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Shunichi Koide,1 Yoshiro Hadano,2,3 Shinji Mizuochi,4 Hitoshi Koga,1 Hisashi Yamashita1 1Department of Emergency Medicine, St. Mary’s Hospital, Kurume, Japan; 2Department of Infection Control and Prevention, Tokyo Medical and Dental University Medical Hospital, Tokyo, Japan; 3Biostatistics Center, Kurume University School of Medicine, Kurume, Japan; 4Department of Pathology, Kurume University School of Medicine, Kurume, JapanCorrespondence: Shunichi KoideDepartment of Emergency Medicine, St. Mary’s Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka 830-8543, JapanTel +81-942-35-3322Fax +81-942-34-3115Email aquarium0131@gmail.comBackground: Pneumonitis and pneumonia after non-fatal drowning are common and the pathogens involved are numerous. However, invasive aspergillosis after non-fatal drowning in immunocompetent individuals is relatively rare. Here, we report a case of invasive aspergillosis complicated by pulmonary embolism after non-fatal drowning that proved fatal.Case Presentation: A 75-year-old Japanese man accidentally fell into a creek and was brought to a local hospital. His oxygenation steadily deteriorated to the point that he required intubation and mechanical ventilation. He was then transferred to the emergency department at our hospital. On arrival, he had severe respiratory dysfunction with diminished breath sounds. Radiography of the chest and computed tomography of the lungs showed diffuse bilateral infiltrates. The diagnosis was acute respiratory distress syndrome caused by aspiration pneumonitis as a result of non-fatal drowning and septic shock. Despite intensive care, the patient’s hypoxia continued to worsen and he died on day 7. Computed tomography scans obtained at autopsy showed that both lungs were extensively infiltrated with effusion. An embolus was also detected in the right pulmonary artery. Microscopic analysis revealed diffuse filamentous fungi throughout the lungs, heart, stomach, thyroid gland, and the pulmonary embolus, which were identified as Aspergillus fumigatus by culture.Conclusion: Invasive aspergillosis should also be considered in immunocompetent patients with severe respiratory failure after non-fatal drowning who do not respond to broad-spectrum antibiotics. Angioinvasive aspergillosis can even result in fatal pulmonary embolism; hence, early targeted testing for Aspergillus species and empiric intravenous voriconazole should be considered in such cases.Keywords: drowning, aspergillosis, pulmonary embolism, immunocompetent, acute respiratory distress syndrome

Yoshiro Hadano,1 Bin Chang2 1Department of Infectious Diseases, St. Mary’s Hospital, Kurume, Fukuoka, Japan; 2Department of Bacteriology I, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo, Japan Abstract: Streptococcus pneumoniae is a rare cause of pyogenic sacroiliitis and osteomyelitis. A case of pneumococcal sacroiliitis and osteomyelitis is reported herein. The patient was a previously healthy 54-year-old man with a 3-day history of fever and a 3-week history of increasing right-side thigh pain. Computed tomography showed bone destruction of the right sacroiliac joint with perifocal abscess formation in the right iliac muscle. The patient was diagnosed with pyogenic sacroiliitis and osteomyelitis with a right iliac muscle abscess. Mucoid serotype 3 S. pneumoniae was obtained by culture of abscess. The patient was successfully treated with an 8-week course of antibiotics. Keywords: Streptococcus pneumoniae, pyogenic sacroiliitis, osteomyelitis, serotype 3, invasive pneumococcal diseases

Yoshiro Hadano Department of Infectious Diseases, St. Mary’s Hospital, Kurume, Fukuoka, Japan Abstract: Fourteen cases of reported melioidosis in Japan were reviewed. The mean age was 52.4 years (33–69 years), and all patients were male. All of the presumed exposures originated in Southeast Asia. The most common underlying disease was diabetes mellitus, including those patients with impaired glucose tolerance (n=8). As for mode of onset, 13 patients had acute infections and one had chronic infection. Of these 14 patients, the most common infection site on admission was lung (n=8), followed by bone (n=5), skin (n=4), gastrointestinal abscess formation (n=3), urinary tract (n=3), aorta (n=2), mediastinal lymph node swelling (n=1), and central nervous system (n=1). Bacteremia was observed in nine patients, and Burkholderia pseudomallei isolates were mostly susceptible to ceftazidime and carbapenem. Overall mortality was 14.3%. Melioidosis is a rare infection in Japan, with all known cases to date having been imported from Southeast Asia. Diabetes was a common risk factor. Keywords: melioidosis, Burkholderia pseudomallei, Japan, Southeast Asia

