Comparison of Four Carbapenems; Imipenem-Cilastatin, Panipenem-Betamipron, Meropenem, and Biapenem with Review of Clinical Trials in Japan

The development of carbapenem gives a revolutionary impact to the chemotherapy of infectious diseases. The bacteriological and clinical efficacies of carbapenems, including imipenem/cilastatin, panipenem/betamipron, meropenem and biapenem, were evaluated. All four carbapenems were potent against gram-positive and gram-negative bacteria except Stenotrophomonas maltophilia. The antimicrobial activities of meropenem against Enterobacteriaceae were slightly superior to other carbapenems. Imipenem and panipenem were slightly more active against gram-positive bacteria than meropenem and biapenem. Biapenem was the most potent against Acinetobacter anitratus. The in vitro activity of imipenem was compared between 1990 and 1992 in Nagasaki University Hospital. The resistance rate of S. aureus, whose MIC is higher than 25 mg/l, increased from 3% to 22%, S. pneumoniae, whose MIC is higher than 0.05 mg/l, increased from 9% to 30% and P. aeruginosa, whose MIC is higher than 5 mg/l, increased from 20% to 32%. The isolation rates of S. maltophilia from sputum increased gradually from 0.9% in 1984 to 3.5% in 1991. The clinical efficacy rates of imipenem/cilastatin and panipenem/betamipron were 79% and 77%, and the rates of meropenem and biapenem 100% and 96.2% for the treatment of respiratory infection in our department, respectively. The efficacy rates of imipenem/cilastatin decreased from 79% to 67.7% after being commercialized. This decline was due to administration to patients with severe underlying diseases and with infection caused by resistant strains such as P. aeruginosa and S. aureus. The phase II and III trials of carbapenems in internal medicine, which were performed separately in Japan, showed that the clinical efficacy rates were 73%, 79%, 86% and 89%, and the rates of adverse reaction were 4.7%, 3.3%, 1.8% and 2.2% in imipenem /cilastatin, panipenembetamipron, meropenem and biapenem, respectively. Newly develope

Risk for the occupational infection by cytomegalovirus among health-care workers

Background Cytomegalovirus (CMV) are ubiquitously distributed worldwide, causing a wide range of clinical manifestations from congenital infection to a life-threatening disease in immunocompromised individuals. CMV can be transmitted via human-to-human contact through body fluids; however, the risk of CMV infection among healthcare workers (HCWs) has not been fully evaluated. Aim This study aimed to assess the risk of CMV infection among HCWs through daily medical practices. Methods Serum samples from HCWs at Osaka University Hospital (Japan) were analysed. Initially, we compared CMV IgG seropositivity among HCWs (medical doctors, nurses, and others) in 2017, which was examined after 1 year to evaluate seroconversion rates among those with seronegative results. Then, we examined CMV seroconversion rates in HCWs who were exposed to blood and body fluids. Findings We analysed 1153 samples of HCWs (386 medical doctors, 468 nurses, and 299 others), of which CMV seropositivity rates were not significantly different (68.9%, 70.3%, and 70.9%, respectively). Of these, 63.9% (221/346) of CMV seronegative HCWs were followed after 1 year, with CMV seroconversion rates of 3.2% (7/221). Among 72 HCWs who tested negative for CMV IgG when exposed to blood and body fluids, the CMV seroconversion rate was 2.8% (2/72). The CMV seroconversion rates between the two situations were not significantly different. Conclusion Our study indicated that CMV infection through daily patient care seems quite rare. Further well-designed studies with a large sample size are warranted to verify our finding

Helicobacter cinaedi-associated Carotid Arteritis

A 65-year-old Japanese man with bilateral carotid atherosclerosis presented with right neck pain and fever. Contrast-enhanced computed tomography suggested carotid arteritis, and carotid ultrasonography showed an unstable plaque. The patient developed a cerebral embolism, causing a transient ischemic attack. Helicobacter cinaedi was detected in blood culture, and H. cinaedi-associated carotid arteritis was diagnosed. Empirical antibiotic therapy was administered for 6 weeks. After readmission for recurrent fever, he was treated another 8 weeks. Although the relationship between H. cinaedi infection and atherosclerosis development remains unclear, the atherosclerotic changes in our patient’s carotid artery might have been attributable to H. cinaedi infection

Durability of immunity by hepatitis B vaccine in Japanese health care workers depends on primary response titers and durations

