We examined the characteristics of 77 Japanese patients with endogenous endophthalmitis and performed statistical analyses of these real-world data. The primary endpoint was the identification of factors associated with visual prognosis. We examined differences between patients in the better vision and legal blindness groups at 12 weeks after treatment initiation. RESULTS The five risk factors for visual impairment at 12 weeks after treatment initiation were presence of pressure injuries, severe clinical symptoms (presence of eye pain and ciliary injection), pathogen identification, and poor best-corrected visual acuity at baseline. Staphylococcus aureus and fungus were associated with a better visual impairment outcome. CONCLUSIONS Endogenous endophthalmitis remains a severe ocular infection; however, it can be managed with rapid treatments, as well as other advances in medical knowledge and technology.
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Affiliation(s)
- Takaaki Sugisawa
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroto Ishikawa
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
- Department of Ophthalmology, Mirai Eye & Skin Clinic, Osaka, Japan
| | - Kazutaka Uchida
- Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Junya Mori
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Takamasa Kinoshita
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Shohei Morikawa
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Fumiki Okamoto
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoko Sawada
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Masahito Ohji
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Takayuki Kanda
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Masaru Takeuchi
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Akiko Miki
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sentaro Kusuhara
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tetsuo Ueda
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Nahoko Ogata
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Masahiko Sugimoto
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Mineo Kondo
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Shigeo Yoshida
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Kurume University School of Medicine, Kurume, Japan
| | - Tadahiko Ogata
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kazuhiro Kimura
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Yoshinori Mitamura
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Tokushima University Graduate School, Tokushima, Japan
| | - Tatsuya Jujo
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hitoshi Takagi
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroto Terasaki
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Taiji Sakamoto
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yuki Komuku
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Fumi Gomi
- J-CREST (Japan Clinical REtina STudy group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
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Otani N, Shima M, Ueda T, Nakajima K, Takesue Y, Yamamoto T, Okuno T. Changes in the Epidemiology of Rubella: The Influence of Vaccine-Introducing Methods and COVID-19. Vaccines (Basel) 2023; 11:1358. [PMID: 37631927 PMCID: PMC10458369 DOI: 10.3390/vaccines11081358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023] Open
Abstract
Rubella is an infectious disease caused by the rubella virus. Congenital rubella syndrome is a risk for all newborns if pregnant women are infected with rubella, raising an important public health issue. Rubella is a vaccine-preventable disease, and routine immunization has been conducted in Japan. The timing of the vaccine approval did not differ from that in the United States. In 2004, endemic rubella was eliminated in the United States. However, recent rubella outbreaks have occurred in Japan. This may be related to differences in the introduction of routine rubella immunization. In Japan, routine rubella immunization was initially introduced only for junior high school girls, and the rate of susceptibility is high among males who have not received rubella vaccination, causing an outbreak. Therefore, in Japan, measures have been taken to decrease the number of susceptible males in the vaccination-free generation. The coronavirus pandemic has also affected the epidemiology of rubella as well as other infectious diseases.
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Affiliation(s)
- Naruhito Otani
- Department of Public Health, Hyogo Medical University, Nishinomiya 663-8501, Hyogo, Japan
| | - Masayuki Shima
- Department of Public Health, Hyogo Medical University, Nishinomiya 663-8501, Hyogo, Japan
| | - Takashi Ueda
- Department of Infection Control and Prevention, Hyogo Medical University, Nishinomiya 663-8501, Hyogo, Japan
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo Medical University, Nishinomiya 663-8501, Hyogo, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo Medical University, Nishinomiya 663-8501, Hyogo, Japan
| | - Takuma Yamamoto
- Department of Legal Medicine, Hyogo Medical University, Nishinomiya 663-8501, Hyogo, Japan
| | - Toshiomi Okuno
- Department of Microbiology, Hyogo Medical University, Nishinomiya 663-8501, Hyogo, Japan
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Murakami Y, Ogashiwa H, Nozaki Y, Ueda T, Nakajima K, Morosawa M, Doi M, Makino M, Takesue Y. Judicious ending of isolation based on reverse transcription-polymerase chain reaction (RT-PCR) cycle threshold only for patients with coronavirus disease 2019 (COVID-19) requiring in-hospital therapy for longer than 20 days after symptom onset. J Infect Chemother 2023:S1341-321X(23)00117-4. [PMID: 37209841 DOI: 10.1016/j.jiac.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/19/2023] [Accepted: 05/01/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND For patients with coronavirus disease 2019 (COVID-19) requiring hospitalization, extending isolation is warranted. As a cautious protocol, ending isolation based on polymerase chain reaction cycle threshold (Ct) value was introduced for patients requiring therapy for >20 days after symptom onset. METHOD We compared a Ct-based strategy using Smart Gene® between March 2022 and January 2023 with a preceding control period (March 2021 to February 2022) when two consecutive negative reverse transcription-polymerase chain reaction tests using FilmArray® were required for ending isolation. Ct was evaluated on day 21, and ending isolation was permitted in patients with Ct ≥ 38. Although patients with Ct 35-37 were transferred to a non-COVID-19 ward, isolation was continued. RESULTS The duration of stay on a COVID-19 ward in the Ct group was 9.7 days shorter than that in controls. The cumulative number of tests was 3.7 in controls and 1.2 in the Ct group. There was no nosocomial transmission after ending isolation in either group. The number of days from symptom onset to testing was 20.7 ± 2.1 in Ct group, and five patients had Ct < 35, nine Ct 35-37, and 71 Ct ≥ 38. No patients were moderately or severely immunocompromised. Steroid use was an independent risk factor for prolonged low Ct (odds ratio 9.40, 95% confidence interval 2.31-38.15, p = 0.002) CONCLUSIONS: The efficacy of ending isolation based on Ct values could improve bed utilization without the risk of transmission among patients with COVID-19 requiring therapy for >20 days after symptom onset.
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Affiliation(s)
- Yasushi Murakami
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Hitoshi Ogashiwa
- Department of Clinical Technology, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Yasuhiro Nozaki
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, 663-8501, Japan.
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, 663-8501, Japan.
| | - Mika Morosawa
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan; Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
| | - Miki Doi
- Department of Clinical Technology, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Miyuki Makino
- Department of Infection Control and Prevention, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, 479-8510, Japan.
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, 663-8501, Japan; Department of Clinical Infectious Diseases, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, 479-8510, Japan.
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7
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Samura M, Takada K, Hirose N, Kurata T, Nagumo F, Uchida M, Inoue J, Tanikawa K, Enoki Y, Taguchi K, Matsumoto K, Ueda T, Fujimura S, Mikamo H, Takesue Y, Mitsutake K. Comparison of the efficacy and safety of standard- and high-dose daptomycin: A systematic review and meta-analysis. Br J Clin Pharmacol 2023; 89:1291-1303. [PMID: 36693240 DOI: 10.1111/bcp.15671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/14/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
AIMS Standard doses of daptomycin at 4 and 6 mg/kg were used for the treatment of skin and soft tissue for infections and bacteraemia, respectively. However, increased doses of daptomycin are recommended for complicated infections by Gram-positive organisms. METHODS A systematic review was conducted using 4 databases. We compared treatment success between standard-dose (SD, 4-6 mg/kg) and high-dose (HD, >6 mg/kg) daptomycin in patients with all-cause bacteraemia, complicated bacteraemia, infective endocarditis, osteomyelitis and foreign body/prosthetic infection as the primary outcome. We also compared the success between SD and HD2 (≥8 mg/kg) daptomycin treatments in patients with these diseases as the secondary outcome. The incidence of creatine phosphokinase (CPK) elevation was evaluated as safety. RESULTS In patients with complicated bacteraemia and infective endocarditis, the treatment success was significantly lower in the SD group than in the HD group (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.30-0.76 and OR 0.50, 95% CI 0.30-0.82) and HD2 group (OR 0.38, 95% CI 0.21-0.69 and OR 0.30, 95% CI 0.15-0.60), respectively. A significant difference was demonstrated only in the HD2 group in patients with bacteraemia, including simple infection. SD did not decrease the success rate for the treatment of osteomyelitis and foreign body/prosthetic infection. The incidence of elevated CPK was significantly lower in SD group than in HD group. CONCLUSION SD daptomycin was associated with significantly lower treatment success than HD in patients with complicated bacteraemia/infective endocarditis. The CPK elevation should be considered in patients treated with high daptomycin doses.
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Affiliation(s)
- Masaru Samura
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Japan.,Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Keisuke Takada
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Japan
| | - Naoki Hirose
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Japan
| | - Takenori Kurata
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Japan
| | - Fumio Nagumo
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Japan
| | - Masaki Uchida
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Japan
| | - Junki Inoue
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Japan
| | - Koji Tanikawa
- Department of Pharmacy, Yokohama General Hospital, Yokohama, Japan
| | - Yuki Enoki
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Kazuaki Taguchi
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Takashi Ueda
- Department of Infection Prevention and Control, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shigeru Fujimura
- Division of Clinical Infectious Diseases & Chemotherapy, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute, Japan
| | - Yoshio Takesue
- Department of Infection Prevention and Control, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Clinical Infectious Diseases, Tokoname City Hospital, Tokoname, Japan
| | - Kotaro Mitsutake
- Department of Infectious Diseases and Infection Control, Saitama International Medical Center, Saitama Medical University, Saitama, Japan
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8
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Ueda T, Takesue Y, Nakajima K, Ichiki K, Ishikawa K, Yamada K, Tsuchida T, Otani N, Takahashi Y, Ishihara M, Takubo S, Iijima K, Ikeuchi H, Uchino M, Kimura T. Correlation between Antimicrobial Resistance and the Hospital-Wide Diverse Use of Broad-Spectrum Antibiotics by the Antimicrobial Stewardship Program in Japan. Pharmaceutics 2023; 15:pharmaceutics15020518. [PMID: 36839839 PMCID: PMC9964530 DOI: 10.3390/pharmaceutics15020518] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
Increased antibiotic use and antibiotic homogeneity cause selective pressure. This study investigated the correlation between antibiotic diversity and antimicrobial resistance (AMR) in Gram-negative organisms. The days of therapy/100 patient-days (DOT) for four broad-spectrum antibiotic classes were evaluated for 2015-2022. The antibiotic heterogeneity index (AHI) for the equal use of four classes (25%) and the modified AHI for the equal use of three classes (30%), excluding fluoroquinolones (10%), were measured (target: 1.0). Quarterly antibiotic use markers and the resistance rates against ≥2 anti-Pseudomonas antibiotics were compared. The DOT value was 9.94, and the relative DOT were 34.8% for carbapenems, 32.1% for piperacillin/tazobactam, 24.3% for fourth generation cephalosporins/ceftazidime/aztreonam, and 8.9% for fluoroquinolones. Although no correlation was found between the total DOT and the resistance rate for any bacterium, a significant negative correlation was found between the heterogeneity indices and resistance rates for Pseudomonas aeruginosa and Klebsiella pneumoniae. The significant cutoffs that discriminate the risk of resistance were 0.756 for the AHI and 0.889 for the modified AHI for K. pneumoniae. Antibiotic diversity is more important in preventing AMR than overall antibiotic use. The ideal ratio of broad-spectrum antibiotics should be studied for diversified use to prevent AMR.
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Affiliation(s)
- Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan
- Department of Clinical Infectious Diseases, Tokoname City Hospital, Tokoname 479-8510, Aichi, Japan
- Correspondence: ; Tel.: +81-0798-45-6689; Fax: +81-0798-45-6769
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan
| | - Kaoru Ichiki
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan
| | - Kaori Ishikawa
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan
| | - Kumiko Yamada
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan
| | - Toshie Tsuchida
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan
| | - Naruhito Otani
- Department of Public Health, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan
| | - Yoshiko Takahashi
- Department of Pharmacy, Hyogo College of Medicine Hospital, Nishinomiya 663-8501, Hyogo, Japan
| | - Mika Ishihara
- Department of Pharmacy, Hyogo College of Medicine Hospital, Nishinomiya 663-8501, Hyogo, Japan
| | - Shingo Takubo
- Department of Pharmacy, Hyogo College of Medicine Hospital, Nishinomiya 663-8501, Hyogo, Japan
| | - Kosuke Iijima
- Department of Clinical Technology, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan
| | - Hiroki Ikeuchi
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan
| | - Motoi Uchino
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan
| | - Takeshi Kimura
- Department of Pharmacy, Hyogo College of Medicine Hospital, Nishinomiya 663-8501, Hyogo, Japan
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9
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Yoshimura A, Ishikawa H, Uchida K, Takesue Y, Mori J, Kinoshita T, Morikawa S, Okamoto F, Sawada T, Ohji M, Kanda T, Takeuchi M, Miki A, Kusuhara S, Ueda T, Ogata N, Sugimoto M, Kondo M, Yoshida S, Ogata T, Kimura K, Mitamura Y, Jujo T, Takagi H, Terasaki H, Sakamoto T, Sugisawa T, Komuku-Yamamoto Y, Gomi F. Risk Factors for Legal Blindness in 237 Japanese Patients with Exogenous Endophthalmitis: A Multicenter Cohort Study from J-CREST. Ocul Immunol Inflamm 2023:1-9. [PMID: 36701518 DOI: 10.1080/09273948.2023.2165111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 12/26/2022] [Accepted: 12/31/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE We investigated potential risk factors for visual prognosis in Japanese patients with exogenous endophthalmitis. METHODS In this retrospective observational multicenter cohort study, risk factors for legal blindness at 12 weeks after treatment initiation were evaluated based on patient characteristics, initial BCVA, causative events, pathogens, ocular symptoms, duration from symptom onset to initial treatment, and selected treatments. RESULTS Overall, 23.1% of eyes developed legal blindness. The six risk factors for legal blindness were presence of eye pain, pathogen identification, poor BCVA at the initial visit, longer duration from symptom onset to initial treatment, type of causative event, and type of causative pathogen. Regarding the type of causative pathogen, coagulase-negative staphylococci was associated with a better visual impairment outcome. CONCLUSION Exogenous endophthalmitis remains a severe ocular infection; however, it can be managed with rapid treatment, as well as other advances in medical knowledge and technology.
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Affiliation(s)
- Ayano Yoshimura
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroto Ishikawa
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
- Department of Ophthalmology, Mirai Eye & Skin Clinic, Osaka, Japan
| | - Kazutaka Uchida
- Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Junya Mori
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Takamasa Kinoshita
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Shohei Morikawa
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Fumiki Okamoto
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoko Sawada
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Masahito Ohji
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Takayuki Kanda
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Masaru Takeuchi
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Akiko Miki
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sentaro Kusuhara
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tetsuo Ueda
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Nahoko Ogata
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Masahiko Sugimoto
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Mineo Kondo
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Shigeo Yoshida
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Kurume University School of Medicine, Kurume, Japan
| | - Tadahiko Ogata
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kazuhiro Kimura
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Yoshinori Mitamura
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Tokushima University Graduate School, Tokushima, Japan
| | - Tatsuya Jujo
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hitoshi Takagi
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroto Terasaki
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Taiji Sakamoto
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takaaki Sugisawa
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yuki Komuku-Yamamoto
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Fumi Gomi
- J-CREST (Japan Clinical Retina Study group), Kagoshima, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
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10
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Morosawa M, Ueda T, Nakajima K, Inoue T, Toyama M, Ogasiwa H, Doi M, Nozaki Y, Murakami Y, Ishii M, Takesue Y. Comparison of antibiotic use and antibiotic resistance between a community hospital and tertiary care hospital for evaluation of the antimicrobial stewardship program in Japan. PLoS One 2023; 18:e0284806. [PMID: 37093821 PMCID: PMC10124824 DOI: 10.1371/journal.pone.0284806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/06/2023] [Indexed: 04/25/2023] Open
Abstract
Assessment of risk-adjusted antibiotic use (AU) is recommended to evaluate antimicrobial stewardship programs (ASPs). We aimed to compare the amount and diversity of AU and antimicrobial susceptibility of nosocomial isolates between a 266-bed community hospital (CH) and a 963-bed tertiary care hospital (TCH) in Japan. The days of therapy/100 bed days (DOT) was measured for four classes of broad-spectrum antibiotics predominantly used for hospital-onset infections. The diversity of AU was evaluated using the modified antibiotic heterogeneity index (AHI). With 10% relative DOT for fluoroquinolones and 30% for each of the remaining three classes, the modified AHI equals 1. Multidrug resistance (MDR) was defined as resistance to ≥ 3 anti-Pseudomonas antibiotic classes. The DOT was significantly higher in the TCH than in the CH (10.85 ± 1.32 vs. 3.89 ± 0.93, p < 0.001). For risk-adjusted AU, the DOT was 6.90 ± 1.50 for acute-phase medical wards in the CH, and 8.35 ± 1.05 in the TCH excluding the hematology department. In contrast, the DOT of antibiotics for community-acquired infections was higher in the CH than that in the TCH. As quality assessment of AU, higher modified AHI was observed in the TCH than in the CH (0.832 ± 0.044 vs. 0.721 ± 0.106, p = 0.003), indicating more diverse use in the TCH. The MDR rate in gram-negative rods was 5.1% in the TCH and 3.4% in the CH (p = 0.453). No significant difference was demonstrated in the MDR rate for Pseudomonas aeruginosa and Enterobacteriaceae species between hospitals. Broad-spectrum antibiotics were used differently in the TCH and CH. However, an increased antibiotic burden in the TCH did not cause poor susceptibility, possibly because of diversified AU. Considering the different patient populations, benchmarking AU according to the facility type is promising for inter-hospital comparisons of ASPs.