Yoshiro Hadano, Michinori Shirano, Tetsushi Goto Center for Infectious Diseases, Osaka City General Hospital, Osaka, Japan Abstract: We analyzed the travel-related health problems in persons returning to Japan from overseas. Data were extracted retrospectively for all patients visiting the infectious diseases department of Osaka City General Hospital, Osaka, Japan, between July 2012 and September 2013. There were 209 sick returning travelers during the period of the study. The median age of the subjects was 34.3 years, and the subjects consisted of 133 tourists (63.6%), 39 business travelers (18.7%), 17 expatriates (8.1%), 14 volunteer workers (6.7%), and four persons who visited friends and relatives (1.9%). The most visited destinations were Asia (n=162, 77.5%), including East Asia (n=26, 12.4%), Southeast Asia (n=116, 55.5%), South Asia (n=25, 12.0%), Central Asia (n=3, 1.4%), and Africa (n=30, 14.3%). The most commonly diagnosed diseases were gastrointestinal tract infection (n=81, 38.8%), dengue fever (n=26, 12.4%), and animal bites (n=26, 12.4%). Twenty-nine patients (13.8%) were hospitalized, mainly for dengue fever and gastrointestinal tract infection. Keywords: travel medicine, travel-related health problems, Japan

Yoshiro Hadano,1 Taro Shimizu,2 Shimon Takada,3 Toshiya Inoue,4 Sumire Sorano51Department of General Internal Medicine and Infectious Diseases, Rakuwakai Otowa Hospital, Yamashina-ku, Kyoto, Japan; 2Rollins School of Public Health, Emory University, Atlanta, GA, USA; 3Department of General Internal Medicine, Osaka City General Hospital, Miyakojima-ku, Osaka, Japan; 4Department of Emergency Medicine, Urasoe General Hospital, Urasoe-city, Okinawa, Japan; 5Kobe University School of Medicine, Kusunokicho, Chuoku, Kobe, JapanAbstract: Purple urine bag syndrome is characterized by the urinary drainage bag turning purple in patients on prolonged urinary catheterization, especially those in the bedridden state. It is associated with bacterial urinary tract infections caused by indigo-producing and indirubin-producing bacteria, usually affects women, and is associated with alkaline urine, constipation, and a high bacterial load in the urine. Almost all patients with purple urine bag syndrome are catheterized due to significant disability, and the urinary pH is 7.0 or more. In general, intensive treatment with antibiotics is not recommended. Purple urine bag syndrome per se almost always appears to be asymptomatic and harmless. However, caution is needed, because some cases have been reported to show progression to severe disease states, so further research into the morbidity and mortality of this infection is warranted.Keywords: purple urine, urinary catheterization, geriatrics, urinary tract infection

Yoshiro Hadano,1 Kenta Ito,1 Jun Suzuki,1 Ichiro Kawamura,1 Hanako Kurai,1 Kiyofumi Ohkusu21Division of Infectious Diseases, Shizuoka Cancer Center, Shizuoka; 2Department of Microbiology, Graduate Medical School of Medicine, Gifu University, Gifu, JapanAbstract: Moraxella osloensis is a rare causative organism of infections in humans, with most cases reported in cancer patients. We report the case of a 67-year-old Japanese man with advanced cancer of the pancreatic head and multiple liver metastases who developed fever with chills. Blood culture was found to be positive for Gram-negative bacilli that were aerobic, oxidase-positive, and catalase-positive. M. osloensis was identified by 16 rRNA gene sequencing. Prompt control of the infection was achieved by treatment with cefepime for 14 days, without the need for removal of the central venous catheter.Keywords: Moraxella osloensis, central venous catheter, infection, cancer

Pseudomonas otitidis bacteremia is rare. We herein report a case of bacteremia caused by P. otitidis in a patient with advanced appendiceal cancer. A 79-year-old Japanese man developed infection when he was admitted to our hospital for palliative care. Blood culture revealed the presence of Pseudomonas spp. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry was used to identify the organism accurately. The patient was treated with a two-week course of piperacillin/tazobactam, and the bacteremia was successfully controlled. Clinicians should be aware that P. otitidis can cause bacteremia, particularly in immunocompromised patients.

Acute undifferentiated febrile illnesses (AUFIs) are short-duration infectious diseases with nonspecific symptoms. In Thailand, common AUFIs include dengue, malaria, leptospirosis, scrub typhus, and typhoid fever. This study aimed to determine the case numbers of AUFI etiologies in Thailand before coronavirus disease 2019 (COVID-19) (phase 1 from January 2018 to February 2020) and during the COVID-19 pandemic with preventive measures (phase 2 from March 2020 to April 2022), and the loosening of the preventive measures (phase 3 from May 2022 to December 2022). We used Thailand's national database from 2018 to 2022 to determine the case numbers of AUFIs and geographic heat maps to identify endemic areas in Thailand. The case numbers of malaria, dengue, leptospirosis, typhoid, and scrub typhus significantly decreased during phase 2 (preventive measures) (P = 0.02), and cases of malaria and leptospirosis increased during phase 3 (loosened preventive measures) (P = 0.01). In 2022, malaria and leptospirosis increased by 39% and 48%, respectively, compared with the previous year. Malaria increased in western Thailand along the border between Thailand and Myanmar, where malaria preventive measures were insufficient, whereas leptospirosis increased in northern Thailand. The epidemiology of acute febrile diseases changes significantly depending on the global epidemic of infectious diseases such as COVID-19 and the implementation of preventive measures, such as face masks, hand hygiene, social distancing, and stay-at-home and lockdown measures.

