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1.
Artigo em Inglês | MEDLINE | ID: mdl-33257451

RESUMO

IMP-type carbapenemase, found in various Gram-negative bacteria, has been increasingly detected worldwide. We aimed to study the outcomes and risk factors for acquisition of IMP-type carbapenemase-producing carbapenem-resistant Enterobacteriaceae (IMP-CRE), as this has not been evaluated in detail. We conducted a matched case-case-control study of patients from whom IMP-CRE isolates were obtained. All patients who tested positive for IMP-CRE were included; they were matched with patients with carbapenem-susceptible Enterobacteriaceae (CSE) and with controls at a ratio of 1:1:2. The risk factors for acquisition for the CRE and CSE groups and mortality rates, which were calculated using multivariate logistic regression models with weighting according to the inverse probability of propensity scores, were compared. In total, 192 patients (96 patients each in the CRE and CSE groups, with 130 Enterobacter cloacae isolates and 62 Klebsiella sp. isolates) were included. The IMP-11 type was present in 43 patients, IMP-1 in 33, and IMP-60 and IMP-66 in 1 each; 31 patients with CRE (32.3%) and 34 with CSE (35.4%) developed infections. Multivariate analysis identified the following independent risk factors: gastrostomy, history of intravenous therapy or hemodialysis, and previous exposure to broad-spectrum ß-lactam antibiotics, including penicillin with ß-lactamase inhibitors, cephalosporins, and carbapenems. In propensity score-adjusted analysis, mortality rates for the CRE and CSE groups were similar (15.0% and 19.5%, respectively). We found that IMP-CRE may not contribute to worsened clinical outcomes, compared to CSE, and gastrostomy, previous intravenous therapy, hemodialysis, and broad-spectrum antimicrobial exposure were identified as risk factors for CRE isolation. Fluoroquinolone and aminoglycosides are potentially useful antibiotics for IMP-CRE infections.


Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos , Infecções por Enterobacteriaceae , Humanos , Antibacterianos/uso terapêutico , Proteínas de Bactérias/genética , beta-Lactamases/genética , Enterobacteriáceas Resistentes a Carbapenêmicos/genética , Carbapenêmicos/uso terapêutico , Estudos de Casos e Controles , Infecções por Enterobacteriaceae/tratamento farmacológico , Japão , Fatores de Risco
2.
J Infect Chemother ; 27(1): 120-122, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32988731

RESUMO

INTRODUCTION: Information on the effectiveness of personal protective equipment (PPE) for preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among healthcare workers (HCWs), especially among HCWs with frequent contact with patients with SARS-CoV-2, is limited. METHODS: We conducted a prospective cohort study on 49 HCWs who worked in close contact with patients with SARS-CoV-2 infection. HCWs had blood samples taken every 2 weeks to test for SARS-CoV-2 antibodies using two different types of assay. RESULTS: Forty-nine participants (31 nurses, 15 doctors, 3 other workers) were enrolled. In total, 112 blood samples are obtained from participants. The median work days in 2 weeks was 9 (interquartile range (IQR): 5-10) days. In a single work day, 30 of the 49 participants (61.5%) had contact with patients with suspected or conformed SARS-CoV-2 at least 8 times, and approximately 60% of participants had more than 10 min of contact with a single patient. The median self-reported compliance to PPE was 90% (IQR: 80-100%). Seven participants tested positive for SARS-CoV-2 antibody using enzyme-linked immunosorbent assay (ELISA); however, none were seropositive for SARS-CoV-2 neutralizing antibody, so the positive ELISA results were assumed to be false-positive. CONCLUSIONS: The study provides evidence that appropriate PPE is sufficient to prevent infection amongHCWs. It is necessary to establish a system that provides a stable supply of PPE for HCWs to perform their duties.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Pessoal de Saúde , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Adulto , Idoso , Anticorpos Antivirais/sangue , Betacoronavirus/imunologia , Betacoronavirus/isolamento & purificação , COVID-19 , Infecções por Coronavirus/diagnóstico , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Estudos Prospectivos , SARS-CoV-2 , Adulto Jovem
3.
J Infect Chemother ; 25(5): 396-399, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30509484

