Characteristics of pediatric patients claimed with acute upper respiratory infection during otorhinolaryngology consultations: A descriptive study of a large Japanese medical claims database.

This study aimed to clarify other diseases claimed simultaneously with acute upper respiratory infection (URI), antibiotic prescriptions, and examinations associated with infectious diseases in pediatric patients with acute URI insurance claims at otorhinolaryngology outpatient visits. Pediatric patients who visited an otolaryngology department between 2019 and 2021 and were definitively diagnosed with URI were selected using a large Japanese medical claims database. Patient backgrounds, antibiotic use, and examinations were descriptively evaluated. In total, 8010 patients were included in the analysis. The median number (interquartile range) of diseases claimed in the same month as acute URI was 4 (3-6). Only 519 (6.5 %) patients were claimed as acute URI alone. Regardless of the prescription of antibiotics, the most commonly redundantly claimed disease in these patients was allergic rhinitis, followed by acute bronchitis, acute sinusitis, and earwax impaction. The frequently prescribed antibiotics were third-generation cephalosporins, macrolides, and penicillins with extended-spectrum, including amoxicillin which was recommended by the Japanese manual; the proportion of patients with examinations was low (2.9-21.7 %). Among patients with acute URI, diagnoses requiring antibiotics were also claimed; therefore, when evaluating acute URI using the Japanese medical claims database, care must be taken in patient selection. Moreover, the implementation rate of examinations necessary for diagnosis was low, so there is an urgent need to develop an environment where examinations can be conducted in outpatient settings.

Autochthonous Cryptococcus gattii genotype VGIIb infection in a Japanese patient with anti-granulocyte-macrophage colony-stimulating factor antibodies.

A 31-year-old Japanese man presented with cerebral and pulmonary cryptococcosis. Cryptococcus gattii (C. gattii) genotype VGIIb was detected in the patient's sputum and cerebrospinal fluid specimens. The serum levels of anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) antibodies were elevated in this patient, which has been associated with pulmonary alveolar proteinosis and is considered a risk factor for C. gattii infection. After undergoing >12 months of antifungal treatments, the patient showed improvements in symptoms and findings on brain and lung imaging. Several Japanese patients who develop C. gattii infection have also been reported; however, most of these patients have been infected outside Japan, as C. gattii infection is rare in Japan. Only one patient with C. gattii genotype VGIIb infection has been reported in Japan, and it is believed that this patient contracted the infection in China. In the present case, our patient has never been outside Japan, indicating that the infection originated in Japan. Our findings suggest that C. gattii might be spreading in Japan. Therefore, patients with positive serum anti-GM-CSF antibodies should be thoroughly monitored for C. gattii infection, even those living in Japan.

[Evaluation of Methicillin Resistance Determination Time for MRSA Using Fully Automated Rapid Identification Susceptibility testing system RAISAS S4].

In this study, we examined the accuracy and rapidity of drug susceptibility determination using clinical isolates of MRSA with the fully automated rapid identification susceptibility testing system RAISUS S4. Ninety eight MRSA strains were used and the time until methicillin resistance was determined was analyzed by both of the standard method (18-hr method) and the rapid method. Five strains (5.1%) were determined to be methicillin-sensitive in MPIPC by rapid method only while all strains were determined to be resistant in CFX. The average methicillin resistance determination time was 7.0/5.0 hr for MPIPC, 6.3/5.0 hr for CFX, and 6.3/5.0 hr for the combination of MPIPC and CFX by the standard/rapid method, with the rapid method being significantly shorter (Wilcoxon's signed rank sum test, p<0.01). Strains determined to be methicillin-sensitive by MPIPC tended to have a longer time to methicillin resistance by the standard method, but this effect was much less pronounced for the rapid method using CFX. Methicillin resistance determination by the rapid method using RAISUS S4 enables rapid detection of MRSA without false-susceptible results, which may lead to early and appropriate treatment.