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1.
J Infect Chemother ; 29(8): 731-743, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37116613

RESUMO

The trends and prevalence of antimicrobial susceptibility of pathogens vary by country, region, and time. Long-term regular surveillance is required to investigate trends in the antimicrobial resistance of various isolated bacterial pathogens. We report the results of a nationwide surveillance on the antimicrobial susceptibility of bacterial respiratory pathogens in Japan conducted by the Japanese Society of Chemotherapy, the Japanese Association for Infectious Diseases, and the Japanese Society for Clinical Microbiology. The isolates were collected from clinical specimens obtained from adult patients who visited a collaborating medical facility between June 2019 and December 2020 and were diagnosed with respiratory tract infections by a physician. Antimicrobial susceptibility testing was performed in a centralized laboratory according to the methods recommended by the Clinical and Laboratory Standards Institute. Susceptibility testing was performed for 932 strains (201 Staphylococcus aureus, 158 Streptococcus pneumoniae, 6 S. pyogenes, 136 Haemophilus influenzae, 127 Moraxella catarrhalis, 141 Klebsiella pneumoniae, and 163 Pseudomonas aeruginosa) collected from 32 facilities in Japan. The proportions of methicillin-resistant S. aureus and penicillin-resistant S. pneumoniae were 35.3% and 0%, respectively. In H. influenzae, 16.2% and 16.9% were ß-lactamase-producing ampicillin resistant and ß-lactamase-negative ampicillin resistant, respectively. Extended-spectrum ß-lactamase-producing K. pneumoniae accounted for 5.0% of all K. pneumoniae infections. Carbapenemase-producing K. pneumoniae and multi-drug-resistant P. aeruginosa with metallo-ß-lactamase were not detected in this study. This surveillance will be a useful reference for treating respiratory infections in Japan and will provide evidence to enhance the appropriate use of antimicrobial agents.


Assuntos
Doenças Transmissíveis , Staphylococcus aureus Resistente à Meticilina , Infecções Respiratórias , Adulto , Humanos , Ampicilina , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bactérias , beta-Lactamases , Doenças Transmissíveis/tratamento farmacológico , Farmacorresistência Bacteriana , Haemophilus influenzae , Testes de Sensibilidade Microbiana , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Japão
2.
Oncologist ; 25(3): 208-e417, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32162814

RESUMO

LESSONS LEARNED: The biweekly GEM plus CBDCA dose and schedule showed satisfactory efficacy with mild toxicities in elderly patients with advanced NSCLC. The biweekly GEM plus CBDCA regimen could be considered an alternative to the 3-week regimen in NSCLC. BACKGROUND: The gemcitabine (GEM)-carboplatin (CBDCA) combination is widely used for non-small cell lung cancer (NSCLC) and has some efficacy in elderly patients; however, a high incidence of thrombocytopenia is observed, and the optimal dosage and administration schedules are unknown. This multicenter phase II trial evaluated the efficacy and tolerability of GEM-CBDCA for elderly patients with chemotherapy-naive NSCLC. METHODS: Patients with chemotherapy-naive performance status 0-1 and with stage IIIB/IV NSCLC were administered chemotherapy biweekly (GEM 1,000 mg/m2 with CBDCA area under the blood concentration-time curve (AUC) 3 on days 1 and 15 every 4 weeks). The primary endpoint was the objective response rate (ORR), and the secondary endpoints were progression-free survival (PFS), overall survival (OS), and safety. RESULTS: Forty-eight patients were enrolled. Median age was 76 years (range, 70-83); 35 patients were men (73%), and 27 patients had adenocarcinoma (56%). The ORR was 29.2% (95% confidence interval [CI], 17.0-44.1). The median PFS, median OS, and 1-year survival was 5.9 months (95% CI, 4.1-6.6), 13.3 months (95% CI, 8.3-23.5), and 58%, respectively. Grade ≥3 hematological toxicities included neutropenia (29.2%), thrombocytopenia (4.2%), and anemia (20.8%). The incidence of grade ≥3 nonhematological toxicities was <5%. CONCLUSION: This GEM-CBDCA combination administered biweekly showed satisfactory efficacy with mild toxicities in elderly patients with advanced NSCLC.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carboplatina/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Desoxicitidina/análogos & derivados , Feminino , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Resultado do Tratamento , Gencitabina
3.
J Infect Chemother ; 24(12): 1009-1012, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29861187