Introduction: The objective of this study is to evaluate the epidemiological characteristics of Japanese Spotted Fever (JSF) cases reported through the National Epidemiological Surveillance of Infectious Disease (NESID) system in Shimane Prefecture, Japan, from 2000 to 2022, encompassing the periods before and during the COVID-19 pandemic period., Methods: A retrospective analysis was conducted on JSF cases reported to the NESID system in Shimane Prefecture between 2000 and 2022. Population data were obtained from the Statistical Information of Shimane. Poisson regression analysis was employed to examine the relationship between the annual prevalence rate of JSF and the COVID-19 pandemic., Results: A total of 301 JSF cases were analyzed during the study period. Even the pre-COVID-19 pandemic period, a gradual and significant increase in the prevalence rate was observed (prevalence rate = 1.03, 95% CI: 1.01-1.05; p = 0.01), and a rapid increase was noted since 2020 (prevalence rate = 1.57, 95% CI: 1.39-1.78; p < 0.01). The slope during the pre-COVID-19 pandemic period was estimated to have significantly increased (p < 0.01)., Conclusions: Our findings suggest that while the prevalence rate of JSF had exhibited a slight increase in the years preceding the COVID-19 pandemic, it demonstrated a more significant increase following the pandemic in Shimane Prefecture. JSF has increased since 2020 and may be linked to COVID-19 pandemic. The COVID-19 pandemic has had a substantial impact on global health, underscoring the importance of investigating the prevalence of specific infectious diseases and other health-related indicators to accurately assess the pandemic's impact., Competing Interests: Declaration of competing interest The authors have that no conflict of interest to declare., (Copyright © 2024 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.)

Background: Antimicrobial agents (AMAs) are essential for treating infections. A part of AMAs chelate with metal cations (MCs), reducing their blood concentrations. That drug-drug interaction could lead to a reduction of therapeutic efficacy and the emergence of drug-resistant bacteria. However, prescriptions ordering concomitant intake (co-intake) of AMAs and MCs are frequently seen in clinical settings. A method for preventing such prescriptions is urgently needed., Methods: We implemented pop-up alerts in the hospital's ordering and pharmacy dispensation support system to notify the prescriptions ordering co-intake of AMAs and MCs for physicians and pharmacists, respectively. To assess the effectiveness of the pop-up alerts, we investigated the number of prescriptions ordering co-intake of AMAs and MCs and the number of pharmacist inquiries to prevent co-intake of AMAs and MCs before and after the implementation of pop-up alerts., Results: Before the implementation of pop-up alerts, 84.5% of prescriptions containing AMA and MCs ordered co-intake of AMAs and MCs. Implementing pop-up alerts time-dependently reduced the proportion of prescriptions ordering co-intake of AMAs and MCs to 43.8% and 29.5% one year and two years later, respectively. The reduction of tetracycline-containing prescriptions was mainly significant. Before the implementation of pop-up alerts, the proportion of prescriptions in which pharmacists prevented co-intake of AMAs and MCs was 3.4%. Implementing pop-up alerts time-dependently increased proportions of such prescriptions to 20.9% and 28.2% one year and two years later., Conclusion: Implementing pop-up alerts reduced prescriptions ordering co-intake of AMAs and MCs and accelerated pharmacists to prevent co-intake of AMAs and MCs. The implementation of dual pop-up alerts in the hospital's ordering and pharmacy dispensation support system could help prevent co-intake of AMAs and MCs., (© 2024. The Author(s).)