Photograph taken by Salt Lake Tribune staf

Novel and Simple Approach to Estimating the Actual Incidence of Blood and Body Fluid Exposure

This article has been published in Clinical Laboratory

Prevalence of Antimicrobial Resistance in Haemophilus influenzae and Streptococcus pneumoniae : Comparison of Clinical Isolates of Japan and The Philippines

For clinical isolates of Haemophilus influenzae and Streptococcus pneumoniae in Japan (356 and 179 strains, respectively) and in the Philippines (98 and 59 strains, respectively), minimum inhibitory concentrations (MICs) of ampicillin, cefazolin, cefotiam, ceftizoxim, ofloxacin, erythromycin, and minocycline were examined. The rates of β-lactamase producing H. influenzae were 17.7% (63/356) in Japan and 2.0% (2/98) in the Philippines, and all of these strains were ampicillin MICs 〓1.56 ugml^. In addition, 5 strains in Japan that lacked β-lactamase activity were also less susceptible to ampicillin. Among the antimicrobials tested, ceftizoxim was the most active against H. influenzae in both countries (MICs 〓0.2 ugml^). Five strains of S. pneumoniae in Japan were relatively resistant to ampicillin (MIC=0.1 ugml^), whereas there were no such strains among isolates in the Philippines. Forty strains (22.3%) and 108 strains (60.3%) among S. pneumoniae in Japan exhibited erythromycin MICs 〓0.2 ugml^ and minocycline MICs 〓1.56 ugml^, respectively. In contrast, all isolates in the Philippines were erythromycin MICs 〓0.05 ugml^ and minocycline MICs 〓0.39 ugml^. Present study indicates that H. influenzae and S. pneumoniae in the Philippines remained still susceptible to the antimicrobials tested except for 2 β-lactamase-positive, ampicillin-resistant H. influenzae, whereas ampicillin-resistant H. influenzae mediated by β-lactamase or non-β-lactamase mechanisms and ampicillin-, erythromycin- or minocycline-resistant S. pneumoniae were included among isolates in Japan

Durability of immunity by hepatitis B vaccine in Japanese health care workers depends on primary response titers and durations

Yoshioka N, Deguchi M, Hagiya H, Kagita M, Tsukamoto H, Takao M, et al. (2017) Durability of immunity by hepatitis B vaccine in Japanese health care workers depends on primary response titers and durations. PLoS ONE 12(11): e0187661

PCR-Dipstick-Oriented Surveillance and Characterization of mcr-1- and Carbapenemase-Carrying Enterobacteriaceae in a Thai Hospital

Colistin is used as an alternative therapeutic for carbapenemase-producing Enterobacteriaceae (CPE) infections which are spreading at a very high rate due to the transfer of carbapenemase genes through mobile genetic elements. Due to the emergence of mcr-1, the plasmid-mediated colistin resistance gene, mcr-1-positive Enterobacteriaceae (MCRPEn) pose a high risk for the transfer of mcr-1-carrying plasmid to CPE, leading to a situation with no treatment alternatives for infections caused by Enterobacteriaceae possessing both mcr-1 and carbapenemase genes. Here, we report the application of PCR-dipstick-oriented surveillance strategy to control MCRPEn and CPE by conducting the PCR-dipstick technique for the detection of MCRPEn and CPE in a tertiary care hospital in Thailand and comparing its efficacy with conventional surveillance method. Our surveillance results showed a high MCRPEn (5.9%) and CPE (8.7%) carriage rate among the 219 rectal swab specimens examined. Three different CPE clones were determined by pulsed-field gel electrophoresis (PFGE) whereas only two MCRPEn isolates were found to be closely related as shown by single nucleotide polymorphism-based phylogenetic analysis. Whole genome sequencing (WGS) and plasmid analysis showed that MCRPEn carried mcr-1 in two plasmids types—IncX4 and IncI2 with ~99% identity to the previously reported mcr-1-carrying plasmids. The identification of both MCRPEn and CPE in the same specimen indicates the plausibility of plasmid-mediated transfer of mcr-1 genes leading to the emergence of colistin- and carbapenem-resistant Enterobacteriaceae. The rapidity (<2 h) and robust sensitivity (100%)/specificity (~99%) of PCR-dipstick show that this specimen-direct screening method could aid in implementing infection control measures at the earliest to control the dissemination of MCRPEn and CPE