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Rikiya Taoka,
Yoshikazu Togo,
Tatsuhiko Kubo,
Masahito Kido,
Kenta Miki,
Hiroshi Kiyota,
Shin Egawa,
Takashi Sugawara,
Mitsuru Yasuda,
Masahiro Nakano, [......],
Toyohiko Watanabe,
Hiromi Kumon,
Kanao Kobayashi,
Akio Matsubara,
Takehiko Sho,
Ryoichi Hamasuna,
Tetsuro Matsumoto,
Hiroshi Hayami,
Masayuki Nakagawa,
Shingo Yamamoto
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ABSTRACT: To propose an appropriate prophylactic antimicrobial therapy for patients undergoing brachytherapy, we evaluated the relationships between various antimicrobial prophylaxis (AMP) protocols and the incidence of postimplant infections in a multicenter cohort study conducted in Japan. The records of 826 patients with localized prostate cancer who underwent a transperineal (125)I brachytherapy procedure between January 2009 and December 2010 were retrospectively reviewed. Perioperative infections, including surgical site and remote infections, were recorded up to postoperative day 30. A total of 6 (0.73 %) patients had a perioperative infection following seed implantation, of whom all received AMP for 1 or more days. None of the patients who received a single-dose protocol of AMP using fluoroquinolone p.o. or penicillin with a beta-lactamase inhibitor i.v. developed a perioperative infection. Statistical analysis showed that a single-dose protocol was more significantly related to a lower risk of perioperative infection as compared to the other AMP protocols examined (p = 0.045). Furthermore, our results indicated that bacteriuria and preoperative hair removal were risk factors of perioperative infection with statistical significance (p = 0.007, p = 0.004). Analysis of patient clinical parameters, including age, American Society of Anesthesiologists score, diabetes mellitus, prostate volume, numbers of implanted seeds and needle punctures, operation time, and indwelling duration time of the Foley catheter, did not reveal significant differences in terms of perioperative infection. Our results indicated that a single-dose AMP protocol is sufficient to prevent perioperative infections following seed implantation. On the other hand, AMP is only one of several measures to prevent perioperative infectious complications. It is necessary to know that the patient must have no bacteriuria and that preoperative hair removal should be avoided.
Journal of Infection and Chemotherapy 05/2013; · 1.80 Impact Factor
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Hiroshi Hayami,
Satoshi Takahashi,
Kiyohito Ishikawa,
Mitsuru Yasuda,
Shingo Yamamoto,
Shinya Uehara,
Ryoichi Hamasuna,
Tetsuro Matsumoto,
Shinichi Minamitani,
Akira Watanabe, [......],
Kengo Tsuneyoshi,
Shinji Matsushita,
Takashi Yamane,
Takaoki Hirose,
Shigeru Fujihiro,
Katsuhisa Endo,
Yasuhiko Oka,
Koh Takeyama,
Takahiro Kimura,
Tetsuji Uemura
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ABSTRACT: The Japanese surveillance committee conducted the first nationwide surveillance of antimicrobial susceptibility patterns of uropathogens responsible for female acute uncomplicated cystitis at 43 hospitals throughout Japan from April 2009 to November 2010. In this study, the causative bacteria (Escherichia coli and Staphylococcus saprophyticus) and their susceptibility to various antimicrobial agents were investigated by isolation and culturing of bacteria from urine samples. In total, 387 strains were isolated from 461 patients, including E. coli (n = 301, 77.8 %), S. saprophyticus (n = 20, 5.2 %), Klebsiella pneumoniae (n = 13, 3.4 %), and Enterococcus faecalis (n = 11, 2.8 %). S. saprophyticus was significantly more common in premenopausal women (P = 0.00095). The minimum inhibitory concentrations of 19 antibacterial agents used for these strains were determined according to the Clinical and Laboratory Standards Institute manual. At least 87 % of E. coli isolates showed susceptibility to fluoroquinolones and cephalosporins, and 100 % of S. saprophyticus isolates showed susceptibility to fluoroquinolones and aminoglycosides. The proportions of fluoroquinolone-resistant E. coli strains and extended-spectrum β-lactamase (ESBL)-producing E. coli strains were 13.3 % and 4.7 %, respectively. It is important to confirm the susceptibility of causative bacteria for optimal antimicrobial therapy, and empiric antimicrobial agents should be selected by considering patient characteristics and other factors. However, the number of isolates of fluoroquinolone-resistant or ESBL-producing strains in gram-negative bacilli may be increasing in patients with urinary tract infections (UTIs) in Japan. Therefore, these data present important information for the proper treatment of UTIs and will serve as a useful reference for future surveillance studies.