Objective The novel coronavirus disease 2019 (COVID-19) pandemic has spread worldwide, and hospitals in Japan have been forced to respond to the situation. This study evaluated the broad-spectrum antimicrobial use before and during the COVID-19 pandemic in an acute tertiary-care hospital. Methods This single-center, retrospective study was conducted between January 2019 and June 2021. Patients We reviewed patients treated with three broad-spectrum antipseudomonal agents: carbapenems, tazobactam/piperacillin, and cefepime. Monthly aggregated hospital antimicrobial consumption was measured as days of therapy (DOTs) per 1,000 patient-days, and the monthly incidences of Clostridioides difficile infection (CDI), multidrug-resistant Pseudomonas aeruginosa (MRPA), and carbapenemase-producing Enterobacteriaceae (CPE) were recorded. Results The median monthly carbapenem-DOTs during the pre-pandemic and pandemic era were 8.4 and 8.2 per 1,000 patient-days, respectively. A time-series analysis showed non-significant changes in the level between periods (coefficients: 2.08; 95% confidence interval [CI]: -2.9 to 7.0; p=0.44). No change in the trend of monthly carbapenem-DOTs was observed after intervention. No post-intervention changes in the incidence of MRPA or CPE were observed; however, the trend in the incidence of CDI per 1,000 patient-days significantly differed between the two periods (coefficient: -0.04; 95% CI: -0.07, 0.00; p=0.01), and a downward trend was observed in the monthly CDI incidence during the COVID-19 period. Conclusion The consumption of broad intravenous antimicrobial agents has not changed significantly during the pandemic. We need to maintain the quality of medical care, including antimicrobial stewardship, even in specialized resource-limited facilities during a pandemic.

Background: Clostridioides difficile infection is associated with antibiotic use and manifests as diarrhea; however, emerging cases of fulminant diarrhea caused by binary toxin-producing C. difficile unrelated to prior antibiotic exposure have been reported. Although fulminant colitis caused by C. difficile has been documented, instances of intussusception remain scarce. Here, we present a case of adult intussusception with severe hypokalemia and pneumonia resulting from a community-acquired C. difficile infection in Japan., Case Presentation: An 82-year-old male presented with dizziness, progressive weakness, and diarrhea. Initial vital signs indicated severe respiratory and circulatory distress, and laboratory findings revealed hypokalemia, pneumonia, and septic shock. Imaging confirmed intussusception of the ascending colon. Although colonoscopy suggested a potential tumor, no malignancy was found. The C. difficile rapid test result was positive, indicating community-acquired C. difficile infection. Treatment with vancomycin was initiated; however, intussusception relapsed. Surgical intervention was successful and led to clinical improvement. The patient's complex pathophysiology involved community-acquired C. difficile-induced severe diarrhea, hypokalemia, hypermetabolic alkalosis, and subsequent intussusception. Although adult intussusception is uncommon, this case was uniquely linked to binary toxin-producing C. difficile. The identified strain, SUH1, belonged to a novel sequence type (ST1105) and clade 3, suggesting a highly virulent clone. Resistome analysis aligned with phenotypic susceptibility to metronidazole and vancomycin, confirming their treatment efficacy., Conclusion: This case report highlights a binary toxin-producing C. difficile that caused intussusception. The consideration of community-acquired C. difficile in the differential diagnosis of severe enteritis is necessary, even in Japan., (© 2024. The Author(s).)

Background: We encountered a case of infected soft tissue defect of the fingertip treated using negative pressure wound therapy (NPWT). The development of NPWT was started in the early 1990s, and it is a relatively new treatment method included in insurance coverage in Japan in 2010. NPWT is used for intractable wounds; some reports have examined its use on infected wounds. However, to the best of our knowledge, no study has examined its use on infected fingertip wounds., Methods: A patient with an infected soft tissue defect in the fingertip whose epithelialization period was prolonged despite continued antibiotic therapy was treated using NPWT in combination., Results: After NPWT was started, signs of infection and wound granulation were good. Additionally, completion of epithelialization was confirmed 7 weeks after NPWT started., Conclusions: Conventionally, skin flap or graft by hand surgeons have been performed on fingertip soft tissue defects with infection. NPWT does not require specialized and advanced surgical techniques; treatment for infected soft tissue defects can be administered by anyone if they have the required skills. In conclusion, NPWT may be considered a suitable alternative when treatment options such as flaps and skin grafts are not feasible., Competing Interests: The authors have no financial interest to declare concerning the content of this article., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Amebiasis is a notifiable infectious disease in Japan, and the number of reported cases had been on the rise, but since the discontinuation of insurance-covered serum antibody testing reagent in 2017, concerns have arisen regarding the decrease in reported cases. This study aimed to investigate changes occurring after discontinuation of the serum antibody test reagent production. We retrospectively analyzed amebiasis cases from January 2014 to December 2019 using the National Center for Epidemiology of Infectious Diseases system. Interrupted time-series regression analysis was used to evaluate trends in weekly amebiasis cases before and after the discontinuation period. The study period was divided into prediscontinuation (2014-2017) and discontinuation (2018-2019) periods. A total of 6,179 amebiasis cases were reported. The average numbers of weekly cases were 21.5 during 2014-2017 and 16.3 during 2018-2019. The frequency of diagnoses decreased in the discontinuation period (prevalence rate ratio = 0.78; 95% CI, 0.67-0.89; P < 0.01). Subgroup analysis showed lower diagnostic rates, particularly for extraintestinal amebiasis (prevalence rate ratio = 0.37; 95% CI, 0.22-0.55; P < 0.01). We observed a significant decrease in the number of reported amebiasis cases per week after discontinuation of the serum antibody test reagent in Japan. Our findings hold significance for both public health policy and practice in Japan, underscoring the requirement for enhanced amebiasis diagnostic tools and strategies. To ensure accurate diagnosis, availability of antibody reagents for serum testing, covered by insurance, should be encouraged.

