[Show abstract][Hide abstract] 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 (31.8%). The predominant rotavirus genotype was G2P (19.3%); G1P and G9P 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 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 has the highest prevalence. G3, G4, G9 and G2P combination genotype were found to be associated with severe diarrhea.
[Show abstract][Hide abstract] ABSTRACT: The current situation for the treatments for urinary tract infections (UTIs) has been changed and become more complicated than before. One of the reasons is an increase of antibiotic-resistant strains. UTIs are generally classified into uncomplicated- and complicated UTI according to the presence or absence of systematic or urinary tract underlying diseases when considering the treatment approach and then it is necessary to know the trend of the causative bacteria and antibiogram findings. At the same time, there are several essential approaches for UTI treatments: 1) medical approach, 2) surgical approach, 3) bacterial approach and 4) chemical (antibiotic) approach, and lack of even one of them can cause treatment failure. This review gives an outline on antibiotic therapy considering antibiotic resistant strains especially focusing on the viewpoint of a urological interventional approach.
No preview · Article · Sep 2015 · Japanese Journal of Chemotherapy
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study is to identify significant immune-system related for symptom of patients with prostatic inflammation in order to investigate the etiology of prostatic inflammation which may relate to potentially chronic prostatitis (CP). We investigated the expression of immune system-related biomarkers such as Interleukin (IL) -6 (humoral immunity), CD-3 (T-lymphocyte), and CD-163 (macrophage) in prostate biopsy (PBx) specimens from patients with prostatic inflammation (without cancer) which had been neither clinically diagnosed benign prostatic hyperplasia nor chronic prostatitis. We examined the correlation between these markers' expressions and the symptom scores using the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), International Prostate Symptom Score (IPSS)/quality of life (QOL) which are the index for lower urinary tract symptoms (LUTS). Our results showed CD-163 (macrophage) reflected pain or discomfort on NIH-CPSI scores (P = 0.0389 and r = 0.3307) in the patients with prostatic inflammation; however, the control patients had no significant correlation between symptom scores and those immune-related markers' expression. These results suggest that pain or discomfort related to macrophages in the relationship between immune-system and the symptom of prostatic inflammation. In conclusion, CD-163, related to immune-system (macrophage), correlated with symptoms (pain or discomfort) of prostatic inflammation and might represent a significant immune-system related biomarker for pain or LUTS score in potentially CP.
No preview · Article · Jun 2015 · International journal of clinical and experimental pathology
[Show abstract][Hide abstract] 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.
No preview · Article · Apr 2015 · International Urology and Nephrology
[Show abstract][Hide abstract] 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.
No preview · Article · Apr 2015 · The Journal of Antibiotics
[Show abstract][Hide abstract] ABSTRACT: Study design:
The objective of this study was to investigate the clinical risk factors for febrile urinary tract infection (UTI) in spinal cord injury-associated neurogenic bladder (NB) patients who perform routine clean intermittent catheterization (CIC).
Rehabilitation Hospital, Kobe, Japan.
Over a 3-year period, we retrospectively assessed the clinical risk factors for febrile UTI in 259 spinal cord injury patients diagnosed as NB and performing routine CIC with regard to the factors such as gender, the presence of pyuria and bacteriuria, and the categories of the American Spinal Injury Association (ASIA) impairment scale.
A total of 67 patients had febrile UTI in the follow-up period, with 57 cases of pyelonephritis, 11 cases of epididymitis and 2 cases of prostatitis, including the patients with plural infectious diseases. The causative bacteria were ranked as follows: Escherichia coli (74 cases), Pseudomonas aeruginosa (17 cases), Enterococcus faecalis (14 cases) and Klebsiella pneumoniae (12 cases). Antibiotic-resistant E. coli were seen, with 10.5% instances of extended-spectrum β-lactamase (ESBL) production and 23.8% of fluoroquinolone resistance. Multivariate analyses of clinical risk factors for febrile UTI showed that gender (male, P=0.0431), and ASIA impairment scale C or more severe (P=0.0266) were significantly associated with febrile UTI occurrence in NB patients with routine CIC.
Our data demonstrated gender (male) and ASIA impairment scale C or more severe were significantly associated with febrile UTI occurrence in NB patients using routine CIC. Further prospective studies are necessary to define the full spectrum of possible risk factors for febrile UTI in these patients.Spinal Cord advance online publication, 13 October 2015; doi:10.1038/sc.2015.170.