Journal of Infection and Chemotherapy 05/2013; · 1.80 Impact Factor
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ABSTRACT: The hospital infection control team (ICT) has a major role in suppressing or preventing infectious diseases. The purpose of this study was to investigate whether the work of the ICT had affected the antibiograms at the Kobe University Hospital in the past 3 years. The ICT's works are as follows: (1) to monitor whether physicians are instructed in the use of broad-spectrum antibiotics; (2) to check whether measures for preventing the occurrence or spread of infectious disease are performed along with appropriate standard precautions; (3) to provide rapid communication with physicians in bacteremia cases and (4) reporting the antibiograms in the hospital. In addition, we investigated changes in the antibiograms every 6 months based on all materials. There were 193 physician interventions in 2010 and 491 in 2011. The representative isolated bacteria included no additional bacteria with lower susceptibilities found over the past 1.5 years compared with the initial 1.5 years in the 3-year investigation period. The ratio for performing two sets of blood culture tests in all blood culture tests showed an upward tendency from 58.1% in 2009 to 71.1% in 2010 and 80.3% in 2011 (r=0.995, P=0.063, b=0.089). In conclusion, since the introduction of an expanded ICT role, our data showed an increased antibiotic susceptibilities in bacteria such as Enteroccus faecalis and the total amount of hand disinfectant agents tended to increase year by year, even though direct statistical analyses could not easily be performed. Further observation may be necessary for a definitive evaluation of ICT activities.The Journal of Antibiotics advance online publication, 1 May 2013; doi:10.1038/ja.2013.36.
The Journal of Antibiotics 05/2013; · 1.65 Impact Factor
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ABSTRACT: The purpose of this study is to examine the use of anti-methicillin-resistant Staphylococcus aureus (MRSA) drugs, such as vancomycin (VCM), teicoplanin (TEIC), arbekasin (ABK) and linezolid (LZD), and the antibiotic susceptibilities of MRSAs in Kobe University Hospital. We investigated MRSA isolation and use of anti-MRSA drugs and susceptibilities of MRSA, using linear regression analysis, from 2007 to 2011, and checked for correlation between the use of these drug and the antibiotic susceptibilities of MRSA. The overall monthly isolation rates of MRSA decreased from a mean of 84.8% in 2007 to 70.0% in 2011 (r=0.946, P=0.015, b=-0.220), and the monthly isolation rate of MRSA in inpatients decreased from a mean of 78.6% in 2007 to 57.7% in 2011 (r=0.952, P=0.012, b=-0.160). From 2007 to 2011, VCM consumption significantly increased (r=0.916, P=0.029, b=0.055), whereas TEIC and LZD use remained stable during the study period. In addition, ABK use significantly decreased from 23.8 defined daily dose (DDD) per 1000 patient-days in 2007 to 5.2 DDD per 1000 in 2011 (r=0.902, P=0.036, b=-0.216). Susceptibility rates of MRSA were almost 100% to TEIC and VCM. The rates of MRSA to ABK and LZD significantly increased (r=0.959, P=0.010, b=2.137 for ABK and r=0.933, P=0.020, b=3.111 for LZD). In conclusion, our findings indicated a decreased MRSA isolation rate and the effective use of anti-MRSA drugs (VCM, TEIC, ABK and LZD), and improved susceptibility rates to anti-MRSA drugs, suggesting the possibilities that appropriate and early use of anti-MRSA drugs may cause the decrease of MRSA isolation.The Journal of Antibiotics advance online publication, 27 March 2013; doi:10.1038/ja.2013.14.
