RESUMEN
We conducted a nationwide molecular epidemiological study of Clostridium difficile infection (CDI) in Japan investigated the correlation between the presence of binary toxin genes and CDI severity. This is the first report on molecular epidemiological analyses for CDI in multiple university hospitals in Japan, to our knowledge. We examined 124,484 hospitalized patients in 25 national and public university hospitals in Japan between December 2013 and March 2014, investigating antimicrobial susceptibilities and toxin-related genes for C. difficile isolates from stools. Epidemiological genetic typing was performed by PCR-ribotyping and repetitive sequence-based (rep)-PCR to examine the genetic similarities. The results detected toxin A-positive, toxin B-positive, binary toxin-negative (A+B+CDT-) detected from 135 isolates (80.8%) and toxin A-negative, toxin B-positive, binary toxin-negative (A- B+CDT-) in 23 (13.8%). Toxin A-positive, toxin B-positive, and binary toxin-positive (A+B+CDT+) were seen in 9 isolates (5.4%). Vancomycin (n = 81, 37.7%) or metronidazole (n = 88, 40.9%) therapies were undertaken in analyzed cases. Ribotypes detected from isolates were 017/subgroup 1, 070, 078, 126, 176, 449, 475/subgroup 1, 499, 451, 566 and newtypes. Rep-PCR classified 167 isolates into 28 cluster groups including 2-15 isolates. In addition, 2 pairs of strains isolated from different institutions belonged to the same clusters. Seven out of 9 (77.8%) of the patients with binary toxin producing strains had "mild to moderate" outcome in evaluated symptoms. In conclusion, we found that binary toxin did not show regional specificity and had no relevance to severity of CDI.
Asunto(s)
Antibacterianos/uso terapéutico , Clostridioides difficile/genética , Infecciones por Clostridium/epidemiología , Hospitales Universitarios/estadística & datos numéricos , ADP Ribosa Transferasas/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Proteínas Bacterianas/genética , Clostridioides difficile/efectos de los fármacos , Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/tratamiento farmacológico , Infecciones por Clostridium/microbiología , Monitoreo Epidemiológico , Heces/microbiología , Femenino , Humanos , Concentración 50 Inhibidora , Japón/epidemiología , Masculino , Metronidazol/uso terapéutico , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Epidemiología Molecular , Reacción en Cadena de la Polimerasa , Ribotipificación/métodos , Índice de Severidad de la Enfermedad , Vancomicina/farmacología , Vancomicina/uso terapéutico , Adulto JovenRESUMEN
OBJECTIVES: The increasing prevalence of resistant bacteria such as fluoroquinolone-resistant or extended-spectrum ß-lactamase-producing strains in pathogens causing acute uncomplicated cystitis has been of concern in Japan. Faropenem sodium is a penem antimicrobial that demonstrates a wide antimicrobial spectrum against both aerobic and anaerobic bacteria. It is stable against a number of ß-lactamases. METHODS: We compared 3 and 7 day administration regimens of faropenem in a multicentre, randomized, open-label, controlled study. RESULTS: In total, 200 female patients with cystitis were enrolled and randomized into 3 day (Nâ=â97) or 7 day (Nâ=â103) treatment groups. At the first visit, 161 bacterial strains were isolated from 154 participants, and Escherichia coli accounted for 73.9% (119/161) of bacterial strains. At 5-9 days after the completion of treatment, 73 and 81 patients from the 3 day and 7 day groups, respectively, were evaluated by intention-to-treat analysis; the microbiological efficacies were 58.9% eradication (43/73), 20.5% persistence (15/73) and 8.2% replaced (6/73), and 66.7% eradication (54/81), 6.2% persistence (5/81) and 7.4% replaced (6/81), respectively (Pâ=â0.048). The clinical efficacies were 76.7% (56/73) and 80.2% (65/81), respectively (Pâ=â0.695). Adverse events due to faropenem were reported in 9.5% of participants (19/200), and the most common adverse event was diarrhoea. CONCLUSIONS: The 7 day regimen showed a superior rate of microbiological response. E. coli strains were in general susceptible to faropenem, including fluoroquinolone- and cephalosporin-resistant strains.