In this retrospective study, we aimed to investigate the frequency, trend, and nature of non-infectious diseases (non-IDs) as the final diagnosis for patients during an infectious disease (ID) consultation in an acute care hospital in Japan. This study included adult inpatients who underwent ID consultations between October 2016 and March 2018. The demographic data, clinical manifestations, and final non-ID diagnoses of cases were explored. Among the 502 patients who underwent ID consultations, 45 (9.0%) were diagnosed with non-IDs. The most common diagnoses were tumors (22.2%, n = 10), connective tissue and collagen vascular diseases (13.3%, n = 6), other inflammatory diseases (8.9%, n = 4), and drug-induced fever (8.9%, n = 4). Multiple logistic regression analysis showed that the presence of consultations for diagnosis (odds ratio [OR], 22.0; 95% confidence interval [CI], 10.1-48.2; p<0.01), consultations from the internal medicine department (OR, 2.5; 95% CI, 1.2-5.2; p = 0.02), and non-bacteremia cases (OR, 5.2; 95% CI, 1.4-19.3; p = 0.01) were independently associated with diagnosed non-IDs. Non-IDs after ID consultations were mainly tumor-related, inflammatory diseases, and drug fever. The presence of consultations for diagnosis, consultations from the internal medicine department and non-bacteremia cases were related to non-IDs among ID consultations. Further research is needed to explore the frequency and pattern of non-IDs to improve the quality of ID consultations in daily practice., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Hadano, Matsumoto. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Limited data are available regarding part-time infectious disease consultations (IDCs) and their importance in tertiary care teaching hospitals in Japan. This is a retrospective review of IDCs from June 2016 to March 2021 and describes IDC services provided by part-time infectious disease specialists once a week for 4 hours, and their impact on the quality of medical care, including antimicrobial stewardship. Data, such as the requesting department, requesting reasons, and final diagnoses, were analyzed. In April 2018, part-time infectious disease specialists launched consultation services and attended an antimicrobial stewardship team conference. Meropenem, tazobactam/piperacillin, and cefepime monthly days of therapy (DOT) were calculated to assess the effect of each intervention; a pre-post analysis was conducted using the Kruskal-Wallis test. Additional quality improvement (QI) projects related to infectious diseases were implemented. There were 237 IDCs during the study period. Consultations were mostly requested by the General Internal Medicine, Emergency Medicine, and Cardiology departments. The most common diagnoses were bone/joint, respiratory, and genitourinary infections. Infectious disease services, even on a part-time basis, achieve good outcomes in patient management, antimicrobial stewardship, and QI projects. DOT/1000 patient-days were reduced for meropenem and cefepime, while it increased for tazobactam/piperacillin. The DOT/1000 patient-days for the 3-antipseudomonal agents significantly decreased during this period. After implementing the QI tetanus vaccination project in the Emergency Room, the number of tetanus toxoid vaccinations per month increased., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