RESUMO

Psychotropic medicine has been suggested to be a risk factor for the onset of pneumonia, especially aspiration pneumonia. However, the impact of coexisting psychiatric disease and psychotropic medication on the outcomes of pneumonia patients in the respiratory care unit setting is less well-known. We conducted a single-centre retrospective study of 209 consecutive patients who were hospitalized due to pneumonia. Using the patients' records, coexisting psychiatric diseases and the use of psychotropic medicines were reviewed to examine their association with the clinical course of inpatients with pneumonia. Psychotropic medicines, including agents for insomnia, were used in 73 (34.9%) patients, and there were 35 (16.9%) patients who had psychiatric disease. Among the 12 (5.7%) fatal cases, 4 patients were treated with psychotropic medicines, all of which were agents for insomnia. However, the rate of psychotropic medicine usage in the fatal cases (33.3%) was equivalent to that of the survivors (35%, p = 0.905), and the coexistence of psychiatric disease did not affect survival. The median duration of hospitalization was 15 days. The duration of hospitalization of the patients who received psychotropic medicines (median: 17 [range: 7-89] days) was also equivalent to that of the other patients (14 [2-55] days, p = 0.081). While the present study was a single-centre study and had a small population, coexisting psychiatric disease and psychotropic medicine use did not have a strong impact on the outcomes of pneumonia patients who were hospitalized in the respiratory unit of a university hospital. Further prospective studies targeting a larger cohort are needed.


Assuntos
Tempo de Internação , Transtornos Mentais/tratamento farmacológico , Pneumonia/epidemiologia , Psicotrópicos/efeitos adversos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Idoso , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Psicotrópicos/uso terapêutico , Unidades de Cuidados Respiratórios/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
4.
J Infect Chemother ; 22(4): 235-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26867793

RESUMO

Febrile neutropenia frequently develops after chemotherapy. There is little evidence to indicate the type of antimicrobial agents that should be used in the treatment of febrile neutropenia in patients with solid tumors. The objective is to determine the efficacy and safety of cefepime (CFPM) and meropenem (MEPM) in the treatment of febrile neutropenia in lung cancer patients in a prospective randomized study. FN patients with lung cancer were randomly divided into CFPM or MEPM groups. The primary end-point was the response rate. The secondary end-points were the defervescence rates at 72 h, 7 days, 14 days and the incidence of adverse events. Twenty-one patients were treated with CFPM and 24 patients were treated with MEPM. One patient died of FN. The CFPM treatment completion rate was 17.65% (95% CI; 0.00-35.77%), while the MEPM treatment completion rate was 38.10% (95% CI; 17.33-58.87%). The defervescence rates at 72 h, 7 days, and 14 days were 70.59%, 86.67%, and 100.00%, respectively in the CFPM group; and 65.00%, 84.21%, and 92.31% in the MEPM group. Adverse events were observed in 33.33% of the CFPM group and 45.83% of the MEPM group. The response rate of the CFPM group was 94.12% (95% CI; 73.02-98.95%), while that of the MEPM group was 85.71% (95% CI; 65.36-95.02%). No differences were found in the efficacy or safety of CFPM and MEPM in the treatment of febrile neutropenia in patients with lung cancer.


Assuntos
Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Neutropenia Febril/tratamento farmacológico , Neoplasias Pulmonares/complicações , Tienamicinas/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Cefepima , Cefalosporinas/efeitos adversos , Neutropenia Febril/etiologia , Feminino , Humanos , Masculino , Meropeném , Pessoa de Meia-Idade , Estudos Prospectivos , Tienamicinas/efeitos adversos
5.
Jpn J Antibiot ; 67(3): 205-10, 2014 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-25163253

RESUMO

Treatment for chronic pulmonary aspergillosis is difficult and frequently is required for prolong period. In outpatients setting, only voriconazole and itraconazole could be used. Since liposomal amphotericin B (L-AMB) demonstrated prolonged half-time, we have investigated the feasibility of L-AMB in outpatient setting. Three cases of chronic pulmonary aspergillosis were treated with intermittent administration of 2.5 mg/kg of L-AMB twice weekly for one month in outpatient settings. Improve of symptoms was attained in 2 of 3 cases. Improvement of chest images were in 2 of 3, improvement of laboratory test were in 2 of 3. Adverse events were only fatigue and short period of fever. No recurrence of pulmonary aspergillosis has been found after treatment. Intermittent administration of L-AMB in outpatient settings could be an option for pulmonary aspergillosis.


