Takahiro Fujita

Evaluation of an Automated Rapid Diagnostic Assay for Detection of Gram-Negative Bacteria and Their Drug-Resistance Genes in Positive Blood Cultures

We evaluated the performance of the Verigene Gram-Negative Blood Culture Nucleic Acid Test (BC-GN; Nanosphere, Northbrook, IL, USA), an automated multiplex assay for rapid identification of positive blood cultures caused by 9 Gram-negative bacteria (GNB) and for detection of 9 genes associated with β-lactam resistance. The BC-GN assay can be performed directly from positive blood cultures with 5 minutes of hands-on and 2 hours of run time per sample. A total of 397 GNB positive blood cultures were analyzed using the BC-GN assay. Of the 397 samples, 295 were simulated samples prepared by inoculating GNB into blood culture bottles, and the remaining were clinical samples from 102 patients with positive blood cultures. Aliquots of the positive blood cultures were tested by the BC-GN assay. The results of bacterial identification between the BC-GN assay and standard laboratory methods were as follows: Acinetobacter spp. (39 isolates for the BC-GN assay/39 for the standard methods), Citrobacter spp. (7/7), Escherichia coli (87/87), Klebsiella oxytoca (13/13), and Proteus spp. (11/11); Enterobacter spp. (29/30); Klebsiella pneumoniae (62/72); Pseudomonas aeruginosa (124/125); and Serratia marcescens (18/21); respectively. From the 102 clinical samples, 104 bacterial species were identified with the BC-GN assay, whereas 110 were identified with the standard methods. The BC-GN assay also detected all β-lactam resistance genes tested (233 genes), including 54 bla CTX-M, 119 bla IMP, 8 bla KPC, 16 bla NDM, 24 bla OXA-23, 1 bla OXA-24/40, 1 bla OXA-48, 4 bla OXA-58, and 6 bla VIM. The data shows that the BC-GN assay provides rapid detection of GNB and β-lactam resistance genes in positive blood cultures and has the potential to contributing to optimal patient management by earlier detection of major antimicrobial resistance genes.

Edwardsiella tarda bacteremia. A rare but fatal water- and foodborne infection: Review of the literature and clinical cases from a single centre.

Risk factors of Edwardsiella tarda bacteremia are not well established. Analyzing previous reports and recent clinical cases to determine these risk factors, and examine the distribution and clinical epidemiology of Edwardsiella tarda bacteremia is important because although occurrence is rare, it can be fatal in humans.

Risk factors for recurrent hospital-acquired Clostridium difficile infection in a Japanese university hospital

Background Clostridium difficile infection (CDI) is a highly prevalent hospital-associated infection. Although most patients respond well to discontinuation of antibiotics, 20%–30% of patients relapse. To initiate early therapeutic measures, the risk factors for recurrent CDI must be identified, although very few Japanese studies have used standard surveillance definitions to identify these risk factors. Methods We retrospectively reviewed the medical records of patients with health care facility-onset CDI between August 2011 and September 2013. Patients with diarrhea who were positive for Clostridium difficile (via an enzyme immunoassay) were defined as having CDI. Clinical data (eg, demographics, comorbidities, medication, laboratory results, and clinical outcomes) were evaluated, and multivariate analysis was used to identify risk factors that were associated with recurrent CDI. Results Seventy-six health care facility-onset CDI cases were identified, with an incidence rate of 0.8 cases per 10,000 patient-days. Fourteen cases (18.4%) were recurrent, with 13 patients having experienced a single recurrent episode and one patient having experienced three recurrent episodes. The 30-day and 90-day mortality rates were 7.9% and 14.5%, respectively. Multivariate analysis revealed that recurrent patients were more likely to have underlying malignant disease (odds ratio: 7.98; 95% confidence interval: 1.22–52.2; P=0.03) and a history of intensive care unit hospitalization (odds ratio: 49.9; 95% confidence interval: 1.01–2,470; P=0.049). Conclusion Intensive care unit hospitalization and malignancy are risk factors for recurrent CDI. Patients with these factors should be carefully monitored for recurrence and provided with appropriate antimicrobial stewardship.

Mycobacterium tuberculosis infection in cancer patients at a tertiary care cancer center in Japan

The characteristics of active tuberculosis in cancer patients in Japan and the effects of this infection on cancer treatment have not yet been clarified. The records of all consecutive patients with microbiologically documented Mycobacterium tuberculosis infection diagnosed between September 2002 and March 2008 at Shizuoka cancer center (a 557-bed tertiary care cancer center in Japan) were reviewed. There were 24 cancer patients with active tuberculosis during the study period. Of these, 23 had solid-organ tumors, and the most common site of the underlying malignancy was the lung. Most of the patients had pulmonary tuberculosis. Among 15 patients followed up for more than 2 months prior to the diagnosis of pulmonary tuberculosis, 12 had healed scars suggestive of old tuberculosis lesions, as shown by chest imaging obtained at the time of the initial evaluation. Discontinuation of cancer therapy or more than a months delay in surgery occurred in 10 patients with pulmonary tuberculosis. Development of active tuberculosis can delay cancer treatment in Japanese centers. Cancer patients with scars suggestive of old tuberculosis disease lesions as shown by chest imaging should be screened for active tuberculosis and carefully followed up. In some cases, prophylactic treatment should be considered.

Fournier’s gangrene caused by Listeria monocytogenes as the primary organism

Fournier’s gangrene is a necrotizing infection of the scrotal region, and is typically caused by Exterobacteriaceae and anaerobic bacteria. This report describes a case involving a 70-year-old man of Japanese descent who developed Fournier’s gangrene that was found to be caused by Listeria monocytogenes. The patient’s unique risk factors are discussed.