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Affiliation(s)
- Mika Morosawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Respiratory Medicine, Tokoname City Hospital, Tokoname, Aichi, Japan
| | - Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tomoko Inoue
- Department of Pharmacy, Tokoname City Hospital, Tokoname, Aichi, Japan
| | - Masanobu Toyama
- Department of Pharmacy, Tokoname City Hospital, Tokoname, Aichi, Japan
| | - Hitoshi Ogasiwa
- Department of Clinical Technology, Tokoname City Hospital, Tokoname, Aichi, Japan
| | - Miki Doi
- Department of Clinical Technology, Tokoname City Hospital, Tokoname, Aichi, Japan
| | - Yasuhiro Nozaki
- Department of Respiratory Medicine, Tokoname City Hospital, Tokoname, Aichi, Japan
| | - Yasushi Murakami
- Department of Respiratory Medicine, Tokoname City Hospital, Tokoname, Aichi, Japan
| | - Makoto Ishii
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
- Department of Clinical Infectious Diseases, Tokoname City Hospital, Tokoname, Japan
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11
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Ogura H, Gohda J, Lu X, Yamamoto M, Takesue Y, Son A, Doi S, Matsushita K, Isobe F, Fukuda Y, Huang TP, Ueno T, Mambo N, Murakami H, Kawaguchi Y, Inoue JI, Shirai K, Yamasaki S, Hirata JI, Ishido S. Dysfunctional Sars-CoV-2-M protein-specific cytotoxic T lymphocytes in patients recovering from severe COVID-19. Nat Commun 2022; 13:7063. [PMID: 36526616 PMCID: PMC9758236 DOI: 10.1038/s41467-022-34655-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/02/2022] [Indexed: 12/23/2022] Open
Abstract
Although the importance of virus-specific cytotoxic T lymphocytes (CTL) in virus clearance is evident in COVID-19, the characteristics of virus-specific CTLs related to disease severity have not been fully explored. Here we show that the phenotype of virus-specific CTLs against immunoprevalent epitopes in COVID-19 convalescents might differ according to the course of the disease. We establish a cellular screening method that uses artificial antigen presenting cells, expressing HLA-A*24:02, the costimulatory molecule 4-1BBL, SARS-CoV-2 structural proteins S, M, and N and non-structural proteins ORF3a and nsp6/ORF1a. The screen implicates SARS-CoV-2 M protein as a frequent target of IFNγ secreting CD8+ T cells, and identifies M198-206 as an immunoprevalent epitope in our cohort of HLA-A*24:02 positive convalescent COVID-19 patients recovering from mild, moderate and severe disease. Further exploration of M198-206-specific CD8+ T cells with single cell RNA sequencing reveals public TCRs in virus-specific CD8+ T cells, and shows an exhausted phenotype with less differentiated status in cells from the severe group compared to cells from the moderate group. In summary, this study describes a method to identify T cell epitopes, indicate that dysfunction of virus-specific CTLs might be an important determinant of clinical outcomes.
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Affiliation(s)
- Hideki Ogura
- grid.272264.70000 0000 9142 153XDepartment of Microbiology, Hyogo Medical University, Hyogo, Japan
| | - Jin Gohda
- grid.26999.3d0000 0001 2151 536XResearch Center for Asian Infectious Diseases, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Xiuyuan Lu
- grid.136593.b0000 0004 0373 3971Laboratory of Molecular Immunology, Immunology Frontier Research Center, Osaka University, Suita, Japan
| | - Mizuki Yamamoto
- grid.26999.3d0000 0001 2151 536XResearch Center for Asian Infectious Diseases, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yoshio Takesue
- grid.272264.70000 0000 9142 153XDepartment of Infection Control and Prevention, Hyogo Medical University, Hyogo, Japan ,Tokoname City Hospital, Aichi, Japan
| | - Aoi Son
- grid.272264.70000 0000 9142 153XDepartment of Microbiology, Hyogo Medical University, Hyogo, Japan
| | - Sadayuki Doi
- grid.513274.60000 0004 0569 8532Kawanishi City Hospital, Hyogo, Japan
| | | | - Fumitaka Isobe
- Kyowa Marina Hospital/Wellhouse Nishinomiya, Hyogo, Japan
| | | | | | - Takamasa Ueno
- grid.274841.c0000 0001 0660 6749Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Naomi Mambo
- grid.272264.70000 0000 9142 153XDepartment of Emergency and Critical Care Medicine, Hyogo Medical University, Hyogo, Japan
| | - Hiromoto Murakami
- grid.272264.70000 0000 9142 153XDepartment of Emergency and Critical Care Medicine, Hyogo Medical University, Hyogo, Japan
| | - Yasushi Kawaguchi
- grid.26999.3d0000 0001 2151 536XResearch Center for Asian Infectious Diseases, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan ,grid.26999.3d0000 0001 2151 536XDivision of Molecular Virology, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Jun-ichiro Inoue
- grid.26999.3d0000 0001 2151 536XResearch Platform Office, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Kunihiro Shirai
- grid.272264.70000 0000 9142 153XDepartment of Emergency and Critical Care Medicine, Hyogo Medical University, Hyogo, Japan
| | - Sho Yamasaki
- grid.136593.b0000 0004 0373 3971Laboratory of Molecular Immunology, Immunology Frontier Research Center, Osaka University, Suita, Japan ,grid.136593.b0000 0004 0373 3971Department of Molecular Immunology, Research Institute for Microbial Diseases, Osaka University, Suita, Japan ,grid.177174.30000 0001 2242 4849Division of Molecular Design, Medical Institute of Bioregulation, Kyushu University, Fukuoka, Japan ,grid.136304.30000 0004 0370 1101Division of Molecular Immunology, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Jun-Ichi Hirata
- grid.272264.70000 0000 9142 153XDepartment of Emergency and Critical Care Medicine, Hyogo Medical University, Hyogo, Japan
| | - Satoshi Ishido
- grid.272264.70000 0000 9142 153XDepartment of Microbiology, Hyogo Medical University, Hyogo, Japan
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12
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Takesue Y, Hanai Y, Oda K, Hamada Y, Ueda T, Mayumi T, Matsumoto K, Fujii S, Takahashi Y, Miyazaki Y, Kimura T. Clinical Practice Guideline for the Therapeutic Drug Monitoring of Voriconazole in Non-Asian and Asian Adult Patients: Consensus Review by the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring. Clin Ther 2022; 44:1604-1623. [DOI: 10.1016/j.clinthera.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/18/2022] [Accepted: 10/28/2022] [Indexed: 11/23/2022]
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13
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Hasegawa T, Tashiro S, Mihara T, Kon J, Sakurai K, Tanaka Y, Morita T, Enoki Y, Taguchi K, Matsumoto K, Nakajima K, Takesue Y. Efficacy of surgical skin preparation with chlorhexidine in alcohol according to the concentration required to prevent surgical site infection: meta-analysis. BJS Open 2022; 6:6704885. [PMID: 36124902 PMCID: PMC9487656 DOI: 10.1093/bjsopen/zrac111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022] Open
Abstract
Background A combination of chlorhexidine gluconate and alcohol (CHG–alcohol) is recommended for surgical skin preparation to prevent surgical site infection (SSI). Although more than 1 per cent CHG–alcohol is recommended to prevent catheter-related bloodstream infections, there is no consensus regarding the concentration of the CHG compound for the prevention of SSI. Methods A systematic review and meta-analysis was performed. Four electronic databases were searched on 5 November 2020. SSI rates were compared between CHG–alcohol and povidone-iodine (PVP-I) according to the concentration of CHG (0.5 per cent, 2.0 per cent, 2.5 per cent, and 4.0 per cent). Results In total, 106 of 2716 screened articles were retrieved for full-text review. The risk ratios (RRs) of SSI for 0.5 per cent (6 studies) and 2.0 per cent (4 studies) CHG–alcohol were significantly lower than those for PVP-I (RR = 0.71, 95 per cent confidence interval (c.i.) 0.52 to 0.97; RR = 0.52, 95 per cent c.i 0.31 to 0.86 respectively); however, no significant difference was observed in the compounds with a CHG concentration of more than 2.0 per cent. Conclusions This meta-analysis is the first study that clarifies the usefulness of an alcohol-based CHG solution with a 0.5 per cent or higher CHG concentration for surgical skin preparation to prevent SSI.
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Affiliation(s)
- Tatsuki Hasegawa
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy , Minato-ku, Tokyo , Japan
| | - Sho Tashiro
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy , Minato-ku, Tokyo , Japan
| | - Takayuki Mihara
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy , Minato-ku, Tokyo , Japan
| | - Junya Kon
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy , Minato-ku, Tokyo , Japan
| | - Kazuki Sakurai
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy , Minato-ku, Tokyo , Japan
| | - Yoko Tanaka
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy , Minato-ku, Tokyo , Japan
| | - Takumi Morita
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy , Minato-ku, Tokyo , Japan
| | - Yuki Enoki
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy , Minato-ku, Tokyo , Japan
| | - Kazuaki Taguchi
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy , Minato-ku, Tokyo , Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy , Minato-ku, Tokyo , Japan
| | - Kazuhiko Nakajima
- Department of Infection Prevention and Control, Hyogo College of Medicine , Nishinomiya, Hyogo , Japan
| | - Yoshio Takesue
- Department of Infection Prevention and Control, Hyogo College of Medicine , Nishinomiya, Hyogo , Japan
- Department of Clinical Infectious Diseases, Tokoname City Hospital , Tokoname, Aichi , Japan
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14
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Otani N, Nakajima K, Ishikawa K, Ichiki K, Yoda Y, Ueda T, Takesue Y, Yamamoto T, Tanimura S, Shima M, Okuno T. Comparison of the Hemagglutination Inhibition Titers against Influenza Vaccine Strains in Japan from the 2017/2018 to 2021/2022 Seasons Using a Single Set of Serum Samples. Viruses 2022; 14:v14071455. [PMID: 35891435 PMCID: PMC9323423 DOI: 10.3390/v14071455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 12/10/2022] Open
Abstract
In Japan, inactivated influenza vaccines are used. We measured titers of antibodies to vaccine strains of three influenza types—influenza A (H1N1), influenza A (H3N2), and influenza B/Victoria—from the 2017/2018 to 2021/2022 seasons, but not for influenza A (H3N2) from the 2018/2019 season, using a single set of serum samples from 34 healthy volunteers, and assessed the consistency in antibody positivity between seasons. The antibody titers in the 2017/2018 season were used as a reference. The influenza A (H1N1) antibody titer in 2019/2020 did not differ significantly from that in the 2017/2018 season, but the titers varied in the two subsequent seasons. The influenza A (H3N2) antibody titers toward the 2019/2020, 2020/2021, and 2021/2022 seasonal viruses differed significantly from that in the 2017/2018 season. The influenza B/Victoria antibody titer toward the 2019/2020 seasonal antigen differed from that in the 2017/2018 season, and the antibody positivity was inconsistent between seasons; however, the antibody titer in the 2020/2021 season did not differ significantly from those in the prior two seasons, and the antibody positivity was consistent between seasons. Antibody titers and their consistency can be used to evaluate cross-immunity of antibodies.
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Affiliation(s)
- Naruhito Otani
- Department of Public Health, Hyogo Medical University, Nishinomiya 663-8501, Japan; (Y.Y.); (M.S.)
- Correspondence: ; Tel.: +81-798-45-6566; Fax: +81-798-45-6567
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo Medical University, Nishinomiya 663-8501, Japan; (K.N.); (K.I.); (K.I.); (T.U.); (Y.T.)
| | - Kaori Ishikawa
- Department of Infection Control and Prevention, Hyogo Medical University, Nishinomiya 663-8501, Japan; (K.N.); (K.I.); (K.I.); (T.U.); (Y.T.)
| | - Kaoru Ichiki
- Department of Infection Control and Prevention, Hyogo Medical University, Nishinomiya 663-8501, Japan; (K.N.); (K.I.); (K.I.); (T.U.); (Y.T.)
| | - Yoshiko Yoda
- Department of Public Health, Hyogo Medical University, Nishinomiya 663-8501, Japan; (Y.Y.); (M.S.)
| | - Takashi Ueda
- Department of Infection Control and Prevention, Hyogo Medical University, Nishinomiya 663-8501, Japan; (K.N.); (K.I.); (K.I.); (T.U.); (Y.T.)
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo Medical University, Nishinomiya 663-8501, Japan; (K.N.); (K.I.); (K.I.); (T.U.); (Y.T.)
| | - Takuma Yamamoto
- Department of Legal Medicine, Hyogo Medical University, Nishinomiya 663-8501, Japan;
| | - Susumu Tanimura
- Department of Public Health Nursing, Mie University Graduate School of Medicine, Tsu 514-0001, Japan;
| | - Masayuki Shima
- Department of Public Health, Hyogo Medical University, Nishinomiya 663-8501, Japan; (Y.Y.); (M.S.)
| | - Toshiomi Okuno
- Department of Microbiology, Hyogo Medical University, Nishinomiya 663-8501, Japan;
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15
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Hanai Y, Takahashi Y, Niwa T, Mayumi T, Hamada Y, Kimura T, Matsumoto K, Fujii S, Takesue Y. Clinical practice guidelines for therapeutic drug monitoring of teicoplanin: a consensus review by the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring. J Antimicrob Chemother 2022; 77:869-879. [PMID: 35022752 PMCID: PMC8969460 DOI: 10.1093/jac/dkab499] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Owing to its low risk of adverse effects, teicoplanin has been extensively used in patients with infections caused by MRSA. To promote the better management of patients receiving teicoplanin, we have updated the guidelines for therapeutic drug monitoring (TDM). Methods The guidelines were developed by a committee following the methodology handbook published by the Japanese Medical Information Distribution Service. Nine clinical questions were selected. The committee conducted a systematic review and meta-analysis to establish evidence-based recommendations for the target trough concentration (Cmin). An initial electronic database search returned 515 articles, and 97 articles qualified for a full review. Four and five studies were included for the efficacy evaluation of cut-off Cmin values of 15 and 20 mg/L, respectively. Results Compared with Cmin < 15 mg/L, a target Cmin value of 15–30 mg/L resulted in increased clinical efficacy in patients with non-complicated MRSA infections (OR = 2.68; 95% CI = 1.14–6.32) without an increase in adverse effects. Although there was insufficient evidence, target Cmin values of 20–40 mg/L were suggested in patients with complicated or serious MRSA infections. A 3 day loading regimen followed by maintenance treatment according to renal function was recommended to achieve the target trough concentrations. Because of the prolonged half-life of teicoplanin, measurement of the Cmin value on Day 4 before reaching steady state was recommended. Conclusions The new guideline recommendations indicate the target Cmin value for TDM and the dosage regimen to achieve this concentration and suggest practices for specific subpopulations.