Assuntos
Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Aspergilose Pulmonar/tratamento farmacológico , Idoso , Anfotericina B/efeitos adversos , Antifúngicos/efeitos adversos , Doença Crônica , Feminino , Humanos , Masculino , Projetos Piloto
6.
Jpn J Antibiot ; 67(6): 395-400, 2014 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-25796743

RESUMO

Treatment for pulmonary nontuberculous mycobacteriosis is difficult. Since current treatment has limitation, new application is needed. Fluoroquinolone is one of candidates. We have investigated the feasibility of sitafloxacin (STFX). At first, the drug of MIC (minimum inhibitory concentration) was determined by the methods based on BrothMIC NTM. The MICs of STFX, moxifloxacin (MFLX), gatifloxacin (GFLX) were low. On contrast, the MICs of garenoxacin (GRNX) and tosufloxacin (TFLX) were high. Two cases of pulmonary Mycobacterium avium-intracellulare complex (MAC) disease were treated by STFX-contained regimen. In all cases of pulmonary MAC disease, improve of symptoms and chest CT images were attained. Adverse events were slight. These MIC studies and case reports suggest that STFX might have excellent in vitro and in vivo antimicrobial activities against MAC and is considered to be a candidate for the medication against pulmonary MAC disease.


Assuntos
Antibacterianos/farmacologia , Fluoroquinolonas/farmacologia , Infecções por Mycobacterium/tratamento farmacológico , Complexo Mycobacterium avium/efeitos dos fármacos , Idoso , Feminino , Fluoroquinolonas/uso terapêutico , Humanos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade
7.
J Infect Chemother ; 19(2): 202-7, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23053498

RESUMO

Febrile neutropenia frequently develops after chemotherapy, and the prompt administration of antimicrobial agents is required for treatment. In the present study, we searched for predictive factors for the failure of the initial antimicrobial agents used for febrile neutropenia (FN) in patients with lung cancer. Sixty FN patients treated in our ward from June 2005 to May 2011 were retrospectively analyzed. The definition of FN and the response to antimicrobial agents were determined by the Japanese guidelines. We divided the FN patients into two groups by their response to the initial antimicrobial agents. Next, the characteristics of the two groups were compared. The Multinational Association of Supportive Care in Cancer (MASCC) score did not differ between the two groups. The non-responder group demonstrated significant elevation of serum C-reactive protein (CRP) level. A multivariate analysis demonstrated that a CRP level higher than 10 mg/dl is an independent risk factor for the failure of initial antimicrobial agents for FN with lung cancer (OR 11.0, 95 % CI 1.635-74.5). When the CRP score was added to the MASCC score, the scoring system could more precisely predict the failure of initial antimicrobial agents in patients with lung cancer who developed febrile neutropenia.


Assuntos
Antibacterianos/uso terapêutico , Proteína C-Reativa/metabolismo , Neutropenia Febril Induzida por Quimioterapia/sangue , Neutropenia Febril Induzida por Quimioterapia/tratamento farmacológico , Neoplasias Pulmonares/sangue , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Feminino , Humanos , Modelos Logísticos , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Falha de Tratamento
8.
Jpn J Antibiot ; 66(1): 37-43, 2013 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-23777015

RESUMO

We report a case of pulmonary aspergillosis in lung transplant recipient who was successfully treated with inhalation administration of anti-fungal agent. The case was 33-year-old female. Two years ago, she had received lung transplant because of lymphangioleiomyomatosis. One year ago, she had diagnosed of pulmonary aspergillosis and successfully treated with micafungin and itraconazole. Then she had been continuous administered with itraconazole. In June 20xx, she had nausea and vomiting and was diagnosed of viral enteritis. Although abdominal symptoms were relieved, ground glass opacity was discovered in her right lung. Bronchoscopic examination revealed ulceration of bronchus with white necrotic substance. Laboratory culture test demonstrated Aspergillus spp. Finally she was diagnosed of recurrent pulmonary aspergillosis. First, she was treated with intravascular administration of micafungin. Then, inhalation administration of liposomal amphotericin B was changed. Ground glass opacity and bronchial region of pulmonary aspergillosis was improved. Thereafter, inhalation of amphotericin B was continued and no recurrence of pulmonary aspergillosis has been found. Inhalation of anti-fungal agent could be an option for pulmonary aspergillosis.


