Japanese Journal of Pharmaceutical Health Care and Sciences, Aug 10, 2017
The aim of this report was to evaluate whether days of therapy (DOT), antimicrobial use density (... more The aim of this report was to evaluate whether days of therapy (DOT), antimicrobial use density (AUD), and the rate of resistance of Pseudomonas aeruginosa to meropenem (the rate of resistance) change after stepwise execution of antimicrobial stewardship for carbapenems. Since April 2012, antimicrobial stewardship for carbapenems has been performed by an infection control team comprising physicians and pharmacists specializing in infectious diseases. The stewardship included surveillance of all cases of carbapenem use since April 2012, intervention and feedback for cases of inappropriate carbapenem use since April 2013, and unification of carbapenems since November 2014. Surveillance implementation alone led to an increase in the rate of resistance, DOT, and AUD. However, the rate of resistance, DOT, and AUD decreased when surveillance implementation was combined with intervention and feedback. On the other hand, DOT and AUD decreased and the rate of resistance was unchanged upon combining these approaches and unification of carbapenems. These results suggest that focus on implementation of surveillance would not be sufficient to ensure the appropriate use of carbapenems and that interventions and feedback regarding inappropriate carbapenem use would be important for promoting appropriate carbapenems use. Furthermore, these results suggest that unification of carbapenems does not negatively affect the rate of resistance. Key words -antimicrobial stewardship, the rates of resistance of Pseudomonas aeruginosa to carbapenems, days of therapy (DOT), antimicrobial use density (AUD)
Background: Circulating interferon-γ (IFN-γ) concentration may be sustained at a high level regar... more Background: Circulating interferon-γ (IFN-γ) concentration may be sustained at a high level regardless of the initiation of antiretroviral therapy (ART) in some patients with HIV-1 infection. In the present study, we examined the clinical characteristics of HIV-1-infected patients with high levels of plasma IFN-γ. Methods: The study subjects were patients infected with HIV-1 who were either naïve to ART with CD4 + cell count > 200 cells/μL (n = 12), or had achieved viral suppression after ART for over a year (n = 188). The levels of plasma IFN-γ and interleukin-6 (IL-6) were measured by the enzyme-linked immunosorbent assay. Patients were divided into high IFN-γ and low IFN-γ groups based on a cutoff level of 5 pg/mL. Results: The high IFN-γ group included 41 patients (21%). Compared to the patients on ART with low IFN-γ levels, those on ART in the high IFN-γ group were more likely to be younger than 50 years of age (P = 0.0051) and less likely to have dyslipidemia (P = 0.0476) or to be on a protease inhibitor (P = 0.0449). There was no significant difference between groups in the median increase of CD4 + cell counts from the initiation of ART for up to 3 years. However, after 4 years, the increase in CD4 + cell counts was significantly lower in the high IFN-γ group compared with that in the low IFN-γ group. There were no such significant differences between patients with low and high (> 2 pg/mL) levels of plasma IL-6. Conclusion: We concluded that HIV-1-infected patients with high levels of circulating IFN-γ did not have a higher rate of comorbidities related to immune activation. However, they exhibited lower CD4 + cell count recovery after 4 years of being on ART. This deficit could be a consequence of persistent immune activation.