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Affiliation(s)
- Yuki Hanai
- Department of Pharmacy, Toho University Omori Medical Center, Tokyo, Japan
| | - Yoshiko Takahashi
- Department of Pharmacy, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takashi Niwa
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yukihiro Hamada
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Satoshi Fujii
- Department of Hospital Pharmacy, Sapporo Medical University Hospital, Hokkaido, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
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16
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Ueda T, Takesue Y, Nakajima K, Ichiki K, Ishikawa K, Yamada K, Tsuchida T, Otani N, Ide T, Takeda K, Nishi S, Takahashi Y, Ishihara M, Takubo S, Ikeuchi H, Uchino M, Kimura T. Enhanced loading dose of teicoplanin for three days is required to achieve a target trough concentration of 20 μg/mL in patients receiving continuous venovenous haemodiafiltration with a low flow rate. J Infect Chemother 2021; 28:232-237. [PMID: 34844858 DOI: 10.1016/j.jiac.2021.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/06/2021] [Accepted: 10/24/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Because of its lower risk of renal toxicity than vancomycin, teicoplanin is the preferred treatment for methicillin-resistant Staphylococcus aureus infection in patients undergoing continuous venovenous haemodiafiltration (CVVHDF) in whom renal function is expected to recover. The dosing regimen for achieving a trough concentration (Cmin) of ≥20 μg/mL remains unclear in patients on CVVHDF using the low flow rate adopted in Japan. METHODS The study was conducted in patients undergoing CVVHDF with a flow rate of <20 mg/kg/h who were treated with teicoplanin. We adopted three loading dose regimens for the initial 3 days: the conventional regimen, a high-dose regimen (four doses of 10 mg/kg), and an enhanced regimen (four doses of 12 mg/kg). The initial Cmin was obtained at 72 h after the first dose. RESULTS Overall, 60 patients were eligible for study inclusion. The proportion of patients achieving the Cmin target was significantly higher for the enhanced regimen than for the high-dose regimen (52.9% versus 8.3%, p = 0.003). In multivariate analysis, the enhanced regimen (odds ratio [OR] = 39.93, 95% confidence interval [CI] = 5.03-317.17) and hypoalbuminaemia (OR = 0.04, 95% CI = 0.01-0.44) were independent predictors of the achievement of Cmin ≥ 20 μg/mL. CONCLUSIONS An enhanced teicoplanin regimen was proposed to treat complicated or invasive infections by methicillin-resistant Staphylococcus aureus in patients receiving CVVHDF even with a low flow rate.
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Affiliation(s)
- Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Department of Clinical Infectious Diseases, Tokoname City Hospital, Tokoname, Aichi, Japan.
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Kaoru Ichiki
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Kaori Ishikawa
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Kumiko Yamada
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Toshie Tsuchida
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Naruhito Otani
- Department of Public Health, Hyogo College of Medicine, Nishinomiya, Nishinomiya, Hyogo, Japan.
| | - Takeshi Ide
- Division of Intensive Care Unit, Hyogo College of Medicine, Hyogo, Japan.
| | - Kenta Takeda
- Division of Intensive Care Unit, Hyogo College of Medicine, Hyogo, Japan.
| | - Shinichi Nishi
- Division of Intensive Care Unit, Hyogo College of Medicine, Hyogo, Japan.
| | - Yoshiko Takahashi
- Department of Pharmacy, Hyogo College of Medicine Hospital, Nishinomiya, Hyogo, Japan.
| | - Mika Ishihara
- Department of Pharmacy, Hyogo College of Medicine Hospital, Nishinomiya, Hyogo, Japan.
| | - Shingo Takubo
- Department of Pharmacy, Hyogo College of Medicine Hospital, Nishinomiya, Hyogo, Japan.
| | - Hiroki Ikeuchi
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Motoi Uchino
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Takeshi Kimura
- Department of Pharmacy, Hyogo College of Medicine Hospital, Nishinomiya, Hyogo, Japan.
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17
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Nakada-Motokawa N, Miyazaki T, Ueda T, Yamagishi Y, Yamada K, Kawamura H, Kakeya H, Mukae H, Mikamo H, Takesue Y, Kohno S. Modified Pitt bacteremia score for predicting mortality in patients with candidaemia: A multicentre seven-year retrospective study conducted in Japan. Mycoses 2021; 64:1498-1507. [PMID: 34655487 PMCID: PMC9297953 DOI: 10.1111/myc.13380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several severity indexes have been reported for critically ill patients. The Pitt bacteremia score (PBS) is commonly used to predict the risk of mortality in patients with bacteraemia. OBJECTIVES To develop a scoring system for predicting mortality in candidaemia patients. METHODS Medical records at five Japanese tertiary hospitals were reviewed. Factors associated with mortality were analysed using logistic regression modelling. The discriminatory power of scoring models was evaluated by assessing the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI) and integrated discrimination improvement (IDI). RESULTS In total, 422 candidaemia patients were included. Higher PBS, dialysis and retainment of central venous catheter were independent risk factors for all-cause 30-day mortality. However, among the five PBS components, fever was not associated with mortality; therefore, we developed a modified version of the PBS (mPBS) by replacing fever with dialysis. AUC for PBS and mPBS were 0.74 (95% confidence interval [CI]: 0.68-0.80) and 0.76 (95% CI: 0.71-0.82), respectively. The increase in predictive ability of mPBS for 30-day mortality was statistically significant as assessed by NRI (0.24, 95% CI: 0.01-0.46, p = .04) and IRI (0.04, 95% CI: 0.02-0.06, p = .0008). When patients were stratified by mPBS into low (scores 0-3), moderate (4-7) and high risk (≥8), there were significant differences among the survival curves (p < .0001, log-rank test), and 30-day mortality rates were 13.8% (40/290), 36.8% (28/76) and 69.4% (34/49), respectively. CONCLUSIONS mPBS can be a useful tool for predicting mortality in candidaemia patients.
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Affiliation(s)
| | - Taiga Miyazaki
- Department of Respiratory Medicine, Nagasaki University, Nagasaki, Japan.,Division of Respirology, Rheumatology, Infectious Diseases, and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute, Japan
| | - Koichi Yamada
- Department of Infection Control Science, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hideki Kawamura
- Division of Medical and Environmental Safety, Department of Infection Control and Prevention, Kagoshima University Hospital, Kagoshima, Japan
| | - Hiroshi Kakeya
- Department of Infection Control Science, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University, Nagasaki, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, Nagakute, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shigeru Kohno
- Department of Respiratory Medicine, Nagasaki University, Nagasaki, Japan
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18
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Hashimoto N, Kimura T, Hamada Y, Niwa T, Hanai Y, Chuma M, Fujii S, Matsumoto K, Shigemi A, Kawamura H, Takahashi Y, Takesue Y. Candidates for area under the concentration-time curve (AUC)-guided dosing and risk reduction based on analyses of risk factors associated with nephrotoxicity in vancomycin-treated patients. J Glob Antimicrob Resist 2021; 27:12-19. [PMID: 34371241 DOI: 10.1016/j.jgar.2021.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/22/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES Compared with vancomycin trough concentration (Cmin)-guided dosing, area under the concentration-time curve (AUC)-guided dosing is associated with decreased acute kidney injury (AKI). However, whether Cmin-guided or AUC-guided dosing should be used in patients other than those with serious MRSA infections remains uncertain. The purposes of this multicentre study were to identify risk factors for early- and late-phase vancomycin-induced AKI and to identify candidates for AUC-guided dosing, rather than Cmin-guided dosing, who require a more accurate dose titration to reduce the AKI risk. METHODS A multivariate logistic regression analysis was applied to identify risk factors for AKI. Additionally, the cut‑off day for AKI onset, cut-off Cmin for AKI, safe Cmin for reduced AKI risk and probability of AKI were calculated. RESULTS In total, 8.4% (159/1882) of patients developed AKI. AKI occurred within the first 7 days of therapy (early phase) in the vast majority of patients. Significant risk factors for AKI during the early phase were identified as Cmin > 20 mg/L, ICU stay, concurrent diuretic or piperacillin/tazobactam use, and pre-existing renal dysfunction. A temporarily elevated Cmin (>15-20 mg/L) was not associated with a greater risk of AKI. In patients with risk factors, the cut-off Cmin for AKI and the estimated safe Cmin for reduced AKI risk were 18.8-21.0 mg/L and <11.7-13.5 mg/L, respectively. CONCLUSION Patients with known AKI risk factors require a low target Cmin. The presence of several risk factors for AKI may indicate a need for more accurate dose titration using AUC-guided dosing.
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Affiliation(s)
- Naoto Hashimoto
- Department of Pharmacy, Tokyo Women's Medical University Hospital, 8-1 Kawadacho, Shinjuku, Tokyo 162-8666, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women's Medical University Hospital, 8-1 Kawadacho, Shinjuku, Tokyo 162-8666, Japan.
| | - Yukihiro Hamada
- Department of Pharmacy, Tokyo Women's Medical University Hospital, 8-1 Kawadacho, Shinjuku, Tokyo 162-8666, Japan
| | - Takashi Niwa
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagito, Gifu, Gifu 501-1194, Japan
| | - Yuki Hanai
- Department of Pharmacy, Toho University Omori Medical Center, 6-11-1 Omorinishi, Ota, Tokyo 143-8541, Japan
| | - Masayuki Chuma
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, 2-50-1 Kuramotocho, Tokushima, Tokushima 770-8503, Japan
| | - Satoshi Fujii
- Department of Pharmacy, Sapporo Medical University Hospital, 291 Minami 1-jo, Nishi 16-chome, Chuo, Sapporo, Hokkaidou 060-8556, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato, Tokyo 105-8512, Japan
| | - Akari Shigemi
- Department of Pharmacy, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima 890-8520, Japan
| | - Hideki Kawamura
- Department of Infection Control and Prevention, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima 890-8520, Japan
| | - Yoshiko Takahashi
- Department of Pharmacy, Hyogo College of Medicine Hospital, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501, Japan
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19
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Otani N, Nakajima K, Ishikawa K, Ichiki K, Ueda T, Takesue Y, Yamamoto T, Tanimura S, Shima M, Okuno T. Changes in Cell-Mediated Immunity (IFN-γ and Granzyme B) Following Influenza Vaccination. Viruses 2021; 13:v13061137. [PMID: 34199161 PMCID: PMC8231587 DOI: 10.3390/v13061137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 11/18/2022] Open
Abstract
Interferon gamma (IFN-γ) is considered a key moderator of cell-mediated immunity. However, little is known about its association with granzyme B, which plays an important role in the effector function of cytotoxic T lymphocytes (CTLs). In the present study, we collected blood samples from 32 healthy adults before and after vaccination with inactivated influenza vaccine in 2017/18 to measure the levels of IFN-γ and granzyme B, which play roles in cell-mediated immunity, and hemagglutination inhibition (HAI) antibody, which plays a role in humoral immunity. The levels of IFN-γ and granzyme B were significantly correlated both before and after vaccination. Furthermore, the post-vaccine fold increases in the IFN-γ and granzyme B levels were significantly correlated. The levels of IFN-γ and granzyme B decreased five months after vaccination in more than half of the subjects who exhibited an increase in IFN-γ and granzyme B at two weeks post-vaccination. This is the first study to investigate the correlation between IFN-γ and granzyme B levels following influenza vaccination. Our study suggests that both IFN-γ and granzyme B can be used as markers of cell-mediated immunity.
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Affiliation(s)
- Naruhito Otani
- Department of Public Health, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan;
- Correspondence: ; Tel.: +81-798-45-6566; Fax: +81-798-45-6567
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan; (K.N.); (K.I.); (K.I.); (T.U.); (Y.T.)
| | - Kaori Ishikawa
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan; (K.N.); (K.I.); (K.I.); (T.U.); (Y.T.)
| | - Kaoru Ichiki
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan; (K.N.); (K.I.); (K.I.); (T.U.); (Y.T.)
| | - Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan; (K.N.); (K.I.); (K.I.); (T.U.); (Y.T.)
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan; (K.N.); (K.I.); (K.I.); (T.U.); (Y.T.)
| | - Takuma Yamamoto
- Department of Legal Medicine, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan;
| | - Susumu Tanimura
- Department of Public Health Nursing, Mie University Graduate School of Medicine, Tsu 514-0001, Mie, Japan;
| | - Masayuki Shima
- Department of Public Health, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan;
| | - Toshiomi Okuno
- Department of Microbiology, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan;
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20
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Ueda T, Takesue Y, Matsumoto T, Tateda K, Kusachi S, Mikamo H, Sato J, Hanaki H, Mizuguchi T, Morikane K, Kobayashi M, Harihara Y, Seki S, Ishida Y, Fukushima R, Hada M, Matsuo Y, Kubo S, Kimura Y, Hata H, Nakajima K, Ohge H, Akagi S, Takeda S, Fukui Y, Suzuki K, Okamoto K, Yanagihara K, Kawamura H. Change in antimicrobial susceptibility of pathogens isolated from surgical site infections over the past decade in Japanese nation-wide surveillance study. J Infect Chemother 2021; 27:931-939. [PMID: 33795192 DOI: 10.1016/j.jiac.2021.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/01/2021] [Accepted: 03/11/2021] [Indexed: 12/24/2022]
Abstract
Inappropriate antimicrobial therapy for surgical site infections (SSIs) can lead to poor outcomes and an increased risk of antibiotic resistance. A nationwide survey was conducted in Japan from 2018 to 2019 to investigate the antimicrobial susceptibility of pathogens isolated from SSIs. The data were compared with those obtained in 2010 and 2014-2015 surveillance studies. Although the rate of detection of extended-spectrum β-lactamase producing strains of Escherichia coli was increased from 9.5% in 2010 to 23% in 2014-2015, the incidence decreased to 8.7% in 2018-2019. Although high susceptibility rates were detected to piperacillin/tazobactam (TAZ), the geometric mean MICs were substantially higher than to meropenem (2.67 vs 0.08 μg/mL). By contrast, relatively low geometric mean MICs (0.397 μg/mL) were demonstrated for ceftolozane/TAZ. Although the MRSA incidence rate decreased from 72% in the first surveillance to 53% in the second, no further decrease was detected in 2018-2019. For the Bacteroides fragilis group species, low levels of susceptibility were observed for moxifloxacin (65.3%), cefoxitin (65.3%), and clindamycin (CLDM) (38.9%). In particular, low susceptibility against cefoxitin was demonstrated in non-fragilis Bacteroides, especially B. thetaiotaomicron. By contrast, low susceptibility rates against CLDM were demonstrated in both B. fragilis and non-fragilis Bacteroides species, and a steady decrease in susceptibility throughout was observed (59.3% in 2010, 46.9% in 2014-2015, and 38.9% in 2018-2019). In conclusion, Japanese surveillance data revealed no significant lowering of antibiotic susceptibility over the past decade in organisms commonly associated from SSIs, with the exception of the B. fragilis group.