Asunto(s)
Antibacterianos/uso terapéutico , Cistitis/tratamiento farmacológico , beta-Lactamas/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/farmacología , Cistitis/microbiología , Femenino , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/aislamiento & purificación , Bacterias Grampositivas/efectos de los fármacos , Bacterias Grampositivas/aislamiento & purificación , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven , beta-Lactamas/farmacologíaRESUMEN
The purpose of this study is to examine the use of anti-methicillin-resistant Staphylococcus aureus (MRSA) drugs, such as vancomycin (VCM), teicoplanin (TEIC), arbekasin (ABK) and linezolid (LZD), and the antibiotic susceptibilities of MRSAs in Kobe University Hospital. We investigated MRSA isolation and use of anti-MRSA drugs and susceptibilities of MRSA, using linear regression analysis, from 2007 to 2011, and checked for correlation between the use of these drug and the antibiotic susceptibilities of MRSA. The overall monthly isolation rates of MRSA decreased from a mean of 84.8% in 2007 to 70.0% in 2011 (r=0.946, P=0.015, b=-0.220), and the monthly isolation rate of MRSA in inpatients decreased from a mean of 78.6% in 2007 to 57.7% in 2011 (r=0.952, P=0.012, b=-0.160). From 2007 to 2011, VCM consumption significantly increased (r=0.916, P=0.029, b=0.055), whereas TEIC and LZD use remained stable during the study period. In addition, ABK use significantly decreased from 23.8 defined daily dose (DDD) per 1000 patient-days in 2007 to 5.2 DDD per 1000 in 2011 (r=0.902, P=0.036, b=-0.216). Susceptibility rates of MRSA were almost 100% to TEIC and VCM. The rates of MRSA to ABK and LZD significantly increased (r=0.959, P=0.010, b=2.137 for ABK and r=0.933, P=0.020, b=3.111 for LZD). In conclusion, our findings indicated a decreased MRSA isolation rate and the effective use of anti-MRSA drugs (VCM, TEIC, ABK and LZD), and improved susceptibility rates to anti-MRSA drugs, suggesting the possibilities that appropriate and early use of anti-MRSA drugs may cause the decrease of MRSA isolation.
Asunto(s)
Antibacterianos/uso terapéutico , Utilización de Medicamentos/estadística & datos numéricos , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Antibacterianos/farmacología , Farmacorresistencia Bacteriana , Hospitales Universitarios , Humanos , Japón/epidemiología , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Prevalencia , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiologíaRESUMEN
We examined the rate of relapse, as a variable index, in patients with urinary tract infection (UTI) who suffered from multiple relapses when using cranberry juice (UR65). A randomized, placebo-controlled, double-blind study was conducted from October 2007 to September 2009 in Japan. The subjects were outpatients aged 20 to 79 years who were randomly divided into two groups. One group received cranberry juice (group A) and the other a placebo beverage (group P). To keep the conditions blind, the color and taste of the beverages were adjusted. The subjects drank 1 bottle (125 mL) of cranberry juice or the placebo beverage once daily, before going to sleep, for 24 weeks. The primary endpoint was relapse of UTI. In the group of females aged 50 years or more, there was a significant difference in the rate of relapse of UTI between groups A and P (log-rank test; p = 0.0425). In this subgroup analysis, relapse of UTI was observed in 16 of 55 (29.1 %) patients in group A and 31 of 63 (49.2 %) in group P. In this study, cranberry juice prevented the recurrence of UTI in a limited female population with 24-week intake of the beverage.
