Soichi Arakawa

Kobe University, Kōbe, Hyōgo, Japan

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Publications (427)805.81 Total impact

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    ABSTRACT: Rotavirus infections are a major cause of diarrhea in children in both developed and developing countries. Rotavirus genetics, patient immunity, and environmental factors are thought to be related to the severity of acute diarrhea due to rotavirus in infants and young children. The objective of this study was to provide a correlation between rotavirus genotypes, clinical factors and degree of severity of acute diarrhea in children under 5 years old in Surabaya, Indonesia. A cross-sectional study was conducted in children aged 1-60 months with acute diarrhea hospitalized in Soetomo Hospital, Surabaya, Indonesia from April to December 2013. Rotavirus in stool specimens was identified by ELISA and genotyping (G-type and P-type) using multiplex reverse transcription PCR. Severity was measured using the Ruuska and Vesikari scoring system. The clinical factors were investigated included patient's age (months), hydration, antibiotic administration, nutritional state, co-bacterial infection and co-viral infection. A total of 88 children met the criteria; 80.7% were aged 6-24 months, watery diarrhea was the most common type (77.3%) and 73.6% of the subjects were co-infected with bacteria, of which pathogenic Escherichia coli was the most common (42.5%). The predominant VP7 genotyping (G-type) was G2 (31.8%) and that of VP4 genotyping (P-type) was P[4] (31.8%). The predominant rotavirus genotype was G2P[4] (19.3%); G1P[4] and G9P[4] were uncommon with a prevalence of 4.5%. There were significant differences between the common genotype and uncommon genotype with respect to the total severity score of diarrhea (p <0.05). G3, G4 and G9 were significantly correlated with severe diarrhea (p = 0.009) in multivariate analyses and with frequency of diarrhea (>10 times a day) (p = 0.045) in univariate analyses, but there was no significant correlation between P typing and severity of diarrhea. For combination genotyping of G and P, G2P[4] was significantly correlated with severe diarrhea in multivariate analyses (p = 0.029). There is a correlation between rotavirus genotype and severity of acute diarrhea in children. Genotype G2P[4] has the highest prevalence. G3, G4, G9 and G2P[4] combination genotype were found to be associated with severe diarrhea.
    Gut Pathogens 12/2015; 7(1). DOI:10.1186/s13099-015-0048-2 · 2.07 Impact Factor
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    ABSTRACT: To investigate the optimal dose of vancomycin (VCM) for methicillin-resistant Staphylococcus aureus infections in the urological patients including renal dysfunction. We had 143 sets of available data from the consecutive patients treated in the urological department for analysis in VCM dose, VCM trough and estimated glomerular filtration rate: eGFR at VCM trough examination. Patients were classified according to eGFR level, and we calculated the regression line between VCM dose and VCM trough accordingly. Median VCM dose were 1000 (range 500-3500) mg per day, the VCM trough was 15.6 ± 7.89 μg/ml, and eGFR was 61.1 ± 27.2 ml/min/1.73 m(2). Our regression analysis (x axis: VCM dose (mg) and y axis: VCM trough (μg/ml) was statistically significant in the group with eGFR of 30-60 ml/min/1.73 m(2) (y = 26.103x + 481.7; r (2) = 0.1291) and the group with eGFR of 60-90 ml/min/1.73 m(2) (y = 48.891x + 350.75; r (2) = 0.2561) in both with (p = 0.021 and 0.035, respectively) or without (p = 0.012 and 0.004, respectively) adjustments by body weight for VCM doses. These data showed that the optimal dose of VCM varied according to the eGFR value in consecutive urological patients with various renal functions.
    International Urology and Nephrology 04/2015; DOI:10.1007/s11255-015-0973-5 · 1.29 Impact Factor
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    ABSTRACT: There are several mechanisms for antibiotic-resistant Pseudomonas aeruginosa. The purpose of this study is to investigate the association between the expression of efflux pump-coding genes and antibiotic resistance in P. aeruginosa causing urinary tract infections (UTIs). We extracted the RNA from 105 clinical strains of P. aeruginosa isolated from UTI patients with full data on antibiotic MICs and assayed real-time quantitative reverse-transcription PCR. We investigated the gene expressions of four resistance nodulation cell division-type multi-drug efflux pump systems (MexAB-OprM, MexCD-OprJ, MexEF-OprN and MexXY(-OprA)) and the correlation of the MICs of nine antibiotics, risk factors and antibiotic resistance-related genes with expressions of mexB, mexC, mexE and mexY. Multivariate statistical data demonstrated a significant relationship between increased expression of mexB or mexC and complicated UTI (Odds ratio=8.03, P<0.001 and Odds ratio=8.86, P=0.032, respectively). We also found a significant association between the increased expression of mexC and resistance to levofloxacin (LVFX) (Odds ratio=4.48, P=0.035). In conclusion, increased expression of mexC leads to LVFX resistance in P. aeruginosa causing UTI. These results contribute to our knowledge of the efflux pump system and antibiotic resistance.The Journal of Antibiotics advance online publication, 8 April 2015; doi:10.1038/ja.2015.34.