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Affiliation(s)
- Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Yoshio Takesue
- The Surveillance Committee of Japanese Society of Cemotherapy (JSC), The Japanese Association for Infectious Disease (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tetsuya Matsumoto
- The Surveillance Committee of Japanese Society of Cemotherapy (JSC), The Japanese Association for Infectious Disease (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan
| | - Kazuhiro Tateda
- The Surveillance Committee of Japanese Society of Cemotherapy (JSC), The Japanese Association for Infectious Disease (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan
| | - Shinya Kusachi
- The Surveillance Committee of Japanese Society of Cemotherapy (JSC), The Japanese Association for Infectious Disease (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan
| | - Hiroshige Mikamo
- The Surveillance Committee of Japanese Society of Cemotherapy (JSC), The Japanese Association for Infectious Disease (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan; Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan
| | - Junko Sato
- The Surveillance Committee of Japanese Society of Cemotherapy (JSC), The Japanese Association for Infectious Disease (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan
| | - Hideaki Hanaki
- Infection Control Research Center, Kitasato University, Tokyo, Japan
| | - Toru Mizuguchi
- Department of Nursing, Surgical Science, Sapporo Medical University, Hokkaido Japan
| | - Keita Morikane
- Division of Clinical Laboratory and Infection Control, Yamagata University Hospital, Yamagata, Japan
| | | | | | - Shiko Seki
- Department of Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yuichi Ishida
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryoji Fukushima
- Department of Surgery, Teikyo University Hospital, Tokyo, Japan
| | - Masahiro Hada
- Department of Surgery, Kouseiren Takaoka Hospital, Toyama, Japan
| | - Yoichi Matsuo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yutaka Kimura
- Department of Surgery, Kindai University Hospital, Osaka, Japan
| | - Hiroaki Hata
- Department of Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Akagi
- Department of Surgery, Mazda Hospital, Mazda Motor Corporation, Hiroshima, Japan
| | - Shigeru Takeda
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yasuo Fukui
- Department of Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Katsunori Suzuki
- University of Occupational and Environmental Health Japan, Fukuoka, Japan
| | - Kohji Okamoto
- Department of Surgery, Gastroenterology and Hepatology Center, Kitakyushu City Yahata Hospital, Fukuoka, Japan
| | | | - Hideki Kawamura
- Department of Infection Control and Prevention, Kagoshima University Hospital, Kagoshima, Japan
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21
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Oda K, Hashiguchi Y, Kimura T, Tsuji Y, Shoji K, Takahashi Y, Matsumoto K, Kawamura H, Saito H, Takesue Y. Performance of Area under the Concentration-Time Curve Estimations of Vancomycin with Limited Sampling by a Newly Developed Web Application. Pharm Res 2021; 38:637-646. [PMID: 33782837 DOI: 10.1007/s11095-021-03030-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Therapeutic drug monitoring guided by the area under the concentration-time curve (AUC-guided TDM) is recommended for vancomycin. However, validated efficient software remains elusive to popularize AUC-guided TDM in Japan. The aim of this study was to validate a newly developed web application, PAT, for AUC estimation. METHODS PAT was developed on the R ver. 3.6.2 platform for use with mobile phones and personal computers. AUC estimated by PAT (AUCPAT) was evaluated against the reference AUC (AUCREF) calculated with the log-linear trapezoidal rule using eight measured concentrations, or against AUC (AUCBM-P) calculated using an evaluated available software with clinical data. RESULTS Investigating the best sampling points with limited sampling, PAT produced the least bias using two concentrations at 1 h and 11 h after the end of infusion (slope 1.18, intercept -15.57, median AUCPAT/AUCREF 0.93 [range 0.81-1.24]), where only one estimation (6%) was out of the predetermined acceptable range of 0.8-1.2. Employment of only a trough concentration was more biased (AUCPAT/AUCREF range 0.73-1.30 for 11 h, AUCPAT/AUCREF range 0.62-1.40 for 23 h). In comparison with the evaluated software, AUCPAT was not biased against the AUCBM-P (slope 1.04, intercept -15.80, median AUCPAT/AUCBM-P 1.00 [range 0.86-1.10]). CONCLUSIONS The new application using two concentrations was appropriately validated and might be efficient in popularizing the AUC-guided TDM of vancomycin.
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Affiliation(s)
- Kazutaka Oda
- Department of Pharmacy, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan. .,Department of Infection Control, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan.
| | - Yumi Hashiguchi
- Department of Pharmacy, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yasuhiro Tsuji
- Center for Pharmacist Education, School of Pharmacy, Nihon University, 7-7-1, Narashinodai, Funabashi-shi, Chiba, 274-8555, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Yoshiko Takahashi
- Department of Pharmacy, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya-shi, Hyogo, 663-8501, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30, Shibakoen, Minato-ku, Tokyo, 105-8512, Japan
| | - Hideki Kawamura
- Department of Infection Control and Prevention, Kagoshima University Hospital, 8-35-1, Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Hideyuki Saito
- Department of Pharmacy, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya-shi, Hyogo, 663-8501, Japan
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22
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Ishikawa H, Uchida K, Takesue Y, Mori J, Kinoshita T, Morikawa S, Okamoto F, Sawada T, Ohji M, Kanda T, Takeuchi M, Miki A, Kusuhara S, Ueda T, Ogata N, Sugimoto M, Kondo M, Yoshida S, Ogata T, Kimura K, Mitamura Y, Jujo T, Takagi H, Terasaki H, Sakamoto T, Sugisawa T, Komuku Y, Gomi F. Clinical Characteristics and Outcomes in 314 Japanese Patients with Bacterial Endophthalmitis: A Multicenter Cohort Study from J-CREST. Pathogens 2021; 10:pathogens10040390. [PMID: 33805010 PMCID: PMC8063932 DOI: 10.3390/pathogens10040390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 12/25/2022] Open
Abstract
Bacterial endophthalmitis is an intraocular infection that causes rapid vison loss. Pathogens can infect the intraocular space directly (exogenous endophthalmitis (ExE)) or indirectly (endogenous endophthalmitis (EnE)). To identify predictive factors for the visual prognosis of Japanese patients with bacterial endophthalmitis, we retrospectively examined the bacterial endophthalmitis characteristics of 314 Japanese patients and performed statistics using these clinical data. Older patients, with significantly more severe clinical symptoms, were prevalent in the ExE group compared with the EnE group. However, the final best-corrected visual acuity (BCVA) was not significantly different between the ExE and EnE groups. Bacteria isolated from patients were not associated with age, sex, or presence of eye symptoms. Genus Streptococcus, Streptococcus pneumoniae, and Enterococcus were more prevalent in ExE patients than EnE patients and contributed to poor final BCVA. The presence of eye pain, bacterial identification, and poor BCVA at baseline were risk factors for final visual impairment.
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Affiliation(s)
- Hiroto Ishikawa
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya 6638501, Japan; (T.S.); (Y.K.); (F.G.)
- Correspondence: ; Tel.: +81-798-45-6462
| | - Kazutaka Uchida
- Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya 6638501, Japan;
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya 6638501, Japan;
| | - Junya Mori
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo 0608604, Japan; (J.M.); (T.K.)
| | - Takamasa Kinoshita
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo 0608604, Japan; (J.M.); (T.K.)
| | - Shohei Morikawa
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba 3058576, Japan; (S.M.); (F.O.)
| | - Fumiki Okamoto
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba 3058576, Japan; (S.M.); (F.O.)
| | - Tomoko Sawada
- Department of Ophthalmology, Shiga University of Medical Science, Otsu 5202192, Japan; (T.S.); (M.O.)
| | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Otsu 5202192, Japan; (T.S.); (M.O.)
| | - Takayuki Kanda
- Department of Ophthalmology, National Defense Medical College, Tokorozawa 3598513, Japan; (T.K.); (M.T.)
| | - Masaru Takeuchi
- Department of Ophthalmology, National Defense Medical College, Tokorozawa 3598513, Japan; (T.K.); (M.T.)
| | - Akiko Miki
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe 6500017, Japan; (A.M.); (S.K.)
| | - Sentaro Kusuhara
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe 6500017, Japan; (A.M.); (S.K.)
| | - Tetsuo Ueda
- Department of Ophthalmology, Nara Medical University School of Medicine, Kashihara 6348522, Japan; (T.U.); (N.O.)
| | - Nahoko Ogata
- Department of Ophthalmology, Nara Medical University School of Medicine, Kashihara 6348522, Japan; (T.U.); (N.O.)
| | - Masahiko Sugimoto
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu 5148507, Japan; (M.S.); (M.K.)
| | - Mineo Kondo
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu 5148507, Japan; (M.S.); (M.K.)
| | - Shigeo Yoshida
- Department of Ophthalmology, Kurume University School of Medicine, Kurume 8300011, Japan;
| | - Tadahiko Ogata
- Department of Ophthalmology, Graduate School of Medicine, Yamaguchi University, Ube 7558505, Japan; (T.O.); (K.K.)
| | - Kazuhiro Kimura
- Department of Ophthalmology, Graduate School of Medicine, Yamaguchi University, Ube 7558505, Japan; (T.O.); (K.K.)
| | - Yoshinori Mitamura
- Department of Ophthalmology, Tokushima University Graduate School, Tokushima 7708503, Japan;
| | - Tatsuya Jujo
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki 2168511, Japan; (T.J.); (H.T.)
| | - Hitoshi Takagi
- Department of Ophthalmology, St. Marianna University School of Medicine, Kawasaki 2168511, Japan; (T.J.); (H.T.)
| | - Hiroto Terasaki
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 8908520, Japan; (H.T.); (T.S.)
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 8908520, Japan; (H.T.); (T.S.)
| | - Takaaki Sugisawa
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya 6638501, Japan; (T.S.); (Y.K.); (F.G.)
| | - Yuki Komuku
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya 6638501, Japan; (T.S.); (Y.K.); (F.G.)
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya 6638501, Japan; (T.S.); (Y.K.); (F.G.)
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23
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Ikeuchi H, Uchino M, Bando T, Horio Y, Kuwahara R, Minagawa T, Goto Y, Kusunoki K, Ikeda M, Beppu N, Takesue Y. Localization of recurrent lesions following ileocolic resection for Crohn's disease. BMC Surg 2021; 21:145. [PMID: 33743665 PMCID: PMC7980576 DOI: 10.1186/s12893-020-00980-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/22/2020] [Indexed: 12/13/2022] Open
Abstract
Background Crohn’s disease (CD) recurrence can occur not only at the site of anastomosis but also elsewhere in the bowel following an ileocolic resection (ICR) procedure. The aims of the present study were to assess long-term outcomes of a primary ICR procedure for CD in consecutive patients and examine the location of the reoperation causative lesion. Methods We examined cases of surgery with ICR initially performed at our institution. Those with simultaneous multiple bowel resection or bowel resection with strictureplasty were excluded. Results A total of 169 patients who underwent ICR due to CD were enrolled. The median follow-up period was 12.6 years (range 4–27 years). A reoperation was needed in 45 (26.6%), of whom 14 had lesions causative of the reoperation at other than the anastomotic site. The most common causative lesion location was in the colon rather than the oral side of the small intestine. Furthermore, we investigated the relationship between presence of residual lesions following the initial surgery and lesions causative of reoperation. In the group without residual disease (n = 31), 29.0% (n = 9) had non-anastomotic lesions involved in indications for reoperation, while that was 35.7% (n = 5) in the group with residual disease (n = 14). Conclusions Anastomotic site lesion is not the only causative factor for reoperation following ICR. Regular examinations and applicable treatment with awareness that the cause of reoperation is not limited to the site of anastomosis are important in these cases.
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Affiliation(s)
- Hiroki Ikeuchi
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Motoi Uchino
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Toshihiro Bando
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yuki Horio
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Ryuichi Kuwahara
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tomohiro Minagawa
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshiko Goto
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Kurando Kusunoki
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Masataka Ikeda
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Naohito Beppu
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshio Takesue
- Division of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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24
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Moriyama H, Tsutsuura M, Kojima N, Mizukami Y, Tashiro S, Osa S, Enoki Y, Taguchi K, Oda K, Fujii S, Takahashi Y, Hamada Y, Kimura T, Takesue Y, Matsumoto K. The optimal trough-guided monitoring of vancomycin in children: Systematic review and meta-analyses. J Infect Chemother 2021; 27:781-785. [PMID: 33563525 DOI: 10.1016/j.jiac.2021.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/08/2021] [Accepted: 01/26/2021] [Indexed: 11/26/2022]
Abstract
We carried out a systematic review and meta-analysis exploring the relationship between vancomycin (VCM) trough concentrations and its effectiveness and nephrotoxicity in pediatric patients. We conducted our analysis using MEDLINE, Web of Sciences, and Cochrane Register of Controlled Trials as electronic databases (June 29, 2019). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. We identified 16 studies that were eligible for the meta-analysis. A total of 351 and 3,266 patients were included in the analysis for effectiveness and nephrotoxicity, respectively. Pediatric MRSA infection patients with VCM trough concentrations ≥ 10 μg/mL had significantly lower treatment failure rates (OR 0.54, 95% CI 0.30-0.96). The incidence of nephrotoxicity was significantly higher in trough concentrations ≥ 15 μg/mL than when they were < 15 μg/mL (OR 3.02, 95% CI 2.08-4.38). We identified the optimal VCM trough concentrations associated with effectiveness and nephrotoxicity in pediatric patients with MRSA infection. Further prospective studies are needed to find optimal dosing and monitoring strategy on VCM in pediatric population.
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Affiliation(s)
- Hiromu Moriyama
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan
| | - Moeko Tsutsuura
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan
| | - Nana Kojima
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan
| | - Yuki Mizukami
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan
| | - Sho Tashiro
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan
| | - Sumika Osa
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan
| | - Yuki Enoki
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan.
| | - Kazuaki Taguchi
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan
| | - Kazutaka Oda
- Department of Pharmacy, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan
| | - Satoshi Fujii
- Department of Hospital Pharmacy, Sapporo Medical University Hospital, 16-291, South 1, West 16, Chuo-ku, Sapporo-shi, Hokkaido, 060-8543, Japan
| | - Yoshiko Takahashi
- Department of Pharmacy, Hyogo College of Medicine, 1-1, Mukogawa-machi, Nishinomiya-shi, Hyogo, 663-8501, Japan
| | - Yukihiro Hamada
- Department of Pharmacy, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya-shi, Hyogo, 663-8501, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan
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25
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Hanai Y, Takahashi Y, Niwa T, Mayumi T, Hamada Y, Kimura T, Matsumoto K, Fujii S, Takesue Y. Optimal trough concentration of teicoplanin for the treatment of methicillin-resistant Staphylococcus aureus infection: A systematic review and meta-analysis. J Clin Pharm Ther 2021; 46:622-632. [PMID: 33547647 DOI: 10.1111/jcpt.13366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/26/2020] [Accepted: 01/19/2021] [Indexed: 12/24/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE It has been recommended that the trough concentration (Cmin ) of teicoplanin should be maintained at ≥20 μg/ml for difficult-to-treat complicated infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Conversely, Cmin of teicoplanin of at least 10 μg/ml is required for non-complicated MRSA infections. Considering the low incidence of nephrotoxicity for teicoplanin, Cmin = 15-30 μg/ml has been suggested for most MRSA infections. Thus, we assessed the clinical efficacy and adverse effects of teicoplanin at this target Cmin . METHODS We searched electronic databases (PubMed, Cochrane Central Register of Controlled Trials and Ichushi-Web) to identify eligible studies. Studies were included if they provided the incidence of treatment success, mortality in patients with MRSA infection, and/or hepatotoxicity and nephrotoxicity according to the Cmin range. RESULTS AND DISCUSSION Four trials assessing clinical success (n = 299) and three studies assessing adverse effects (n = 546) were included. Cmin = 15-30 μg/ml significantly increased the probability of treatment success compared with Cmin < 15 μg/ml (odds ratio [OR] = 2.68, 95% confidence interval [CI] = 1.14-6.32, p = 0.02). The all-cause mortality rate did not differ between the groups (OR = 0.46, 95% CI = 0.13-1.61, p = 0.22). Cmin = 15-30 μg/ml did not increase the risks of nephrotoxicity (OR = 0.91, 95% CI = 0.49-1.69, p = 0.76) or hepatotoxicity (OR = 0.67, 95% CI = 0.18-2.44, p = 0.54). WHAT IS NEW AND CONCLUSION Teicoplanin therapy using a Cmin target of 15-30 μg/ml is likely to be associated with better clinical responses than Cmin < 15 μg/ml without increasing the risk of adverse effects.
