Satoshi Ichiyama

Kyoto University, Kioto, Kyōto, Japan

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Publications (224)535.15 Total impact

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    ABSTRACT: This study was conducted to evaluate trends in the isolation of strains of nontuberculous mycobacteria (NTM) and trends in the number of patients with pulmonary Mycobacterium avium complex (MAC) disease. We retrospectively reviewed microbiological results and clinical data to identify patients who were diagnosed with pulmonary MAC disease at Kyoto University Hospital in Japan between 2000 and 2013. NTM were isolated from 6,327 of 80,285 samples (7.9%) for mycobacterial culture. The proportion of NTM isolates among all mycobacterial isolates increased from 355 of 792 samples (44.8%) in 2000 to 688 of 847 samples (81.2%) in 2013. MAC was most frequently observed (5436 isolates, 85.9%), followed by M. abscessus (175 isolates, 2.8%) and M. kansasii (74 isolates, 1.2%). A total of 592 patients with pulmonary MAC disease were identified (age, 66.0±11.5 years; females, 61.1%). Compared with the early cohort (2000-2006, 236 patients), more patients in the late cohort (2007-2013, 356 patients) had an underlying disease (157 [66.5%] vs. 284 [79.8%], P=0.0003), a Charlson comorbidity index score ≥1 (115 [48.7%] vs. 213 [59.8%], P=0.008), collagen vascular disease (18 [7.6%] vs. 60 [16.9%], P=0.001), rheumatoid arthritis (11 [4.7%] vs. 41 [11.5%], P=0.004), and used immunosuppressive drugs (22 [9.3%] vs. 63 [17.7%], P=0.004). The numbers of patients with lung disease, malignant disease and diabetes mellitus increased; however, their frequencies did not differ. The recovery rate of NTM and patients with pulmonary MAC disease increased, especially in patients with collagen vascular disease or rheumatoid arthritis or who used immunosuppressive drugs.
    Journal of Infection and Chemotherapy. 01/2015;
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    ABSTRACT: Stenotrophomonas maltophilia (SM) is an important nosocomial pathogen that exhibits intrinsic resistance to various antimicrobial agents. However, the risk factors for SM bacteraemia have not been sufficiently evaluated. From January 2005 to September 2012, we retrospectively compared the clinical backgrounds and outcomes of SM bacteraemic patients (SM group) with those of bacteraemic patients due to Pseudomonas aeruginosa (PA group) or Acinetobacter species (AC group). DNA genotyping of the SM isolates using the Diversilab system was performed to investigate the genetic relationships among the isolates. The SM, PA, and AC groups included 54, 167, and 69 patients, respectively. Nine of 17 patients in the SM group receiving trimethoprim-sulfamethoxazole prophylaxis developed SM bacteraemia. Independent risk factors for SM bacteraemia were the use of carbapenems and antipseudomonal cephalosporins and SM isolation within 30 days prior to the onset of bacteraemia. Earlier SM isolation was observed in 32 of 48 patients (66.7%) with SM bacteraemia who underwent clinical microbiological examinations. Of these 32 patients, 15 patients (46.9%) had the same focus of bacteraemia as was found in the previous isolation site. The 30-day all-cause mortality rate among the SM group (33.3%) was higher than that of the PA group (21.5%, p = 0.080) and the AC group (17.3%, p = 0.041). The independent factor that was associated with 30-day mortality was the SOFA score. DNA genotyping of SM isolates and epidemiological data suggested that no outbreak had occurred. SM bacteraemia was associated with high mortality and should be considered in patients with recent use of broad-spectrum antibiotics or in patients with recent isolation of the organism.