Journal of Infection and Chemotherapy, Apr 1, 2017
Introduction: High human herpesvirus 8 (HHV-8) seroprevalence has been reported in men who have s... more Introduction: High human herpesvirus 8 (HHV-8) seroprevalence has been reported in men who have sex with men (MSM) and are infected with HIV-1. However, it is unclear when they become infected with HHV-8. Thus, we conducted cross-sectional and longitudinal investigations of HHV-8 seroprevalence in HIV-1-infected individuals in Osaka, Japan. Patients and methods: Plasma was collected from 121 individuals infected with HIV-1 and the anti-HHV-8 antibody titer was measured using an enzyme-linked immunosorbent assay with whole virus lysate. Subjects were classified into those with and without a past medical history of HHV-8-associated disease; the latter group was then classified into 3 subgroups based on the assumed route of HIV-1 infection: blood products, homosexual contact, and other routes. HHV-8 seroprevalence was compared among the groups and measured again approximately 3 years after the baseline measurement. The relationship between HHV-8 seropositivity and possible associated factors was also investigated. Results: All 15 subjects with HHV-8-associated disease were seropositive, and all 11 subjects in the blood product group were seronegative. In the MSM group, 25 (30%) of 79 subjects were HHV-8 seropositive and, in the non-MSM group, 1 (6%) of 16 subjects was (p < 0.0001). In the longitudinal investigation, seroconversion was observed in 10 (19%) of 52 subjects in the MSM group who were seronegative at baseline. A correlation was observed between seroconversion and symptomatic syphilis (p ¼ 0.0432). Conclusions: HHV-8 seropositivity and seroconversion rates were high in HIV-1-infected MSM, suggesting that, currently, HHV-8 is an epidemic pathogen in this population.
Iryo Yakugaku (Japanese Journal of Pharmaceutical Health Care and Sciences), 2017
The aim of this report was to evaluate whether days of therapy (DOT), antimicrobial use density (... more The aim of this report was to evaluate whether days of therapy (DOT), antimicrobial use density (AUD), and the rate of resistance of Pseudomonas aeruginosa to meropenem (the rate of resistance) change after stepwise execution of antimicrobial stewardship for carbapenems. Since April 2012, antimicrobial stewardship for carbapenems has been performed by an infection control team comprising physicians and pharmacists specializing in infectious diseases. The stewardship included surveillance of all cases of carbapenem use since April 2012, intervention and feedback for cases of inappropriate carbapenem use since April 2013, and unification of carbapenems since November 2014. Surveillance implementation alone led to an increase in the rate of resistance, DOT, and AUD. However, the rate of resistance, DOT, and AUD decreased when surveillance implementation was combined with intervention and feedback. On the other hand, DOT and AUD decreased and the rate of resistance was unchanged upon combining these approaches and unification of carbapenems. These results suggest that focus on implementation of surveillance would not be sufficient to ensure the appropriate use of carbapenems and that interventions and feedback regarding inappropriate carbapenem use would be important for promoting appropriate carbapenems use. Furthermore, these results suggest that unification of carbapenems does not negatively affect the rate of resistance.
Japanese Journal of Environmental Infections, 2012
In February 2009, we conducted a survey on the level of awareness of infection control procedures... more In February 2009, we conducted a survey on the level of awareness of infection control procedures among the members of the Higashi yodogawa-District Pharmacists Association (HPA). These results suggested that awareness towards infection control procedures were not adequate. Later that year, the H1N1 ‰u pandemic occurred, and we carried out a post-survey aimed toˆnd out whether infection control procedures had changed at each pharmacy. In May 2010, a questionnaire was sent to all 55 pharmacies of the HPA and 44 responded (response rate; 80). As a result, the rate of mask usage in contact with infectious patients was higher compared with the results of the 2009 survey. A number of pharmacies had changed policies such as giving medicine to infectious patients before other patients. Theˆndings indicated that the awareness of infection control procedure was improved at pharmacies. We believe that hospitals or pharmacies and related organizations must work together through periodically scheduled workshops to consider practical infection control procedures to prevent the spread of regional infection.
Japanese Journal of Environmental Infections, 2010
Infection control in hospitals is extremely important, but patients with infectious diseases and ... more Infection control in hospitals is extremely important, but patients with infectious diseases and other patients may also gather in community pharmacies, thus allowing infectious diseases to spread. Therefore, infection control was examined in cooperation with the members of the Pharmaceutical Association in Higashi-yodogawa-ku using a questionnaire survey. The content of the questionnaire was proposed by the infection control committee in our hospital.The questionnaire was mailed to 55 community pharmacies in February 2009, and the response rate was 89. Community pharmacies provide an important consultation service about infection control. The responses to the survey will contribute to infection control in the community.