The Journal of Antibiotics 03/2013; · 1.65 Impact Factor
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ABSTRACT: A 65-year-old man with diabetes mellitus (DM) presented with an indwelling urethral catheter placed for urinary retention by his previous doctor. Thereafter, he had fever, vomiting and general fatigue. His blood examination showed severe inflammatory findings. He was diagnosed with acute prostatitis and immediately admitted to our hospital. Pelvic computerized tomography (CT) showed a prostate abscess. We performed transrectal ultrasonographic-guided puncture of the prostate abscess for drainage and blood culture was tested. Methicillin-sensitive Staphylococcus aureus (MSSA) was cultured from the puncture fluid and blood. We administered antibiotics with strict control of DM. After the prostate abscess improved and the urethral catheter was removed, the patient was systematically examined for potential sepsis-related disease caused by MSSA septic infection. Magnetic resonance imaging (MRI) of the head indicated multiple cerebral infarction, abdominal CT indicated splenetic infarction, ultrasonography of the heart indicated vegetation on the mitral valve and aortic valve, and chest X-ray indicated pulmonary congestion. Furthermore, MRI of the lumbar spine showed a high intensity lesion at the 4th and 5th lumbar spine, indicating pyogenic spondylitis. We diagnosed prostate abscess with sepsis, infectious endocarditis, congestive heart failure and pyogenic spondylitis. Aortic valve replacement, mitral annuloplasty, tricuspid valvuloplasty and ovale hole closure surgeries were performed to treat these conditions.
Hinyokika kiyo. Acta urologica Japonica 10/2012; 58(10):565-8.
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ABSTRACT: During chemotherapy, patients are more susceptible to infectious complications as a result of bone marrow suppression, leading to neutropenia. The purpose of this study is to investigate risk factors for refractory febrile neutropenia (FN) during urological chemotherapy. Our method for suppressing FN is to use granulocyte colony-stimulating factor and prevent upper respiratory infection by masking and gargling. We studied 47 episodes of FN in 39 patients that occurred during urological chemotherapy for urothelial cancer, testicular cancer, and prostate cancer. Among our cases, there were 5 patients with refractory FN; we set risk factors for refractory FN and performed statistical analyses. The average age of the 39 patients was 60.6 years (range, 18-80 years). In 47 FN episodes, the chemotherapy regimen before the occurrence of FN included 15 (31.9 %) MVAC (methotrexate, vinblastine, adriamycin, cisplatin) for urothelial cancer, 5 (10.6 %) DE (docetaxel, estramustin) for prostate cancer, and 3 (6.4 %) TIP (paclitaxel, ifosfamide, cisplatin) for testicular cancer. The antibiotics used to treat FN included 17 (36.3 %) meropenem and 23 (49.0 %) cefepime, and the average duration of antibiotics was 4.4 days (range, 1-12). We investigated risk factors for refractory FN and showed a significant relationship between refractory FN and indwelling urinary catheter or smaller Multinational Association for Supportive Care in Cancer score by multivariate analysis. A future prospective study is needed for further evaluation for risk factors and establishing treatment protocols and guidelines for FN.
Journal of Infection and Chemotherapy 09/2012; · 1.80 Impact Factor
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Satoshi Takahashi,
Ryoichi Hamasuna,
Mitsuru Yasuda, Soichi Arakawa,
Kazushi Tanaka,
Kiyohito Ishikawa,
Hiroshi Kiyota,
Hiroshi Hayami,
Shingo Yamamoto,
Tatsuhiko Kubo,
Tetsuro Matsumoto
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ABSTRACT: We examined the rate of relapse, as a variable index, in patients with urinary tract infection (UTI) who suffered from multiple relapses when using cranberry juice (UR65). A randomized, placebo-controlled, double-blind study was conducted from October 2007 to September 2009 in Japan. The subjects were outpatients aged 20 to 79 years who were randomly divided into two groups. One group received cranberry juice (group A) and the other a placebo beverage (group P). To keep the conditions blind, the color and taste of the beverages were adjusted. The subjects drank 1 bottle (125 mL) of cranberry juice or the placebo beverage once daily, before going to sleep, for 24 weeks. The primary endpoint was relapse of UTI. In the group of females aged 50 years or more, there was a significant difference in the rate of relapse of UTI between groups A and P (log-rank test; p = 0.0425). In this subgroup analysis, relapse of UTI was observed in 16 of 55 (29.1 %) patients in group A and 31 of 63 (49.2 %) in group P. In this study, cranberry juice prevented the recurrence of UTI in a limited female population with 24-week intake of the beverage.