    PLoS ONE 11/2014; 9(11):e112208. · 3.53 Impact Factor
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    ABSTRACT: During a prospective surveillance using PCR for the detection of plasmid-mediated AmpC β-lactamase (pAmpC)-producing Enterobacteriaceae, outbreaks due to pAmpC-producing Klebsiella pneumoniae (pAmpC-Kp) occurred in an adult liver transplantation unit (aLTU) and a paediatric liver transplantation unit (pLTU), with carbapenem-resistant (CR) variants. Between April 2010 and March 2012, a total of 32 patients infected with pAmpC-Kp were found by prospective surveillance using PCR detection at a Japanese university hospital. Multilocus sequence typing, analysis of outer membrane proteins, and detection of carbapenemases were performed. Clinical courses of patients with bloodstream infection (BSI) were reviewed. Of 32 pAmpC-Kp isolates from each patient, 20 (18 from aLTU patients) were DHA-1-producing sequence type 11 (DHA-1-ST11), 9 were CMY-2-ST45/778 (all from pLTU patients) and the other 3 isolates had different sequence types. CR variants were isolated from 8 aLTU patients with DHA-1-ST11 and from 1 pLTU patient with CMY-2-ST45. All of the pAmpC-Kp isolates, including CR variants, were negative for carbapenemases. All of the DHA-1-ST11 and CMY-2-ST45 isolates lacked OmpK35, and seven CR variants also lacked OmpK36. BSIs due to DHA-1-ST11 isolates, including CR variants, occurred in six aLTU patients, four of whom died. The outbreaks were controlled after application of intensified infection control measures. During pAmpC-Kp outbreaks involving 27 liver transplants, CR variants with porin loss developed in nine patients, and DHA-1-ST11 K. pneumoniae caused BSIs with high mortality.
    International Journal of Antimicrobial Agents 10/2014; · 4.26 Impact Factor
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    ABSTRACT: Environmental exposure is a likely risk factor for the development of pulmonary Mycobacterium avium complex (MAC) disease. The influence of environmental exposure on the response to antimicrobial treatment and relapse is unknown.
    BMC Infectious Diseases 09/2014; 14(1):522. · 2.56 Impact Factor
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    ABSTRACT: Vancomycin-resistant enterococci are important nosocomial pathogens that require rapid and accurate detection for infection control. Matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF/MS) has begun to be used in many clinical laboratories because it is a rapid, simple and inexpensive method for identifying micro-organisms. In this study, the performance of MALDI-TOF/MS to differentiate vanA-positive Enterococcus faecium (VPEF) from vanA-negative E. faecium (VNEF) was evaluated. A total of 61 VPEF isolates collected during regional surveillance in Kyoto (Japan) and 71 VNEF isolates collected from bacteraemia patients were analysed using MALDI-TOF/MS with three ClinProTools models. All of the isolates were correctly identified as E. faecium using the MALDI Biotyper system. To discriminate between VPEF and VNEF, all three ClinProTools models yielded >90% recognition capability (basic sensitivity) and cross-validation (reliability of the models); the genetic algorithm model exhibited the highest performance (99.18% and 92.40%, respectively). The high detection performance of MALDI-TOF/MS for VPEF offers the potential for routine laboratory use.
    International Journal of Antimicrobial Agents 09/2014; · 4.26 Impact Factor
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    ABSTRACT: We conducted this study to identify risk factors that may predict whether Candida spp. are causative agents of suspected catheter-related bloodstream infections (CRBSIs). All patients with laboratory-confirmed CRBSIs at Kyoto University Hospital between 2009 and 2011 were included. We compared the clinical features of candidal CRBSIs (78 cases) and non-candidal CRBSIs (258 cases). According to a multivariate analysis, a solid tumor (odds ratio (OR), 3.11; 95% confidence interval (CI), 1.75 - 5.53), total parental nutrition (OR, 2.65; 95% CI, 1.39 - 5.06), and the administration of anti-anaerobic agents (OR, 2.22; 95% CI, 1.03 – 4.79) were significantly more common among candidal CRBSIs. The 1-3 β-D-glucan test was positive among 94.6 % (35/37) of candidal CRBSI patients and 9.4 % (10/106) of non-candidal CRBSI cases. The administration of antifungal agents may be considered for patients with these risk factors, especially when the 1-3 β-D-glucan test is positive.