Assuntos
Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Transplante de Pulmão/efeitos adversos , Aspergilose Pulmonar/tratamento farmacológico , Administração por Inalação , Adulto , Feminino , Humanos
9.
Microorganisms ; 11(3)2023 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-36985352

RESUMO

Mycobacterium avium is an intracellular proliferating pathogen that causes chronic refractory respiratory infection. Although apoptosis induced by M. avium has been reported in vitro, the role of apoptosis against M. avium infection in vivo remains unclear. Here, we investigated the role of apoptosis in mouse models of M. avium infection. Tumor necrosis factor receptor-1 knockout mice (TNFR1-KO) andTNFR2-KO micewere used. M. avium (1 × 107 cfu/body) was administered intratracheally to mice. Apoptosis in lungs was detected by terminal deoxynucleotidyl transferase mediated dUTP nick end labeling and lung histology as well as cell death detection kits using BAL fluids. TNFR1-KO mice were susceptible to M. avium infection compared with TNFR2-KO and wild type mice based on the bacterial number and lung histology. Higher numbers of apoptotic cells were detected in the lungs of TNFR2-KO and wild-type mice were compared with TNFR1-KO mice. The inhalation of Z-VAD-FMK deteriorated M. avium infection compared with vehicle-inhaled controls. Overexpression of Iκ-B alpha by adenovirus vector attenuated M. avium infection. Our study showed apoptosis had an important role in innate immunity against M. avium in mice. The induction of apoptosis in M. avium-infected cells might be a new strategy to control M. avium infection.

10.
J Infect Chemother ; 18(1): 53-8, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21773751

RESUMO

Information about the development of febrile neutropenia in patients with solid tumors remains insufficient. In this study, we tried to identify the risk factors for refractory febrile neutropenia in patients with lung cancer. A total of 59 neutropenic fever episodes associated with anti-tumor chemotherapy for lung cancer were retrospectively analyzed. We compared patient characteristics according to their initial response to treatment with antibiotics. For 34 of 59 (58%) episodes a response to initial antibiotics was obtained whereas 25 of 59 (42%) were refractory to treatment. Multivariate analysis demonstrated independent risk factors for refractory febrile neutropenia with lung cancer. These risk factors were the severity of febrile neutropenia (odds ratio (OR) 6.11; 95% confidence interval (CI) 1.85-20.14) and C-reactive protein more than 10 mg/dl (OR 4.39; 95% CI 1.22-15.74). These factors could predict outcome for patients with lung cancer who develop refractory febrile neutropenia.


Assuntos
Febre/sangue , Neoplasias Pulmonares/sangue , Neutropenia/etiologia , Idoso , Antibacterianos/uso terapêutico , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Proteína C-Reativa/metabolismo , Feminino , Febre/tratamento farmacológico , Humanos , Modelos Logísticos , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Neutropenia/complicações , Neutropenia/tratamento farmacológico , Razão de Chances , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento
11.
J Infect Chemother ; 18(2): 146-51, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21927844

RESUMO

Despite recent advances in chemotherapy, the treatment of pulmonary Mycobacterium avium complex (MAC) disease remains unsatisfactory. Judging from its MIC, fluoroquinolones including gatifloxacin (GFLX) are expected to demonstrate efficacy against MAC disease. However, there have been few clinical studies using fluoroquinolones. Therefore, a prospective study to evaluate the clinical efficacy and safety of a fluoroquinolone-containing regimen for the treatment of pulmonary MAC disease was conducted. In this trial, patients with pulmonary MAC disease received protocol-guided combined chemotherapy with rifampin (RFP) and ethambutol (EB) plus either GFLX or clarithromycin (CAM). Adult patients who fulfilled the criteria of the ATS definition of pulmonary MAC disease were enrolled in this study. The patients provided their informed consent, and treatments were administered for 1 year. Of 27 patients enrolled from three facilities, 14 patients were treated with the CAM-containing regimen and 13 patients were treated with the GFLX-containing regime. Four patients did not complete the 1-year treatment because of adverse events. Nine patients (64.3%) in the CAM group and 11 patients (84.6%) in the GFLX group achieved eradication of pathogens. Adverse events were observed more frequently in the GFLX group than in the CAM group. However, there were no severe adverse events in either group. The long-term results showed a similar relapse rate between the CAM and GFLX groups. The fluoroquinolone-containing regimen demonstrated both high efficacy and relative safety for pulmonary MAC disease that was similar to that of the CAM-containing regimen, which is considered to be the standard regimen.