RESUMO

Staphylococcus aureus bacteremia (SAB) and candidemia have significant impacts on mortality. Both have important implications for antimicrobial stewardship programs (ASPs). However, there are limited data regarding who should be educated and what components should be considered for the ASPs. Hence, we investigated the possibility of the key elements for implications of SAB and candidemia managements for ASPs. We conducted a cross-sectional study on the knowledge of antimicrobial stewardship institution policies targeting SAB and candidemia for all medical doctors (MDs) and pharmacists to using an E-learning system. To compare the differences in proportions of appropriate knowledge between junior residents and other MDs, and all MDs and pharmacists, we performed bivariate analyses using Fisher's exact test and χ2 test with odds ratios (ORs) with 95% confidence intervals (CIs). In total, all 395 MDs (71 junior residents, 137 senior residents and fellows, and 187 attending doctors) and all 63 pharmacists including 4 antimicrobial stewardship teams pharmacists responded to survey. MDs other than junior residents responded significantly inappropriately to the questions on the candidemia than junior residents (OR = 0.6, 95% CI: 0.4-1.0). Pharmacists had a significantly lower proportion of appropriate knowledge to the candidemia than MDs (OR = 0.4, 95% CI: 0.2-0.8). The major pitfall was failure to consult an ophthalmologist (82.5%). Next step, we will conduct educational intervention about institution policies, and evaluate whether to improve the knowledges and practices by pre-post test and chart review.


Assuntos
Anti-Infecciosos/uso terapêutico , Gestão de Antimicrobianos/normas , Competência Clínica/estatística & dados numéricos , Hospitais de Ensino/legislação & jurisprudência , Políticas , Anti-Infecciosos/normas , Bacteriemia/tratamento farmacológico , Candidemia/tratamento farmacológico , Estudos Transversais , Avaliação Educacional/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Humanos , Internato e Residência/estatística & dados numéricos , Japão , Farmacêuticos/estatística & dados numéricos , Médicos/estatística & dados numéricos , Infecções Estafilocócicas/tratamento farmacológico
4.
J Infect Chemother ; 23(2): 117-119, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27693180

RESUMO

Data on community-associated extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (CA-ESBLEC) infections in Japan are scarce. We compared the clinical and microbiological epidemiology of CA-ESBLEC infections with that of healthcare-associated-ESBLEC infections among 76 patients with ESBLEC infections. We identified a high prevalence (26%) of CA-ESBLEC infections in Japan; only a small proportion (15%) of patients with CA-ESBLEC infections had recent exposure to antibiotics.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Infecção Hospitalar/epidemiologia , Infecções por Escherichia coli/epidemiologia , Escherichia coli/enzimologia , beta-Lactamases/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Escherichia coli/enzimologia , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Estatísticas não Paramétricas
5.
J Infect Chemother ; 22(11): 777-779, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27118211

RESUMO

The 2014/15 influenza season started earlier than usual, and intense activity was reflection of circulation of antigenically-drifted and vaccine-mismatched dominant A(H3N2) viruses. Although inpatients and health-care workers (HCWs) had a high influenza vaccination coverage rate well prior to the beginning of influenza season, numerous outbreaks of influenza A(H3N2) infection with fatal cases were reported in long-term care facilities (LTCFs) in Japan during 2014/15 influenza season. In January 2015, we were given opportunity to conduct outbreak investigation of influenza A at facility A (LTCF attached with hospital) in Western part of Japan. We evaluated overall and occupation-stratified influenza vaccine effectiveness (VE) among HCWs at facility A using a retrospective cohort design. Overall VE, occupation-stratified VE and adjusted VE (AVE) with 95% confidence intervals (CIs) were estimated using the following formula: (1-relative risks (RR) or 1-adjusted RR) × 100%. Overall vaccine coverage rate among HCWs was 85%. Overall VE for HCWs was 28% (95% CI: -70 to 67) and overall AVE was 3% (95% CI: -34 to 30). Although there was no severe cases, our results indicated that even with high vaccination coverage rate with appropriate vaccination timing, the VE was low for HCWs, which echoes with previously reported VE from other northern hemisphere countries. However, rehabilitation group who had high awareness against influenza as a group and carried out intensive precautions from early influenza season had no cases. We conclude that multiple preventive measures in addition to high vaccination rate is necessary for preventing influenza of HCWs working at LCTFs.


Assuntos
Vírus da Influenza A Subtipo H3N2/imunologia , Vacinas contra Influenza/imunologia , Influenza Humana/imunologia , Idoso , Feminino , Pessoal de Saúde , Hospitais , Humanos , Japão , Assistência de Longa Duração , Masculino , Casas de Saúde , Vigilância da População , Estudos Retrospectivos , Estações do Ano , Vacinação/métodos
6.
J Infect Chemother ; 21(3): 212-4, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25444675

RESUMO

We report a case of multidrug-resistant (MDR) Acinetobactor baumannii isolates obtained from a traveler returned from Brunei. Whole-genome sequencing analysis revealed that the isolates harbored blaOxA-23 and armA. The minimum inhibitory concentrations of antibiotics against the strain were as follows: imipenem, 32 µg/ml; meropenem, 32 µg/ml; ciprofloxacin, 16 µg/ml; amikacin, ≧ 1024 µg/ml; arbekacin, ≧ 1024 µg/ml; aztreonam, 64 µg/ml; colistin, 4 µg/ml. A. baumannii harboring both blaOxA-23 and armA is rarely reported in Japan, and, to the best of our knowledge, this is the second report of A. baumannii harboring both resistant genes in Japan.