In Japan, general internal medicine (GIM) physicians must be aware of frequently encountered infections because of the shortage of infectious disease (ID) specialists. However, there are currently no epidemiological data on this subject. This study aimed to describe the frequency and pattern of ID consultations requested by GIM physicians in Japan. This is a 3-year retrospective review of the ID consultations requested by GIM physicians in Japan at a community-based acute tertiary care teaching hospital in Tokyo from April 2018 to March 2021. Demographic data, such as reasons for consultation, causative organism, and final diagnoses, were collected. During the study period, ID consultations were requested by GIM physicians 128 times. The incidence rates of bacteremia and 30-day mortality were 65.6% (n = 84) and 3.1% (n = 4), respectively. The most common diagnostic classifications after ID consultation were bone/joint (24.2%, n = 31), respiratory (17.7%, n = 22), and cardiovascular infections (12.5%, n = 16). The most common final diagnoses were bacteremia (11.7%, n = 15), infective endocarditis (9.4%, n = 12), and vertebral osteomyelitis (7.8%, n = 10). This is the first study to describe the ID consultation cases requested by GIM physicians in Japan in a community-based acute tertiary care teaching hospital. Despite the shortage of ID specialists, GIM physicians covered a wide range of IDs, including bone/joint infections and infectious endocarditis, which require long-term care. ID and GIM physicians, including hospitalists, should cooperate to promote the quality of care and clinical management. Future multi-center studies with large numbers of clinical cases are needed to determine the ID clinical knowledge required by GIM physicians in Japan., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Staphylococcus pettenkoferi is a coagulase-negative staphylococci (CoNS) species first isolated in 2002. Human infections caused by S. pettenkoferi are rare. We herein report three cases of S. pettenkoferi bacteremia in a tertiary care hospital in Japan. Staphylococcus pettenkoferi can be a causative pathogen of catheter related blood stream infection including complicated infection, and unknown source of bacteremia. All of the patients presented with fever and shaking chills, and good clinical outcome. Further research is needed to determine the role of this organism as a pathogen and frequency., (Copyright © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Antibiotic stewardship programs reduce antibiotic use without negative clinical outcomes. However, epidemiological data describing the relationship between implementing antimicrobial stewardship and candidemia incidence are scarce. This study aimed to evaluate the effect of antibiotic stewardship on the incidence of hospital acquired candidemia. We conducted a retrospective study from April 2017 to September 2020. We reviewed patients that were treated with three broad-spectrum antipseudomonal agents: carbapenem, tazobactam/piperacillin, and cefepime. Monthly aggregated hospital antimicrobial consumption was measured as days of therapy (DOTs) per 1000 patient-days, and the monthly incidence of hospital acquired candidemia was recorded. The median monthly carbapenem-DOTs during pre-intervention and intervention were 28.4 and 10.0, respectively. Time-series analysis showed significant level changes after intervention: - 10.0 DOTs (p = 0.02). There was a downward trend in the monthly carbapenem-DOTs after intervention. The median hospital-acquired candidemia incidence was 0.17 and 0.08 per 1000 patient-days during pre-intervention and intervention periods, respectively. Time-series analysis showed a significant level change after intervention (- 0.16 per 1000 patient-days; p = 0.048). The trend in the incidence of hospital-acquired candidemia did not significantly change between pre-intervention and intervention. Decreased broad-spectrum antibiotic use (particularly carbapenem) by our antimicrobial stewardship term may reduce hospital-acquired candidemia incidences., (© 2022. The Author(s).)

An 11-year-old girl presented with pain in the sinus tarsi and a foot deformity after spraining her left foot. She had flat foot due to spasticity of the peroneal tendon, which was difficult to correct manually. An imaging study revealed an accessory anterolateral talar facet (AALTF) and bone marrow oedema at the lateral aspect of the posterior talocalcaneal joint. We diagnosed peroneal spastic flat foot with possible involvement of sinus tarsi syndrome and AALTF. When conservative therapy failed, we applied a cast with the foot in full plantar flexion and an inverted position. After 4 weeks, the patient had a normal range of motion in the foot, the pain had resolved completely and the peroneal spasticity had disappeared. Orthopaedic treatment with a cast may be worth attempting before surgery in such cases., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Rheumatoid arthritis (RA) is an inflammatory disease characterized by a variety of symptoms and pathologies often presenting with polyarthritis. The primary symptom in the initial stage is joint swelling due to synovitis. With disease progression, cartilage and bone are affected to cause joint deformities. Advanced osteoarticular destruction and deformation can cause irreversible physical disabilities. Physical disabilities not only deteriorate patients' quality of life but also have substantial medical economic effects on society. Therefore, prevention of the progression of osteoarticular destruction and deformation is an important task. Recent studies have progressively improved our understanding of the molecular mechanism by which synovitis caused by immune disorders results in activation of osteoclasts; activated osteoclasts in turn cause bone destruction and para-articular osteoporosis. In this paper, we review the mechanisms of bone metabolism under physiological and RA conditions, and we describe the effects of therapeutic intervention against RA on bone.

Competing Interests: The author has no conflict of interest to disclose.

IVIA is a joint initiative of at least 8 Latin-American countries plus Portugal and Spain to make good use of large telecommunications antennas that are out of service in these countries, because most international communications are now using submarine cables. The first step will be to refurbish the antennas and then to start doing single dish observations of radiosources. In a second step the antennas will be equipped with VLBI (Very Long Base Interferometry) equipment, to establish a VLBI network. This project will be able to effectively promote scientific integration in Ibero-America. The work is starting in several countries; here we present several scientific cases for the use of the antennas, and we report on the first Brasilian activities.