    Diagnostic Microbiology and Infectious Disease 08/2014; · 2.57 Impact Factor
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    ABSTRACT: Patients with pulmonary Mycobacterium avium complex (MAC) disease are often co-infected with various pathogenic microorganisms. This study aimed to determine the prevalence of co-infection with non-MAC pathogens and the risk factors associated with co-infection in patients with pulmonary MAC disease. We retrospectively reviewed the patient characteristics, microbiological results and chest CT findings in 275 patients with pulmonary MAC who visited the Kyoto University Hospital from January 2001 to May 2013. We defined chronic pathogenic co-infection as the isolation of non-MAC pathogens from sputum samples taken on more than two visits that occurred at least 3 months apart. The participants were predominantly female (74.5%) and infected with M. avium (75.6%). Chronic co-infection with any pathogen was observed in 124 patients (45.1%). Methicillin-sensitive Staphylococcus aureus (MSSA; n=64), Pseudomonas aeruginosa (n=35) and Aspergillus spp (n=18) were the most prevalent pathogens. The adjusted factors were chronic obstructive pulmonary disease (COPD; OR=4.2, 95% CI 1.6 to 13.1) and pulmonary M. intracellulare disease (OR=2.2, 95% CI 1.1 to 4.4) in chronic co-infections; COPD (OR=4.2, 95% CI 2.1 to 31.4), long duration of MAC disease (OR=2.2, 95% CI 1.2 to 4.4) and nodules (OR=3.5, 95% CI 1.2 to 13.2) in chronic MSSA co-infection; COPD (OR=7.5, 95% CI 2.1 to 31.4) and lower lobe involvement (OR=9.9, 95% CI 2.0 to 90.6) in chronic P. aeruginosa co-infection; and use of systemic corticosteroids (OR=7.1, 95% CI 1.2 to 50.9) and pulmonary M. intracellulare disease (OR=4.0, 95% CI 1.1 to 14.5) in chronic Aspergillus spp co-infection. Patients with pulmonary MAC disease frequently had chronic co-infections with pathogenic microorganisms such as MSSA, P. aeruginosa and Aspergillus. The risk factors for chronic co-infection were COPD and pulmonary M. intracellulare disease.
    BMJ open respiratory research. 05/2014; 1(1):e000050.
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    ABSTRACT: Bacillus cereus, an opportunistic pathogen, can cause fatal infection. However, B. cereus bloodstream infections (BSIs) have not been well characterised. From 2008 to 2013, B. cereus isolates from all of the specimens and patients with B. cereus BSIs were identified. Environmental samples were collected to detect B. cereus contamination. We also characterised the clinical presentation of B. cereus BSI through analyses of risk factors for BSI and mortality. A total of 217 clinical B. cereus isolates was detected. Fifty-one patients with nosocomial infections were diagnosed as B. cereus BSI, and 37 had contaminated blood cultures. The number of B. cereus isolates and BSI patients was significantly greater from June to September than from January to April (4.9 vs. 1.5 per month and 1.2 vs. 0.2, respectively). All BSIs were nosocomial and related to central or peripheral vascular catheter. Urinary catheter [odds ratio (OR) 6.93, 95 % confidence interval (CI) 2.40-20.0] was the independent risk factor associated with BSI patients when compared to patients regarded as contaminated. In-hospital mortality among BSI patients was 20 % and was associated with urinary catheter (OR 34.7, 95 % CI 1.89-63.6) and higher Charlson index (OR 1.99, 95 % CI 1.26-3.12). The number of B. cereus isolates and BSI increased during summer. Inpatients with indwelling vascular or urinary catheters should be carefully monitored for potential B. cereus BSIs.