A 54-year-old woman with lung adenocarcinoma which has EGFR point mutation at exon 21 initially i... more A 54-year-old woman with lung adenocarcinoma which has EGFR point mutation at exon 21 initially improved by administration of gefi tinib. Lung lesions responded to gefi tinib at 250 mg, but central nervous system lesions, such as carcinomatous meningitis and brain metastasis occurred. The therapy was changed from gefi tinib to erlotinib at 150 mg, resulting in remarkable improvement of carcinomatous meningitis and brain metastasis improved dramatically. We hypothesized that the effective concentration of the clinical dose of erlotinib in the CSF is higher than that of gefi tinib.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society, 2008
A 57-year-old man was admitted to our hospital because of dyspnea and right abdominal pain. Chest... more A 57-year-old man was admitted to our hospital because of dyspnea and right abdominal pain. Chest X-ray radiogram showed right massive pleural effusion. Ultrasonic echogram of abdomen showed a unilocular liver cyst. He was treated with intravenous infusion of meropenem, and percutaneous pleural and liver drainage were performed. At the time of drainage, we injected contrast medium into the liver cyst and confirmed a fistula connecting to the right pleural space. Initially we made a diagnosis of bacterial empyema and liver abscess, yet there was no response to the initial treatment. Cultures of pleural effusion and liver abscess were confirmed to be negative. A few days after admission, the patient stated that he was a homosexual. Liver amebiasis and its perforation became the most likely diagnosis, and metronidazole was administered. On admission day 21, tests for anti-amebic antibody were positive. Finally he fully recovered. We must be aware of the rare pulmonary manifestation of ...
Background: Circulating interferon-γ (IFN-γ) concentration may be sustained at a high level regar... more Background: Circulating interferon-γ (IFN-γ) concentration may be sustained at a high level regardless of the initiation of antiretroviral therapy (ART) in some patients with HIV-1 infection. In the present study, we examined the clinical characteristics of HIV-1-infected patients with high levels of plasma IFN-γ. Methods: The study subjects were patients infected with HIV-1 who were either naïve to ART with CD4 + cell count > 200 cells/μL (n = 12), or had achieved viral suppression after ART for over a year (n = 188). The levels of plasma IFN-γ and interleukin-6 (IL-6) were measured by the enzyme-linked immunosorbent assay. Patients were divided into high IFN-γ and low IFN-γ groups based on a cutoff level of 5 pg/mL. Results: The high IFN-γ group included 41 patients (21%). Compared to the patients on ART with low IFN-γ levels, those on ART in the high IFN-γ group were more likely to be younger than 50 years of age (P = 0.0051) and less likely to have dyslipidemia (P = 0.0476) or to be on a protease inhibitor (P = 0.0449). There was no significant difference between groups in the median increase of CD4 + cell counts from the initiation of ART for up to 3 years. However, after 4 years, the increase in CD4 + cell counts was significantly lower in the high IFN-γ group compared with that in the low IFN-γ group. There were no such significant differences between patients with low and high (> 2 pg/mL) levels of plasma IL-6. Conclusion: We concluded that HIV-1-infected patients with high levels of circulating IFN-γ did not have a higher rate of comorbidities related to immune activation. However, they exhibited lower CD4 + cell count recovery after 4 years of being on ART. This deficit could be a consequence of persistent immune activation.