Asunto(s)
Bebidas , Proantocianidinas/uso terapéutico , Prevención Secundaria , Infecciones Urinarias/prevención & control , Vaccinium macrocarpon , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Fitoterapia , Adulto JovenRESUMEN
BACKGROUND: Urinary tract infections (UTIs) can be hard to treat and treatment plans need to include accurate categorization such as uncomplicated or complicated UTI, or catheterized or uncatheterized UTI. We investigated the antibiotic susceptibilities of representative uropathogens in UTI categories. METHODS: We isolated uropathogens and analyzed their antimicrobial susceptibilities according to UTI categorization such as: (1) urology outpatients, urology inpatients, or other department inpatients; (2) uncomplicated or complicated UTIs; (3) upper or lower UTIs, and (4) non-catheterized or catheterized UTIs. RESULTS: Escherichia coli, Enterococcus faecalis, and Pseudomonas aeruginosa were representative uropathogens. Susceptibilities to levofloxacin (LVFX) in E. coli in urology outpatients (p = 0.0179), those to ceftadizime in E. coli in other department inpatients (p = 0.0327), and those to LVFX in E. faecalis in complicated UTI (p = 0.0137) significantly decreased in these 3 years compared with the previous 3 years. Susceptibilities of upper UTI to LVFX in E. coli were significantly lower in the recent 4 years compared to lower UTI (p = 0.0452) and those of catheterized UTI to LVFX in E. faecalis were significantly lower than in non-catheterized UTI (p = 0.0153). CONCLUSIONS: Data demonstrated different tendencies of uropathogens' antibiotic susceptibilities according to UTI categorizations and they could be useful for planning UTI treatments.
Asunto(s)
Antiinfecciosos/uso terapéutico , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/microbiología , Pacientes Internos/clasificación , Pacientes Ambulatorios/clasificación , Cateterismo Urinario/clasificación , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología , Infecciones Relacionadas con Catéteres/clasificación , Infecciones Relacionadas con Catéteres/diagnóstico , Ceftazidima/uso terapéutico , Enterococcus faecalis/efectos de los fármacos , Enterococcus faecalis/patogenicidad , Escherichia coli/efectos de los fármacos , Escherichia coli/patogenicidad , Humanos , Japón , Levofloxacino , Pruebas de Sensibilidad Microbiana , Ofloxacino/uso terapéutico , Pseudomonas aeruginosa/efectos de los fármacos , Pseudomonas aeruginosa/patogenicidad , Factores de Tiempo , Cateterismo Urinario/efectos adversos , Infecciones Urinarias/clasificación , Infecciones Urinarias/diagnóstico , Servicio de Urología en Hospital/clasificaciónRESUMEN
Overuse of antibiotics can cause the emergence of resistant bacterial strains. This study retrospectively investigated recent trends in Escherichia coli causing urinary tract infections (UTIs), focusing on antibiotic use and antibiotic susceptibilities. Patients diagnosed with UTIs caused by E. coli in Akashi Municipal Hospital between April 2004 and March 2010 were enrolled in the study. A total of 858 UTI cases were examined. Antibiotics used in our hospital during that period and the antibiotic susceptibilities of E. coli in UTI cases were assessed. We analyzed the data on a yearly basis, with the year being defined as the period from April to the following March (e.g., in this study the period from April 2004 to March 2005 represents 2004). The first 3 years (2004-2006) were compared to the last 3 years (2007-2009). The use of piperacillin, cephazolin, amikacin, oral cefotiam, and levofloxacin decreased significantly and the use of imipenem, gentamicin (GM), cefcapene, and oral minocycline (MINO) increased significantly in the last 3 years compared to the previous 3 years. The susceptibilities of MINO in complicated cystitis significantly increased and those of GM in uncomplicated pyelonephritis significantly decreased in these 3 years (2007-2009) compared to the previous 3 years (2004-2006) (P < 0.05). Additionally, extended-spectrum ß-lactamase (ESBL)-producing E. coli tended to be isolated more often; this was statistically significant in the last 3 years (2007-2009) compared to the previous 3 years (2004-2006) (P < 0.05). In conclusion, we found changes in our pattern of antibiotic use associated with changes in antibiotic susceptibilities and an increase in ESBL-producing E. coli isolated from our UTI cases. Monitoring of antibiotic use and emergence of resistant strains should be continued.