Assuntos
Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/isolamento & purificação , Bacteriemia/microbiologia , Farmacorresistência Bacteriana Múltipla , Pneumonia Bacteriana/microbiologia , Viagem , Infecções por Acinetobacter/diagnóstico , Infecções por Acinetobacter/tratamento farmacológico , Acinetobacter baumannii/enzimologia , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Proteínas de Bactérias/metabolismo , Brunei/epidemiologia , Humanos , Masculino , Metiltransferases/metabolismo , Testes de Sensibilidade Microbiana , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/tratamento farmacológico , beta-Lactamases/metabolismo
7.
Antimicrob Agents Chemother ; 58(6): 3441-50, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24709261

RESUMO

IMP-type metallo-ß-lactamase enzymes have been reported in different geographical areas and in various Gram-negative bacteria. However, the risk factors and epidemiology pertaining to IMP-type metallo-ß-lactamase-producing Enterobacter cloacae (IMP-producing E. cloacae) have not been systematically evaluated. We conducted a retrospective, matched case-control study of patients from whom IMP-producing E. cloacae isolates were obtained, in addition to performing thorough molecular analyses of the clinically obtained IMP-producing E. cloacae isolates. Unique cases with IMP-producing E. cloacae isolation were included. Patients with IMP-producing E. cloacae were matched to uninfected controls at a ratio of 1 to 3. Fifteen IMP-producing E. cloacae cases were identified, with five of the isolates being obtained from blood, and they were matched to 45 uninfected controls. All (100%) patients from whom IMP-producing E. cloacae isolates were obtained had indwelling devices at the time of isolation, compared with one (2.2%) uninfected control. Independent predictors for isolation of IMP-producing E. cloacae were identified as cephalosporin exposure and invasive procedures within 3 months. Although in-hospital mortality rates were similar between cases and controls (14.3% versus 13.3%), the in-hospital mortality of patients with IMP-producing E. cloacae-caused bacteremia was significantly higher (40%) than the rate in controls. IMP-producing E. cloacae isolates were frequently positive for other resistance determinants. The MICs of meropenem and imipenem were not elevated; 10 (67%) and 12 (80%) of the 15 IMP-producing E. cloacae isolates had a MIC of ≤ 1 µg/ml. A phylogenetic tree showed a close relationship among the IMP-producing E. cloacae samples. Indwelling devices, exposure to cephalosporin, and a history of invasive procedures were associated with isolation of IMP-producing E. cloacae. Screening for carbapenemase production is important in order to apply appropriate clinical management and infection control measures.


Assuntos
Proteínas de Bactérias/genética , Enterobacter cloacae/isolamento & purificação , Infecções por Enterobacteriaceae/epidemiologia , beta-Lactamases/genética , Idoso , Idoso de 80 Anos ou mais , Bacteriemia , Proteínas de Bactérias/metabolismo , Cefalosporinas/uso terapêutico , Enterobacter cloacae/efeitos dos fármacos , Enterobacter cloacae/enzimologia , Enterobacter cloacae/genética , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/microbiologia , Infecções por Enterobacteriaceae/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Imipenem/uso terapêutico , Controle de Infecções , Inosina Monofosfato , Japão/epidemiologia , Masculino , Meropeném , Pessoa de Meia-Idade , Filogenia , Fatores R , Estudos Retrospectivos , Fatores de Risco , Atenção Terciária à Saúde , Tienamicinas/uso terapêutico , beta-Lactamases/metabolismo
8.
Glob Health Med ; 2(2): 127-130, 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33330790

RESUMO

In Japan, four medical facilities including our own - the National Center for Global health and Medicine (NCGM) - have been designated for the treatment of specified infectious diseases by the Minister of Health, Labour, and Welfare. Here, we report our nursing care for patients with severe COVID-19 on extracorporeal membrane oxygenation (ECMO) support. In addition to infection control measures in the form of an N95 mask, a water-repellent isolation gown, a cap, a shielded mask on top of the N95, and double-layered gloves, nurses were required to wear one-piece suits (DuPont™ Tyvek®) and use powered air-purifying respirators (PAPRs). While closed system catheters are normally changed once a day to limit aerosol exposure, they are now changed once every 4 days. Nursing care included equipment checks, monitoring of hemodynamics and respiratory status, management of anticoagulants, observation of the patients general condition, management of sedatives and analgesics, prevention of medical device-related pressure ulcers and bedsores, and maintenance of hygiene. Fundamentally sound nursing remains the best practice for patient treatment and management. During nursing care for patients with COVID-19 on ECMO, infection control measures should be faithfully and properly followed.