    European Journal of Clinical Microbiology 03/2014; · 3.02 Impact Factor
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    ABSTRACT: Invasive Aspergillus infection (IA) is a significant cause of morbidity in lung transplantation (LT). However, its optimal prophylaxis is unclear. We routinely administer itraconazole (ITCZ) prophylaxis to all patients undergoing LT. In this study, we retrospectively evaluated the duration of prophylaxis and risk factors of IA. Among 30 adult patients who underwent LT, 5 patients developed IA. All patients with IA stopped ITCZ treatment within 1 year. At least 1 year of ITCZ prophylaxis is essential for the prevention of IA. Cytomegalovirus infection, renal replacement therapy, and tracheotomy were risk factors for IA.
    Transplant Infectious Disease 03/2014; · 1.98 Impact Factor
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    ABSTRACT: Escherichia coli sequence type 131 (ST131) and ST405 are important clonal groups because they are associated with the global increase of extended-spectrum β-lactamase (ESBL) producers. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) is emerging as a rapid, inexpensive, and accurate method for bacterial identification. We investigated the detection performance of MALDI-TOF for the ST131 and ST405 clonal groups using 41 ST131-O25b, 26 ST131-O16, 41 ST405, and 41 other ST ESBL-producing isolates. Main spectra representing each clonal group were used for classification with Biotyper. The peak that had the highest area under the receiver-operating characteristic curve generated by ClinProTools was detected with FlexAnalysis, and an optimal signal to noise ratio cut-off was determined. The optimal detection models were generated by ClinProTools. Classification by Biotyper could detect the ST131-whole (O25b and O16 together) group with a sensitivity of 98.5% and specificity of 93.9%. With FlexAnalysis, a peak of 9720 Da detected the ST131-whole group with a sensitivity of 97.0% and a specificity of 91.5% at a cut-off value of 8.0. The ClinProTools models exhibited good performance for the detection of the ST131-whole group (sensitivity and specificity of 94.0% and 92.7%, respectively), the ST131-O25b group (95.1% and 98.2%, respectively), and the ST405 group (90.2% and 96.3%, respectively). MALDI-TOF MS had high detection performance for the ST131-whole, ST131-O25b, and ST405 clonal groups. MALDI-TOF MS should be considered as an alternative method to monitor the epidemiology of the ESBL-producing E. coli ST131 and ST405 clonal groups.
    Journal of clinical microbiology 01/2014; · 4.23 Impact Factor
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    ABSTRACT: Pneumocystis polymerase chain reaction (PCR) and blood (1→3)-β-d-glucan assays are known to be useful for the diagnosis of Pneumocystis pneumonia (PCP). However, their impact on the outcome of clinically suspected PCP patients has not yet been elucidated. Between January 2008 and July 2011, we prospectively observed 190 immunocompromised patients who had ground-glass opacity on chest computed tomography scans and were suspected to have PCP. The blood β-d-glucan levels of these patients were measured, and PCR was used to detect Pneumocystis jirovecii in the respiratory samples. The 30-day mortality rates and related factors were assessed. The 30-day mortality rate of all included patients was 21.6%. Both β-d-glucan-positive (10.1%) and PCR-positive patients (15.0%) had significantly lower mortality rates than β-d-glucan-negative (28.1%) or PCR-negative patients (30.1%). All of the 13 definite PCP patients had positive PCR and β-d-glucan results, received anti-PCP treatments, and survived. Among the 72 patients who were negative for microscopic detection of P. jirovecii but received anti-PCP treatments, positive PCR results (odds ratio [OR], 0.14; 95% confidence interval [CI], 0.02-0.74), a high Sequential Organ Failure Assessment score (OR, 1.42; CI, 1.08-1.88), and positive β-d-glucan levels (OR 0.25, CI 0.06-1.02) were associated with mortality rates using stepwise logistic regression analyses. A positive Pneumocystis PCR or β-d-glucan test was a candidate predictor of survival in patients who were suspected of having PCP, even though negative for visual detection by microscopy.