    The Journal of Antibiotics 04/2015; DOI:10.1038/ja.2015.34 · 2.04 Impact Factor
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    ABSTRACT: Therapeutic options are limited for Neisseria gonorrhoeae infection, especially for oral drugs. The purpose of this study is to investigate the susceptibility of N. gonorrohoeae to oral Azithromycin (AZM) and the correlation between AZM resistance-related gene mutations and minimum inhibitory concentration (MIC). We measured the AZM MIC of clinical strains of N. gonorrhoeae and sequenced such as the peptidyltransferase loop in domain V of 23S rRNA, and investigated the statistical correlation between AZM MIC and those presence and number of the mutations. In 59 N. gonorrhoeae strains, our statistical data showed a deletion mutation was seen significantly more often in the higher MIC group (0.5 μg/mL or higher) (35/37: 94.6 %) compared with the lower MIC group (0.25 μg/mL or less) (4/22: 13.6 %) (p<0.0001). However, a mutation of codon 40 (Ala→Asp) in the mtrR gene (Helix Turn Helix) was seen significantly more often in the lower MIC group (12/22: 54.5 %) (p<0.0001). In NG-MAST analyses, ST4777 was representative of the lower MIC group and ST1407, ST6798 and ST6800 was representative of the higher MIC group. The NG-MAST type 1407 was detected as the most prevalent type in AZM resistant or intermediate strains as previously described. In conclusion, A deletion mutation of the mtrR promoter region may be a significant indicator for higher MIC (0.5 μg/mL or higher). ST4777 was often seen in the lower MIC group and ST1407, ST6798 and ST6800 were characteristic of the higher MIC group. Further research with a greater number of strains would help elucidate the mechanism of AZM resistance in N. gonorrhoeae infection. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
    Antimicrobial Agents and Chemotherapy 02/2015; 59(5). DOI:10.1128/AAC.04320-14 · 4.45 Impact Factor
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    ABSTRACT: Objectives To study the current scenario of diagnosis, treatment and mortality of obstructive pyelonephritis secondary to urolithiasis in Japan.Methods The study was a retrospective and multicenter survey for hospitalized patients with obstructive pyelonephritis as a result of urolithiasis in educational facilities for specialists by the Japanese Urological Association. Patients' characteristics including physical or laboratory examinations, treatment and prognosis were recorded, and the risk factors for disease death were analyzed.ResultsA total of 1363 patients from 208 hospitals were analyzed. The median age of patients was 68 years, and there were 2.2-fold more female patients than male patients. From 844 patients, 891 species of bacteria or fungi were isolated, and Gram-negative rods accounted for 76.5% of cases. The mortality of patients was 2.3%. The risk factors related to disease death by univariate analysis were identified as older age, solitary kidney, ambulance use to visit hospital, disturbance of consciousness, severe appetite loss, higher performance status, disseminated intravascular coagulation status or systemic inflammatory response syndrome, vasopressors and anti-disseminated intravascular coagulation therapies, increased pulse rates, lower hemoglobin, lower serum albumin, and high blood urea nitrogen values. The predictive risk factors for disease death of patients' status at hospitalization were age over 80 years, systemic inflammatory response syndrome, disseminated intravascular coagulation status, disturbance of consciousness and solitary kidney by multivariate analysis.Conclusions Obstructive pyelonephritis as a result of urolithiasis represents an emergent disease in the urological field with relatively high mortality. Patients with older age or poor conditions should be hospitalized, and intervention by a urology specialist is likely to be required.