Background: In patients infected with human immunodeficiency virus (HIV)-1 at our hospital, we ob... more Background: In patients infected with human immunodeficiency virus (HIV)-1 at our hospital, we observed increases in skin and soft-tissue infections (SSTIs) by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). Therefore, we analyzed factors related to CA-MRSA infection and performed a molecular epidemiological investigation. Methods: HIV-1-infected patients were diagnosed with SSTIs related to S. aureus between 2007 and 2017, and MRSA was classified into community and hospital-acquired types according to published criteria. Information was collected retrospectively from clinical records, and multivariate analysis by logistic regression was performed concerning factors related to CA-MRSA infection. We evaluated the staphylococcal cassette chromosome mec (SCCmec) type, multilocus sequence type, and the presence of genes encoding PantoneValentine leucocidin (PVL) in 27 MRSA samples isolated during and after 2015. Results: We found 218 episodes of SSTIs in 169 patients, and among initial episodes of SSTIs, the MRSA ratio was higher from 2015 to 2017 relative to that from 2007 to 2014 (88% vs. 44%; p < 0.0001). Multivariate analysis showed that in men having sex with men [MSM; odds ratio (OR): 13] and exhibiting onset during and after 2015 (OR: 5.4), CD4 þ cell count !200 cells/mL (OR: 5.6) and the presence of lesions in the lower abdomen or buttocks (OR: 9.5) were independent factors related to CA-MRSA infection. Additionally, PVLþ/ST8/SCCmec type IV MRSA was the predominant pathogen (22 cases; 81%). Conclusions: These data describe an increased prevalence of SSTIs due to PVL-positive ST8-MRSA-IV, not previously considered epidemic in Japan, in MSM infected with HIV-1 in Osaka, Japan.
[A case of Wegener's granulomatosis with pachymeningitis]
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society, 2000
A 62-year-old woman who had been receiving corticosteroid therapy for pachymeningitis since 1997 ... more A 62-year-old woman who had been receiving corticosteroid therapy for pachymeningitis since 1997 was admitted to our hospital when an abnormal shadow was noticed in her chest radiograph. In bronchial and nasal mucosal biopsies, the findings of a necrotic granulomatous lesion and vasculitis were compatible with Wegener's granulomatosis, although this is rarely seen with pachymeningitis. After further corticosteroid therapy together with cyclophosphamide treatment, the size of the thoracic X-ray shadow decreased. Methicillin-resistant Staphylococcus aureus (MRSA) was cultured from the sputum and the nasal fluid, and may have contributed to the advance of the disease in the airway. This case will require continuing careful observation.
Japanese Journal of Pharmaceutical Health Care and Sciences, Aug 10, 2017
The aim of this report was to evaluate whether days of therapy (DOT), antimicrobial use density (... more The aim of this report was to evaluate whether days of therapy (DOT), antimicrobial use density (AUD), and the rate of resistance of Pseudomonas aeruginosa to meropenem (the rate of resistance) change after stepwise execution of antimicrobial stewardship for carbapenems. Since April 2012, antimicrobial stewardship for carbapenems has been performed by an infection control team comprising physicians and pharmacists specializing in infectious diseases. The stewardship included surveillance of all cases of carbapenem use since April 2012, intervention and feedback for cases of inappropriate carbapenem use since April 2013, and unification of carbapenems since November 2014. Surveillance implementation alone led to an increase in the rate of resistance, DOT, and AUD. However, the rate of resistance, DOT, and AUD decreased when surveillance implementation was combined with intervention and feedback. On the other hand, DOT and AUD decreased and the rate of resistance was unchanged upon combining these approaches and unification of carbapenems. These results suggest that focus on implementation of surveillance would not be sufficient to ensure the appropriate use of carbapenems and that interventions and feedback regarding inappropriate carbapenem use would be important for promoting appropriate carbapenems use. Furthermore, these results suggest that unification of carbapenems does not negatively affect the rate of resistance. Key words -antimicrobial stewardship, the rates of resistance of Pseudomonas aeruginosa to carbapenems, days of therapy (DOT), antimicrobial use density (AUD)