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/microbiología , Escherichia coli/efectos de los fármacos , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología , Prescripciones de Medicamentos , Escherichia coli/aislamiento & purificación , Femenino , Humanos , Prescripción Inadecuada , Japón , Masculino , Pruebas de Sensibilidad Microbiana , Oportunidad Relativa , Estudios Retrospectivos , Estadísticas no Paramétricas , Resistencia betalactámicaRESUMEN
Febrile urinary tract infections (UTIs) often require the intravenous infusion of antibiotics and/or hospitalization. Acute pyelonephritis (AP) is one of the most severe forms of UTI, and the antibiotics we should use as the first line and the risk factors for treatment failure remain controversial. The objective of this study was to investigate the efficacy of i.v. antibiotics selected for the treatment of febrile AP and to examine the risk factors for antibiotic resistance. We set risk factors for antibiotic treatment failure such as age, sex, and the presence of underlying urinary tract disease. We classified all cases into 49 cases of complicated AP and 24 cases of uncomplicated AP according to the presence of underlying urinary tract diseases, and examined the characteristics of the patients and the efficacy of the antibiotics used in this study. We investigated risk factors which relate to initial treatment failure and the duration of antibiotic treatment. Initial antibiotic treatment failure was significantly correlated to C-reactive protein in complicated AP and to positive blood culture in uncomplicated AP. We revealed a significant correlation between the duration of the given antibiotics and diabetes mellitus or positive blood culture in uncomplicated AP, and tazobactam/piperacillin was significantly related to prolongation of antibiotic treatment in complicated AP. In conclusion, in this study, a positive blood culture was the representative risk factor that related to both initial treatment failure and longer duration of the given antibiotics in uncomplicated AP.
Asunto(s)
Antibacterianos/uso terapéutico , Urgencias Médicas , Hospitalización , Pielonefritis/tratamiento farmacológico , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Antibacterianos/farmacología , Bacterias/efectos de los fármacos , Sangre/microbiología , Medios de Cultivo , Esquema de Medicación , Farmacorresistencia Bacteriana , Femenino , Fiebre/tratamiento farmacológico , Fiebre/microbiología , Humanos , Infusiones Intravenosas , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Pielonefritis/microbiología , Factores de Riesgo , Insuficiencia del Tratamiento , Adulto JovenRESUMEN
We investigated the actions of Gosha-jinki-gan, a traditional Japanese medicine containing processed Aconiti tubers, on urinary bladder function in anesthetized rats. In cystometrical investigations, Gosha-jinki-gan (1.0 g/kg, i.d.) increased bladder capacity as well as micturition threshold pressure. In addition, it decreased the frequency of distension-induced rhythmic bladder contractions. However, it did not influence the amplitude of bladder contractions induced by electrical stimulation of the pontine micturition center. The inhibitory effect of Gosha-jinki-gan on bladder motility was abolished by pretreatment with nor-binaltorphimine (10 mg/kg, s.c.), and was diminished by the concomitant use of anti-dynorphin A antiserum (10 microg, i.t.), yohimbine (10 microg, i.t.), or methysergide (20 microg, i.t.). Processed Aconiti tuber extract (27 mg/kg, i.d.) also suppressed bladder motility, and the effect was abolished by nor-binaltorphimine. These results suggest that Gosha-jinki-gan attenuates bladder sensation via the kappa-opioid receptor-stimulating action of processed Aconiti tuber. Gosha-jinki-gan may be a useful anti-pollakiuria agent that does not influence bladder contractility at micturition.