Naoto Hosokawa

Impact of infectious diseases service consultation on diagnosis of infective endocarditis

Abstract Background: The infectious diseases (ID) consultation service is a new clinical entity in Japan. We examined the impact of ID consultation on the diagnosis of infective endocarditis (IE) at a large teaching hospital in Japan. Methods: Routine consultation with an ID service for cases of positive blood culture was implemented at Kameda Medical Center in November 2004. In addition, ID service doctors started to give lectures on ID to doctors and also provided local guidelines on ID. We compared the incidence of IE during a 3-y and 10-month period before intervention with that during a 5-y and 2-month period after intervention. The modified Duke criteria were used to confirm the diagnosis of definite IE. Patients who fulfilled the criteria for definite IE were included in the analysis. Results: Twenty-seven cases of IE were diagnosed before the implementation of routine consultation, and 76 cases after. The respective incidences of IE were 48.7 and 84.8 per 100,000 patients discharged from the hospital (p = 0.01). The relapse rate of IE within 6 months was significantly lower in patients who underwent routine consultation (22.2% vs 2.2%; p = 0.02). Conclusion: Routine consultation with an ID service for cases of positive blood culture, together with consecutive lecturing and local guidelines by ID specialists, resulted in improved detection of IE and a reduced relapse rate within 6 months. Timely consultation with an ID specialist in bacteraemia cases may be beneficial for improving the outcomes of patients in this setting.

Bacterial meningitis in the absence of cerebrospinal fluid pleocytosis: A case report and review of the literature

Bacterial meningitis is typically diagnosed with a lumbar puncture, which usually reveals an elevated opening pressure and high white blood cell count. In this article, the authors report a case involving an 83-year-old woman who had normal cerebrospinal fluid findings on presentation, but who was subsequently found to have meningitis caused by Neisseria meningitidis. The authors discuss potential reasons for normal cerebrospinal fluid findings in the context of meningitis.

Clinical Features of Community-Acquired Helicobacter cinaedi Bacteremia.

There are growing numbers of reports concerning the clinical and pathological features of Helicobacter cinaedi (H. cinaedi) bacteremia; however, few reports have discussed the features of this condition in healthy individuals.

Profile of infective endocarditis at a tertiary-care hospital in Japan over a 14-year period: characteristics, outcome and predictors for in-hospital mortality

OBJECTIVES The aims of this study were to describe the epidemiological features and clinical characteristics of infective endocarditis (IE) at a tertiary-care hospital in Japan and to identify the factors associated with in-hospital mortality. METHODS A retrospective observational study was conducted at a 925-bed tertiary-care teaching hospital in Japan. All adult patients diagnosed with definite IE between August 2000 and July 2014 according to the modified Duke criteria were included. RESULTS A total of 180 patients (60.6% men; mean age, 69.1 years) with definite IE were included. The most common pathogen was Staphylococcus aureus (27.2%). Nine patients (5.0%) had culture-negative IE. Transthoracic and transoesophageal echocardiography were performed in 180 (100%) and 132 patients (73.3%), respectively, and vegetations were detected in 128 patients (71.1%). Surgical therapy was performed in 31 patients (17.2%). Overall, the in-hospital mortality rate was 26.1%. The independent predictors of in-hospital mortality were methicillin-resistant S. aureus (MRSA), vascular phenomena, health care-associated IE and heart failure. CONCLUSIONS MRSA, vascular phenomena, health care-associated IE and heart failure were independent predictors of in-hospital mortality. The unique characteristics in our cohort were the very high mean age, low rate of culture-negative IE, high rate of definite IE without detected vegetations and predominance of S. aureus.

Urosepsis caused by Globicatella sanguinis and Corynebacterium riegelii in an adult: case report and literature review

We report an extremely rare case of urosepsis caused by Globicatella sanguinis and Corynebacterium riegelii coinfection in a 94-year-old Japanese man with nephrolithiasis. Prompt identification of this coinfection is important so that effective antimicrobial coverage can be initiated.

Bloodstream infections caused by Streptococcus anginosus group bacteria: A retrospective analysis of 78 cases at a Japanese tertiary hospital.