Journal of Infection and Chemotherapy 09/2012; · 1.80 Impact Factor
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ABSTRACT: Fluoroquinolone (FQ) resistance in Pseudomonas aeruginosa has spread. The purpose of this study was to investigate the correlation between representative FQ, i.e. levofloxacin (LVX), resistance and mutations in the gyrA and parC genes of P. aeruginosa clinical isolates from the urine of urinary tract infection patients and their rapid detection by denaturing high-performance liquid chromatography (DHPLC). The susceptibility to LVX of 114 clinical isolates was measured and the quinolone resistance-determining regions (QRDRs) in the gyrA and parC genes of these isolates were sequenced. DHPLC was undertaken to correlate the distinctive chromatograms with their DNA mutation patterns. Among 114 isolates tested, 22 isolates (19.3%) were resistant to LVX. Six amino acid mutations were detected (Thr83Ile, Asp87Tyr and Asp87Asn in gyrA and Ser87Leu, Ser87Trp and Glu91Arg in parC), existing alone or in combination. There were 10 kinds of mutation patterns. The presence of two or more kinds of mutation significantly correlated with LVX resistance compared with the wild-type or a single mutation (P<0.0001). DHPLC data identified the number of amino acid mutations with reproducibility distinguishable by peak number and profile of the DHPLC chromatogram. In conclusion, two or more mutations in gyrA and parC were significantly related to LVX resistance in P. aeruginosa. DHPLC facilitated the detection of resistant alleles, providing a rapid (5min per sample), economical (96 samples per run) and reliable technique for characterising LVX resistance in P. aeruginosa. This rapid detection system could forecast LVX resistance by the DHPLC profile.
International journal of antimicrobial agents 08/2012; 40(5):440-4. · 3.03 Impact Factor
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Tetsuro Matsumoto,
Ryoichi Hamasuna,
Kiyohito Ishikawa,
Satoshi Takahashi,
Mitsuru Yasuda,
Hiroshi Hayami,
Kazushi Tanaka,
Tetsuro Muratani,
Koichi Monden, Soichi Arakawa,
Shingo Yamamoto
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ABSTRACT: We investigated whether the presence of menopause influenced the species and distribution of causative bacteria isolated from patients with acute uncomplicated cystitis (the most common urinary tract infection), and we also investigated the sensitivity of the isolated species to antibacterial agents. Using multivariate analysis, we also investigated risk factors for infection with quinolone-resistant Escherichia coli, because its frequency has increased and it is now a clinical problem in Japan. Six hundred and thirty-four strains were isolated from 489 premenopausal patients (mean age 32.3 ± 10.1 years). Major causative bacteria detected were Escherichia coli (65.0 %), Enterococcus faecalis (12.0 %), Streptococcus agalactiae (5.5 %), and Klebsiella pneumoniae (1.6 %). From 501 postmenopausal patients (mean age 68.7 ± 10.29 years), 657 strains were isolated, and the major causative bacteria detected were E. coli (61.5 %), E. faecalis (13.7 %), K. pneumoniae (5.2 %), and S. agalactiae (4.0 %). The sensitivities to fluoroquinolones (FQs) and cephems of E. coli isolated from premenopausal patients were both ≥90 %, while the sensitivities to FQs of E. coli isolated from postmenopausal patients were about 5 % lower. In regard to infection with quinolone-resistant E. coli (minimal inhibitory concentration of levofloxacin [LVFX] ≥4 μg/mL), significant risk factors were observed in patients with more than two episodes of cystitis within a year (p = 0.0002), patients to whom antibacterial agents were used previously for this episode of cystitis (p = 0.0175), and patients who had a history of FQ administration within 1 month. Although the species and distribution of causative bacteria of acute uncomplicated cystitis were the same regardless of the presence of menopause, the sensitivities to FQs of E. coli detected in postmenopausal patients were significantly lower than those in the premenopausal women. The major risk factors for infection with quinolone-resistant E. coli were a history of FQ administration and the morbidity of cystitis rather than the menopausal status. It was considered that taking an appropriate history including the morbidity of cystitis and history of FQ administration, and the appropriate selection of an antibacterial agent, would be important when empirical therapy is required.