Assuntos
Antituberculosos , Claritromicina , Fluoroquinolonas , Pneumopatias/tratamento farmacológico , Complexo Mycobacterium avium/efeitos dos fármacos , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Idoso , Antituberculosos/efeitos adversos , Antituberculosos/uso terapêutico , Claritromicina/efeitos adversos , Claritromicina/uso terapêutico , Quimioterapia Combinada , Etambutol/efeitos adversos , Etambutol/uso terapêutico , Feminino , Fluoroquinolonas/efeitos adversos , Fluoroquinolonas/uso terapêutico , Gatifloxacina , Humanos , Pneumopatias/microbiologia , Masculino , Pessoa de Meia-Idade , Infecção por Mycobacterium avium-intracellulare/microbiologia , Rifampina/efeitos adversos , Rifampina/uso terapêutico , Resultado do Tratamento
12.
J Infect Chemother ; 18(5): 668-74, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22350405

RESUMO

In spite of recent advances in chemotherapy, the treatment of pulmonary aspergilloma remains unsatisfactory. To evaluate the clinical efficacy and safety of combination therapy for pulmonary aspergilloma, we conducted a multi-institutional prospective study using micafungin (MCFG) and itraconazole (ITCZ). Adult patients who fulfilled the criteria for pulmonary aspergilloma were enrolled in this study. After patient consent had been obtained, intravenous MCFG 150 mg/day and an oral capsule of ITCZ 200 mg/day were administered for at least 1 month. The primary endpoint was the response assessed using an algorithm that incorporated the levels of improvement by evaluating clinical symptoms and signs, mycological and serological tests, and diagnostic imaging. A total of 17 patients were enrolled from three facilities. The response rate to the combination therapy was 58.8% (10/17). The long-term control in the group of patients who responded to treatment was better than that in the group of patients who did not respond. Adverse events occurred in 6 of the 17 patients (35.3%), but there were no severe adverse events. MCFG-ITCZ combination therapy appeared to be relatively safe and effective in patients with pulmonary aspergilloma.


Assuntos
Antifúngicos/efeitos adversos , Antifúngicos/uso terapêutico , Equinocandinas/efeitos adversos , Equinocandinas/uso terapêutico , Itraconazol/efeitos adversos , Itraconazol/uso terapêutico , Lipopeptídeos/efeitos adversos , Lipopeptídeos/uso terapêutico , Aspergilose Pulmonar/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Aspergillus fumigatus/isolamento & purificação , Quimioterapia Combinada , Feminino , Humanos , Masculino , Micafungina , Pessoa de Meia-Idade , Estudos Prospectivos , Aspergilose Pulmonar/diagnóstico por imagem , Aspergilose Pulmonar/microbiologia , Aspergilose Pulmonar/patologia , Radiografia Torácica , Resultado do Tratamento
13.
JMA J ; 5(3): 334-340, 2022 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-35992295

RESUMO

Introduction: Febrile episodes in patients with cancer and chemotherapy-induced neutropenia can be life-threatening and generally require prompt administration of broad-spectrum antimicrobials. However, little evidence exists for treating patients with solid tumors and febrile neutropenia (FN) with oral antimicrobials. Methods: In this prospective study, we aimed to determine the efficacy and safety of sitafloxacin (STFX) for treating FN in lung cancer patients. In this prospective study, low-risk FN patients with lung cancer received STFX. The primary endpoint was response rate, defined as 5 sequential days of absence of fever without adverse events. The study was registered as UMIN000010911. Results: As a result, STFX was administered to 26 patients, all of whom survived during its administration. Of the 26, 14 completed primary endpoint (53.85%). The low response rate was attributed to occurrence of fevers of unknown cause rather than failure of FN treatment. Only two patients received antibacterial agents other than STFX. If response rate omitted absence of fever and been defined only as recovery from FN without changing microbial agents or serious complications, the response rate would have been 91.67%. Adverse events occurred in eight patients, none of which were serious. Conclusions: In conclusion, STFX might be used to treat low-risk FN in patients with lung cancer; however, a more detailed study will be required in future.