Background: Circulating interferon-γ (IFN-γ) concentration may be sustained at a high level regar... more Background: Circulating interferon-γ (IFN-γ) concentration may be sustained at a high level regardless of the initiation of antiretroviral therapy (ART) in some patients with HIV-1 infection. In the present study, we examined the clinical characteristics of HIV-1-infected patients with high levels of plasma IFN-γ. Methods: The study subjects were patients infected with HIV-1 who were either naïve to ART with CD4 + cell count > 200 cells/μL (n = 12), or had achieved viral suppression after ART for over a year (n = 188). The levels of plasma IFN-γ and interleukin-6 (IL-6) were measured by the enzyme-linked immunosorbent assay. Patients were divided into high IFN-γ and low IFN-γ groups based on a cutoff level of 5 pg/mL. Results: The high IFN-γ group included 41 patients (21%). Compared to the patients on ART with low IFN-γ levels, those on ART in the high IFN-γ group were more likely to be younger than 50 years of age (P = 0.0051) and less likely to have dyslipidemia (P = 0.0476) or to be on a protease inhibitor (P = 0.0449). There was no significant difference between groups in the median increase of CD4 + cell counts from the initiation of ART for up to 3 years. However, after 4 years, the increase in CD4 + cell counts was significantly lower in the high IFN-γ group compared with that in the low IFN-γ group. There were no such significant differences between patients with low and high (> 2 pg/mL) levels of plasma IL-6. Conclusion: We concluded that HIV-1-infected patients with high levels of circulating IFN-γ did not have a higher rate of comorbidities related to immune activation. However, they exhibited lower CD4 + cell count recovery after 4 years of being on ART. This deficit could be a consequence of persistent immune activation.
Journal of Infection and Chemotherapy, Apr 1, 2017
Introduction: High human herpesvirus 8 (HHV-8) seroprevalence has been reported in men who have s... more Introduction: High human herpesvirus 8 (HHV-8) seroprevalence has been reported in men who have sex with men (MSM) and are infected with HIV-1. However, it is unclear when they become infected with HHV-8. Thus, we conducted cross-sectional and longitudinal investigations of HHV-8 seroprevalence in HIV-1-infected individuals in Osaka, Japan. Patients and methods: Plasma was collected from 121 individuals infected with HIV-1 and the anti-HHV-8 antibody titer was measured using an enzyme-linked immunosorbent assay with whole virus lysate. Subjects were classified into those with and without a past medical history of HHV-8-associated disease; the latter group was then classified into 3 subgroups based on the assumed route of HIV-1 infection: blood products, homosexual contact, and other routes. HHV-8 seroprevalence was compared among the groups and measured again approximately 3 years after the baseline measurement. The relationship between HHV-8 seropositivity and possible associated factors was also investigated. Results: All 15 subjects with HHV-8-associated disease were seropositive, and all 11 subjects in the blood product group were seronegative. In the MSM group, 25 (30%) of 79 subjects were HHV-8 seropositive and, in the non-MSM group, 1 (6%) of 16 subjects was (p < 0.0001). In the longitudinal investigation, seroconversion was observed in 10 (19%) of 52 subjects in the MSM group who were seronegative at baseline. A correlation was observed between seroconversion and symptomatic syphilis (p ¼ 0.0432). Conclusions: HHV-8 seropositivity and seroconversion rates were high in HIV-1-infected MSM, suggesting that, currently, HHV-8 is an epidemic pathogen in this population.
Iryo Yakugaku (Japanese Journal of Pharmaceutical Health Care and Sciences), 2017
The aim of this report was to evaluate whether days of therapy (DOT), antimicrobial use density (... more The aim of this report was to evaluate whether days of therapy (DOT), antimicrobial use density (AUD), and the rate of resistance of Pseudomonas aeruginosa to meropenem (the rate of resistance) change after stepwise execution of antimicrobial stewardship for carbapenems. Since April 2012, antimicrobial stewardship for carbapenems has been performed by an infection control team comprising physicians and pharmacists specializing in infectious diseases. The stewardship included surveillance of all cases of carbapenem use since April 2012, intervention and feedback for cases of inappropriate carbapenem use since April 2013, and unification of carbapenems since November 2014. Surveillance implementation alone led to an increase in the rate of resistance, DOT, and AUD. However, the rate of resistance, DOT, and AUD decreased when surveillance implementation was combined with intervention and feedback. On the other hand, DOT and AUD decreased and the rate of resistance was unchanged upon combining these approaches and unification of carbapenems. These results suggest that focus on implementation of surveillance would not be sufficient to ensure the appropriate use of carbapenems and that interventions and feedback regarding inappropriate carbapenem use would be important for promoting appropriate carbapenems use. Furthermore, these results suggest that unification of carbapenems does not negatively affect the rate of resistance.