Journal of Infection and Chemotherapy 05/2012; 18(4):597-607. · 1.80 Impact Factor
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ABSTRACT: The purpose of this study was to investigate the association between prophylactic antibiotic administration (PAA) and post-operative infection in radical cystectomy with orthotopic neobladder urinary diversion carried out for patients with bladder cancer. Fifty-seven consecutive cases were analyzed retrospectively. Post-operative infections were categorized as urinary tract, wound, and remote infections. We used the antibiotics tazobactam/piperacillin (TAZ/PIPC), sulbactam/ampicillin (SBT/ABPC), flomoxef (FMOX), cefazolin (CEZ), cefotiam (CTM), and cefmetazole (CMZ). Twenty-five (43.9%) patients had post-operative infections. Five of these (8.77%) patients had wound infections, 22 (38.6%) patients had urinary tract infections, and 2 (3.51%) had remote infections. Our statistical analysis demonstrated that the patients with TAZ/PIPC used for PAA (5/18: 27.8%) had a significantly lower post-operative infection rate than patients with other antibiotics (24/39: 61.5%) (p = 0.0442). In addition, the patients with a shorter-duration PAA (within 72 h after the operation (48-72 h)) had a significantly lower rate of post-operative infections (12/33: 36.4%) than those with longer-duration PAA (longer than 72-96 h after the operation) (16/24: 66.7%) (p = 0.0239). Taken together, these results suggest that TAZ/PIPC with shorter PAA duration (within 72 h) might lead to a lower rate of post-operative infections. In conclusion, our data showed that PAA with TAZ/PIPC with a shorter duration PAA (within 72 h) might be recommended for radical cystectomy with orthotopic neobladder reconstruction. A prospective study based on our data is desirable to establish or revise guidelines for prophylactic medication for preventing post-operative infection after radical cystectomy with orthotopic neobladder urinary diversion.
Journal of Infection and Chemotherapy 01/2012; 18(4):479-84. · 1.80 Impact Factor
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ABSTRACT: Urinary tract infections (UTIs) can be hard to treat and treatment plans need to include accurate categorization such as uncomplicated or complicated UTI, or catheterized or uncatheterized UTI. We investigated the antibiotic susceptibilities of representative uropathogens in UTI categories.
We isolated uropathogens and analyzed their antimicrobial susceptibilities according to UTI categorization such as: (1) urology outpatients, urology inpatients, or other department inpatients; (2) uncomplicated or complicated UTIs; (3) upper or lower UTIs, and (4) non-catheterized or catheterized UTIs.
Escherichia coli, Enterococcus faecalis, and Pseudomonas aeruginosa were representative uropathogens. Susceptibilities to levofloxacin (LVFX) in E. coli in urology outpatients (p = 0.0179), those to ceftadizime in E. coli in other department inpatients (p = 0.0327), and those to LVFX in E. faecalis in complicated UTI (p = 0.0137) significantly decreased in these 3 years compared with the previous 3 years. Susceptibilities of upper UTI to LVFX in E. coli were significantly lower in the recent 4 years compared to lower UTI (p = 0.0452) and those of catheterized UTI to LVFX in E. faecalis were significantly lower than in non-catheterized UTI (p = 0.0153).
Data demonstrated different tendencies of uropathogens' antibiotic susceptibilities according to UTI categorizations and they could be useful for planning UTI treatments.
Urologia Internationalis 01/2012; 88(2):198-208. · 0.99 Impact Factor
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ABSTRACT: Invasive upper urinary tract procedures such as retrograde pyelography (RP) or single (S-J) or double J (D-J) stenting are commonly performed to assess or treat ureteral strictures. Urinary tract infection (UTI) can result after such procedures, and prophylactic antimicrobial administration (PAA) may be necessary. This study investigated infectious complications and risk factors, focusing on PAA.
We studied antimicrobial prevention in 353 upper urinary tract examinations or treatments. Procedures included S-J or D-J installation or exchange, RP and percutaneous nephrostomy. We investigated PAA and the occurrence of febrile infectious complications with respect to each procedure and attempted to find the risk factors.
Levofloxacin was used in 149 subjects (42.2%) and cefcapene pivoxil in 114 cases (32.3%). There were 16 febrile infectious complication cases (4.5%) after procedures, and pyuria or hydronephrosis prior to examination or treatment was an independent risk factor for infectious complication (p < 0.05) as well.
These data showed that it is necessary to evaluate the risk factors before urological procedures of the upper urinary tract and to offer a definite preventive methodology according to these risk factors for the establishment and update of guidelines.
