Nationwide surveillance of bacterial respiratory pathogens conducted by the surveillance committee of Japanese Society of Chemotherapy, the Japanese Association for Infectious Diseases, and the Japanese Society for Clinical Microbiology in 2012: General view of the pathogens' antibacterial susceptibility.

The nationwide surveillance on antimicrobial susceptibility of bacterial respiratory pathogens from the patients in Japan was conducted by Japanese Society of Chemotherapy, Japanese association for infectious diseases and Japanese society for Clinical Microbiology in 2012. The isolates were collected from clinical specimens obtained from well-diagnosed adult patients with respiratory tract infections during the period between January and December in 2012 by three societies. Antimicrobial susceptibility testing was conducted at the central reference laboratory according to the method recommended by Clinical Laboratory Standard Institutes. Susceptibility testing was evaluated in 1236 strains (232 Staphylococcus aureus, 225 Streptococcus pneumoniae, 16 Streptococcus pyogenes, 231 Haemophilus influenzae, 147 Moraxella catarrhalis, 167 Klebsiella pneumoniae and 218 Pseudomonas aeruginosa). Ratio of methicillin-resistant S. aureus was 51.3%, and those of penicillin-intermediate S. pneumoniae was 0.4%. Among H. influenzae, 5.6% of them were found to be ß-lactamase-producing ampicillin-resistant strains, and 37.2% to be ß-lactamase-non-producing ampicillin-resistant strains. Extended spectrum ß-lactamase-producing K. pneumoniae and multi-drug resistant P. aeruginosa with metallo ß-lactamase were 4.2% and 3.2%, respectively. Continuous national surveillance is important to determine the actual situation of the resistance shown by bacterial respiratory pathogens to antimicrobial agents.

Nationwide surveillance of bacterial respiratory pathogens conducted by the Japanese Society of Chemotherapy in 2008: general view of the pathogens' antibacterial susceptibility.

For the purpose of nationwide surveillance of the antimicrobial susceptibility of bacterial respiratory pathogens collected from patients in Japan, the Japanese Society of Chemotherapy conducted a third year of nationwide surveillance during the period from January to April 2008. A total of 1,097 strains were collected from clinical specimens obtained from well-diagnosed adult patients with respiratory tract infections. Susceptibility testing was evaluable with 987 strains (189 Staphylococcus aureus, 211 Streptococcus pneumoniae, 6 Streptococcus pyogenes, 187 Haemophilus influenzae, 106 Moraxella catarrhalis, 126 Klebsiella pneumoniae, and 162 Pseudomonas aeruginosa). A total of 44 antibacterial agents, including 26 ß-lactams (four penicillins, three penicillins in combination with ß-lactamase inhibitors, four oral cephems, eight parenteral cephems, one monobactam, five carbapenems, and one penem), three aminoglycosides, four macrolides (including a ketolide), one lincosamide, one tetracycline, two glycopeptides, six fluoroquinolones, and one oxazolidinone were used for the study. Analysis was conducted at the central reference laboratory according to the method recommended by the Clinical and Laboratory Standard Institute (CLSI). The incidence of methicillin-resistant S. aureus (MRSA) was as high as 59.8%, and those of penicillin-intermediate and penicillin-resistant S. pneumoniae (PISP and PRSP) were 35.5 and 11.8%, respectively. Among H. influenzae, 13.9% of them were found to be ß-lactamase-non-producing ampicillin (ABPC)-intermediately resistant (BLNAI), 26.7% to be ß-lactamase-non-producing ABPC-resistant (BLNAR), and 5.3% to be ß-lactamase-producing ABPC-resistant (BLPAR) strains. A high frequency (76.5%) of ß-lactamase-producing strains was suspected in Moraxella catarrhalis isolates. Four (3.2%) extended-spectrum ß-lactamase-producing K. pneumoniae were found among 126 strains. Four isolates (2.5%) of P. aeruginosa were found to be metallo ß-lactamase-producing strains, including three (1.9%) suspected multidrug-resistant strains showing resistance to imipenem, amikacin, and ciprofloxacin. Continual national surveillance of the antimicrobial susceptibility of respiratory pathogens is crucial in order to monitor changing patterns of susceptibility and to be able to update treatment recommendations on a regular basis.

Evaluated reference intervals for serum free thyroxine and thyrotropin using the conventional outliner rejection test without regard to presence of thyroid antibodies and prevalence of thyroid dysfunction in Japanese subjects.

