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The increasing incidence of candidemia and the emergence of drug-resistant Candida species are major concerns worldwide. Therefore, long-term surveillance studies are required. Here, we provide one of the largest longitudinal overviews of the trends in the prevalence of Candida species using national data of 57 001 candidemia isolates obtained from2000 hospitals for the 2010-2019 period in the Japan Nosocomial Infections Surveillance database. The proportion of Candida species, except Candida krusei and Candida guilliermondii, was almost the same during the study period. The proportion of C. guilliermondii surpassed that of C. krusei in 2014. The incidence of candidemia due to C. albicans (P 0.0001), C. parapsilosis (P = 0.0002), and C. tropicalis (P 0.0001) have decreased significantly over this period. Azole susceptibility of C. tropicalis was low, with 17.8% of isolates resistant to fluconazole and 13.5% resistant to voriconazole. The micafungin susceptibility of C. glabrata was low, with 8.0% of isolates showing resistance. The resistance rate of C. krusei toward amphotericin B fluctuated considerably (between 3.2% and 35.7%) over this period. The incidence rate of candidemia caused by C. parapsilosis and C. guilliermondii in hospitals responsible for bone marrow transplantation was significantly higher than that in other hospitals. Overall, our study suggests that in Japan, the species distribution of Candida was almost the same in this period and similar to that reported in North America and Europe. A relatively high resistance to azoles and micafungin was observed in C. glabrata, C. tropicalis, and C. krusei isolates, which require continued surveillance.This study verifies that the proportion of Candida species in Japan was almost the same from 2010–2019. A relatively higher resistance to azoles and micafungin was observed for C. glabrata, C. tropicalis, and C. krusei isolates.

A 56-year-old Japanese man diagnosed with acquired immunodeficiency syndrome, Pneumocystis jirovecii pneumonia and cytomegalovirus infection presented with thrombocytopenia after starting antiretroviral therapy, which included dolutegravir (DTG). Although good control of the human immunodeficiency virus and cytomegalovirus infections was achieved, the patient's thrombocytopenia persisted. The patient's platelet count decreased to ≤50,000 /μL even after the cessation of valganciclovir, which can cause bone marrow suppression. At five months after starting antiretroviral therapy, DTG was replaced by ritonavir-boosted darunavir. Soon after, his platelet count improved and was maintained at a level of >100,000 /μL. This is the first reported case of severe thrombocytopenia during DTG-containing antiretroviral therapy.

HIV infection, in particular in patients with developing AIDS, carries a risk of causing toxoplasmosis with encephalitis, which is mostly caused by a form (bradyzoite) of the protozoan parasite Toxoplasma gondii. HIV/AIDS in Japan has been recognized as a serious health issue in recent years. In this study, to elucidate T. gondii seroprevalence in HIV-positive patients in Japan and associated characteristics with Toxoplasma parasite infection, the titer of T. gondii IgG (Tg-IgG) was measured in 399 HIV-positive patients who visited a hospital in Tokyo, Japan, between 2015 and 2017. A questionnaire survey was also conducted to investigate associations between lifestyle and customs. As a result, the overall prevalence of Tg-IgG-positive serum was 8.27% (33 cases of 399). All the cases positive for Tg-IgG were confirmed using the Sabin-Feldman dye test; the titers between each examination correlated robustly (p 0.001, r = 0.6). A correlation between Toxoplasma infection rate and age was determined (p 0.001), whereas there was no significant correlation with lifestyle customs such as consuming undercooked meat or owning a cat. An association between Toxoplasma infection and experience of dwelling in the Hokkaido area, the northern part of Japan, was observed (p = 0.001). These results suggested that the proportion of those who were previously exposed to Toxoplasma parasites in the HIV-positive population has been maintained at a similar level as that of the HIV-negative population in Japan, providing clear information about the potential risk of toxoplasmic encephalitis.

The objective of this study was to evaluate the association between the number of blood cultures collected and the appropriateness of care for suspected bacteremic community-acquired urinary tract infection (UTI) in the elderly. We retrospectively evaluated the medical records of 129 patients with UTI >65 years old admitted to a large community-based training hospital in Japan from 1 January 2006 to 31 December 2009. We assessed the association between the number of blood cultures collected and the appropriateness of care received, as well as other factors. Two-thirds of the patients were women, and patients >85 years old accounted for 45.0% of the cases. Most of the organisms isolated from the urine and blood were Escherichia coli (65.4–67.0%). More than two blood cultures were collected 79.1% of the time, and 66.7% of the cases were evaluated as having been treated appropriately. The appropriateness of care was not significantly related to the number of blood cultures. The appropriateness of care received in the general internal medicine department was significantly higher (p = 0.016) than that in other departments. Thus, the appropriateness of care for suspected bacteremic UTI in the elderly was not significantly associated with the number of blood cultures. However, the department of hospitalization may have influenced the appropriateness of care.

