Second nationwide surveillance of bacterial pathogens in patients with acute uncomplicated cystitis conducted by Japanese Surveillance Committee from 2015 to 2016: antimicrobial susceptibility of Escherichia coli, Klebsiella pneumoniae, and Staphylococcus saprophyticus

The Japanese Surveillance Committee conducted a second nationwide surveillance of antimicrobial susceptibility patterns of uropathogens responsible for acute uncomplicated cystitis (AUC) in premenopausal patients aged 16–40 years old at 31 hospitals throughout Japan from March 2015 to February 2016. In this study, the susceptibility of causative bacteria (Escherichia coli, Klebsiella pneumoniae, Staphylococcus saprophyticus) for various antimicrobial agents was investigated by isolation and culturing of organisms obtained from urine samples. In total, 324 strains were isolated from 361 patients, including E. coli (n = 220, 67.9%), S. saprophyticus (n = 36, 11.1%), and K. pneumoniae (n = 7, 2.2%). The minimum inhibitory concentrations (MICs) of 20 antibacterial agents for these strains were determined according to the Clinical and Laboratory Standards Institute (CLSI) manual. At least 93% of the E. coli isolates showed susceptibility to fluoroquinolones and cephalosporins, whereas 100% of the S. saprophyticus isolates showed susceptibility to fluoroquinolones and aminoglycosides. The proportions of fluoroquinolone-resistant and extended-spectrum β-lactamase (ESBL)-producing E. coli strains were 6.4% (13/220) and 4.1% (9/220), respectively. The antimicrobial susceptibility of K. pneumoniae was retained during the surveillance period, while no multidrug-resistant strains were identified. In summary, antimicrobial susceptibility results of our second nationwide surveillance did not differ significantly from those of the first surveillance. Especially the numbers of fluoroquinolone-resistant and ESBL-producing E. coli strains were not increased in premenopausal patients with AUC in Japan

Cisplatin-Based Neoadjuvant Chemotherapy for Invasive Bladder Cancer

Between February 1988 and March 1993, 24 patients with locally advanced bladder cancer (stages T2-4N0-3M0) were included in this study. Combination chemotherapy consisting of methotrexate, vinblastine, epirubicin (doxorubicin) and cisplatin (M-VAC) was given to the patients in a neoadjuvant setting.　　 The clinical stage was T2N0M0 in eight patients, T3aN0M0 in three, T3bN0M0 in seven, T4N0M0 in five and T4N3M0 in one. After chemotherapy, total cystectomy was performed in 20 patients and partial cystectomy 4. Of 24 patients, one (4%) showed a pathological complete response, and eight (33%) had a pathological partial response, for an overall response rate of 38% (95% confidence limits 20 to 57%). Nine patients who achieved a pathological response to chemotherapy had a significantly higher survival rate than the nonresponders (p<0.01). In the relationship between the clinical stage and the response to chemotherapy, clinical T2 and T3a diseases were more likely to respond to chemotherapy than clinical T3b and T4 diseases, with a response rate of 64% and 15%, respectively. While a positive relationship between the pathological response and survival was observed, adequate follow-up is needed to assess the ability of neoadjuvant chemotherapy to improve the prognosis of patients with locally advanced bladder cancer

Factors Related to the Outcome of M-VAC in 101 Patients with Advanced Urothelial Cancer

The objective of this study is to identify factors related to the results of intravenous methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) for 101 patients with advanced urothelial cancer. The effects of various factors on response and survival were evaluated using univariate and multivariate analyses. The factors included in the analyses were sex, age, performance status (PS), primary site, histological type, grade, T category, N category, M category, prior chemotherapy, prior radiotherapy, and dose of chemotherapeutic drugs. Univariate analysis revealed that M category and prior chemotherapy had a significant correlation with the response, and that factors significantly related to survival were PS, primary site, N category, M category, prior chemotherapy and prior radiotherapy. A multiple logistic regression model showed that N category, M category and prior chemotherapy were related to response. The response rates of patients with N1-4 or M1 or prior chemotherapy were lower than those with N0 or M0 or without prior chemotherapy. A Cox regression model demonstrated that PS and M category independently contributed to survival. Patients with high grade PS or distant metastases showed a lower survival rate than those with low grade PS or localized diseases. M category was the most important factor related to response and survival. These results seem to indicate the low effectiveness of M-VAC for distant metastases, and the inability of this regimen to improve the outcome of patients with advanced urothelial cancer