    Journal of Infection and Chemotherapy 12/2013; · 1.38 Impact Factor
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    ABSTRACT: Rationale: Polyclonal and mixed mycobacterial Mycobacterium avium complex (MAC) infection is observed in pulmonary MAC disease. Human living environments contain multiple species or genotypes of non-tuberculous mycobacterial strains and are considered sources of infection. Objectives: To investigate the association of environmental exposure with polyclonal and mixed mycobacterial infection in pulmonary MAC disease after adjustments for potential confounding diseases and conditions, and radiographic findings. Methods: We collected two separate sputum samples from 102 patients and single sputum samples from 18 patients in whom the second MAC strain was not isolated in our prospective cohort of pulmonary MAC disease. MAC isolates from sputum samples and patients' residential soils were used for variable number of tandem repeats (VNTR) analyses. Polyclonal and mixed mycobacterial MAC infections were defined as having different VNTR genotypes and other mycobacterial species, respectively. Monoclonal MAC infection was defined as all isolates showing a single VNTR genotype. Associations of the type of infection with clinical and radiographic findings, and environmental exposure were measured. Measurements and Main Results: Polyclonal and mixed mycobacterial MAC and monoclonal infections were observed in 42 and 78 patients, respectively. By stepwise regression analysis, patients with polyclonal and mixed mycobacterial MAC infections were associated with history of asthma [odds ratio (OR) 11.56, 95% confidence interval (CI) 1.41-255.77, P=0.021], high soil exposure (≥2 hours per week, OR 4.31, 95% CI 1.72-11.45, P<0.01), shower use in a bathroom (OR 4.57, 95% CI 1.28-23.23, P=0.018) and swimming in a pool (OR 9.69, 95% CI 1.21-206.92, P<0.01). Conclusions: Environmental exposure was associated with polyclonal and mixed mycobacterial MAC infection in pulmonary MAC disease.
    Annals of the American Thoracic Society. 11/2013;
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    ABSTRACT: Stenotrophomonas maltophilia (SM) is an important nosocomial pathogen. Due to its intrinsic resistance to various therapeutic drugs, the optimal antimicrobial therapy is often delayed. From January 2005 to September 2012, we retrospectively compared drug susceptibilities, clinical backgrounds, and outcome of SM bacteremic patients (SM group) with these of other non fermentative gram negative bacilli bacteremic patients (non-SM group), at a tertiary-care hospital in Kyoto, Japan. Among the SM group, risk factors of 30-day mortality were evaluated. The SM group and non-SM group included 54 and 237 cases, respectively. Among the non-SM group, bacteremic patients due to Pseudomonas aeruginosa, Acinetobacter species, and other non-fermentative gram negative bacilli included 156, 68, and 13 patients, respectively. SM isolates were susceptible to trimethoprim-sulfamethoxazole and minocycline (82.0% and 100%, respectively). Non-SM isolates were susceptible to meropenem (88.6%), ceftazidime (88.6%), cefepime (85.2%), and amikacin (97.0%). Both SM and non-SM isolates were susceptible to levofloxacin (87.5% and 82.0%, respectively). The use of carbapenems, antipseudomonal cephalosporins, and isolation of SM within 30 days represented an independent risk factor for SM bacteremia. The 30 day mortality rate among the SM group was significantly higher compared with the non-SM group (35% vs 18%, odds ratio: 2.2, 95% CI: 1.2-4.3 p = 0.012). Among the SM group, an independent factor which was associated with 30-day mortality was the SOFA score. SM bacteremia showed a worse outcome compared with bacteremia due to non-SM. For the patients who present risk factors for SM bacteremia, empirical antimicrobial therapy including trimethoprim-sulfamethoxazole, minocycline or levofloxacin should be considered.
    Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 09/2013; 87(5):596-602.