Urologia Internationalis 01/2012; 88(1):43-7. · 0.99 Impact Factor
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International Journal of Urology 12/2011; 19(1):5-6. · 1.75 Impact Factor
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ABSTRACT: Radical cystectomy is associated with the highest morbidity and mortality of all commonly performed urological cancer treatment procedures. Postoperative infection remains a major problem. We herein report the results of an open prospective study involving radical cystectomies, undertaken to evaluate the efficacy of 0.5/2 g tazobactam-piperacillin (TAZ-PIPC) in the prevention of postoperative infectious complications. Antimicrobial prophylaxis was performed using 0.5/2 g TAZ-PIPC (2.5 g i.v.) every 3 h during surgery and then twice a day for 3 days postoperatively. The patients were monitored to detect any postoperative infections. During surgery, irrigation fluid from the total abdominal cavity was taken for bacterial culture just before closing the abdomen. Surveillance cultures of drain discharge and urine from ureteral stents were also performed. Other samples were taken for bacterial culture when an infection was suspected. The total postoperative bacterial infection rate was 20.0% (7/35), and surgical site infection rate was 5.7% (2/35). These rates are lower than those documented in other studies. This study, even though open and noncomparative, showed that a short-interval regimen containing 0.5/2 g TAZ-PIPC provides adequate antimicrobial prophylaxis in patients undergoing radical cystectomy.
Journal of Infection and Chemotherapy 10/2011; 18(2):175-9. · 1.80 Impact Factor
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ABSTRACT: Ureteroscopic lithotripsy (UL), for renal or ureteral stones, is a standard technique for every urologist. However, the length of time the double J (DJ) stent needs to be kept in postoperatively is still controversial. This study investigated how the duration of DJ stenting after UL affects postoperative adverse events, especially infection and pain. One hundred and twenty-five patients were enrolled in this study and data were analyzed retrospectively. We set the median duration for keeping the DJ stent postoperatively as 14 days from median value in all cases and compared it to a longer duration group (>15 days) and a shorter duration group (<14 days) in terms of febrile complications, urinalysis, and the need to give antibiotics at the time of DJ stent removal. The duration of DJ stenting was from 3 to 61 (median 14) days. Thirteen patients had adverse events related to DJ stent removal (febrile complications, 11 patients; lumbago, 2 patients). Thirty-one patients were given antibiotics at the time of DJ stent removal. Patients with longer durations (>15 days) of DJ stenting had a significantly higher ratio of adverse events such as fever or lumbago (p = 0.041). In conclusion, this study demonstrated that shorter duration (<14 days) DJ stent use after UL may decrease adverse events and require less antibiotic use. Further prospective studies are needed to determine the optimal duration of DJ stent use after UL.
Urological Research 09/2011; 40(4):373-6. · 1.23 Impact Factor
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ABSTRACT: We examined Enterococcus faecalis strains clinically isolated from 100 patients with urinary tract infections (UTIs) for their susceptibility to levofloxacin (LVX) by measuring the MIC and investigated amino acid mutations by direct DNA sequencing, which were then correlated with LVX resistance. Next, we studied risk factors for LVX resistance, such as age, gender, and previous fluoroquinolone use, and investigated the statistical correlation of these risk factors with each amino acid mutation and LVX resistance. Of the 100 isolates tested, 14 isolates showed LVX resistance and all of these isolates had amino acid mutations. We demonstrated that 2 out of 4 mutations (Ser83-to-Ile in gyrA and Ser80-to-Ile in parC) had a significant correlation with LVX resistance. There was a significant relationship between isolates with 2 or 3 amino acid mutations and LVX resistance. In addition, we found a significant correlation between the previous use of fluoroquinolones and LVX resistance or the presence of mutations and also demonstrated that previous use of other types of antibiotics was significantly related to the presence of mutations by multivariate analysis. In conclusion, we found significant correlation between amino acid mutations in E. faecalis, LVX resistance, and risk factors such as previous use of fluoroquinolones.
Journal of clinical microbiology 09/2011; 49(11):3912-6. · 4.16 Impact Factor
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Soichi Arakawa
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ABSTRACT: Human immunology and relationship between immune mechanism and infection were explained. Humoral immunity and cellular immunity collaborate properly and eliminate microorganisms. In immunocompromised host these mechanisms are broken. For prevention of healthcare associated infections, standard precausion is important basically. Additionary, according to the status of the patient, contact precaution, droplet precaution or airborne precaution should be applied.