The determination of the reference intervals for serum free thyroxine (FT4) and thyrotropin (TSH) is usually based on central 95 percentile intervals using subjects without detectable antibodies against thyroid peroxidase (TPO) or thyroglobulin (Tg). However, some subjects with extreme data over reference intervals are generally included. The study objective was to evaluate the reference intervals for FT4 and TSH using different outlier tests. 1,007 Japanese subjects screened based on the National Academy of Clinical Biochemistry criteria in the United States participated in this study. Serum FT4, TSH, and TPOand Tg antibodies were measured in all subjects. To make appropriate reference intervals, the Smirnov-Grubbus' outlier test was taken for antibody-free subjects (Ab[-] S-G), and the conventional outlier rejection method rejecting the value out of +/-3 standard deviation was taken for antibody-free subjects (Ab[-] STD) and all subjects (ALSTD), respectively. 12.8% of all subjects had either TPOor Tg antibodies in their serum. The 2.5(th) and 97.5(th) percentiles of reference intervals of serum FT4 (ng/dL) and TSH (mU/L) were 1.03~1.66 and 0.51 approximately 5.14 in (Ab[-] S-G), 1.03 approximately 1.65 and 0.51 approximately 4.57 in (Ab[-] STD) and 1.03 approximately 1.66 and 0.51 approximately 4.67 in (ALSTD), respectively. FT4 in males were significantly and negatively correlated with age, and TSH was significantly and positively correlated with age (P<0.000001 and P<0.00001, respectively). There was a significant difference between the sexes in FT4 (P<0.00001) but not in TSH. The prevalence of hypothyroidism, subclinical hypothyroidism, sublinical hyperthyroidism and hyperthyroidism were 0.2, 3.1, 2.3 and 0.3% (Ab[-] S-G), 0.3, 4.7, 2.3 and 0.3%(Ab[-] STD), and 0.3, 4.3, 2.3 and 0.3% (AL STD), respectively. This finding indicates that the conventional outlier rejection method is both convenient and appropriate to provide reference intervals for serum FT4 and TSH levels without regard to thyroid antibodies using large samples.

[Clostridium difficile TOX A/B II TEST evaluation].

We compared the performance of two commercial toxin detection kits, C. difficile toxin A/B (C. difficile TOX A/B II test; TOX A/B II) and C. difficile toxin A (Uniquick), for (i) detection using highly purified toxin A solution; (ii) cross-reactivity using culture supernatants of toxin A-positive and B-positive C. difficile, toxin A-negative and B-positive C. difficile, and toxin A-negative and B-negative C. difficile strains and other bacteria; and (iii) sensitivity and specificity using clinical specimens. Results indicated that TOX A/B II detected toxin A at concentrations of 0.35 ng/mL and Uniquick at concentrations of 0.7 ng/mL. Uniquick performance was specific for detecting toxin A alone, while TOX A/B II detected toxin A/B specifically. Kit performance was then evaluated using 99 fecal specimens--43 specimens from patients with toxin B-positive C. difficile and 56 from those without. Sensitivity of TOX A/B II vs Uniquick was 95.3% vs 76.7%, specificity 98.2% vs 98.2%, positive predictive 97.6% vs 97.1%, and negative predictive value 96.5% vs 84.6%. Findings thus indicate that TOX A/B II is a more suitable diagnostic aid for CDAD than Uniquick because it correlates well with toxin B-positive C. difficile culture results. Stool culture for C. difficile is also required, however.

[Anaerobiospirillum succiniciproducens septicemia].

We report the first case of septicemia caused by anaerobic spiral-shaped Gram negative bacilli, Anaerobiospirillum succiniciproducens in Japan. A 71-year-old male who had been suffered from terminal stage of liver cirrhosis and hepatocelluler carcinoma was admitted to our hospital for his symptoms of general malaise and increasing ascites on September 1, 2004. He developed diarrhea seven times a day on the eighth hospital day and had fever of 38.7 degrees C with WBC 12,600/microl and CRP 6.6 mg/dl on the next day. Blood culture grew Gram negative spiral bacilli. We initially could not identify the offending bacterium that resembled to Campyrobacter morphologically using commercially available indentification kits. However, 16SrRNA sequencing test revealed 100% compatibility with Anaerobiospirillum succiniciproducens.

Increased use of alcohol-based hand sanitizers and successful eradication of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit: a multivariate time series analysis.

BACKGROUND: We analyzed time series data to investigate factors that contributed to the gradual decrease and eventual eradication of methicillin-resistant Staphylococcus aureus (MRSA) from our neonatal intensive care unit (NICU). METHODS: A multivariate adjusted autoregressive integrated moving average (ARIMA) model was used for time series analyses of monthly MRSA incidence density rates and their predictors in the NICU from July 2003 to July 2009. RESULTS: Based on our ARIMA (0,1,1), which is a nonseasonal and nonstationary moving average model, the monthly pooled mean of the amount of alcohol-based hand sanitizer used for 1 patient per day (lag time, 0 month; P = .011) was the only factor significantly associated with the MRSA incidence density rates. MRSA colonization pressure, patient-to-nurse ratios, and bed occupancy rates were not associated with MRSA acquisition in the NICU. Active surveillance, which had been practiced since the late 1980s, alone was not sufficient to control the spread of MRSA until it was accompanied by enhanced hand hygiene. CONCLUSION: Increasing the use of alcohol-based hand sanitizers by improving accessibility and providing periodic hand hygiene training sessions to health care workers is strongly recommended for decreasing the risk of MRSA acquisition among neonates in NICU settings.