    International Journal of Urology 11/2014; 22(3). DOI:10.1111/iju.12666 · 1.80 Impact Factor
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    ABSTRACT: The prevalence of extended-spectrum β-lactamases (ESBLs) has been increasing worldwide. Recently, a pandemic clone of Escherichia coli O25:H4, sequence type 131 (ST131), producing ESBL-type CTX-M-15 has been reported as a major problem. In this study, we investigated the molecular characteristics of 72 ESBL-producing E. coli isolates. We detected the ESBL blaCTX-M gene and nine virulence factor genes (papC, papEF, fimH, hlyA, iutA, sfa, eaeA, bfpA, and aggR) by PCR and DNA sequencing, plasmid replicon typing, phylogenetic grouping, repetitive-sequence-based PCR (rep-PCR), and multilocus sequence typing. All strains were positive for blaCTX-M. Twenty-two (30.6%) strains in CTX-M-1 group included 9 (12.5%) of CTX-M-15, 3 (4.2%) in CTX-M-2 group, and 47 (65.3%) strains in CTX-M-9 group. The CTX-M-15-producing E. coli O25:H4 ST131 was derived from phylogenetic group B2 and rep-PCR pattern d. The most prevalent virulence factor was fimH (72 strains; 100%) and the most common replicon type was the IncF type (65 strains; 90.3%). The CTX-M-9 group was significantly associated with the presence of papC and papEF [OR (95% CI)=9.22 (1.32-64.7), p=0.025] or hlyA [OR (95% CI)=5.57 (1.17-26.4), p=0.031]. In conclusion, we confirmed that CTX-M-15-producing E. coli O25:H4 ST131 has emerged in Japan and found significant virulence factors with CTX-M-9 group.
    Microbial drug resistance (Larchmont, N.Y.) 10/2014; 21(2). DOI:10.1089/mdr.2014.0083 · 2.52 Impact Factor
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    ABSTRACT: We investigated the clinical effectiveness and safety of tazobactam/piperacillin (TAZ/PIPC) in a 1:8 ratio, a β-lactamase inhibitor with penicillin antibiotic, for the prevention of febrile infectious complication after prostate biopsy. Each patient received a single dose of TAZ/PIPC 4.5 g, 30 min before the biopsy in Group 1 or TAZ/PIPC 4.5 g twice, once 30 min before and once after the biopsy (just before discharge or 5 h after the biopsy), in Group 2. Estimation of efficacy was performed within 1-month after prostate biopsy. Clinical diagnosis of febrile infectious complication was based on a body temperature elevation greater than 38 °C. Infectious complication after prostate biopsy was detected in 2.5% (4/160 patients) in Group 1 and in 0.45% (2/442 patients) in Group 2. All of the patients with febrile infectious complication had risk factors: 5 patients had voiding disturbance, 2 patients had diabetes mellitus and 1 patient had steroid dosing. In group 1, 88 patients had at least one risk factor and 72 patients had no risk factors. Of the patients with a risk factor, 4 had febrile infectious complication after prostate biopsy, but there was no significant difference between the two groups. In group 2, 87 patients had at least one risk factor and 255 patients had no risk factors. The patients with a risk factor had febrile infectious complication significantly more frequently than did patients without a risk factor (P = 0.038). Therefore, TAZ/PIPC appears to be effective as preoperative prophylaxis against the occurrence of febrile infectious complication after prostate biopsy.
    Journal of Infection and Chemotherapy 10/2014; 20(9-10). DOI:10.1016/j.jiac.2014.06.011 · 1.38 Impact Factor
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    ABSTRACT: Objective:To evaluate measures for preventing multidrug resistant Pseudomonas aeruginosa (MDRP) in catheter-associated urinary tract infection (CAUTI) in spinal cord injury patients.Setting:Spinal Cord Injury Unit of Hyogo Prefectural Hyogo Prefectural Rehabilitation Center, Kobe, Japan.Methods:We defined MDRP as resistance to amikacin, imipenem and levofloxacin. We had eight cases of MDRP-causing CAUTI in hospitalized neurogenic bladder patients caused by spinal cord injury in 2 months. Pulse-field gel electrophoresis (PFGE) was performed for epidemiological studies. We assessed prevention measures against MDRP emergence from the 2nd month, such as surveillance of CAUTI and infection control, and evaluated the outcomes of these measures over a total of 8 months.Results:Our PFGE results showed that these eight MDRP isolates could be considered as closely related strains. We concluded that this was an MDRP outbreak that was causing CAUTI. The isolated ratio of MDRP began to decrease over 4 months of surveillance and significantly decreased in the 4th quarter (7th and 8th months) compared with the 1st quarter (1st and 2nd months) (P=0.021) even though urinary tract device usage significantly increased over the same period (P<0.001).Conclusion:We experienced an outbreak of emergent MDRP causing CAUTI in neurogenic bladder patients with spinal cord injury. Our preventive measures for isolating the outbreak, including surveillance, may have led to the decrease we observed in the ratio of MDRP isolated.Spinal Cord advance online publication, 2 September 2014; doi:10.1038/sc.2014.154.