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    ABSTRACT: The global increase of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is associated with the specific clonal group sequence type 131 (ST131). In order to understand the successful spread of ESBL-producing E. coli clonal groups, we characterized fluoroquinolone resistance determinants, virulence genotypes, and plasmid replicons of ST131 and another global clonal group, ST405. We investigated 41 ST131-O25b, 26 ST131-O16, 41 ST405, and 41 other ST (OST) ESBL-producing isolates, which were collected at seven acute care hospitals in Japan. The detection of ESBL types, fluoroquinolone resistance associated mutations including quinolone-resistance determining regions (QRDRs), virulence genotypes, plasmid replicon types, and IncF replicon sequence typing was performed using PCR and sequencing. blaCTX-M, specifically blaCTX-M-14, was the most common ESBL type among the four groups. Ciprofloxacin resistance was found in 90% of ST131-O25b, 16% of ST131-O16, 100% of ST405, and 54% of OST groups. Multidrug resistance was more common in the ST405 group than in the ST131-O25 group (56% vs. 32%, p=0.045). All ST131-O25b isolates except one had four characteristic mutations in QRDRs, but most of the isolates from the other three groups had three mutations in common. The ST131-O25b and ST405 groups had a higher number of virulence genes than the OST group. All of the ST131-O25b and ST405 isolates and most of the ST131-O16 and OST isolates carried IncF replicons. The most prevalent IncF replicon sequence types differed between the four clonal groups. Both the ST131-O25b and ST405 clonal groups had a fluoroquinolone resistance mechanism in QRDRs, multidrug resistance, high virulence, and IncF plasmids, which suggest a potential for further global expansion and a need for measures against these clonal groups.
    Antimicrobial Agents and Chemotherapy 07/2013; · 4.57 Impact Factor
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    ABSTRACT: Kyoto, Japan. To validate the St George's Respiratory Questionnaire (SGRQ) in pulmonary Mycobacterium avium-intracellulare complex disease and to analyse the significance of high-resolution computed tomography (HRCT) findings as determinants of health-related quality of life (HRQoL) after adjusting for clinical and physiological parameters. Eighty-five patients completed the SGRQ, pulmonary function tests and other patient-reported measurements. HRCT findings were assessed using an established computed tomography (CT) scoring method. The SGRQ was validated with good internal consistency, test-retest reliability and significant correlations with most physiological variables and other patient-reported measurements. White blood cell counts, C-reactive protein levels, sputum culture results, treatment history, total CT scores, and consolidation, cavity and lobar volume-decrease CT component scores were significantly correlated with the SGRQ total and component scores. Stepwise multiple regression analyses revealed that the consolidation, cavity and lobar volume-decrease component scores were correlated with the SGRQ total and/or component scores. The total CT scores had the strongest relationships with the SGRQ total scores among the various clinical parameters tested, including microbiological, radiological, physiological and laboratory findings (32.8% of variance). HRCT findings, particularly consolidation, cavity and lobar volume-decreases, were the most significant clinical parameters related to patient HRQoL.
    The International Journal of Tuberculosis and Lung Disease 06/2013; 17(6):829-35. · 2.76 Impact Factor
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    ABSTRACT: BACKGROUND: The incidence of fungaemia has been increasing worldwide. It is important to distinguish non-Candida fungaemia from candidaemia because of their different antifungal susceptibilities. The aims of this study were to investigate the clinical characteristics of non-Candida fungaemia and identify the clinical factors that differentiate it from candidaemia. METHODS: We investigated the clinical manifestations and mortality of non-Candida fungaemia in Kyoto University Hospital from 2004 to 2009. RESULTS: There were 110 episodes of fungaemia during the study period. There were 11 renal replacement therapy episodes of fungaemia due to non-Candida yeasts (10.0%), including 6 episodes with Cryptococcus neoformans, 4 with Trichosporon asahii, and 1 with Kodamaea ohmeri, in addition to 99 episodes of candidaemia (90.0%). The presence of collagen disease [odds ratio (OR) 9.00; 95% confidence interval (CI) 1.58-51.4; P = 0.01] or renal replacement therapy (OR 15.0; 95% CI 3.06-73.4; P < 0.01) was significantly more common in non-Candida fungaemia patients than in candidaemia patients. Prior colonisation by the species may be a predictor of non-Candida fungaemia. Non-Candida fungaemia had a higher mortality than candidaemia (54.5% versus 21.2%, P = 0.03). CONCLUSIONS: Although Candida species frequently cause fungaemia, we should also be aware of non-Candida yeasts because of their high mortality, particularly among high-risk patients, such as those with collagen disease and those under renal replacement therapy. Prior colonisation by the causative organisms may be an important predictor of non-Candida fungaemia.