Japanese Journal of Environmental Infections, 2012
In February 2009, we conducted a survey on the level of awareness of infection control procedures... more In February 2009, we conducted a survey on the level of awareness of infection control procedures among the members of the Higashi yodogawa-District Pharmacists Association (HPA). These results suggested that awareness towards infection control procedures were not adequate. Later that year, the H1N1 ‰u pandemic occurred, and we carried out a post-survey aimed toˆnd out whether infection control procedures had changed at each pharmacy. In May 2010, a questionnaire was sent to all 55 pharmacies of the HPA and 44 responded (response rate; 80). As a result, the rate of mask usage in contact with infectious patients was higher compared with the results of the 2009 survey. A number of pharmacies had changed policies such as giving medicine to infectious patients before other patients. Theˆndings indicated that the awareness of infection control procedure was improved at pharmacies. We believe that hospitals or pharmacies and related organizations must work together through periodically scheduled workshops to consider practical infection control procedures to prevent the spread of regional infection.
Japanese Journal of Environmental Infections, 2010
Infection control in hospitals is extremely important, but patients with infectious diseases and ... more Infection control in hospitals is extremely important, but patients with infectious diseases and other patients may also gather in community pharmacies, thus allowing infectious diseases to spread. Therefore, infection control was examined in cooperation with the members of the Pharmaceutical Association in Higashi-yodogawa-ku using a questionnaire survey. The content of the questionnaire was proposed by the infection control committee in our hospital.The questionnaire was mailed to 55 community pharmacies in February 2009, and the response rate was 89. Community pharmacies provide an important consultation service about infection control. The responses to the survey will contribute to infection control in the community.
A 54-year-old woman with lung adenocarcinoma which has EGFR point mutation at exon 21 initially i... more A 54-year-old woman with lung adenocarcinoma which has EGFR point mutation at exon 21 initially improved by administration of gefi tinib. Lung lesions responded to gefi tinib at 250 mg, but central nervous system lesions, such as carcinomatous meningitis and brain metastasis occurred. The therapy was changed from gefi tinib to erlotinib at 150 mg, resulting in remarkable improvement of carcinomatous meningitis and brain metastasis improved dramatically. We hypothesized that the effective concentration of the clinical dose of erlotinib in the CSF is higher than that of gefi tinib.
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society, 2008
A 57-year-old man was admitted to our hospital because of dyspnea and right abdominal pain. Chest... more A 57-year-old man was admitted to our hospital because of dyspnea and right abdominal pain. Chest X-ray radiogram showed right massive pleural effusion. Ultrasonic echogram of abdomen showed a unilocular liver cyst. He was treated with intravenous infusion of meropenem, and percutaneous pleural and liver drainage were performed. At the time of drainage, we injected contrast medium into the liver cyst and confirmed a fistula connecting to the right pleural space. Initially we made a diagnosis of bacterial empyema and liver abscess, yet there was no response to the initial treatment. Cultures of pleural effusion and liver abscess were confirmed to be negative. A few days after admission, the patient stated that he was a homosexual. Liver amebiasis and its perforation became the most likely diagnosis, and metronidazole was administered. On admission day 21, tests for anti-amebic antibody were positive. Finally he fully recovered. We must be aware of the rare pulmonary manifestation of ...