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Affiliation(s)
- Yuki Hanai
- Department of Pharmacy, Toho University Omori Medical Center, Tokyo, Japan
| | - Yoshiko Takahashi
- Department of Pharmacy, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takashi Niwa
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yukihiro Hamada
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Satoshi Fujii
- Department of Hospital Pharmacy, Sapporo Medical University Hospital, Hokkaido, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
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26
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Yoneda A, Takesue Y, Takahashi Y, Ichiki K, Tsuchida T, Ikeuchi H, Uchino M, Hatano E, Shinohara H, Tomita N. Improvement in Hyperglycemia Prevents Surgical Site Infection Irrespective of Insulin Therapy in Non-diabetic Patients Undergoing Gastrointestinal Surgery. World J Surg 2021; 44:1450-1458. [PMID: 31974651 DOI: 10.1007/s00268-020-05371-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intensive glycemic control is recommended to prevent surgical site infections (SSI). Our aim was to evaluate retrospectively the effect of improvement in hyperglycemia irrespective of insulin use on the incidence of SSI in non-diabetic patients. METHODS The highest blood glucose (BG) concentration within 12 h (early peak BG) and the final BG from 12 to 24 h after surgery were evaluated in patients who underwent gastrointestinal surgery. Patients with an early peak BG of ≥150 mg/dL were divided into those with persistent (final BG of ≥150 mg/dL) and improved hyperglycemia (final BG of <150 mg/dL). Patients without hyperglycemia and those with late-onset hyperglycemia were also assessed for SSI risk. RESULTS Overall, 1612 patients were studied (diabetes, n = 293). Although hyperglycemia increased the SSI rates in non-diabetic patients, no correlation was demonstrated in patients with diabetes at any cutoff final BG defining htperglycemia except for 180 mg/dL. Hyperglycemia improved without insulin therapy in 283 of 512 non-diabetic patients who had early hyperglycemia. The adjusted standardized residual for those with SSI and persistent hyperglycemia was 5.2 (P < 0.05). In contrast, the absence of hyperglycemia was a significant preventive factor for SSI. In the multivariate analyses, persistent hyperglycemia was an independent risk factor for SSI (odds ratio 1.54; 95% confidence interval 1.03-2.31). CONCLUSIONS Remission of hyperglycemia within 24 h after surgery prevented SSI in non-diabetic patients. Considering that hyperglycemia improved in approximately half of patients without insulin therapy, commencement of insulin dosing after two consecutive BGs of ≥150 mg/dL might be reasonable, especially in general wards.
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Affiliation(s)
- Ayami Yoneda
- Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Yoshiko Takahashi
- Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kaoru Ichiki
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Toshie Tsuchida
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hiroki Ikeuchi
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Motoi Uchino
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Etsuro Hatano
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hisashi Shinohara
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Naohiro Tomita
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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27
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Takesue Y, Hanaki H, Kusachi S, Mikamo H, Ueda T, Tateda K, Kiyota H. 878. Antimicrobial Susceptibility of Pathogens Isolated from Surgical Site Infections in Japan: Comparison of Data from Nationwide Surveillance Studies Conducted in 2010, 2014–2015 and 2018-2019. Open Forum Infect Dis 2020. [PMCID: PMC7776531 DOI: 10.1093/ofid/ofaa439.1066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background A nationwide survey was conducted in Japan from 2018–2019 to investigate the antimicrobial susceptibility of pathogens isolated from surgical site infections (SSI). Methods The resulting data were compared with that obtained in earlier surveys, conducted in 2010, 2014–2015, and 2018-2019. Results Seven main organisms were collected, and in total 2081 isolates were studied. Although a significant increase of extended-spectrum β-lactamase (ESBL) producing organisms among Enterobacteriaceae was demonstrated in 2014–15 (13.5%) compared with 2010 (5.3%), the incidence remained 6.6% in 2018–19. Only one carbapenemase-producing Enterobacteriaceae isolates were identified in the 2018–2019 study. The geometric mean (GM) MICs for ESBL producing isolates in 2018–2019 were 0.08 µg/mL for meropenem, 2.67 µg/mL for tazobactam/piperacillin, 0.40 µg/mL for tazobactam/ceftolozane, 6.35 µg/mL for cefoxitin, and 1.12 µg/mL for gentamycin. Antibiotic susceptible rate in Pseudomonas aeruginosa was 95.5% in meropenem, 93.9% in piperacillin/tazobactam, 100% in tazobactam/ceftolozane, 97.0% in cefepime, 90.9% in ciprofloxacin, and 86.4% in gentamycin. There was no significant difference in methicillin resistance rate of Staphylococcus aureus isolates among 3 study periods (72.0% in 2010, 53.4% in 2014–2015, and 63% in 2018-19). MRSA isolates with a vancomycin MIC of 2μg/mL accounted for 9.7% in 2010, 1.2% in 2014–2015, and 3.1% in 2018-19. GM MICs for MRSA isolates were 2.09 µg/mL for linezolid, 0.32 µg/mL for tedizolid, and 0.61 µg/mL for daptomycin. GM MICs in linezolid and daptomycin for the isolates in 2018–19 tended to be increased compared with isolates in 2010 (1.74 to 2.09 and 0.35 to 0.61 µg/mL, respectively). More than 90% of isolates belonging to the Bacteroides fragilis group remained susceptible to tazobactam/piperacillin, meropenem, and metronidazole. In contrast, lower levels of susceptibility were observed for moxifloxacin (65.3%), cefmetazole (47.2%) and clindamycin (38.9%). In cefoxitin, non-fragilis Bacteroides isolates had lower rates of antibiotic susceptibility compared with B. fragilis. (51.3% vs. 81.8%). Conclusion Overall, the surveillance data clarified trends in antimicrobial susceptibility for organisms commonly associated with SSI. Disclosures Yoshio Takesue, M.D, Ph.D, Astellas Pharma Inc (Speaker’s Bureau)MSD Japan (Speaker’s Bureau)Sumitomo Dainippon Pharma Co. Ltd. (Grant/Research Support) Hiroshige Mikamo, M.D, Ph.D, Astellas Pharma Inc. (Grant/Research Support, Speaker’s Bureau)MSD Japan (Grant/Research Support, Speaker’s Bureau)Pfizer Japan Inc. (Grant/Research Support)Sumitomo Dainippon Pharma Co., Ltd (Grant/Research Support, Speaker’s Bureau)
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Affiliation(s)
| | - Hideaki Hanaki
- Kitasato University Institute, Tokyo, Japan., Tokyo, Tokyo, Japan
| | - Shinya Kusachi
- Department of Surgery, Toho University Medical Center Ohashi, Tokyo, Japan., Tokyo, Tokyo, Japan
| | | | - Takashi Ueda
- Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | | | - Hiroshi Kiyota
- Surveillance Committee of Japanese Society of Chemotherapy (JSC), the Japanese Association for Infectious Disease (JAID) and the Japanese Society for Clinical Microbiology (JSCM), Tokyo, Japan, Tokyo, Tokyo, Japan
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Hanai Y, Hamada Y, Kimura T, Matsumoto K, Takahashi Y, Fujii S, Nishizawa K, Takesue Y. Optimal trough concentration of voriconazole with therapeutic drug monitoring in children: A systematic review and meta-analysis. J Infect Chemother 2020; 27:151-160. [PMID: 33376032 DOI: 10.1016/j.jiac.2020.11.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/26/2020] [Accepted: 11/11/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This systematic review and meta-analysis was designed to determine the optimal trough concentration of voriconazole for children with invasive fungal infections (IFIs). METHODS We searched electronic databases (PubMed, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Japana Centra Revuo Medicina) for clinical studies describing the voriconazole trough concentration. We used stepwise cut-off values of 1.0-2.0 mg/L for efficacy and 3.0-6.0 mg/L for safety. The efficacy outcomes were treatment success and all-cause mortality, and the safety outcomes were hepatotoxicity, neurotoxicity and all-cause adverse events. RESULTS Nine studies involving 211 patients were included in the analysis. The probability of treatment success against IFIs was significantly increased at cut-off values of ≥1.0 mg/L (odds ratio [OR] = 2.65, 95% confidence interval [CI] = 1.20-5.87). Our analysis did not find any relationship between the trough concentration and survival. Concerning safety, the occurrence of any outcomes did not significantly differ according to the voriconazole trough concentrations at any cut-off value. However, in a subgroup analysis of Asian study locations, a significantly higher risk of hepatotoxicity was demonstrated at voriconazole trough cut-off values ≥ 3.0 mg/L (OR = 8.40, 95% CI = 1.36-51.92). Although a significant correlation between the voriconazole concentration and hepatotoxicity was evident in regression curve analysis, (y = 0.1198e0.2298x), no correlation was demonstrated for neurotoxicity (y = 0.3913e-0.008x). CONCLUSION Our findings suggest that the optimal trough concentration for increasing clinical success and minimizing hepatotoxicity during voriconazole therapy in children with IFIs, particularly for Asian populations, is 1.0-3.0 mg/L.
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Affiliation(s)
- Yuki Hanai
- Department of Pharmacy, Toho University Omori Medical Center, Tokyo, Japan.
| | - Yukihiro Hamada
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Yoshiko Takahashi
- Department of Pharmacy, Hyogo College of Medicine, Nishinomiya, Japan
| | - Satoshi Fujii
- Department of Hospital Pharmacy, Sapporo Medical University Hospital, Hokkaido, Japan
| | - Kenji Nishizawa
- Department of Pharmacy, Toho University Omori Medical Center, Tokyo, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
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Horio Y, Uchino M, Bando T, Sasaki H, Goto Y, Kuwahara R, Minagawa T, Takesue Y, Ikeuchi H. Incidence, Risk Factors and Outcomes of Cancer of the Anal Transitional Zone in Patients with Ulcerative Colitis. J Crohns Colitis 2020; 14:1565-1571. [PMID: 32365200 DOI: 10.1093/ecco-jcc/jjaa089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Performing a mucosectomy with a hand-sewn ileal pouch-anal anastomosis [IPAA] for ulcerative colitis [UC] theoretically reduces the risk of carcinoma arising from the anal transitional zone [ATZ]. Although current guidelines suggest a stapled anastomosis due to the low incidence of cancer after pouch surgery in UC patients, only a few small series have addressed the oncological advantage of mucosectomy. Therefore, we aimed to investigate the incidence of ATZ/pouch cancer. METHODS A total of 1970 UC patients who underwent surgery between April 1987 and December 2018 were included. We retrospectively analysed the incidences of primary ATZ cancer in the original operative specimen and de novo ATZ/pouch cancer after surgery. Possible risk factors for primary ATZ cancer and the pouch survival rate were assessed. RESULTS Fourteen [6.4%] primary ATZ cancers developed in 220 UC-colorectal cancer [CRC] cases. Multiple (odds ratio [OR] = 8.79, 95% confidence interval [CI] 2.77-27.83, p < 0.01) and rectal [OR = 6.48, 95% CI 1.41-29.7, p = 0.01] cancers were identified as independent risk factors for primary ATZ cancer. Four of 1970 [0.2%] patients developed de novo ATZ/pouch cancer and dysplasia. The 10-year estimated cumulative pouch survival rate was not significantly different between stapled IPAA and hand-sewn IPAA cases [95.9% and 97.3%, p = 0.25]. CONCLUSION The risk of de novo ATZ/pouch cancer and dysplasia was rare. The decision to perform a hand-sewn or a stapled IAA should be made on a case-by-case basis. However, the relatively high incidence of primary ATZ cancer in UC patients with CRC suggests that mucosectomy should be recommended for this patient group.
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Affiliation(s)
- Yuki Horio
- Department of Inflammatory Bowel Disease, Division of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Motoi Uchino
- Department of Inflammatory Bowel Disease, Division of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Toshihiro Bando
- Department of Inflammatory Bowel Disease, Division of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Hirofumi Sasaki
- Department of Inflammatory Bowel Disease, Division of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Yoshiko Goto
- Department of Inflammatory Bowel Disease, Division of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Ryuichi Kuwahara
- Department of Inflammatory Bowel Disease, Division of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Tomohiro Minagawa
- Department of Inflammatory Bowel Disease, Division of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Yoshio Takesue
- Infection Control and Prevention, Hyogo College of Medicine, Hyogo, Japan
| | - Hiroki Ikeuchi
- Department of Inflammatory Bowel Disease, Division of Surgery, Hyogo College of Medicine, Hyogo, Japan
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Yanagihara K, Kosai K, Mikamo H, Mukae H, Takesue Y, Abe M, Taniguchi K, Petigara T, Kaku M. Serotype distribution and antimicrobial susceptibility of Streptococcus pneumoniae associated with invasive pneumococcal disease among adults in Japan. Int J Infect Dis 2020; 102:260-268. [PMID: 33065297 DOI: 10.1016/j.ijid.2020.10.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES This study evaluated the serotype distribution and antimicrobial susceptibility of Streptococcus pneumoniae isolates from adults (aged ≥20 years) with invasive pneumococcal disease (IPD) in Japan. METHODS This prospective observational study was conducted in 49 participating Japanese hospitals. S. pneumoniae isolates were serotyped and tested for antimicrobial susceptibility at a central laboratory. Information regarding patient characteristics, underlying disease, IPD clinical syndromes, and treatment was collected through medical chart review. RESULTS The final analysis included 177 patients enrolled from 45 hospitals between September 2016 and April 2018 (bacteraemic pneumonia, 110; bacteraemia without identified focus, 29; meningitis, 19). Most patients (70.1%) were aged ≥65 years and most had underlying disease (79.1%). The proportion of isolates from serotypes contained in the pneumococcal polysaccharide vaccine (PPV) 23 was 61.0%, while those in the pneumococcal conjugate vaccine (PCV) 7 and PCV13 were 2.8% and 28.2%, respectively. Non-vaccine serotypes accounted for 37.9% of all isolates and 50.8% of isolates from immunosuppressed patients. Serotype 12F was the most common vaccine serotype, followed by serotype 3. CONCLUSIONS The continued disease burden of IPD in adults in Japan warrants improved vaccination rates and development of next-generation vaccines that include serotypes not currently covered. CLINICAL TRIAL REGISTRATION Clinical trial summary registration number 160,822,918,146; JapicCTI-163352.