    BMC Infectious Diseases 05/2013; 13(1):247. · 2.56 Impact Factor
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    ABSTRACT: Klebsiella pneumonia usually causes urinary tract infections, pneumonia, and other infectious diseases in hospitalized and immunocompromised patients. Among the types of Klebsiella pneumonia, serotype K1 is known to be a highly virulent pathogen. We herein report the case of a healthy 63-year-old man with a pyogenic liver abscess and bilateral endogenous endophthalmitis caused by serotype K1 Klebsiella pneumonia. Although the patient received percutaneous abscess drainage and antibiotic therapy, he lost his eyesight. To improve the poor prognoses of ocular complications, providing both an earlier diagnosis and treatment is critical.
    Internal Medicine 01/2013; 52(8):919-22. · 0.97 Impact Factor
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    ABSTRACT: Urine culture remains the gold standard for diagnosing urinary tract infections, but most clinical samples yield negative results. Fast screening methods will improve the turnaround time and also reduce the associated costs. We evaluated the detection of bacteria using the Sysmex UF-1000i urine analyzer to identify negative samples which do not need further culture testings. The bacterial counts of the UF-1000i method and of the conventional culture of 197 samples, including 117 samples of midstream urine (MU) and 80 from catheter ports (CU), were prospectively compared, and the patient backgrounds were reviewed. The cut-off values to determine the necessity for culture were 2.7 bacteria/microL for MU and 11.0 bacteria/microL for CU samples, and 16.2% of the MU and 30.0% of the CU samples did not require cultures. These cut-off values are similar to those described in previous studies, however, our findings suggest that it would therefore be possible to reduce the need for unnecessary samples by the use of our cut-off values, which utilize the CU and MU samples separately. The cost reduction was calculated to be $239-306 per 100 samples. This UF-1000i screening method is an acceptable modality which improves the turnaround time, workload and cost to perform urine cultures.
    Rinsho byori. The Japanese journal of clinical pathology 11/2012; 60(11):1070-4.
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    ABSTRACT: Background: Environmental exposure is the primary route for Mycobacterium avium-intracellularecomplex (MAC) infection. We reported that environmental soil exposure is a likely risk factor for the development of pulmonary MAC disease. However, the implications of environmental exposure in responses to antimicrobial treatments and relapses are unknown. Methods: A total of 87 patients with pulmonary MAC disease (men [women], 25 [62]; age, 64.3 ± 9.2 years) were treated with clarithromycin-containing regimens for at least 12 months between January 2002 and December 2010 at a single medical center. Sputum conversion was defined as three consecutive negative cultures after induction of treatments. Sputum relapse was defined as two consecutive positive cultures after sputum conversion. Treatment success included patients who achieved sputum conversion without relapse. Factors associated with sputum conversion and treatment success were assessed after adjustment for potential confounders. Results: Fifty-three patients (60.9%) achieved sputum conversion and 15 patients relapsed. Finally 38 patients (43.7%) achieved treatment success. More patients with high soil exposure (≥ 2 h per week) relapsed than those with low soil exposure (42.9% vs. 10.3%. p =0.01). In multiple logistic regression analysis, negative smear at the start of treatments and ethambutol use were associated with sputum conversion (odds ratio [OR], 7.7; 95% confidence interval [CI], 2.5-25.6; p = 0.004 and OR, 10.3; 95% CI, 2.2-50.0; p = 0.03, respectively), and negative smear, high dose of clarithromycin use (≥ 600 mg/day [14.5 ± 3.1 mg/kg/day]) and low soil exposure were associated with treatment success (OR, 5.1; 95% CI, 1.8-14.0; p = 0.002, OR, 7.0; 95% CI, 1.6-29.4; p = 0.008 and OR, 4.1; 95% CI, 1.1-15.6, p = 0.04, respectively). Conclusion: High soil exposure increased relapse after sputum conversion and was significantly associated with treatment failure.