    Spinal Cord 09/2014; 53(1). DOI:10.1038/sc.2014.154 · 1.70 Impact Factor
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    ABSTRACT: Objectives To determine current epidemiology and treatment patterns of urogenital tuberculosis in Japan.MethodsA questionnaire was sent to the urological departments of 1203 Japanese hospitals. Clinical data was reviewed retrospectively; no time range was specified.ResultsOf the 1203 hospitals, 399 returned questionnaires with information about 355 urogenital tuberculosis patients. Of the 399, 153 institutions reported at least one patient, and 201 patients were identified between 2000 and 2007. Infections were located in the kidneys (n = 242), ureter (n = 96), bladder (n = 100), epididymis or testes (n = 81) and prostate (n = 9).Conclusions Urogenital tuberculosis is rare in Japan, but patients do exist, and we should not ignore them.
    International Journal of Urology 08/2014; 21(11). DOI:10.1111/iju.12549 · 1.80 Impact Factor
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    ABSTRACT: The methods for typing and epidemiological study for especially antibiotic-resistant bacteria has been issued but there are the debates regarding which method is best for this purpose. The purpose of this study is to investigate and apply a comparatively new technology, phage-open-reading frame typing (POT) and repetitive-sequence-based PCR (rep-PCR) using DiversiLab system and compare for the discrimination of major methicillin-resistant Staphylococcus aureus (MRSA) lineages in epidemiological surveillance. We analyzed 47 representative MRSA stains isolated in Kobe University Hospital between January and December 2009. We performed MRSA typing using the POT kit and rep-PCR using the DiversiLab system. POT method classified all the MRSA strains into 35 clusters, whereas rep-PCR method typed all the MRSA strains in 10 kinds of clusters with a definition of 95% similarity. The discriminatory power and congruence between the methods were compared using the Simpson's index of diversity, adjusted Rand's and Wallace's coefficients. Our statistical analyses showed that the POT (POT 1-2-3 and POT 2-3) revealed a higher discriminatory power in the Simpson's index of diversity (SID; 0.969, range 0.939-1.000 and 0.967, range 0.935-0.998, respectively) for MRSA isolates than the rep-PCR (0.821 (0.767-0.876)). The adjusted Rand's and Wallace's coefficients did not show higher concordance among the methods. In conclusion, we demonstrated that the POT can perform accurate and reliable epidemiological surveillance studies for analyzing the genetic relatedness of MRSA strains.The Journal of Antibiotics advance online publication, 16 April 2014; doi:10.1038/ja.2014.41.
    The Journal of Antibiotics 04/2014; 67(8). DOI:10.1038/ja.2014.41 · 2.04 Impact Factor
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    ABSTRACT: Although proper hand hygiene among health care workers is an important component of efforts to prevent health care-associated infection, there are few data available on adherence to hand hygiene practices in Japan. The aim of this study was to examine hand hygiene adherence at teaching hospitals in Japan. An observational study was conducted from July to November 2011 in 4 units (internal medicine, surgery, intensive care, and/or emergency department) in 4 geographically diverse hospitals (1 university hospital and 3 community teaching hospitals) in Japan. Hand hygiene practice before patient contact was assessed by an external observer. In a total of 3545 health care worker-patient observations, appropriate hand hygiene practice was performed in 677 (overall adherence, 19%; 95% confidence interval, 18%-20%). Subgroup rates of hand hygiene adherence were 15% among physicians and 23% among nurses. The ranges of adherence were 11% to 25% between hospitals and 11% to 31% between units. Adherence of the nurses and the physicians to hand hygiene was correlated within each hospital. There was a trend toward higher hand hygiene adherence in hospitals with infection control nurses, compared with hospitals without them (29% versus 16%). The hand hygiene adherence in Japanese teaching hospitals in our sample was low, even lower than reported mean values from other international studies. Greater adherence to hand hygiene should be encouraged in Japan.