Background Metastatic infections, such as infective endocarditis and pyogenic spondylitis, are very serious complications of Staphylococcus aureus bacteremia (SAB), because failure to identify metastatic infections may cause poor prognosis. The aim of the present study is to determine the predictive factors for metastatic infections of SAB. Methods This retrospective cohort study was conducted among patients with bacteremia due to S. aureus (including both methicillin-sensitive S. aureus and methicillin-resistant S. aureus: MSSA and MRSA) in The Jikei University Kashiwa Hospital. The study population comprised 125 adult patients with SAB between January 2014 and December 2017. Patients, that died or transferred within 3 months after the initial positive blood culture, were excluded, because metastatic infection was defined as deep-seated infection detected within 3 months after the initial positive blood culture. We analyzed several factors, including demographics, comorbidities, community acquisition, primary site of infection, persistent fever and laboratory data such as c-reactive protein (CRP) levels after treatment. Results Seventy-four patients met inclusion criteria of this study. The most common primary site of bacteremia was catheter-related [24 (32.4%) of 74]. Metastatic infection occurred in 22 (29.7%) of 74 patients, and spondylitis was most common, following psoas abscess. Of these, 11 infections (50% of 22) were community acquired. We did not find any significant differences in demographics and comorbidities, except central venous catheter-associated bloodstream infection, which was associated with low rate of metastatic infection. By multivariate analysis, the predictive factors associated with the development of metastatic infection were community onset of infection (OR 11.6; 95% CI 2.98–45.1; P < 0.001), persistent fever over 72 hours (OR 6.7; 95% CI 2.12–21.8; P = 0.001), and higher CRP levels (>3 mg/dL) lasting 2 weeks after the administration of appropriate antibiotics (OR 7.47; 95% CI 2.39–23.3; P < 0.001). Conclusion This study demonstrated that additional diagnostic tests to identify metastatic infection should be performed, especially in the patients with community-acquired SAB, persistent fever or persistently high CRP levels after the administration of appropriate antibiotics. Disclosures All authors: No reported disclosures.

Using a hybrid baculovirus system, we compared the expression of 45 recombinant proteins from six categories using two models: silkworm (larvae and pupae) and an Sf9 cell line. A total of 45 proteins were successfully expressed; preparation of hybrid baculovirus was unsuccessful for one protein, and two proteins were not expressed. A similar pattern of expression was seen in both silkworm and Sf9 cells, with double and multiple bands found in immunoblotting of the precipitate of both hosts. Degraded proteins were seen only in the silkworm system (particularly in the larvae). Production was more efficient in silkworms; a single silkworm produced about 70 times more protein than 10(6) Sf9 cells in 2 ml of culture medium.

A 64-year-old man with prostate cancer and bone metastasis admitted for nausea, left abdominal pain showed no abnormal, and fever, abdominal ultrasound or chest X-ray findings. Despite antibiotics, left abdominal pain persisted for several days. Abdominal computed tomography (CT), showed splenic infarction. Transesophageal echocardiography suggested infectious endocarditis (IE) as a possible infarction cause, and roth spots were found on the retina. Gemella morbillorum was detected from blood culture. IE commonly causes Fever of Unknown Origin found by infarction. G. morbillorum, an anaerobic gram-positive, viridans group streptococci, is indigenous to the oropharynx, upper respiratory, urogenital, and gastrointestinal tracts, and is thought to have weak toxicity and pathogenicity in the body.

A 64-year-old man with prostate cancer and bone metastasis admitted for nausea, left abdominal pain showed no abnormal, and fever, abdominal ultrasound or chest X-ray findings. Despite antibiotics, left abdominal pain persisted for several days. Abdominal computed tomography (CT), showed splenic infarction. Transesophageal echocardiography suggested infectious endocarditis (IE) as a possible infarction cause, and roth spots were found on the retina. Gemella morbillorum was detected from blood culture. IE commonly causes Fever of Unknown Origin found by infarction. G. morbillorum, an anaerobic gram-positive, viridans group streptococci, is indigenous to the oropharynx, upper respiratory, urogenital, and gastrointestinal tracts, and is thought to have weak toxicity and pathogenicity in the body.

Background Metastatic infections such as infective endocarditis and psoas abscess are serious complications of Staphylococcus aureus bacteremia because failure to identify these infections may result in bacteremia relapse or poor prognosis. in the present study, we determined the predictive factors for metastatic infection due to methicillin-sensitive S. aureus bacteremia. Methods A retrospective cohort study was conducted among patients with methicillin-sensitive S. aureus bacteremia at the Jikei University Hospital between January 2008 and December 2012. Factors analyzed included the underlying disease, initial antimicrobial treatment and primary site of infection. Results During the 5-year study period, 73 patients met the inclusion criteria and were assessed. The most common primary site of bacteremia was catheter-related bloodstream infection (25/73 [34.2%]). Metastatic infection occurred in 14 of 73 patients (19.2%) (infective endocarditis [3], septic pulmonary abscess [3], spondylitis [4], psoas abscess [4], epidural abscess [3] and septic arthritis [1]). six patients had multiple metastatic infections. Multivariate analysis revealed that the predictive factors associated with the development of metastatic infection were a delay in appropriate antimicrobial treatment of > 48 hours, persistent fever for > 72 hours after starting antibiotic treatment and lowest C-reactive protein levels of > 3 mg/dL during 2 weeks after the onset of bacteremia. Conclusions This study demonstrated that additional diagnostic tests should be conducted to identify metastatic infection, particularly in patients with delayed antimicrobial treatment, persistent fever and persistently high C-reactive protein levels.