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Affiliation(s)
- Katsunori Yanagihara
- Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Kosuke Kosai
- Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Hiroshige Mikamo
- Aichi Medical University Graduate School of Medicine, 1-1 Yazakokarimata, Aichi 480-1195, Japan
| | - Hiroshi Mukae
- Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Yoshio Takesue
- Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo 663-8501, Japan
| | - Machiko Abe
- MSD K.K., 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo 102-8667, Japan.
| | | | - Tanaz Petigara
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, N.J. 07033, USA
| | - Mitsuo Kaku
- Tohoku Medical and Pharmaceutical University, 4-4-1 Komatsushima, Aobaku, Sendai, Miyagi 981-8558, Japan
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Mimura Y, Yahiro M, Masumoto M, Fukui R, Okamoto R, Aichi M, Mihara Y, Ueda T, Takesue Y, Ikawa K, Morikawa N, Kuragano T. The pharmacokinetics of oral metronidazole in patients with metronidazole‐induced encephalopathy undergoing maintenance hemodialysis. Hemodial Int 2020; 24:528-533. [DOI: 10.1111/hdi.12857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/15/2020] [Accepted: 07/09/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Yasuyuki Mimura
- Department of Internal Medicine, Division of Kidney and Dialysis Hyogo College of medicine Hospital Hyogo Japan
| | - Mana Yahiro
- Department of Internal Medicine, Division of Kidney and Dialysis Hyogo College of medicine Hospital Hyogo Japan
| | - Miwa Masumoto
- Department of Internal Medicine, Division of Kidney and Dialysis Hyogo College of medicine Hospital Hyogo Japan
| | - Risako Fukui
- Department of Internal Medicine, Division of Kidney and Dialysis Hyogo College of medicine Hospital Hyogo Japan
| | - Rina Okamoto
- Department of Internal Medicine, Division of Kidney and Dialysis Hyogo College of medicine Hospital Hyogo Japan
| | - Makoto Aichi
- Department of Internal Medicine, Division of Kidney and Dialysis Hyogo College of medicine Hospital Hyogo Japan
| | - Yuki Mihara
- Department of Internal Medicine Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc. Saiseikai Hyogo‐ken Hospital Hyogo Japan
| | - Takashi Ueda
- Department of Infection Control and Prevention Hyogo College of Medicine Hyogo Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention Hyogo College of Medicine Hyogo Japan
| | - Kazuro Ikawa
- Department of Clinical Pharmacotherapy Hiroshima University Hiroshima Japan
| | - Norifumi Morikawa
- Department of Clinical Pharmacotherapy Hiroshima University Hiroshima Japan
| | - Takahiro Kuragano
- Department of Internal Medicine, Division of Kidney and Dialysis Hyogo College of medicine Hospital Hyogo Japan
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Oda K, Fujii S, Yamamoto T, Mayumi T, Takesue Y. Evaluation of once-daily dosing and target concentrations in therapeutic drug monitoring for arbekacin: A meta-analysis. J Infect Chemother 2020; 27:26-31. [PMID: 32828677 DOI: 10.1016/j.jiac.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/17/2020] [Accepted: 08/03/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Arbekacin is the first aminoglycoside antibacterial agent approved for treating methicillin-resistant Staphylococcus aureus infection in Japan. Although therapeutic drug monitoring (TDM) is recommended during arbekacin treatment, little evidence for the target exposure and once-daily dosing has been reported. This study aimed to clarify the target peak/trough concentrations and the effectiveness of once-daily dosing of arbekacin against nephrotoxicity or treatment failure via meta-analysis. METHODS A literature search was performed using MEDLINE, Cochrane Library, and Ichushi-Web. RESULTS Nine observational cohort studies met the inclusion criteria. A peak arbekacin concentration of ≥15-16 μg/mL did not exhibit a statistically significant lower risk of treatment failure (risk ratio [RR] = 0.61, 95% confidence interval [CI] = 0.30-1.24). A trough arbekacin concentration of <2 μg/mL resulted in a significantly lower risk of nephrotoxicity (RR = 0.30, 95% CI = 0.15-0.61). Once-daily dosing significantly reduced the risk of treatment failure (RR = 0.61, 95% CI = 0.39-0.97) but not nephrotoxicity (RR = 0.54, 95% CI = 0.16-1.75). CONCLUSIONS Once-daily dosing can improve the therapeutic efficacy of arbekacin, and a trough arbekacin concentration of <2 μg/mL can reduce the risk of nephrotoxicity. A peak arbekacin concentration of ≥15-16 μg/mL did not exhibit the significant lower risk of treatment failure. Additional clinical trials are required to confirm these findings.
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Affiliation(s)
- Kazutaka Oda
- Department of Pharmacy, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan; Department of Infection Control, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Satoshi Fujii
- Department of Pharmacy, Sapporo Medical University Hospital, S1 W16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Takehito Yamamoto
- Department of Pharmacy, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku Kitakyushu, Fukuoka, 807-8555, Japan.
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
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Osa S, Tashiro S, Igarashi Y, Watabe Y, Liu X, Enoki Y, Taguchi K, Mayumi T, Miyazaki Y, Takesue Y, Matsumoto K. Azoles versus conventional amphotericin B for the treatment of candidemia: A meta-analysis of randomized controlled trials. J Infect Chemother 2020; 26:1232-1236. [PMID: 32828679 DOI: 10.1016/j.jiac.2020.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/25/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
Because exclusive use of echinocandins can induce the drug-resistant strains, appropriate use of azoles and polyenes is still necessary in the treatment of candidemia. In this study, we conducted a meta-analysis of randomized controlled trials regarding the efficacy and safety of azole and polyene antifungals in the treatment of candidemia. MEDLINE and the Cochrane Register of Controlled Trials were used as reference databases, and papers published up to June 10, 2019 were searched. The search results were carefully scrutinized, duplicate references were removed, and the study was ultimately carried out using three reports. Among azole antifungals, fluconazole and voriconazole were extracted, however; only conventional amphotericin B (AMPH-B) was extracted among polyene antifungals. Treatment successes with the use of azoles and AMPH-B were compared, and findings showed that AMPH-B was significantly superior (RR = 0.90, 95% CI 0.82-1.00, p = 0.04). However, there was no significant difference in mortality (RR = 0.87, 95% CI 0.72-1.07, p = 0.19). Analysis of adverse events showed that renal disorders were significantly less common with azoles than with AMPH-B (RR = 0.26, 95% CI 0.10-0.68, p = 0.006). In conclusion, AMPH-B were superior to azoles in terms of efficacy, but had a risk of causing renal disorders.
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Affiliation(s)
- Sumika Osa
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Sho Tashiro
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Yuki Igarashi
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Yuki Watabe
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Xiaoxi Liu
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Yuki Enoki
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan.
| | - Kazuaki Taguchi
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Toshihiko Mayumi
- Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 By the Japanese Society for Medical Mycology, Japan; Department of Emergency Medicine, School of Medicine University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yoshitsugu Miyazaki
- Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 By the Japanese Society for Medical Mycology, Japan; Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yoshio Takesue
- Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 By the Japanese Society for Medical Mycology, Japan; Department of Infection Control and Prevention, Hyogo College of Medicine, Hyogo, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan; Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 By the Japanese Society for Medical Mycology, Japan
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Mori M, Ikeda N, Taketomi A, Asahi Y, Takesue Y, Orimo T, Ono M, Kuwayama T, Nakamura S, Yamada Y, Kuroda T, Yuzawa K, Hibi T, Nagano H, Unno M, Kitagawa Y. COVID-19: clinical issues from the Japan Surgical Society. Surg Today 2020; 50:794-808. [PMID: 32651686 PMCID: PMC7351651 DOI: 10.1007/s00595-020-02047-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 02/07/2023]
Abstract
In this unprecedented COVID-19 pandemic, several key issues must be addressed to ensure safe treatment and prevent rapid spread of the virus and a consequential medical crisis. Careful evaluation of a patient's condition is crucial for deciding the triage plan, based on the status of the disease and comorbidities. As functionality of the medical care system is greatly affected by the environmental situation, the treatment may differ according to the medical and infectious disease circumstances of the institution. Importantly, all medical staff must prevent nosocomial COVID-19 by minimizing the effects of aerosol spread and developing diagnostic and surgical procedures. Polymerase chain reaction (PCR) screening for COVID-19 infection, particularly in asymptomatic patients, should be encouraged as these patients are prone to postoperative respiratory failure. In this article, the Japan Surgical Society addresses the general principles of surgical treatment in relation to COVID-19 infection and advocates preventive measures against viral transmission during this unimaginable COVID-19 pandemic.
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Affiliation(s)
- Masaki Mori
- The Japanese Surgical Society, Tokyo, Japan.
- Committee for novel coronavirus disease 2019 outbreak of the Japanese Surgical Society, Tokyo, Japan.
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Norihiko Ikeda
- Committee for novel coronavirus disease 2019 outbreak of the Japanese Surgical Society, Tokyo, Japan
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Akinobu Taketomi
- Committee for novel coronavirus disease 2019 outbreak of the Japanese Surgical Society, Tokyo, Japan
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Yo Asahi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tatsuya Orimo
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Minoru Ono
- Committee for novel coronavirus disease 2019 outbreak of the Japanese Surgical Society, Tokyo, Japan
- Department of Cardiovascular Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takashi Kuwayama
- Department of Breast Surgical Oncology, Showa University School of Medicine, 1-5-8, Hatanodai, Shibagawa-ku, Tokyo, 142-8666, Japan
| | - Seigo Nakamura
- Department of Breast Surgical Oncology, Showa University School of Medicine, 1-5-8, Hatanodai, Shibagawa-ku, Tokyo, 142-8666, Japan
| | - Yohei Yamada
- Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kenji Yuzawa
- Department of Transplantation Surgery, National Hospital Organization Mito Medical Center, Ibaraki-machi, Higashiibaraki-gun, Ibaraki, 311-3193, Japan
| | - Taizo Hibi
- Committee for novel coronavirus disease 2019 outbreak of the Japanese Surgical Society, Tokyo, Japan
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto, 860-8556, Japan
| | - Hiroaki Nagano
- Committee for novel coronavirus disease 2019 outbreak of the Japanese Surgical Society, Tokyo, Japan
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yuko Kitagawa
- Committee for novel coronavirus disease 2019 outbreak of the Japanese Surgical Society, Tokyo, Japan
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Ueda T, Takesue Y, Nakajima K, Ichiki K, Ishikawa K, Takai Y, Yamada K, Tsuchida T, Otani N, Takahashi Y, Ishihara M, Takubo S, Ikeuchi H, Uchino M, Kimura T. Clinical efficacy and safety in patients treated with teicoplanin with a target trough concentration of 20 μg/mL using a regimen of 12 mg/kg for five doses within the initial 3 days. BMC Pharmacol Toxicol 2020; 21:50. [PMID: 32641110 PMCID: PMC7341468 DOI: 10.1186/s40360-020-00424-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/10/2020] [Indexed: 12/22/2022] Open
Abstract
Background A trough concentration (Cmin) ≥20 μg/mL of teicoplanin is recommended for the treatment of serious methicillin-resistant Staphylococcus aureus (MRSA) infections. However, sufficient clinical evidence to support the efficacy of this target Cmin has not been obtained. Even though the recommended high Cmin of teicoplanin was associated with better clinical outcome, reaching the target concentration is challenging. Methods Pharmacokinetics and adverse events were evaluated in all eligible patients. For clinical efficacy, patients who had bacteremia/complicated MRSA infections were analyzed. The primary endpoint for clinical efficacy was an early clinical response at 72–96 h after the start of therapy. Five dosed of 12 mg/kg or 10 mg/kg was administered as an enhanced or conventional high loading dose regimen, respectively. The Cmin was obtained at 72 h after the first dose. Results Overall, 512 patients were eligible, and 76 patients were analyzed for treatment efficacy. The proportion of patients achieving the target Cmin range (20–40 μg/mL) by the enhanced regimen was significantly higher than for the conventional regimen (75.2% versus 41.0%, p < 0.001). In multivariate analysis, Cmin ≥ 20 μg/mL was an independent factor for an early clinical response (odds ratio 3.95, 95% confidence interval 1.25–12.53). There was no significant difference in the occurrence of adverse events between patients who did or did not achieve a Cmin ≥ 20 μg/mL. Conclusion A target Cmin ≥ 20 μg/mL might improve early clinical responses during the treatment of difficult MRSA infections using 12 mg/kg teicoplanin for five doses within the initial 3 days.
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Affiliation(s)
- Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Kaoru Ichiki
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Kaori Ishikawa
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshiko Takai
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Kumiko Yamada
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Toshie Tsuchida
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Naruhito Otani
- Department of Public Health, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yoshiko Takahashi
- Department of Pharmacy, Hyogo College of Medicine Hospital, Nishinomiya, Hyogo, Japan
| | - Mika Ishihara
- Department of Pharmacy, Hyogo College of Medicine Hospital, Nishinomiya, Hyogo, Japan
| | - Shingo Takubo
- Department of Pharmacy, Hyogo College of Medicine Hospital, Nishinomiya, Hyogo, Japan
| | - Hiroki Ikeuchi
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Motoi Uchino
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takeshi Kimura
- Department of Pharmacy, Hyogo College of Medicine Hospital, Nishinomiya, Hyogo, Japan
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Tashiro S, Osa S, Igarashi Y, Watabe Y, Liu X, Enoki Y, Taguchi K, Mayumi T, Miyazaki Y, Takesue Y, Matsumoto K. Echinocandins versus non-echinocandins for the treatment of invasive candidiasis: A meta-analysis of randomized controlled trials. J Infect Chemother 2020; 26:1164-1176. [PMID: 32620421 DOI: 10.1016/j.jiac.2020.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/02/2020] [Accepted: 06/06/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Echinocandins are frequent use antifungals in the treatment of invasive candidiasis, and it is important to update information on their efficacy and safety for optimal antifungal drug treatment. The aim of this study is to clarify whether echinocandins are superior to non-echinocandins for the treatment of invasive candidiasis. METHODS We conducted a meta-analysis of RCTs of echinocandins and non-echinocandins for adult invasive candidiasis. The MEDLINE, Web of Sciences, Cochrane Register of Controlled Trials, and ClinicalTrials.gov databases before June 2019 were used. The risk ratio (RR) and 95% confidence interval (95% CI) were calculated using the Mantel-Haenszel method random-effects model. RESULTS We identified 14,846 articles and screened, and five studies were included meta-analysis. The treatment success ratio for echinocandins was significantly higher than that for non-echinocandins (RR = 1.14, 95% CI 1.06-1.22, p = 0.0003). In regard to adverse events, there was no significant difference between the two treatment groups. A subgroup analysis showed that the treatment success ratio for echinocandins was significantly higher than that for azoles (RR = 1.20, 1.08-1.34, p = 0.001), whereas no significant differences were observed between echinocandins and polyenes. In safety analysis, the incidence ratio of electrolyte disorder (RR = 0.50, 0.33-0.76, p = 0.001), renal disorder (RR = 0.19, 0.09-0.40, p < 0.0001), and fever (RR = 0.46, 0.23-0.93, p = 0.03) were significantly lower in patients receiving echinocandins than in those receiving polyenes. CONCLUSIONS This meta-analysis based on RCTs was first to show that use of echinocandins was associated with improved clinical success. Echinocandins may be useful as a first-line drug for invasive candidiasis.
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Affiliation(s)
- Sho Tashiro
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Sumika Osa
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Yuki Igarashi
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Yuki Watabe
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Xiaoxi Liu
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Yuki Enoki
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan.
| | - Kazuaki Taguchi
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Toshihiko Mayumi
- Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 by the Japanese Society for Medical Mycology, Japan; Department of Emergency Medicine, School of Medicine University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yoshitsugu Miyazaki
- Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 by the Japanese Society for Medical Mycology, Japan; Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yoshio Takesue
- Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 by the Japanese Society for Medical Mycology, Japan; Department of Infection Control and Prevention, Hyogo College of Medicine, Hyogo, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan; Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 by the Japanese Society for Medical Mycology, Japan
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Hamada Y, Ueda T, Miyazaki Y, Nakajima K, Fukunaga K, Miyazaki T, Nakada-Motokawa N, Nagao M, Kawamura H, Shigemi A, Ebihara F, Kimura T, Ikegame K, Uchino M, Ikeuchi H, Takesue Y. Effects of antifungal stewardship using therapeutic drug monitoring in voriconazole therapy on the prevention and control of hepatotoxicity and visual symptoms: A multicentre study conducted in Japan. Mycoses 2020; 63:779-786. [PMID: 32510723 PMCID: PMC7496238 DOI: 10.1111/myc.13129] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 11/25/2022]
Abstract
Background Hepatotoxicity and visual symptoms are common adverse effects (AEs) of voriconazole therapy. Objective To retrospectively evaluate the effects of treatment modification based on therapeutic drug monitoring on AEs in patients undergoing voriconazole therapy. Methods The target voriconazole trough concentration (Cmin) was 1‐5 µg/mL. Receiver operating characteristic curves were used to determine Cmin cut‐offs for AEs. Results A total of 401 patients were included. Among 108 patients with high initial Cmin, voriconazole was discontinued in 32 and the dose was reduced in 71. Among 44 patients with low initial Cmin, voriconazole was discontinued in 4 and the dose was increased in 19. Hepatotoxicity occurred in 6.0% of patients, after a median of 10 days. Visual symptoms were evident in 9.5% of patients after a median of 4 days. Initial Cmin was significantly associated with visual symptoms but not hepatotoxicity, which suggested the effect of treatment modification on hepatotoxicity. However, both hepatotoxicity and visual symptoms were significantly correlated with Cmin at the onset of AEs, and the Cmin cut‐offs were 3.5 μg/mL for hepatotoxicity and 4.2 μg/mL for visual symptoms. Voriconazole was discontinued after the occurrence of AEs in 62.5% of patients with hepatotoxicity but only 26.3% of patients with visual symptoms. With dose adjustment, treatment was completed in 8/9 patients with hepatotoxicity and 27/28 patients with visual symptoms. Conclusions A significant preventive effect was demonstrated on hepatotoxicity, but not on visual symptoms because of earlier occurrence. With treatment modification after the occurrence of AEs, most patients completed therapy.