Background: Circulating interferon-γ (IFN-γ) concentration may be sustained at a high level regar... more Background: Circulating interferon-γ (IFN-γ) concentration may be sustained at a high level regardless of the initiation of antiretroviral therapy (ART) in some patients with HIV-1 infection. In the present study, we examined the clinical characteristics of HIV-1-infected patients with high levels of plasma IFN-γ. Methods: The study subjects were patients infected with HIV-1 who were either naïve to ART with CD4 + cell count > 200 cells/μL (n = 12), or had achieved viral suppression after ART for over a year (n = 188). The levels of plasma IFN-γ and interleukin-6 (IL-6) were measured by the enzyme-linked immunosorbent assay. Patients were divided into high IFN-γ and low IFN-γ groups based on a cutoff level of 5 pg/mL. Results: The high IFN-γ group included 41 patients (21%). Compared to the patients on ART with low IFN-γ levels, those on ART in the high IFN-γ group were more likely to be younger than 50 years of age (P = 0.0051) and less likely to have dyslipidemia (P = 0.0476) or to be on a protease inhibitor (P = 0.0449). There was no significant difference between groups in the median increase of CD4 + cell counts from the initiation of ART for up to 3 years. However, after 4 years, the increase in CD4 + cell counts was significantly lower in the high IFN-γ group compared with that in the low IFN-γ group. There were no such significant differences between patients with low and high (> 2 pg/mL) levels of plasma IL-6. Conclusion: We concluded that HIV-1-infected patients with high levels of circulating IFN-γ did not have a higher rate of comorbidities related to immune activation. However, they exhibited lower CD4 + cell count recovery after 4 years of being on ART. This deficit could be a consequence of persistent immune activation.
Background: In patients infected with human immunodeficiency virus (HIV)-1 at our hospital, we ob... more Background: In patients infected with human immunodeficiency virus (HIV)-1 at our hospital, we observed increases in skin and soft-tissue infections (SSTIs) by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). Therefore, we analyzed factors related to CA-MRSA infection and performed a molecular epidemiological investigation. Methods: HIV-1-infected patients were diagnosed with SSTIs related to S. aureus between 2007 and 2017, and MRSA was classified into community and hospital-acquired types according to published criteria. Information was collected retrospectively from clinical records, and multivariate analysis by logistic regression was performed concerning factors related to CA-MRSA infection. We evaluated the staphylococcal cassette chromosome mec (SCCmec) type, multilocus sequence type, and the presence of genes encoding PantoneValentine leucocidin (PVL) in 27 MRSA samples isolated during and after 2015. Results: We found 218 episodes of SSTIs in 169 patients, and among initial episodes of SSTIs, the MRSA ratio was higher from 2015 to 2017 relative to that from 2007 to 2014 (88% vs. 44%; p < 0.0001). Multivariate analysis showed that in men having sex with men [MSM; odds ratio (OR): 13] and exhibiting onset during and after 2015 (OR: 5.4), CD4 þ cell count !200 cells/mL (OR: 5.6) and the presence of lesions in the lower abdomen or buttocks (OR: 9.5) were independent factors related to CA-MRSA infection. Additionally, PVLþ/ST8/SCCmec type IV MRSA was the predominant pathogen (22 cases; 81%). Conclusions: These data describe an increased prevalence of SSTIs due to PVL-positive ST8-MRSA-IV, not previously considered epidemic in Japan, in MSM infected with HIV-1 in Osaka, Japan.
[A case of Wegener's granulomatosis with pachymeningitis]
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society, 2000
A 62-year-old woman who had been receiving corticosteroid therapy for pachymeningitis since 1997 ... more A 62-year-old woman who had been receiving corticosteroid therapy for pachymeningitis since 1997 was admitted to our hospital when an abnormal shadow was noticed in her chest radiograph. In bronchial and nasal mucosal biopsies, the findings of a necrotic granulomatous lesion and vasculitis were compatible with Wegener's granulomatosis, although this is rarely seen with pachymeningitis. After further corticosteroid therapy together with cyclophosphamide treatment, the size of the thoracic X-ray shadow decreased. Methicillin-resistant Staphylococcus aureus (MRSA) was cultured from the sputum and the nasal fluid, and may have contributed to the advance of the disease in the airway. This case will require continuing careful observation.
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Papers by Takashi Ueji