14.
Multidiscip Respir Med ; 16(1): 731, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33708383

RESUMO

BACKGROUND: Transbronchial lung cryobiopsy (TBLC) is a new technique that enables larger tissue collection than can be obtained by conventional transbronchial lung biopsy. TBLC is becoming popular worldwide and is performed for diffuse lung disease and lung cancer. However, only a few reports of TBLC have been published in Japan. This study was performed to evaluate the efficacy and safety of TBLC at our hospital and compare these findings with past reports. METHODS: From April 2018 to January 2020, 38 patients who underwent TBLC for diffuse lung disease at our hospital were evaluated with respect to age, sex, biopsy site, biopsy size, diagnostic disease, and complications. RESULTS: The patients who underwent TBLC were 20 men and 18 women with an average age of 63.7 years. The average sample size was 5.7 mm, and the diagnostic rate was 65.7% (25/38). Grade ≥2 complications included bleeding (15.8%), pneumothorax (2.6%), and atrial fibrillation (2.6%). CONCLUSIONS: TBLC was considered to be useful for the diagnosis of diffuse lung disease and could be safely performed.

15.
Kansenshogaku Zasshi ; 84(3): 305-8, 2010 May.
Artigo em Japonês | MEDLINE | ID: mdl-20560423

RESUMO

The incidence of Acinetobacter baumannii pneumonia in hospital-acquired pneumonia in Japan is rare. We report a case of ventilator-associated A. baumanii pneumonia. A 69-year-old man admitted for fever was diagnosed with Streptococcus pneumoniae pneumonia based on chest radiography, urine antigen, and sputum examination. Despite appropriate antibiotics, the pneumonia progressed, necessitating intensive respiratory management. Ten days there after, he suffered sudden septic shock and superimposed pneumonia despite both carbapenem and fluoroquinolone administration. A. baumanii was detected from blood and sputum. Piperacilline/tazobactam, amikacin, and intensive care saved his life.


Assuntos
Infecções por Acinetobacter/transmissão , Acinetobacter baumannii/efeitos dos fármacos , Carbapenêmicos/farmacologia , Infecção Hospitalar/microbiologia , Pneumonia Bacteriana/transmissão , Pneumonia Associada à Ventilação Mecânica/microbiologia , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/isolamento & purificação , Idoso , Humanos , Masculino , Pneumonia Bacteriana/microbiologia , Quinolonas/farmacologia
16.
Respir Investig ; 58(6): 473-478, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32753313

RESUMO

BACKGROUND: Fatal acute exacerbation of interstitial lung diseases is often accompanied by indicators of infection such as fever, cough, and sputum. Although viral infection can contribute to acute exacerbation of interstitial lung diseases, few studies have identified a relationship between acute exacerbations and viral infections. The present study aimed to prospectively clarify the role of viral infection in patients showing acute exacerbation of interstitial lung disease in Japan. METHODS: Nasopharyngeal swab specimens were collected from patients with acute exacerbation of interstitial lung disease between May 2017 and February 2019. Respiratory viruses were detected by the Luminex xTAG Respiratory Viral Panel FAST v2 RUO kit and the BioFire FilmArray Respiratory Panel assay. RESULTS: Three of 29 patients demonstrated respiratory viral infection during acute exacerbation of interstitial lung diseases. The infectious agents were identified as respiratory syncytial virus, respiratory syncytial virus and influenza A virus, and influenza A virus and rhino/enterovirus in the three patients, respectively. CONCLUSIONS: These results suggest that viral infection did not frequently induce acute exacerbation of interstitial lung diseases in Japan.


Assuntos
Doenças Pulmonares Intersticiais , Infecções Respiratórias , Viroses , Humanos , Japão/epidemiologia , Doenças Pulmonares Intersticiais/epidemiologia , Prevalência , Viroses/complicações , Viroses/epidemiologia
18.
Nihon Kokyuki Gakkai Zasshi ; 46(2): 111-5, 2008 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-18318253

RESUMO

A 18-year-old man complaining of remittent fever and nonproductive cough visited a nearby clinic. He did not recover despite treatment of oral azithromycin. We admitted him because his chest radiograph showed consolidation in the left upper lung field. We diagnosed his pneumonia as co-infection by non-bacterial and bacterial pathogens, and initiated treatment with intravenous ampicillin and oral clarithromycin. On the 3rd day after admission his symptom had not improved, so his treatment was changed to intravenous panipenem/betamipron and erythromycin. Ciprofloxacin was administered intravenously because consolidative shadows with atelectasis increased on the chest radiograph on the 6th day. Clinical symptoms such as fever, CRP and chest radiograph findings were rapidly improved after the start of ciprofloxacin treatment. He was discharged on the 22nd hospital day. Since serum antibody titer against Mycoplasma pneumoniae was elevated to x 20,480 on the 13th hospital day, it is confirmed that causative pathogen was macrolide-ineffective Mycoplasma Pneumoniae.