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Affiliation(s)
- Yukihiro Hamada
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshitsugu Miyazaki
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Keiko Fukunaga
- Department of Hematology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Taiga Miyazaki
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Nana Nakada-Motokawa
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Miki Nagao
- Department of Infection Control and Prevention, Kyoto University Hospital, Kyoto, Japan
| | - Hideki Kawamura
- Division of Medical and Environmental Safety, Department of Infection Control and Prevention, Kagoshima University Hospital, Kagoshima, Japan
| | - Akari Shigemi
- Division of Medical and Environmental Safety, Department of Infection Control and Prevention, Kagoshima University Hospital, Kagoshima, Japan
| | - Fumiya Ebihara
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Kazuhiro Ikegame
- Department of Hematology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Motoi Uchino
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroki Ikeuchi
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
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Ueda T, Takesue Y, Nakajima K, Ichiki K, Ishikawa K, Takai Y, Yamada K, Wada Y, Tsuchida T, Otani N, Takahashi Y, Ishihara M, Shibata S, Ikeuchi H, Uchino M, Kimura T. Vancomycin loading dose is associated with increased early clinical response without attainment of initial target trough concentration at a steady state in patients with methicillin-resistant Staphylococcus aureus infections. J Clin Pharm Ther 2020; 45:682-690. [PMID: 32301537 DOI: 10.1111/jcpt.13144] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/21/2020] [Accepted: 03/22/2020] [Indexed: 12/19/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Vancomycin therapeutic guidelines suggest a loading dose of 25-30 mg/kg for seriously ill patients. However, high-quality data to guide the use of loading doses are lacking. We aimed to evaluate whether a loading dose (a) achieved a target trough concentration at steady state and (b) improved early clinical response. METHODS Patients with an estimated glomerular filtration rate ≥ 90 mL/min/1.73 m2 were included. A loading dose of 25 mg/kg vancomycin followed by 15 mg/kg twice daily was compared with traditional dosing. A Cmin sample was obtained before the fifth dose. An early clinical response 48-72 hours after the start of therapy and clinical success at end of therapy (EOT) was evaluated in patients with methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant coagulase-negative Staphylococci or Enterococcus faecium. RESULTS There was no significant difference in Cmin between the regimen with and without a loading dose (median: 10.4 and 10.2 µg/mL, P = .54). Proportions of patients achieving 10-20 and 15-20 µg/mL were 56.9% and 5.6%, respectively, in patients with a loading dose. Although there was no significant difference in success rate at EOT between groups, a loading dose was associated with increased early clinical response for all infections (adjusted odds ratio [OR]: 4.588, 95% confidence interval [CI]: 1.373-15.330) and MRSA infections (OR: 12.065, 95% CI: 1.821-79.959). Study limitations included no Cmin measurements within 24 hours and the inclusion of less critically ill patients. WHAT IS NEW AND CONCLUSION A loading dose of 25 mg/kg followed by 15 mg/kg twice daily did not achieve the optimal Cmin at steady state in patients with normal renal function. However, more early clinical responses were obtained with a loading dose compared with traditional dosing, possibly because of a prompt albeit temporary achievement of a more effective concentration.
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Affiliation(s)
- Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kaoru Ichiki
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kaori Ishikawa
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshiko Takai
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kumiko Yamada
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yasunao Wada
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toshie Tsuchida
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Naruhito Otani
- Department of Public Health, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshiko Takahashi
- Department of Pharmacy, Hyogo College of Medicine Hospital, Nishinomiya, Japan
| | - Mika Ishihara
- Department of Pharmacy, Hyogo College of Medicine Hospital, Nishinomiya, Japan
| | - Sumiyo Shibata
- Department of Pharmacy, Hyogo College of Medicine Hospital, Nishinomiya, Japan
| | - Hiroki Ikeuchi
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Motoi Uchino
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Kimura
- Department of Pharmacy, Hyogo College of Medicine Hospital, Nishinomiya, Japan
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Mochizuki Y, Ishikawa H, Sato A, Yamada K, Takesue Y, Gomi F. Pasteurella multocida-induced endophthalmitis after a cat scratch. Am J Ophthalmol Case Rep 2020; 18:100711. [PMID: 32322756 PMCID: PMC7170947 DOI: 10.1016/j.ajoc.2020.100711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/26/2019] [Accepted: 04/12/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose To report the case of a Japanese girl with a perforating ocular injury caused by a cat scratch, resulting in Pasteurella multocida-induced endophthalmitis. Observations A 10-year-old girl presented with a red eye, eye pain, and blurred vision in her right eye immediately after receiving a cat scratch. We performed lensectomy and vitrectomy for endophthalmitis 4 hours after her arrival. After culturing a sample of the vitreous humor, Pasteurella multocida was identified, and the antibiotic was changed to ampicillin. The best-corrected visual acuity of her right eye improved to 20/20 6 months after surgery. Conclusions and importance We present a rare case of Pasteurella multocida-induced endophthalmitis after a cat scratch. Our findings suggest the great importance of identifying the responsible bacterium and using matched antibiotics as soon as possible in such cases to prevent vision loss.
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Affiliation(s)
- Yoshihito Mochizuki
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya 663-8501, Japan
| | - Hiroto Ishikawa
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya 663-8501, Japan
- Corresponding author. Department of Ophthalmology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan..
| | - Aki Sato
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya 663-8501, Japan
| | - Kumiko Yamada
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya 663-8501, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya 663-8501, Japan
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya 663-8501, Japan
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Uchino M, Ikeuchi H, Shimizu J, Ohge H, Haji S, Mizuguchi T, Mohri Y, Yamashita C, Kitagawa Y, Suzuki K, Kobayashi M, Kobayashi M, Sakamoto F, Yoshida M, Mayumi T, Hirata K, Takesue Y. Association between preoperative tumor necrosis factor alpha inhibitor and surgical site infection after surgery for inflammatory bowel disease: a systematic review and meta-analysis. Surg Today 2020; 51:32-43. [PMID: 32277281 DOI: 10.1007/s00595-020-02003-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
Tumor necrosis factor-alpha inhibitor (TNFi) treatment is effective for ulcerative colitis (UC) and Crohn's disease (CD). Although several meta-analyses have been performed to evaluate the association between TNFi treatment and surgical morbidity, the results are controversial. We conducted a systematic review and meta-analysis of the prevention of surgical site infection (SSI) after surgery for UC and CD in patients on TNFis, based on literature published between January 2000 and May 2019 (registered on PROSPERO, No. CRD42019134156). Overall, 2175 UC patients in 13 observational studies (OBSs) and 7084 CD patients in 16 OBSs were included. The incidences of incisional (INC) SSI and organ/space (O/S) SSI after surgery for UC were 179/1985 (9.0%) and 176/2175 (8.1%), respectively. TNFi use was not associated with the incidences of INC SSI (odds ratio (OR) 1.04, 95% confidence interval (CI) (0.47-2.32) or O/S SSI (OR 1.85, 95% CI (0.82-4.20)) after surgery for UC. The INC SSI and O/S SSI incidences after surgery for CD were 289/3089 (9.4%) and 526/7,084 (7.4%), respectively. Preoperative TNFi use was not associated with INC SSI (OR 0.98, 95% CI (0.52-1.83)) or O/S SSI incidence (OR 1.09, 95% CI (0.78-1.52)) after surgery for CD. We did not find a significant association between preoperative TNFi use and SSI in surgery for UC or CD.
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Affiliation(s)
- Motoi Uchino
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, 1-1, Mukogawacho, Nishinomiya, Hyogo, Japan.
| | - Hiroki Ikeuchi
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, 1-1, Mukogawacho, Nishinomiya, Hyogo, Japan
| | - Junzo Shimizu
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - Seiji Haji
- Department of Surgery, Takatsuki General Hospital, Osaka, Japan
| | - Toru Mizuguchi
- Department of Nursing, Surgical Science and Technology, Sapporo Medical University, Sapporo, Japan
| | - Yasuhiko Mohri
- Department of Surgery, Mie Prefectural General Medical Center, Mie, Japan
| | - Chizuru Yamashita
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Yuichi Kitagawa
- Department of Infection Control, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Katsunori Suzuki
- Division of Infection Control and Prevention, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Motomu Kobayashi
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | | | - Fumie Sakamoto
- Infection Control Manager, QI Center, St. Luke's International Hospital, Tokyo, Japan
| | - Masahiro Yoshida
- Hemodialysis and Surgery, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Koichi Hirata
- Department of Surgery, JR Sapporo Hospital, Sapporo, Japan
| | - Yoshio Takesue
- Division of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
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Yamashita C, Takesue Y, Matsumoto K, Ikegame K, Enoki Y, Uchino M, Miyazaki T, Izumikawa K, Takada T, Okinaka K, Ueda T, Miyazaki Y, Mayumi T. Echinocandins versus non-echinocandins for empirical antifungal therapy in patients with hematological disease with febrile neutropenia: A systematic review and meta-analysis. J Infect Chemother 2020; 26:596-603. [PMID: 32171659 DOI: 10.1016/j.jiac.2020.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/16/2020] [Accepted: 01/28/2020] [Indexed: 01/05/2023]
Abstract
Empirical antifungal therapy is recommended in high-risk patients who have persistent febrile neutropenia (FN) despite broad-spectrum antibiotic therapy. Based on high-quality evidence, most guidelines recommend caspofungin. The aim of this study was to clarify whether echinocandins, including micafungin, are associated with improved clinical outcomes in patients with persistent FN. We conducted a meta-analysis of randomized controlled trials (RCTs) of empirical therapy with echinocandins and non-echinocandins for FN in patients with hematological disease. The primary outcome was all-cause mortality within 7 days after completion of therapy. Secondary outcomes included treatment success, and discontinuation of therapy because of adverse events. For subgroup analysis, we compared RCTs of echinocandins with liposomal amphotericin B. Six RCTs (four that evaluated caspofungin and two that evaluated micafungin) were included in the meta-analysis. Mortality and adverse events in echinocandin-treated patients were significantly lower than in those treated with non-echinocandins [risk ratio (RR) 0.70, 95% confidence interval (CI) 0.49-0.99; RR 0.48, 95% CI 0.33-0.71, respectively]. There was no significant difference in treatment success (RR 1.09, 95% CI 0.87-1.36). Mortality and adverse events in echinocandin-treated patients were significantly lower than in those treated with liposomal amphotericin B (RR 0.68, 95% CI 0.46-0.99; RR 0.53, 95% CI 0.37-0.74, respectively). In conclusion, patients with persistent FN treated with echinocandins had decreased risk of death and adverse events. Both caspofungin and micafungin may be recommended as first-line empirical antifungal therapy in these patients. However, the small number of enrolled patients and the lack of RCTs involving pediatric patients should be considered when using micafungin.
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Affiliation(s)
- Chizuru Yamashita
- Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 by the Japanese Society for Medical Mycology, Japan; Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Nagoya, Japan
| | - Yoshio Takesue
- Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 by the Japanese Society for Medical Mycology, Japan; Department of Infection Control and Prevention, Hyogo College of Medicine, Hyogo, Japan.
| | - Kazuaki Matsumoto
- Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 by the Japanese Society for Medical Mycology, Japan; Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Kazuhiro Ikegame
- Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 by the Japanese Society for Medical Mycology, Japan; Department of Hematology, Hyogo College of Medicine, Hyogo, Japan
| | - Yuki Enoki
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Motoi Uchino
- Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 by the Japanese Society for Medical Mycology, Japan; Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Hyogo, Japan
| | - Taiga Miyazaki
- Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 by the Japanese Society for Medical Mycology, Japan; Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Koichi Izumikawa
- Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 by the Japanese Society for Medical Mycology, Japan; Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tohru Takada
- Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 by the Japanese Society for Medical Mycology, Japan; Department of Infection Control and Prevention, Fukuoka University Hospital, Fukuoka, Japan
| | - Keiji Okinaka
- Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 by the Japanese Society for Medical Mycology, Japan; Department of Hematology, National Cancer Center Hospital East, Japan
| | - Takashi Ueda
- Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 by the Japanese Society for Medical Mycology, Japan; Department of Infection Control and Prevention, Hyogo College of Medicine, Hyogo, Japan
| | - Yoshitsugu Miyazaki
- Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 by the Japanese Society for Medical Mycology, Japan; Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo, Japan
| | - Toshihiko Mayumi
- Committee of Clinical Practice Guidelines for the Diagnosis and Management of Invasive Candidiasis 2020 by the Japanese Society for Medical Mycology, Japan; Emergency Department, University of Occupational and Environmental Health, Fukuoka, Japan
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Kosai K, Yamagishi Y, Hashinaga K, Nakajima K, Mikamo H, Hiramatsu K, Takesue Y, Yanagihara K. Multicenter surveillance of the epidemiology of gram-negative bacteremia in Japan. J Infect Chemother 2020; 26:193-198. [DOI: 10.1016/j.jiac.2019.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/15/2019] [Accepted: 11/13/2019] [Indexed: 02/04/2023]
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Yamada K, Ueda T, Nakajima K, Ichiki K, Tsuchida T, Otani N, Takahashi Y, Ikeuchi H, Uchino M, Koshiba M, Takesue Y. Clinical efficacy of teicoplanin in the treatment of bloodstream infection caused by methicillin-resistant coagulase-negative staphylococci. J Infect Chemother 2019; 26:459-464. [PMID: 31870587 DOI: 10.1016/j.jiac.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/21/2019] [Accepted: 12/03/2019] [Indexed: 02/04/2023]
Abstract
Empirical combination therapy with β-lactams and glycopeptides is recommended for patients with presumed staphylococcal bloodstream infection (BSI). While coagulase-negative staphylococci (CNS) remain susceptible to vancomycin, such isolates have become less susceptible to teicoplanin. The aim of this retrospective study was to evaluate the clinical efficacy of teicoplanin in the treatment of BSI caused by methicillin-resistant CNS according to teicoplanin susceptibility. Inclusion criteria were patients with intravascular-catheter related BSIs caused by methicillin-resistant CNS (positive for two or more specimens); teicoplanin therapy; and at least one of the signs or symptoms caused by BSI. Antimicrobial resistance was defined as minimum inhibitory concentration (MIC) ≥8 μg/mL. The primary efficacy endpoint was clinical success evaluated 2 weeks after the completion of teicoplanin therapy [test of cure (TOC)]. Resistant rate of CNS was 0% for vancomycin and 22.9% for teicoplanin, and geometric mean MICs were 1.31 μg/mL and 3.41 μg/mL, respectively (p < 0.001). The catheter was removed in all patients except one, and high early clinical response at 72 h after starting therapy was obtained irrespective of teicoplanin susceptibility. The clinical success rate at TOC was 60% in patients with BSIs caused by teicoplanin-resistant strains, while 90% in patients with BSIs caused by susceptible strains (p = 0.052). In multivariate analyses, teicoplanin resistance was significant factor for decreased clinical success at TOC (adjusted odds ratio 0.138, 95% confidence interval 0.020-0.961, p = 0.045). Because of the poor clinical efficacy of teicoplanin against teicoplanin-resistant CNS, combination therapy comprising vancomycin and β-lactam antibiotics should be considered in presumed staphylococci BSI.