OBJECTIVES To investigate the characteristics of Streptococcus anginosus group (SAG) bacteremia in recent years, we conducted a retrospective cohort study and compared its findings with the data from previous studies. METHODS All patients with positive blood cultures from May 2005 to September 2014 in a tertiary care center with 925 beds were included. RESULTS There were 78 cases of SAG bacteremia (51 cases men; median age, 68 years) during the study period. The most common comorbidities were solid tumors in 32.1% of the patients. The most common infection source was hepatobiliary in one-third of all cases. Other infection sites included the following: intra-abdominal (12.8%), thoracic (10.3%), musculoskeletal (9%), urinary tract (7.7%), soft tissues (7.7%), and cervicofacial (6.4%). Susceptibility to penicillin, clindamycin and erythromycin were 100% (78/78), 95% (70/74) and 85% (39/46), respectively. Surgery along with systemic antibiotic treatment was administered in 53% of the cases. In-hospital mortality was 14.1%. CONCLUSION The clinical sources of the SAG bacteria were diverse, and hepatobiliary infection was the most common source of infection. In more than half of the patients, surgical treatment was performed. Susceptibility to penicillin was 100%, but susceptibility to erythromycin was lower than that reported in previous studies.

Patterns of outpatient ceftriaxone use in a Japanese general hospital: an increased need for development of outpatient parenteral antimicrobial therapy programs

Patterns of outpatient ceftriaxone use in a Japanese general hospital: an increased need for development of outpatient parenteral antimicrobial therapy programs Ryota Hase & Naoto Hosokawa To cite this article: Ryota Hase & Naoto Hosokawa (2015) Patterns of outpatient ceftriaxone use in a Japanese general hospital: an increased need for development of outpatient parenteral antimicrobial therapy programs, Infectious Diseases, 47:9, 668-671 To link to this article: http://dx.doi.org/10.3109/23744235.2015.1031174

Burkholderia contaminans: unusual cause of biliary sepsis

We report a case of biliary tract infection caused by a strain of Burkholderia contaminans, a member of the Burkholderia cepacia complex. The patient developed sepsis after endoscopic retrograde cholangiopancreatography (ERCP). Gram-negative bacilli were isolated from blood and bile cultures. Automated bacterial identification systems identified the organism as Burkholderia cepacia, whereas DNA sequence analysis revealed that the recA gene isolate was identical to that of B. contaminans. The patient responded to therapy with the antibiotics trimethoprim/sulfamethoxazole and biliary tract decompression. This case suggests that B. contaminans can be a causative agent of healthcare-associated biliary tract infections such as ERCP-related cholangitis.

Prosthetic valve endocarditis caused by Bartonella henselae presenting as recurrent fever and imitating granulomatosis with polyangiitis

a Department of General Internal Medicine, Kameda Medical Center, Japan b Department of Infectious Diseases, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba 296-8602, Japan c Center for Infectious Diseases and Infection Control, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan d Kitasato Daiichi Sankyo Vaccine Co., Ltd., 6-111 Arai, Kitamoto City, Saitama 364-0026, Japan

Effectiveness of inactivated influenza vaccine against laboratory-confirmed influenza pneumonia among adults aged ≥65 years in Japan

Abstract Background The effectiveness of inactivated influenza vaccine (IIV) against laboratory-confirmed influenza pneumonia in older adults remains to be established. Methods Pneumonia patients aged ≥65 years who visited a study hospital in Chiba, Japan, were prospectively enrolled from February 2012 to January 2014. Sputum samples were collected from participants and tested for influenza virus by polymerase chain reaction assays. Influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza pneumonia was estimated by a test-negative design. Results Among a total of 814 pneumonia patients, 42 (5.2%) tested positive for influenza: 40 were positive for influenza A virus, and two were positive for influenza B virus. The IVE against laboratory-confirmed influenza pneumonia was 58.3% (95% confidence interval, 28.8–75.6%). The IVE against influenza pneumonia hospital admission, severe pneumonia, and death was 60.2% (95% CI, 22.8–79.4%), 65.5% (95% CI, 44.3–78.7%), and 71% (95% CI, −62.9% to 94.8%), respectively. In the subgroup analyses, the IVE against influenza pneumonia was higher for patients with immunosuppressive conditions (85.9%; 95% CI, 67.4–93.9%) than for those without (48.7%; 95% CI, 2.7–73%) but did not differ by patients’ statin use status. Conclusion IIV effectively reduces the risk of laboratory-confirmed influenza pneumonia in older adults.