Five-year point prevalence survey of healthcare-associated infections and antimicrobial use in a Japanese university hospital.

BACKGROUND: Periodic point prevalence surveys (PPSs) provide a method for assessing changes in healthcare-associated infections (HAIs) and antimicrobial use over time. Following the introduction of an antimicrobial stewardship programme at Nagoya University Hospital (Aichi, Japan) a five-year PPS study was performed to highlight any epidemiological changes. METHODS: One-day PPSs were performed annually in July at Nagoya University Hospital. Data on patient characteristics, medical devices, active HAIs and antimicrobial use were collected using a standard data-collection form. RESULTS: A total of 4339 patients were included. Over the five-year study period the median patient age was 62 years, median duration of hospital admission was nine days, 9% of patients had an HAI and 35.2% received at least one antimicrobial. Overall there were 406 HAIs (95% confidence interval, 369-447) with surgical site infection, pneumonia and febrile neutropenia occurring most frequently. Enterobacterales were the most common pathogens (N = 78, 28.6%) and 32.1% were third-generation cephalosporin-resistant. Meropenem was the most frequently prescribed antimicrobial for HAIs. Surgical antimicrobial prophylaxis changed drastically, with shorter durations and a marked reduction in oral cephalosporin use. However, antimicrobials for medical prophylaxis gradually increased. CONCLUSIONS: This five-year PPS study shows consistent data for patient background, HAIs and causative pathogens and highlights changes in antimicrobial use during the era of the National Action Plan on Antimicrobial Resistance. To describe the epidemiology of Japanese hospitals by PPS, multicentre PPSs including in community hospitals should be performed annually.

Is driving a car a risk for Legionnaires' disease?

Legionnaires' disease (LD) is a major cause of severe community-acquired pneumonia but the source and mode of transmission are not always apparent, especially in sporadic cases. We hypothesized that LD can be acquired from the air-conditioning systems of motor cars. Swabs were taken from the evaporator compartments of the air-conditioning system of scrapped cars. Healthy subjects who were mainly employees of regional transportation companies were tested for antibody to Legionella pneumophila serogroups 1-6; they also completed a questionnaire. Legionella species were detected in 11/22 scrapped cars by the loop-mediated isothermal amplification method. The prevalence of microplate agglutination titres > or =1:32 was significantly higher in subjects who sometimes used car air-conditioning systems. Although we did not prove a direct link between Legionella spp. in the car evaporator and LD, our findings point to a potential risk of car air-conditioning systems in LD, which needs further investigation.

[Three cases of intracranial chordoma. Typical chordoma and chondroid chordoma].

Three cases of intracranial chordoma: 2 cases of typical chordoma and a case of chondroid chordoma, were reported and the clinico-pathological difference between these two types of chordoma was discussed. It is well known that typical chordoma is composed of physaliferous cells containing various quantities of intracytoplasmic mucin histologically, whereas chondroid chordoma as Heffelfinger reported in 1973 is composed of cellular area with scanty myxoid matrix and Chondroid matrix. Clinical course of the typical chordoma shows recurrence of the tumor within 2 years after surgical removal and radiation therapy in the majority of the cases, and the average survival range is said to be about 4.1 years, while chondroid chordoma takes benign course with average survival of 24.1 years after surgery and radiation therapy. One of our two patients with typical chordoma died from the recurrence two years after surgery and radiation therapy. However, the patients with chondroid chordoma showed no sign of recurrence over 2 years after subtotal removal and radiation. Surgical approach for the removal of the tumor was discussed as well. When the tumor is rather small and located at the upper clival region, transsphenoidal approach may be preferable, otherwise other approach should be chosen. When tumor has forward extension over the clivus, subtemporal approach will be most favorable with wider operative field. Identification of vessels and nerves around the tumor will be readily obtained by this approach.