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Affiliation(s)
- Kumiko Yamada
- Department of Clinical Technology, Hyogo College of Medicine, Hyogo, Japan.
| | - Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, Hyogo, Japan.
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo College of Medicine, Hyogo, Japan.
| | - Kaoru Ichiki
- Department of Infection Control and Prevention, Hyogo College of Medicine, Hyogo, Japan.
| | - Toshie Tsuchida
- Department of Infection Control and Prevention, Hyogo College of Medicine, Hyogo, Japan.
| | - Naruhito Otani
- Department of Infection Control and Prevention, Hyogo College of Medicine, Hyogo, Japan.
| | - Yoshiko Takahashi
- Department of Pharmacy, The Hospital of Hyogo College of Medicine, Hyogo, Japan.
| | - Hiroki Ikeuchi
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Hyogo, Japan.
| | - Motoi Uchino
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Hyogo, Japan.
| | - Masahiro Koshiba
- Department of Clinical Laboratory Medicine, Hyogo College of Medicine, Hyogo, Japan.
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Hyogo, Japan.
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Uchino M, Ikeuchi H, Bando T, Chohno T, Sasaki H, Horio Y, Nakajima K, Takesue Y. Efficacy of Preoperative Oral Antibiotic Prophylaxis for the Prevention of Surgical Site Infections in Patients With Crohn Disease: A Randomized Controlled Trial. Ann Surg 2019; 269:420-426. [PMID: 29064884 DOI: 10.1097/sla.0000000000002567] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES We investigated the efficacy of oral antimicrobial prophylaxis in patients undergoing surgery for Crohn disease. BACKGROUND Although oral antibiotic prophylaxis with mechanical bowel preparation has been recommended for colorectal surgery, the use of this approach remains somewhat controversial. Moreover, the efficacy of this approach for inflammatory bowel disease also remains unclear. METHODS This study was conducted as a randomized controlled trial at the Hyogo College of Medicine. The study protocols were registered with the University Hospital Medical Information Network Clinical Trials Registry (000013369). In this study, 335 patients with Crohn disease who were scheduled to undergo intestinal resection with an open approach were randomly assigned to either group A or group B. The patients in group A received both preoperative oral antibiotics and intravenous antimicrobial prophylaxis, and intravenous antimicrobial prophylaxis alone was given to the patients in group B. All patients underwent preoperative mechanical bowel preparation with sodium picosulfate hydrate. The primary endpoint of this study was the incidence of surgical site infection (SSI) according to an intention-to-treat analysis. RESULTS Although the incidences of overall and organ/space SSI were not significantly different, the incidence of incisional SSI was significantly lower in group A (12/163; 7.4%) than in group B (27/162; 16.6%) (P = 0.01). In the multivariate analysis, the absence of oral antibiotic prophylaxis was an independent risk factor for incisional SSI (odds ratio: 3.3; 95% confidence interval: 1.3-8.3; P = 0.01). CONCLUSIONS Combined oral and intravenous antimicrobial prophylaxis in patients with Crohn disease contributed to the prevention of SSI.
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Affiliation(s)
- Motoi Uchino
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroki Ikeuchi
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toshihiro Bando
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Teruhiro Chohno
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hirofumi Sasaki
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yuki Horio
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuhiko Nakajima
- Division of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshio Takesue
- Division of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
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Ueda T, Takesue Y, Nakajima K, Miyazaki T, Nakada-Motokawa N, Mikamo H, Yamagishi Y, Nagao M, Kawamura H, Kakeya H, Yamada K, Miyazaki Y. 1706. Use of Management Bundles as a Checklist for Candidemia: Impact of Compliance on Clinical Outcomes in a Multicenter Study in Japan. Open Forum Infect Dis 2019. [PMCID: PMC6810128 DOI: 10.1093/ofid/ofz360.1570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background We previously developed management bundles for candidemia and beneficial effects on clinical outcomes were shown in compliant patients (JAC 2015). However, there is a risk for bias because some elements cannot be achieved in patients who have an early death. Methods Patients with candidemia who were treated at six medical centers between 2015 and 2017 were prospectively evaluated. Bundle elements consisted of removal of central venous catheters within 24 hours, initial appropriate selection and dosing of antifungals, an ophthalmological examination, follow-up blood cultures, consideration of alternative antifungals on the 3rd to 5th days, and at least 2 weeks of therapy. To exclude bias by early death, we investigated the clinical results in patients who survived ≥2 weeks. Results Among 221 patients with candidemia, 190 patients were analyzed (31 patients were excluded because of early death). Clinical success and the 28-day mortality rate were 77.4% (171/221) and 22.2% (49/221) in all patients with candidemia and 88.9% (167/190) and 9.5% (18/190) in eligible patients, respectively. Compliance in achieving all bundle elements was accomplished in 67.9% of eligible patients. In multivariate analysis, compliance with the bundles was an independent factor for 28-day mortality (4.7% vs. 19.7%, odds ratio 0.19, 95% confidence interval 0.05–0.63). However, compliance did not affect clinical success (92.2% vs. 82.0%, odds ratio 2.13, 95% CI 0.77–5.86). Non-Candida albicans, disseminated candidiasis, and total parenteral nutrition were independent factors for poor clinical success. Severe severity and total parenteral nutrition were independent factors for 28-day mortality. Conclusion With prospective use of bundles as a checklist in patients with candidemia, compliance of bundles has a beneficial effect on clinical outcomes. This research was supported by AMED (JP18fk0108045). Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Takashi Ueda
- Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Ueda T, Takesue Y, Hamada Y, Fukunaga K, Ikegame K, Ebihara F, Kimura T, Nakajima K, Miyazaki T, Nakada-Motokawa N, Nagao M, Kawamura H, Shigemi A, Miyazaki Y. 1537. Multicenter Study with Therapeutic Drug Monitoring (TDM) of Voriconazole (VRCZ) in Japanese Patients. Open Forum Infect Dis 2019. [PMCID: PMC6810842 DOI: 10.1093/ofid/ofz360.1401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background TDM of VRCZ might be useful, especially in Asian people because of CYP2C19 genetic polymorphisms. However, limited data are available because of the small sample size. Methods Patients who received VRCZ and had TDM were reviewed retrospectively at five institutions. Adequate VRCZ dosage was defined as a loading dose of 5–6 ± 0.5 mg/kg twice daily followed by a maintenance dose of 3–4 ± 0.5 mg/kg twice daily. For prophylaxis, the loading dose was left to the physician’s discretion. Optimal timing of TDM was defined as 4–7 days after starting therapy. Patients with adequate dosing and optimal timing of TDM were evaluated for analysis of trough levels (Cmin). Target Cmin was set at 1–5 µg/mL. Results The study included 584 patients (treatment: 402; prophylaxis: 182). TDM was conducted on days 4–7 in 66.5% of patients (>7, 30.2%). A low adequate dosage (44.5%) was observed for treatment mainly because of a low performance of the loading dose (46.8%). Achievement of target Cmin was obtained in 62.7% (>5 µg/mL, 32.2%) in the treatment group and in 67.6% (11.0%) in the prophylaxis group. Seventy-one of 81 (81.7%) patients who required a dose reduction reached target Cmin by the second TDM. In 38 patients whose dose was not altered at oral switching, Cmin was significantly reduced from 2.5 ± 1.6 to 1.2 ± 1.3 μg/mL (P = 0.002), which indicated the necessity of TDM after oral switching. Hepatotoxicity occurred in 4.6% and visual symptoms in 7.9% of patients. Visual symptoms resolved without discontinuation of VRCZ in 73.9% of patients. Because of dosage adjustment based on TDM, high Cmin did not cause hepatotoxicity. However, the incidence of visual symptoms was significantly higher in patients with a high Cmin (12.7% vs. 5.4%, P = 0.002). Conclusion One-third of Japanese patients who underwent VRCZ treatment with a loading dose showed high Cmin. Occurrence of hepatotoxicity was prevented with alteration of dosage in these patients (AMED, JP18fk0108045). Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Takashi Ueda
- Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Takesue Y, Uchino M, Ikeuchi H, Ueda T, Nakajima K. Is fixed short-course antimicrobial therapy justified for patients who are critically ill with intra-abdominal infections? J Anus Rectum Colon 2019; 3:53-59. [PMID: 31559368 PMCID: PMC6752122 DOI: 10.23922/jarc.2019-001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 01/22/2019] [Indexed: 12/29/2022] Open
Abstract
A long-course antibiotic therapy increases the risk of antibiotic resistance. A 7- to 14-day duration of therapy has been traditionally adopted in patients with intra-abdominal infections (IAIs). Prophylactic antibiotic use is warranted in uncomplicated IAIs, in which the infection involves a single organ, and the source of the infection is completely eradicated by a surgical procedure. A large, randomized clinical trial of the treatment of complicated IAIs recently demonstrated that a fixed 4-day course of antibiotic therapy was as effective as a long-course therapy in patients who underwent adequate source control. Considering the poor prognosis and lack of clear evidence available for shortening the duration of antibiotic therapy in patients who are critically ill or those with ongoing signs of sepsis, the duration of therapy for complicated IAIs should be individually determined according to the clinical course. Limiting therapy to no more than 7 days seems to be warranted in patients who are critically ill with a good clinical response.
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Affiliation(s)
- Yoshio Takesue
- Department of Infection Prevention and Control, Hyogo College of Medicine
| | - Motoi Uchino
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine
| | - Hiroki Ikeuchi
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine
| | - Takashi Ueda
- Department of Infection Prevention and Control, Hyogo College of Medicine
| | - Kazuhiko Nakajima
- Department of Infection Prevention and Control, Hyogo College of Medicine
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Hagihara M, Kusachi S, Kato Y, Yamagishi Y, Niitsuma T, Mikamo H, Takesue Y, Sumiyama Y. Current status of post-operative infections due to antimicrobial-resistant bacteria after digestive tract surgery in Japan: Japan Postoperative Infectious Complications Survey in 2015 (JPICS'15). Surg Today 2019; 50:56-67. [PMID: 31399783 DOI: 10.1007/s00595-019-01857-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/01/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE We herein report the findings of the Japan Postoperative Infectious Complication Survey in 2015 (JPICS'15), which evaluated the rate of post-operative infections and colonization due to antimicrobial-resistant (AMR) bacteria after digestive tract surgery. METHODS This survey by the Japan Society of Surgical Infection included patients undergoing digestive tract surgery at 28 centers between September 2015 and March 2016. Data included patient background characteristics, type of surgery, contamination status, and type of post-operative infections, including surgical site infections (SSIs), remote infections (RIs), and colonization. RESULTS During the study period, 7,565 surgeries (of 896 types) were performed; among them, 905 cases demonstrated bacteria after digestive tract surgery. The survey revealed that post-operative infections or colonization by AMR bacteria occurred in 0.9% of the patient cohort, constituting 7.5% of post-operative infections, including 5.6% of SSIs and 1.8% of RIs. Extended-spectrum β-lactamase-producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureus were the predominant AMR bacteria isolated from patients after digestive tract surgery. Patients infected with AMR bacteria had a poor prognosis. CONCLUSION Our results reveal that 7.5% of the post-operative infections were due to AMR bacteria, indicating the need for antibacterial coverage against AMR bacteria in patients with critical post-operative infections.
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Affiliation(s)
- Mao Hagihara
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Shinya Kusachi
- Department of Surgery, Ohashi Medical Center, Toho University, Tokyo, Japan
| | - Yukiko Kato
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan
| | - Toru Niitsuma
- Department of Surgery, Ohashi Medical Center, Toho University, Tokyo, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, 480-1195, Aichi, Japan.
| | - Yoshio Takesue
- Department of Infection Prevention and Control, Hyogo College of Medicine, Hyogo, Japan
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Takesue Y, Miyata H, Gotoh M, Wakabayashi G, Konno H, Mori M, Kumamaru H, Ueda T, Nakajima K, Uchino M, Seto Y. Risk calculator for predicting postoperative pneumonia after gastroenterological surgery based on a national Japanese database. Ann Gastroenterol Surg 2019; 3:405-415. [PMID: 31346580 PMCID: PMC6635692 DOI: 10.1002/ags3.12248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/26/2019] [Accepted: 03/13/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The aim of the present study was to develop a risk calculator predictive of postoperative pneumonia in patients undergoing gastroenterological surgery. METHODS We analyzed data from 382 124 patients undergoing eight main gastroenterological surgeries between 2011 and 2013 using the National Clinical Database in Japan. A risk model was developed using multivariate logistic regression analysis with patient data from 2011 to 2012 (n = 247 604) and validated using data from 2013 (n = 134 520). RESULTS Pneumonia was observed in 11 105 patients (2.9%). After the input of significant primary disease and surgical procedures, 18 patient characteristics including gender, chronic obstructive pulmonary disease, sepsis, and need for any assistance in the activities of daily living, six laboratory parameters, and two intraoperative factors were used for risk calculation. Area under the receiver-operating characteristic curve was 0.822 (95% confidence interval, 0.817-0.826) in the derivation group and 0.826 (0.819-0.832) in the validation group. CONCLUSION The risk calculator accurately predicted the occurrence of pneumonia following gastroenterological surgery.
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Affiliation(s)
- Yoshio Takesue
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | | | - Mitsukazu Gotoh
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Go Wakabayashi
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | | | - Masaki Mori
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Hiraku Kumamaru
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Takashi Ueda
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | | | - Motoi Uchino
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
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Otani N, Shima M, Ueda T, Ichiki K, Nakajima K, Takesue Y, Okuno T. Evaluation of influenza vaccine-induced cell-mediated immunity: Comparison between methods using peripheral blood mononuclear cells and whole blood. Microbiol Immunol 2019; 63:223-228. [PMID: 31070266 DOI: 10.1111/1348-0421.12687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/25/2019] [Accepted: 05/05/2019] [Indexed: 11/29/2022]
Abstract
Assessment of cell-mediated immunity (CMI) may be critical to evaluating the ability of individuals to protect themselves against influenza virus infection. However, it has been difficult to evaluate CMI because no simple means of measuring it is currently available. The aim of this study was to compare the performance of a CMI measurement method developed by us, which involves reacting whole blood with antigen, with the conventional method, which is based on isolating peripheral blood mononuclear cells (PBMCs). Correlations between these methods before and after vaccination of 26 healthy adults (aged 28-58 years; 12 men and 14 women) were assessed and changes in CMI after influenza vaccination in PBMCs cultured with antigen for 48 and 96 hr and whole blood cultured with antigen for 48 hr were studied. Results of CMI measurement using whole blood on Day 2 and PBMCs on Day 4 were found to be correlated. Spearman's correlation coefficients with four antigens (A [H1N1], A [H3N2], B [Yamagata lineage], and B [Victoria lineage]) before vaccination were 0.55, 0.61, 0.58, and 0.70, respectively and 0.40, 0.45, 0.62, and 0.52, respectively, after vaccination. CMI was detected sooner when whole blood was reacted with antigen than when PBMCs were reacted with antigen. The rate of positive reaction of influenza A (H1N1 and H3N2) in whole blood on Day 2 was higher than that in PBMCs on Day 2. Our method is simple and may be useful for vaccine development because it can measure CMI in a small amount of blood without separating off PBMCs.
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Affiliation(s)
- Naruhito Otani
- Department of Public Health, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Masayuki Shima
- Department of Public Health, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kaoru Ichiki
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Toshiomi Okuno
- Department of Microbiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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