Perianal tuberculosis: A case report and review of the literature.

Tuberculosis (TB) is still a major health problem worldwide. We present a rare case of an immuno-competent patient with perianal TB. A 38-year-old man visited a clinic with pain, swelling, and redness in the perineum. He had been persistently coughing for the past 6 mo. The abscess had formed a fistula to the perianal region, indicating perianal abscess. Mycobacterium tuberculosis was found in sputum and perianal abscess. Surgical drainage was performed, and oral anti-tuberculous drugs were administered for 6 mo. The patients clinical course was favorable. On review of the literature on 58 cases of perianal TB, we found that the duration of persistent perianal lesion was much longer in patients without active pulmonary TB (APTB) than in those with APTB (66.4 mo vs 8.3 mo; confidence interval, 0.0760-0.9620, P = 0.0380). Thus, in cases of non-healing or recurrent perianal lesions, TB should be considered.

Truncal rash in adult measles

36 37 1 38 39 40 41 42 a non-productive cough of several days’ duration. Both had truncal rashes and Koplik’s spots on the oral mucosa. Measles was confirmed by positive serologic test for serum measles IgM antibody in each patient. The first patient showed intestinal pneumonia with hypoxemia (PaO2, 57.5 mmHg), while the second had elevated levels of liver enzymes (aspartate aminotransferase 364 IU/l, alanine aminotransferase 285 IU/l). They both required hospitalization for several days. The rash (Figures 1 and 2) was characterized by a small speckled appearance and progressed rapidly, spreading from the head to the extremities within 24–48 h. They had not been vaccinated against measles. In Japan, immunization against measles was made compulsory in 1978; the measles–mumps–rubella (MMR) vaccine was discontinued once in 1993 . There were 18 000 cases of measles in patients aged <15 years in 2007. In 2008, at least 9631 cases of measles were reported during the first half of the year; 4229 (43.9%) of these cases occurred in Tokyo and 5794 (60.2%) cases were in persons aged 15 years. Of note, only 104 (4.1%) had received the second dose of measles vaccine. The low immunization rate, 43 44 45 46 47 48 § This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivative Works License, which permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

Multicenter study of the clinical presentation of Staphylococcus lugdunensis bacteremia in Japan

Staphylococcus lugdunensis (SL) is a bacterium with a highly pathogenicity than most other coagulase-negative Staphylococcus spp. (CoNS). In Japan, data on this pathogen are sparse, and the current prevalence of SL bacteremia is unknown. Therefore, we investigated the prevalence of SL in blood culture specimens in a prospective multicenter study across 5 facilities. A total of 3,284 patients had positive blood cultures, and 2,478 patients had bacteremia. Among the patients with bacteremia, 7 patients (0.28%) had SL bacteremia. A total of 281 patients had CoNS bacteremia, with SL accounting for 2.49% of these cases. Of the 7 patients with SL bacteremia, 1 patient (14.3%) had infective endocarditis, and 1 patient (14.3%) died within 30 days. In this study, SL resulted in the development of bacteremia in select patients. Clinicians in Japan should be aware of the prevalence of SL and the complications of SL bacteremia.

Pulmonary Histoplasmosis in a Japanese Man Infected During Travel to Mexico and Management of His Wife's Condition: A Case Report.

We report herein on the case of a 33-year-old Japanese man in whom an abnormal shadow was detected on chest radiography during a medical checkup after a 1-year-stay in Mexico. Chest computed tomography showed a nodule in the left lower lobe adjacent to the visceral pleura. Histopathologic examination of a thoracoscopic partial pulmonary resection specimen showed coagulation necrosis with a number of yeast-like forms on Grocott staining. In addition, serum anti-Histoplasma antibody positivity was detected with an enzyme-linked immunosorbent assay, and Histoplasma-specific nested real-time polymerase chain reaction results were positive in the pulmonary region. Finally, pulmonary histoplasmosis was diagnosed, and treatment with itraconazole was initiated. The patients wife who had accompanied him to Mexico was asymptomatic and was not found to have histoplasmosis based on diagnostic imaging and serological findings. Although rare in Japan, histoplasmosis should be considered in the differential diagnosis of pulmonary lesions in patients who have returned from travel to endemic areas.

First Case of Liver Abscess with Endogenous Endophthalmitis due toNon- K1/K2 Serotype Hypermucoviscous Klebsiella pneumoniae Clone ST268

The hypermucoviscous (hv) Klebsiella pneumoniae (KP) can cause invasive liver abscess syndrome (ILAS) including endophthalmitis dominantly in eastern Asia. We report a 80-years old woman who diagnosed with invasive liver abscess syndrome due to K. pneumoniae (KP) non-K1/K2 hvKP multi-locus sequence type ST268 by DNA amplification methods isolated from blood culture. Soon she developed endogenous endopththalmitis and immediately right vitrectomy was performed. Although intravenous 2g of ceftriaxone (CTRX) was administrated, total enucleation of right eyeball had performed due to orbital cellulitis and necrosis of eye ball finally. To find complication (i.e. endophthalmitis) with caution and to select antimicrobial agents with sufficient penetration to CNS (i.e. ceftriaxone) is needed in a patient with severe hvKP infection. Usually ILAS is caused by K1/K2 hvKP. However, to our knowledge, this is a first report of ILAS with endophthalmitis and orbital cellulitis due to non-K1/K2 hvKP ST268.