Assuntos
Ciprofloxacina/administração & dosagem , Pneumonia por Mycoplasma/tratamento farmacológico , Adolescente , Antibacterianos , Anticorpos Antibacterianos/sangue , Biomarcadores/sangue , Humanos , Macrolídeos , Masculino , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/imunologia , Pneumonia por Mycoplasma/microbiologia , Resultado do Tratamento
19.
Int J Chron Obstruct Pulmon Dis ; 13: 3503-3509, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30498340

RESUMO

BACKGROUND: The use of inhaled corticosteroid (ICS) in patients with chronic obstructive pulmonary disease (COPD) decreases the frequency of COPD exacerbations. Recently, pneumonia was reported as a complication of ICS in patients with COPD. However, there have been few reports concerning the relationship between ICS and pneumonia in Japan. Moreover, there is little information on the types of ICS. PATIENTS AND METHODS: To clarify these issues, we investigated the occurrence of pneumonia in Japanese patients with COPD. We retrospectively investigated the occurrence of pneumonia in patients with COPD in our hospital from January 2009 to August 2013. Morbidity and mortality, ICS use, age, sex, and COPD classification were investigated. A group of patients with COPD who received ICS and a group of patients with COPD who did not receive ICS were compared each other. RESULTS: Fifty-one patients developed pneumonia among 639 (7.98%) patients with COPD. Among 252 ICS-treated patients with COPD, 13 (5.16%) developed pneumonia, and among 387 ICS-untreated patients with COPD, 38 (9.82%) developed pneumonia. The mortality rate in ICS-treated patients with COPD was 7.7%, while that in ICS-untreated patients was 10.5% (P=0.767). Fluticasone/salmeterol use tended to show a higher risk of pneumonia than budesonide/formoterol use. The use of ICS did not increase the risk of pneumonia or mortality due to pneumonia in Japanese patients with COPD. CONCLUSION: ICS might not increase the risk of pneumonia in Japanese patients with COPD. In regard to pneumonia, ICS can be safely used in Japanese patients with COPD. Because there are apparent differences in lung diseases among races, appropriate treatment should be investigated in each country.


Assuntos
Corticosteroides/administração & dosagem , Pulmão/efeitos dos fármacos , Pneumonia/etnologia , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Administração por Inalação , Corticosteroides/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Povo Asiático , Progressão da Doença , Feminino , Humanos , Incidência , Japão/epidemiologia , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pneumonia/induzido quimicamente , Pneumonia/diagnóstico , Pneumonia/mortalidade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/etnologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
20.
Respir Investig ; 56(5): 405-409, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30037662

RESUMO

BACKGROUND: Small-bore aspiration catheters (Aspiration Kit®) cause less pain than conventional trocar catheters in patients. The objective of this study was to examine the usefulness of these less invasive small-bore aspiration catheters for drainage of pneumothorax. METHODS: Baseline characteristics and laboratory test data at admission of 70 patients who were admitted to and underwent drainage treatment for pneumothorax at our hospital between April 2011 and February 2017 were retrospectively reviewed based on their medical records. The primary endpoints were factors associated with drainage treatment failure, and baseline characteristics and laboratory test data were compared between those treated with a small-bore aspiration catheter and those treated with a trocar catheter. RESULTS: The numbers of patients with anticoagulant use (P < 0.0001), ischemic stroke (P = 0.0063), and atrial fibrillation (P = 0.0410) were significantly different between the two groups. No significant intergroup differences were noted with respect to the length of hospitalization, drainage duration, subcutaneous emphysema, and treatment failure. Logistic regression analyses of baseline characteristics showed that the severity of pneumothorax, localization of pneumothorax, and recurrent pneumothorax were significantly associated with drainage treatment failure, but the type of drainage catheter was not significantly associated with treatment failure. [Conclusions] The results suggest that small-bore aspiration catheters, which cause less pain in patients, are potentially useful for pneumothorax drainage.


Assuntos
Catéteres , Drenagem/instrumentação , Pneumotórax/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Análise de Regressão , Estudos Retrospectivos , Índice de Gravidade de Doença , Sucção/instrumentação , Falha de Tratamento , Resultado do Tratamento , Adulto Jovem
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