Rationale: Ecthyma gangrenosum (EG) is an uncommon cutaneous infection usually associated with Pseudomonas aeruginosa bacteremia in immunocompromised patients, particularly those with underlying malignant diseases. Despite its rarity, especially in immunocompetent or nondiagnosed immunodeficiency patients, EG can present as the first manifestation of an underlying immunosuppression., Patient Concerns: A 42-year-old Japanese man was admitted to our hospital with a 3-day history of a painless red macule on his right forearm and fever., Diagnoses: Blood culture on admission revealed the presence of Pseudomonas aeruginosa, whereas pus culture of the skin lesion showed Pseudomonas aeruginosa and methicillin-susceptible Staphylococcus aureus positivity., Interventions: Additional bone marrow aspirate examination and immunophenotyping were performed to confirm the diagnosis of acute promyelocytic leukaemia with PML-retinoic acid alpha receptor., Outcomes: The patient was successfully treated with a 14-day course of antibiotics, and no evidence of relapse was noted. The patient achieved complete remission after treatment for acute promyelocytic leukaemia., Lessons: It should be kept in mind that EG is an important cutaneous infection that is typically associated with P aeruginosa bacteremia and the presence of underlying immunodeficiency, such as acute leukaemia., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: Most Japanese hospitals need to keep to higher Staphylococcus aureus bacteremia (SAB) quality-of-care indicators (QCIs) and create strategies that can maximize the effect of these QCIs with only a small number of infectious disease specialists. This study aimed to evaluate the clinical outcomes of patients with SAB before and after the enhancement of the mandatory infectious disease consultations (IDCs)., Methods: This retrospective study was conducted at a tertiary care hospital in Japan. The primary outcome was the 30-day mortality between each period. A generalized structural equation model was employed to examine the effect of the mandatory IDC enhancement on 30-day mortality among patients with SAB., Results: A total of 114 patients with SAB were analyzed. The 30-day all-cause mortality differed significantly between the two periods (17.3% vs. 4.8%, P = 0.02). Age, three-QCI point ≥ 1, and Pitt bacteremia score ≥ 3 were the significant risk factors for 30-day mortality. The intervention was also significantly associated with improved adherence to QCIs., Conclusion: Mandatory IDCs for SAB improved 30-day mortality and adherence to QCIs after the intervention. In Japan, improving the quality of management in patients with SAB should be an important target., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The coronavirus disease 2019 (COVID-19) has become a major health threat. To overcome COVID-19, appropriate diagnosis methods are urgently needed. The aim of this study was to clinically evaluate the colloidal gold immunochromatography assay for SARS-Cov-2 IgM/IgG antibody (Ab)., Methods: Patients confirmed COVID-19 (n = 51) were recruited prospectively from the Musashino Red Cross hospital and Tokyo Medical and Dental University Medical Hospital, between March and May 2020. And the analytical specificity was assessed with serum samples of patients without COVID-19 (n = 100) collected between August to September 2019 before SARS-CoV-2 was first reported in China., Results: Among COVID-19 patients, a total of 87 serum samples were tested for SARS-Cov-2 IgM/IgG Ab assay. IgM was detected 71.0 %, 86.9 %, and 83.3 % at day8-14, 15-28, >29 after symptom onset and IgG was detected in 81.6 %, 87.0 %, and 94.4 %, respectively. The sensitivity of IgM and IgG Ab after day8 assay was significantly higher than before day7, respectively (p=0.0016, 0.0003). There were no positive results in 100 serum samples from patients without COVID-19., Conclusion: The SARS-Cov-2 IgM/IgG Ab assay had 79.7% / 86.1% sensitivity (the 8 days after from onset) and 100% specificity in this population., (© 2020 Wiley Periodicals LLC.)

Noninfectious diseases may be diagnosed during infectious disease (ID) consultations. Among non-IDs, cancer diagnosis is important; however, epidemiological data describing the relationship between ID consultations and newly diagnosed cancer patients are scarce. This study described the frequency and tendency of new cancer diagnoses in patients after ID consultation.This retrospective study included adult inpatients who underwent ID consultations between October 2016 and March 2018. The demographic data and clinical manifestations of each case are described.Among the 380 inpatients who underwent ID consultations, 6 (1.6%) received a new cancer diagnosis after ID consultation. Among the initial most likely diagnoses, 3 patients were diagnosed with IDs and 3 were diagnosed with non-IDs. The initial most likely ID diagnosis was important for new cancer diagnoses (P = .004, odds ratio: 11.1, 95% confidence interval: 2.11-57.2); diagnostic errors, as judged by the physicians, occurred in 2 of the 6 cases.While the frequency of establishing new diagnoses during ID consultations is low, coexisting infection and cancer is possible. ID specialists should identify any patterns related to new cancer diagnosis in patients to prevent diagnostic error and improve the quality of diagnosis.