Full-text · Article · Apr 2015 · The Journal of Urology
[Show abstract][Hide abstract] ABSTRACT: An outbreak of Pseudomonas aeruginosa producing metallo–β-lactamase (MBLPA) in the hematology ward was controlled after use of toilet seats with bidet functions was terminated. Twenty four strains of MBLPA were identified from hospitalized patients in the hematology unit from January 2007 to December 2012. Multidisciplinary interventions including routine active surveillance, strengthening contact precautions, and analysis of risk factors for MBLPA were performed. However, new MBLPA infections continued to be identified after institution of infection control strategies. During the outbreaks, environmental surveys were conducted and 6 MBLPA isolates were detected from the spray nozzles of the toilet seats with bidet functions in this ward. Twenty four MBLPA isolates from the patients and 6 from spray nozzles were analyzed for chromosomal DNA typing by PCR–based ORF typing (POT). All 24 MBLPAs from the patients and all 6 isolates from nozzles had the same POTS patterns (Pot No. 644–41). Use of the toilet seats with bidet functions was discontinued during January to September 2013 and only 1 new isolate was identified in this period. Use of the toilet seats with bidet functions in October 2013 and 2 new MBLPAs were identified in only 3 months. Therefore, use of toilet seats with bidet functions was again terminated since January 2014 and occurrence of new isolates decreased again (1 isolate during 12 months). Incidence of MBLPA isolate per 1000 patient-days was 0.49 in the period of use of the toilet seats with bidet functions and 0.10 in the period of no use. In conclusion, use of toilet seats with bidet functions in the hematological unit is highly suspected as a risk factor for transmission of MBL producing Pseudomonas aeruginosa.
Preview · Article · Jan 2015 · Japanese Journal of Environmental Infections
[Show abstract][Hide abstract] 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.
No preview · Article · Nov 2014 · International Journal of Urology
[Show abstract][Hide abstract] 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.
No preview · Article · Oct 2014 · Microbial drug resistance (Larchmont, N.Y.)
[Show abstract][Hide abstract] 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.
No preview · Article · Oct 2014 · Journal of Infection and Chemotherapy
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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.
No preview · Article · Aug 2014 · International Journal of Urology
[Show abstract][Hide abstract] ABSTRACT: Difficulties may occur in the treatment of complicated urinary tract infection (UTI) and male accessory sex organ infection partly because of the spread of antibiotic-resistant strains. The purpose of this study was to investigate the efficacy of tazobactam/piperacillin (TAZ/PIPC) on complicated UTI or male accessory sex organ infection. We examined 49 patients with complicated UTI or male accessory sex organ infection and their backgrounds, underlying diseases, doses of TAZ/PIPC, causative bacteria, treatment outcomes, involvement of bacteremia, and adverse events associated with TAZ/PIPC. The patients comprised 37 males and 12 females with ages ranging from 22-89 yr (median: 68 yr). The diagnoses of the infectious disease were as follows: 34 cases of complicated pyelitis, 11 acute prostatitis, 2 acute epididymitis and 2 others. There were 5 cases where bacteremia was involved. The underlying diseases were as follows: 11 cases of bladder cancer, 10 benign prostate hyperplasia, 8 ureteral stone, 6 renal pelvic or ureteral cancer, and there were 6 cases of diabetes mellitus. The daily doses of TAZ/PIPC were as follows: 4.5 g in 7 cases, 6.75 g in 3 cases, 9 g in 25 cases, 13.5 g in 12 cases and 18 g in 1 case. The urine culture was positive in 26 cases with 10 cases of Escherichia coli and 10 of Enterococcus faecalis; one case of extended-spectrum beta-lactamase (ESBL) producing bacteria was noted in the E. coli group. As for the treatment outcome, TAZ/PIPC was effective in 45 out of 49 cases (91.8%) and in detail, it was 30 out of 34 cases of complicated pyelitis (88.2%) and it was 11 out of 11 cases of acute prostatitis (100%). The TAZ/PIPC regimen did not have to be stopped in any of the patients as a result of the drug-induced adverse events. In summary, TAZ/PIPC is considered an effective and safe drug for the treatments of complicated UTI or male accessory sex organ infection.
No preview · Article · May 2014 · Japanese Journal of Chemotherapy
[Show abstract][Hide abstract] 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.
No preview · Article · Apr 2014 · The Journal of Antibiotics
[Show abstract][Hide abstract] 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.