    Journal of Patient Safety 04/2014; DOI:10.1097/PTS.0000000000000108 · 0.88 Impact Factor
  • The Journal of Urology 04/2014; 191(4):e76-e77. DOI:10.1016/j.juro.2014.02.350 · 3.75 Impact Factor
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    ABSTRACT: Background Catheter-associated urinary tract infection (CAUTI) is a common clinic problem. The purpose of this study was to investigate recent trends in CAUTI in neurogenic bladder patients focusing on extended-spectrum β-lactamase (ESBL)-producing Escherichia coli. Methods Isolates from the urine of neurogenic bladder patients with UTI were investigated. Nine strains of ESBL-producing E coli were assayed by molecular strain typing using the Diversilab system for repetitive-sequence-based polymerase chain reaction (rep-PCR). Results E coli accounted for most of the bacteria (74.1% to 81.0%) that produced ESBLs. Rep-PCR data showed that 7 out of 9 ESBL-producing E coli belonged to the same typing group with high similarity (more than 97% similarity) and that this distribution corresponded with antibiotic resistance patterns. Conclusion ESBL producing E coli strains isolated from CAUTI patients could be discriminated by rep-PCR typing using the Diversilab system in consistent with antibiotic resistance patterns.
    American journal of infection control 03/2014; 42(3):e29–e31. DOI:10.1016/j.ajic.2013.11.018 · 2.33 Impact Factor
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    ABSTRACT: The increasing prevalence of resistant bacteria such as fluoroquinolone-resistant or extended-spectrum β-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 β-lactamases. We compared 3 and 7 day administration regimens of faropenem in a multicentre, randomized, open-label, controlled study. In total, 200 female patients with cystitis were enrolled and randomized into 3 day (N = 97) or 7 day (N = 103) 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 (P = 0.048). The clinical efficacies were 76.7% (56/73) and 80.2% (65/81), respectively (P = 0.695). Adverse events due to faropenem were reported in 9.5% of participants (19/200), and the most common adverse event was diarrhoea. 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.
    Journal of Antimicrobial Chemotherapy 02/2014; 69(6). DOI:10.1093/jac/dku014 · 5.44 Impact Factor
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    ABSTRACT: The purpose of this study is to investigate the risk factors and susceptibilities to antifungal agents of Candida albicans and Candida non-albicans species (spp.) in candidemia cases in Kobe University Hospital. We investigated all consecutive patients with candida bloodstream infection (BSI) from 2008-2013 for whose full data were available for analyses, examining clinical factors such as gender, general complications, postoperative status or susceptibilities to antifungal agents. These factors were also compared between Candida albicans spp. and Candida non-albicans by univariate and multivariate analyses. Univariate analyses showed a significantly higher rate of Candida non-albicans species BSI patients cancer (odds ratio (OR) (95% confidence interval (CI))=2.29 (1.04-5.06) and P=0.040), chemotherapy (OR=4.35 (1.11-17.1) and P=0.035), fluconazole (FLCZ) resistance (OR=77.3 (4.51-1324) and P=0.003), and itraconazole (ITCZ) resistance (OR=15.6 (5.39-45.1) and P<0.001) and lower rate of underlying cardiovascular diseases (OR=0.27 (0.09-0.80) and P=0.018) and postoperative status (OR=0.35 (0.16-0.77) and P=0.035) in than Candida albicans. Multivariate analyses demonstrated that Candida non-albicans spp. had significantly higher rate of chemotherapy (OR=4.44 (1.04-19.0) and P=0.045), FLCZ resistance (OR=5.87 (2.01-17.1) and P=0.001), and ITCZ resistance (OR=18.7(5.77-60.4) and P<0.001) and lower rate of underlying cardiovascular diseases (OR=0.25 (0.08-0.82) and P=0.022) than Candida albicans. In conclusion, this study revealed several risk factors for BSI with Candida albicans (underlying cardiovascular diseases and postoperative status) and Candida non-albicans spp. (cancer and chemotherapy), and demonstrated that Candida non-albicans spp. were more resistant to FLCZ and ITCZ than Candida albicans.The Journal of Antibiotics advance online publication, 15 January 2014; doi:10.1038/ja.2013.141.
