Community-acquired Disseminated Exophiala dermatitidis Mycosis with Necrotizing Fasciitis in Chronic Graft-versus-host Disease.

We herein report a case of systemic phaeohyphomycosis by Exophiala dermatitidis (E. dermatitidis) with chronic graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT). The patient had been taking oral corticosteroids for years to control the GVHD. Yeast-like fungi were identified in a blood culture, so treatment with micafungin (150 mg/day) was begun, with no improvement. The patient passed away on hospital Day 12. A sequence analysis of rRNA revealed the isolate to be E. dermatitidis. This report brings attention to an emerging mycosis of community-acquired Exophiala species infection in the very-late phase after allogenic HSCT in patients with chronic GVHD.

[Comparison of the antimicrobial susceptibility testing with three automated systems for MRSA, VISA, ESBL-producing Escherichia coli and Klebsiella pneumoniae].

Some automated systems of the identification and susceptibility for microorganisms are used and prevail in hospital laboratories. One of the most serious problems is to perform accurate susceptibility testing for low-level resistant organisms, while antibiotic resistant microbes are increasing in medical fields. To evaluate automated machines for the susceptibility testing, several antibiotic resistant organisms were examined by plural technicians in some laboratories. Each strain of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycinintermediate S. aureus (VISA), extended-spectrum ß-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae was tested by three automated systems of WalkAway, VITEK2/VITEK2 compact and Phoenix for susceptibility. The results for antibiotics generated by the systems were compared to those generated by reference methods according to CLSI guidelines. The results of WalkAway, VITEK2/VITEK2 compact, and Phoenix demonstrated 92%, 91%, and 96% of reproducibilities, 92%, 94%, and 91% of MIC agreements, 0.5%, 0.8%, and 0.3% of very major error (VME) and 0.3%, 1.4%, and 2.3% of major error (ME), respectively. All automated systems had a high reproducibility even under the performance of plural technicians, although the differences of VMEs and MEs were observed among the systems. From these data, the automated systems for antimicrobial susceptibility testing were more useful for the detection of antibiotic resistant organisms by understanding the characteristics of each system.

[Antimicrobial susceptibility patterns of Pseudomonas aeruginosa isolated from 2006 to 2008 in Fukuoka University Hospital].

Pseudomonas aeruginosa has been reported to be a leading cause of nosocomial infections. We evaluated the characteristics using 903 P. aeruginosa strains that were isolated in Fukuoka University Hospital from 2006 to 2008. Clinical specimens of P. aeruginosa were detected 47.8% from respiratory tract, 24.4% from urine, and were detected from the pus by 18.9%. Age distribution of the patients was 70 years old or older. Antimicrobial susceptibility ratio of isolates of P. aeruginosa from the outpatients against all agents tested except amikacin had more susceptible than it of isolates from the inpatients. In P. aeruginosa isolates detected from the inpatients, susceptibilities to other antibiotics were about 60% though 93.3% and 83.2% were susceptible to amikacin and piperacillin/tazobactam respectively. Isolation rate of multidrug-resistant P. aeruginosa (MDRP) in all clinical isolates was 3.3%. The report of carbapenem use was obligated in our hospital from the experience of the outbreak by MDRP in 2007, and the infection control team came to regulate the administering of antimicrobial agents more than before. Afterwards, the amounts of the antimicrobial agent use except piperacillin/tazobactam have decreased to 69% compared with the previous year. The susceptibility rates of various antimicrobial agents except amikacin have recovered by 10-17%. These results suggest that there is a necessity for attending to the drug susceptibility and the amount of the antimicrobial agent use.