Nihon Hansenbyo Gakkai zasshi = Japanese journal of leprosy: official organ of the Japanese Leprosy Association 09/2011; 80(3):301-4.
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ABSTRACT: For developing the Japanese guideline for the prevention of health care-associated infection in urological practice, we surveyed the literature including standard precautions, environmental considerations in both the inpatient and outpatient settings, the management of urinary catheters, endoscopy techniques, and the disinfection and sterilization of instruments used in endoscopies and related procedures. The concept of this guideline is to show the minimum precautions that urologists and other medical professionals should observe when they work in the urological field. Standard precautions based on hand hygiene and the use of personal protective equipment should be observed in both the inpatient and outpatient settings. In the inpatient setting, the management of the toilet is important. Collecting urine should be restricted only when it is necessary to determine a patient's urinary output. The management for urinary catheter and infection are created based on the "European and Asian guidelines on management and prevention of catheter-associated urinary tract infections". In addition, we propose that nephrostomy should be carried out after maximum barrier precautions have been taken. Urinary catheters are replaced in the event of an occlusion or if there are signs that an occlusion might occur, but the same catheter cannot be left in place for more than 2 months. Regarding the handling of urine containing Mycobacterium tuberculosis, airborne infection countermeasures are unnecessary, except for the laboratory personnel. For the procedures using urological endoscopes, aseptic techniques are recommended. Endoscopes and related devices should be used by sterilization or high-level disinfection, but formaldehyde gas cannot be used.
International Journal of Urology 07/2011; 18(7):495-502. · 1.75 Impact Factor
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ABSTRACT: Mycoplasma genitalium and Chlamydia trachomatis are the primary pathogens detected from non-gonococcal urethritis (NGU). In this study, the efficacy of gatifloxacin was examined against M genitalium-related urethritis.
The study was an open clinical trial evaluating the effectiveness of gatifloxacin with 200 mg doses twice a day for 7 days against male NGU.
Between March and September 2008, 169 male patients were enrolled, and microbiological and clinical cure rates could be evaluated in 86 patients detected with C trachomatis or M genitalium and in 135 with NGU, respectively. Microbiological cure rates of gatifloxacin against C trachomatis and M genitalium were 100% and 83%, respectively, and the total clinical cure rate was 99%.
Analysis of in-vivo and in-vitro data from the literature of fluoroquinolone efficacies against M genitalium suggests that a MIC90 of 0.125 μg/ml or less may be useful for optimal activity against M genitalium infection.
Sexually transmitted infections 04/2011; 87(5):389-90. · 2.18 Impact Factor
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ABSTRACT: Overuse of antibiotics can cause the emergence of resistant bacterial strains. This study retrospectively investigated recent trends in Escherichia coli causing urinary tract infections (UTIs), focusing on antibiotic use and antibiotic susceptibilities. Patients diagnosed with UTIs caused by E. coli in Akashi Municipal Hospital between April 2004 and March 2010 were enrolled in the study. A total of 858 UTI cases were examined. Antibiotics used in our hospital during that period and the antibiotic susceptibilities of E. coli in UTI cases were assessed. We analyzed the data on a yearly basis, with the year being defined as the period from April to the following March (e.g., in this study the period from April 2004 to March 2005 represents 2004). The first 3 years (2004-2006) were compared to the last 3 years (2007-2009). The use of piperacillin, cephazolin, amikacin, oral cefotiam, and levofloxacin decreased significantly and the use of imipenem, gentamicin (GM), cefcapene, and oral minocycline (MINO) increased significantly in the last 3 years compared to the previous 3 years. The susceptibilities of MINO in complicated cystitis significantly increased and those of GM in uncomplicated pyelonephritis significantly decreased in these 3 years (2007-2009) compared to the previous 3 years (2004-2006) (P < 0.05). Additionally, extended-spectrum β-lactamase (ESBL)-producing E. coli tended to be isolated more often; this was statistically significant in the last 3 years (2007-2009) compared to the previous 3 years (2004-2006) (P < 0.05). In conclusion, we found changes in our pattern of antibiotic use associated with changes in antibiotic susceptibilities and an increase in ESBL-producing E. coli isolated from our UTI cases. Monitoring of antibiotic use and emergence of resistant strains should be continued.
Journal of Infection and Chemotherapy 04/2011; 17(5):646-51. · 1.80 Impact Factor
