Integration of DPC and clinical microbiological data in Japan reveals importance of confirming a negative follow-up blood culture in patients with MRSA bacteremia.

Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is one of the commonest and most life-threatening of all infectious diseases. The morbidity and mortality rates associated with MRSA bacteremia are higher than those associated with bacteremia caused by other pathogens. A common guideline in MRSA bacteremia treatment is to confirm bacteremia clearance through additional blood cultures 2-4 days after initial positive cultures and as needed thereafter. However, no study has presented statistical evidence of how and to what extent confirming a negative follow-up blood culture impacts clinical outcome. We present this evidence for the first time, by combining clinical microbiological data of blood cultures and the DPC administrative claims database; both had been systematically accumulated through routine medical care in hospitals. We used electronic medical records to investigate the clinical background and infection source in detail. By analyzing data from a university hospital, we revealed how survival curves change when a negative follow-up blood culture is confirmed. We also demonstrated confirmation of a negative culture is significantly associated with clinical outcomes: there was a more than three-fold increase in mortality risk (after adjusting for clinical background) if a negative blood culture was not confirmed within 14 days of the initial positive blood culture. Although we used data from only one university hospital, our novel approach and results will be a basis for future studies in several hospitals in Japan to provide statistical evidence of the clinical importance of confirming a negative follow-up blood culture in bacteremia patients, including those with MRSA infections.

[A case with Abiotrophia defectiva isolated from postoperative blood culture of a patient with diffuse peritonitis].

We have recently detected Abiotrophia defectiva (A. defectiva) from postoperative blood culture of a patient with diffuse peritonitis. Pleomorphic Gram positive rod appearance and no growth on a standard sheep blood agar led us to suspect aerotolerant anaerobe. From the test results of simplified identification kit for anaerobes, we tentatively reported Clostridium tertium (C. tertium) to the clinician. However, the analysis of 16SrRNA sequence proved it to be A. defectiva. When Gram positive coccus or pleomorphic Gram positive rod are observed on blood culture, it is recommended to incubate Brucella HK (RS) blood agar plates for 24 hours at 35 degrees C both aerobically and anaerobically. The growth both aerobically and anaerobically suggests A. defectiva and Satellitism test and Rapid ID 32 STREP(SYSMEX) testing should be performed to identify the responsible bacteria. A. defectiva is Gram positive streptococcus and requires pyridoxal hydrochloride or L-cysteine to grow. It could be unidentified or misidentified and its particularity often leads incomplete report to the clinician. Our study shows that more careful examination will increase the detection of A. defectiva.

[A case of Desulfovibrio desulfuricans cultured from blood in Japan].

We report a case of Desulfovibrio desulfuricans bacteremia in a 60-year-old-man. In our case, anaerobic blood culture bottle turned out positive after five days' incubation. Gram stain showed the presence of slightly-curved Gram negative rod. Suspecting Campylobacter and Helicobacter, we added microaerobic culture while tentatively reporting Campylobacter to the physician. We then added anaerobic culturing with Brucella HK (RS) Agar because microaerobic culture proved the absence of microaerophile. We found small colonies on the third day, then we started anaerobic culture and eventually identified Desulfovibrio desulfuricans. We believe this is the first report of Desulfovibrio desulfuricans cultured from blood in Japan. In case Gram stain shows the presence of spiral bacterium, it is recommended to observe closely considering Desulfovibrio.

"Green odor" inhalation reduces the skin-barrier disruption induced by chronic restraint stress in rats: physiological and histological examinations.

We investigated whether inhalation of green odor (a mixture of equal amounts of trans-2-hexenal and cis-3-hexenol) prevents the skin-barrier disruption induced by chronic restraint stress in rats. To this end, transepidermal water loss (TEWL) was measured as an index of the disruption of skin-barrier function, whereas light- and electron-microscope examinations were performed to observe histological changes in the skin of the stressed animals. In addition, the effects on TEWL induced by chronic administration of a glucocorticoid, dexamethasone (DEX), were examined. Chronic restraint stress (8 h per day for 14 days) increased TEWL (vehicle + stress group). This effect (and the chronic stress-induced increase in adrenal weight) was prevented in rats that inhaled green odor at the beginning of each day's restraint (2 h each day for 14 days; green odor + stress group). Electron-microscope studies revealed that rats in the green odor + stress group possessed sufficient intercorneocyte lipids to create an effective skin barrier, although these had apparently been decreased in the vehicle + stress group. Daily administration of DEX for 14 days increased TEWL. The present results suggest that chronic stress-induced disruption of the skin barrier in rats can be reduced or prevented by green odor (possibly at least in part through an inhibitory effect on the stress-induced activation of the hypothalamo-pituitary-adrenocortical axis).