9.
Infect Prev Pract ; 2(4): 100098, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34316568

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) continues to spread around the world. In addition to community-acquired infections, nosocomial infections are also a major social concern. The likelihood of environmental contamination and transmission of the virus based on disease severity is unknown. METHODS: We collected nasopharyngeal, environmental and air samples from patients with COVID-19 admitted to the National Centre for Global Health and Medicine between January 29th and February 29th, 2020. The patients were classified by severity of disease. The collected samples were tested using severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) real-time reverse transcription polymerase chain reaction (real-time RT-PCR). RESULTS: SARS-CoV-2 was not detected in a subset of 11 air samples. Of the 141 environmental samples collected from three patient bays and two single rooms, four samples tested positive for SARS-CoV-2 by real-time RT-PCR. Detections were made on the surface of a stethoscope used in the care of a patient with severe disease, on the intubation tube of a patient classified as critical (and on ventilator management), and on the surface of a gown worn by the nurse providing care. CONCLUSIONS: Regardless of the patients' disease severity, SARS-CoV-2 was detected on very few environmental surfaces. However, detection of SARS-CoV-2 on stethoscopes used in the care of multiple patients and on the surface of gowns worn by clinical staff indicates that medical devices may be linked to the spread of infection.

10.
Glob Health Med ; 2(2): 107-111, 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33330786

RESUMO

Due to the significant spread of a new type of coronavirus (SARS-CoV-2) infection (COVID-19) in China, the Chinese government blockaded several cities in Hubei Province. Japanese citizens lost a means of transportation to return back to Japan. The National Center for Global Health and Medicine (NCGM) helped the operation of charter flights for evacuation of Japanese residents from Hubei Province, and this article outlines our experiences. A total of five charter flights were dispatched, and the majority of returnees (793/829 [95.7%]) were handled at NCGM. A large number of personnel from various departments participated in this operation; 107 physicians, 115 nurses, 110 clerical staff, and 45 laboratory technicians in total. Several medical translators were also involved. In this operation, we conducted airborne precautions in addition to contact precautions. Eye shields were also used. The doctors collecting the pharyngeal swab used a coverall to minimize the risk of body surface contamination from secretions and droplets. Enhanced hand hygiene using alcohol hand sanitizer was performed. Forty-eight persons were ultimately hospitalized after the triage at NCGM operation, which was more than the number of persons triaged at the airport (n = 34). Of those hospitalized after NCGM triage, 8.3% (4/48 patients) ultimately tested positive for SARS-CoV-2, significantly higher than the positive rate among subjects not triaged (4/48 [8.3%] vs. 9/745 [1.2%]: p = 0.0057). NCGM participated in a large-scale operation to evacuate Japanese nationals from the COVID-19 epidemic area. We were able to establish a scheme through this experience that can be used in the future.

11.
Jpn J Infect Dis ; 71(1): 62-64, 2018 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-29093311

RESUMO

In Japan, infectious diseases are classified into 4 types based on how contagious and severe the pathogens are, and Ebola virus disease (EVD) is categorized as a category 1 infectious disease. The National Center for Global Health and Medicine in Tokyo, Japan, is designated as a specified hospital for category 1 infectious disease patients and has experienced 4 probable cases of EVD from West Africa. Even after the outbreak in West Africa is ended, we should continue to pay attention for new EVD outbreaks. Increasing the number of infectious disease specialists with the proper knowledge of viral hemorrhagic fever, including EVD, is a common problem for infectious disease physicians working in Japan, the academic society, and the government.


Assuntos
Doença pelo Vírus Ebola/diagnóstico , África Ocidental/epidemiologia , Surtos de Doenças , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/prevenção & controle , Humanos , Japão/epidemiologia , Reação em Cadeia da Polimerase Multiplex , Viagem
12.
Am J Infect Control ; 44(11): e257-e259, 2016 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-27810070

RESUMO

We performed 4 years of active screening for multidrug resistant organism (MDRO) colonization among patients with a history of overseas hospitalization. Thirteen (56.5%) of 23 cases were positive for MDROs, which highlights the importance of preemptive infection control to prevent the spread of MDROs in this population.


Assuntos
Infecções Bacterianas/epidemiologia , Portador Sadio/epidemiologia , Farmacorresistência Bacteriana Múltipla , Hospitalização , Viagem , Adulto , Idoso , Infecções Bacterianas/microbiologia , Portador Sadio/microbiologia , Feminino , Humanos , Controle de Infecções , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade
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