Background: Little is known about the impact of infectious disease (ID) consultations on the management of patients with cancer. This study aimed to describe the consultation services provided by ID specialists to all departments in a comprehensive cancer center in Japan., Methods: We conducted a retrospective review of ID consultations with adult patients at a comprehensive cancer center in Japan from April 2017 to March 2018., Results: During the study period, 776 patients with cancer had an ID consultation. Of these, 414 (53.4%) were hospital inpatients. Reasons for the ID consultation comprised clinical management (n = 481, 62.0%), immunization (n = 272, 35.1%), and infection control (n = 23, 3.0%). Of the 474 ID consultations for diagnostic purposes, the most frequent condition was fever or elevated inflammatory markers of unknown origin (n = 125, 26.4%). The most frequent diagnoses after the diagnostic ID consultation were hepatobiliary infections (n = 97, 22.4%), respiratory infections (n = 89, 20.618.8%), and intra-abdominal infections (n = 71, 16.4%). The commonest reasons for immunization consultations were to prevent seasonal influenza (n = 193, 71.0%) and post-splenectomy vaccination (n = 58, 21.3%). The commonest reasons for infection control consultations were suspected tuberculosis or contact with tuberculosis (n = 11, 47.8%) and herpes zoster infection (shingles) (n = 7, 30.4%)., Conclusions: ID specialists play an important role in the clinical management of patients with cancer. ID physicians who work in cancer centers need to be specialized in treating IDs, diagnosing the causes of fevers of unknown origin, and controlling infection.

The micromolding process using biocompatible thermoplastic polymers is highly attractive as a fabrication process of microdevices in biomedical applications. In this study, we investigated the effect of the thermal history in the micromolding process on the crystallinity of semi-crystalline polymers, such as poly (L-lactic acid) (PLLA), during their crystallization from the amorphous and molten states. In particular, the thermal history in the micromolding process using poly(dimethylsiloxane) replica mold embedded with a thermocouple was recorded. The crystallinity of PLLA constructs fabricated using the micromolding process was measured via wide-angle X-ray scattering, and crystallization kinetics was analyzed based on the Kolmogorov-Johnson-Mehl-Avrami equation. A crystallization rate of k = 0.061 min - n was obtained in the micromolding process of PLLA crystallization from the amorphous state, accompanied by the quenching operation, forming a large number of crystal nuclei. Finally, the fabrication of PLLA microneedles was performed using micromolding processes with different thermal histories. The information about the thermal history during the micromolding process is significant in the development of polymer microdevices to achieve better material properties.

Background: Clostridioides difficile ribotype (RT) 019/sequence type (ST) 67 strains belong to a hypervirulent lineage closely related to RT027/ST1; however, limited data are available for hypervirulent clade 2 lineages in Japan. Herein, we report the draft genome of a C. difficile strain B18-123 belonging to clade 2, RT019/ST67 for the first time in Japan., Results: The pathogenicity locus carried by B18-123 (19.6 kb) showed higher homology (97.29% nucleotide identity) with strain R20291 (RT027/ST1) than the reference strain 630 (RT012/ST54), and B18-123 harbored 8-nucleotide substitutions in tcdC . However, it did not contain an 18-base pair (bp) deletion or a single-bp deletion at position 117 in tcdC , which was identified in the previous strain R20291. A cytotoxicity assay revealed similar cytotoxicity levels between strains B18-123 and ATCC BAA-1870 (RT027/ST1). The B18-123 strain was found to be susceptible to metronidazole and vancomycin., Conclusion: Our findings contribute to the further understanding of the characteristics of hypervirulent clade 2 including RT019/ST67 lineages., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2019.)

The GHIJKL fragment of gymnocin-B was synthesized using the oxiranyl anion strategy. The first highlight of the synthesis is the bromoketone cyclization reaction on the oxepane ring to construct the fused bisoxepane GH ring. The second key step is the introduction of the trans -4-hydroxy-3-methyloxepane J ring via addition of trimethylaluminum to a conjugated oxonium moiety, followed by diastereoselective epoxidation and regioselective reduction.

Objectives: The emergence and spread of carbapenemase-producing Enterobacteriaceae is a worldwide concern. This study reports the whole genome sequence of an NDM-5-, CTX-M-14-, OXA-10- and MCR-1-co-producing Escherichia coli sequence type 167 (ST167) multidrug-resistant clinical strain (EC129) isolated from a sputum sample of a hospitalised patient diagnosed with pneumonia., Methods: The genome of E. coli EC129 was subjected to next-generation sequencing and reads were assembled. The draft genome was annotated using DDBJ Read Annotation Pipeline DFAST server, followed by subsequent in silico analysis., Results: The genome of E. coli ST167 strain EC129 is 5319159 bp in length and contains 5022 protein-coding sequences. The bla NDM-5 , bla CTX-M-14 , bla OXA-10 and mcr-1 genes were detected along with other antimicrobial resistance genes conferring resistance to aminoglycosides, fluoroquinolones, sulfonamides, trimethoprim and tetracyclines. Antimicrobial susceptibility testing revealed that the isolate was resistant to all antimicrobial agents except colistin., Conclusion: To our knowledge, this study is the first to report anE. coli ST167 strain co-producing NDM-5, CTX-M-14, OXA-10 and MCR-1 isolated from a sputum sample of an individual with pneumonia in Japan, thus elucidating the molecular characteristics and resistance gene diversity of this strain., (Copyright © 2019 International Society for Antimicrobial Chemotherapy. Published by Elsevier Ltd. All rights reserved.)