    IDWeek 2012 Meeting of the Infectious Diseases Society of America; 10/2012
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    ABSTRACT: Background: Surgical site infection (SSI) remains a major threat for liver transplant recipients, and the incidence of infection after liver transplantation is generally higher than that after other types of solid-organ transplantation. Methods: We prospectively studied SSIs after living-donor liver transplantation (LDLT) at Kyoto University Hospital from January 2011 to March 2012. We investigated the incidence, causative organisms, and risk factors of SSIs after LDLT. Results: During the study period, 87 LDLT procedures performed in 86 patients were included in this study. One patient required a second transplant for chronic rejection. The median follow-up for living patients was 67 days (range: 9-252 days). Forty-two patients were female (48.8%), and the age range was 0.08 to 69 years (median; 36 years). Of the 87 LDLT recipients, 38 (44.2%) developed 45episodes of SSIs (19 cholangitis, 15 peritonitis, 10 intra-abdominal abscess, and 4 wound infection). Twenty-three of the SSI episodes (51.1%) were complicated with secondary bacteremia and 8 of 38 recipients (21.1%) died. Causative pathogens, including 9 episodes of polymicrobial infections, were 22 Gram-positive cocci (13 Enterococcus spp., 5 Staphylococcus aureus, and 4 others), 28 Gram-negative rods (8 Pseudomonas aeruginosa, 7 Klebsiella spp., 6 Escherichia coli, 3 Enterobacter cloacae, and 4 others). Two isolates (14.3%) of Klebsiella spp. and 3 isolates (50.0%) of E. coli were extended-spectrum β-lactamase-producers. Univariate analysis revealed that obesity, ABO incompatibility, total operation duration, right lobe transplantation, Roux-en-Y biliary reconstruction, and National Nosocomial Infection Surveillance risk index were associated with the development of SSIs. Independent risk factors for SSIs after LDLT included ABO incompatibility [odds ratio (OR) 5.81; 95% confidence interval (CI) 1.76-19.2; P=0.004], total operation duration (OR 1.33; 95% CI 1.11-1.58; P=0.002), and Roux-en-Y biliary reconstruction (OR 3.95; 95% CI 1.37-11.4; P=0.011). Conclusion: SSIs occurred in 44.2% of LDLT recipients and more than half of the SSIs were complicated with secondary bacteremia, which had high mortality rate. ABO incompatibility, total operation duration, and Roux-en-Y biliary reconstruction increased the risk of developing SSIs after LDLT.
    IDWeek 2012 Meeting of the Infectious Diseases Society of America; 10/2012

Publication Stats

2k Citations
535.15 Total Impact Points

Institutions

  • 2001–2014
    • Kyoto University
      • • Department of Clinical Laboratory Medicine
      • • Department of Dermatology
      • • Department of Respiratory Medicine
      Kioto, Kyōto, Japan
  • 1988–2002
    • Nagoya University
      • Clinical Laboratory
      Nagoya-shi, Aichi-ken, Japan
  • 1998
    • Vanderbilt University
      Nashville, Michigan, United States