    The Journal of Antibiotics 01/2014; 67(4). DOI:10.1038/ja.2013.141 · 2.04 Impact Factor
  • Japanese Journal of Environmental Infections 01/2014; 29(3):164-171. DOI:10.4058/jsei.29.164
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    ABSTRACT: We retrospectively investigated the incidence of genitourinary tract infection in 5895 patients who underwent transrectal and/or transperineal prostate biopsy procedure between January and December 2011 at 46 institutions belonging to Japanese Research Group for Urinary Tract Infection (JRGU). The total rate of genitourinary tract infection after prostate biopsy was 0.76%, while that following transrectal procedure was 0.83% and following transperineal procedure was 0.57%, which were not significantly different. In contrast, febrile infection associated with a fever (≥38 °C) occurred significantly more frequently after transrectal (0.71%) than transperineal (0.16%) approach (P = 0.04). Notably, in infectious cases, Escherichia coli was most frequently isolated. Of the 9 E. coli strains isolated by urine culture, 6 (66.7%) produced extended spectrum β-lactamase (ESBL) and 7 (77.8%) showed levofloxacin resistance. Similarly, of 6 E. coli strains isolated by blood culture, 4 (66.7%) produced ESBL and 6 (100%) showed levofloxacin resistance. When the efficacy of antimicrobial prophylaxis (AMP) with levofloxacin for the patients undergoing transrectal or transperineal biopsy was compared between a single dose (500 mg) and that given for 2 or more days, no significant difference was observed for the rate of infection (transrectal: 0.82% vs. 1.04%, p = 0.94; transperineal: 0.30% vs. 0.46%, p = 0.68). Although a single dose of levofloxacin for AMP is sufficient to prevent genitourinary infection after transrectal or transperineal prostate biopsy, and recommended in this era of increased multi-drug resistant pathogens, the increase in fluoroquinolone-resistant E. coli and ESBL-producing E. coli has emerged as a profound problem for surveillance.
    Journal of Infection and Chemotherapy 12/2013; 20(9-10). DOI:10.1016/j.jiac.2013.10.003 · 1.38 Impact Factor
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    ABSTRACT: We report the epidemiological investigation of a nosocomial pneumonia case due to Legionella pneumophila linked to a contaminated hospital cooling tower in an immune-compromised patient. A 73-year-old female patient was diagnosed with nosocomial Legionella pneumonia proven by a culture of L. pneumophila serogroup 1 from bronchoalveolar lavage fluid. Two strains isolated from the patient and two strains isolated from two cooling towers were found to be identical using repetitive-sequence-based-PCR with a 95% probability. This Legionella pneumonia case might be caused by aerosol from cooling towers on the roof of the hospital building which was contaminated by L. pneumophila. We increased up the temperature of hot water supply appropriately for prevention of Legionella breeding in an environment of patients' living. On the other hand, as the maintenance of cooling tower, we increased the frequency of Legionella culture tests from twice a year to three times a year. In addition, we introduced an automated disinfectants insertion machine and added one antiseptic reagent (BALSTER ST-40 N, Tohzai Chemical Industry Co., Ltd., Kawasaki, Japan) after this Legionella disease, and thereafter, we have no additional cases of Legionella disease or detection of Legionella spp. from the cooling tower or hot water supply. This case demonstrates the importance of detecting the infection source and carrying out environmental maintenance in cooperation with the infection control team.
    Journal of Infection and Chemotherapy 12/2013; DOI:10.1016/j.jiac.2013.07.007 · 1.38 Impact Factor

Publication Stats

4k Citations
805.81 Total Impact Points

Institutions

  • 1987–2014
    • Kobe University
      • • Department of Surgery
      • • Division of Urology
      Kōbe, Hyōgo, Japan
  • 2009
    • Obihiro University of Agriculture and Veterinary Medicine
      • Department of Clinical Veterinary Science
      Obibiro, Hokkaidō, Japan
  • 2006–2007
    • Nishiwaki Municipal Hospital
      Нишиваки, Hyōgo, Japan
  • 1994–2006
    • Sapporo Medical University
      • • Division of Urology
      • • School of Medicine
      Sapporo, Hokkaidō, Japan
  • 2004
    • Tsumura & Co.
      Edo, Tōkyō, Japan
    • Kyoto University
      • Department of Urology
      Kyoto, Kyoto-fu, Japan
  • 2003
    • Kawasaki Medical University
      Kurasiki, Okayama, Japan
  • 1999–2001
    • Furukawa Electric
      Edo, Tōkyō, Japan
  • 1997–2001
    • Yokohama Rubber Co. Ltd.
      Yokohama, Kanagawa, Japan
  • 1996
    • Hyogo Prefectural Kakogawa Medical Center
      Ōsaka, Ōsaka, Japan
    • Universität Witten/Herdecke
      Witten, North Rhine-Westphalia, Germany
  • 1993
    • Yodogawa Christian Hospital
      Ōsaka, Ōsaka, Japan