[Show abstract][Hide abstract] ABSTRACT: A 76-year-old male diagnosed with interstitial pneumonia in December 2002 was treated with a steroid in a nearby hospital. Exacerbation of infectious pneumonitis and interstitial pneumonia required complementary inpatient treatment in August 2007. Although polymerase chain reaction examination of expectorated sputa revealed the absence of Mycobacterium tuberculosis, M. avium, and M. intracellulare on admission, nontuberculous M. abscessus was detected in the routine blood cultures. Taken together with clinical findings, M. abscessus was most likely the primary causative organism. Diagnosis of mycobaterium-induced septicemia generally involves the use of mycobacterium-designated bottles, MGIT method, and Ogawa medium; however, we used microbe cultures with routine blood-culture bottles in the present case. Of the 24 mycobacterium-induced septicemia cases reported in the past 10 years, only eight cases were detected from routine blood-culture bottles; they were all rapidly growing bacteria. Mycobacteria other than the rapidly growing mycobacteria display delayed culture proliferation, therefore it is possible that non-detected microbes were probably present in the patients despite the fact that they were suffering from septicemia. In cases suspected to have severe infections, particularly those with a depressed immunodefense system, blood-culture testing for mycobacteria would be highly helpful for diagnosis.
No preview · Article · Sep 2011 · Rinsho byori. The Japanese journal of clinical pathology
[Show abstract][Hide abstract] ABSTRACT: The active involvement of hospital laboratory in surveillance is crucial to the success of nosocomial infection control. The recent dramatic increase of antimicrobial-resistant organisms and their spread into the community suggest that the infection control strategy of independent medical institutions is insufficient. To share the clinical data and surveillance in our local medical region, we developed a microbiology data warehouse for networking hospital laboratories in Akita prefecture. This system, named Akita-ReNICS, is an easy-to-use information management system designed to compare, track, and report the occurrence of antimicrobial-resistant organisms. Participating laboratories routinely transfer their coded and formatted microbiology data to ReNICS server located at Akita University Hospital from their health care system's clinical computer applications over the internet. We established the system to automate the statistical processes, so that the participants can access the server to monitor graphical data in the manner they prefer, using their own computer's browser. Furthermore, our system also provides the documents server, microbiology and antimicrobiotic database, and space for long-term storage of microbiological samples. Akita-ReNICS could be a next generation network for quality improvement of infection control.
No preview · Article · Apr 2011 · Rinsho byori. The Japanese journal of clinical pathology
[Show abstract][Hide abstract] ABSTRACT: Infection control is essential for health care facilities. Aiming at improving the activity for infection control, increasing number of health care facilities has settled infection control team (ICT) in this decade. However, the quality of infection control activity has not been evaluated.
The quality of infection control was investigated in 49 hospitals and 55 welfare institutions for the aged in Akita prefecture using a questionnaire.
All the hospitals with more than 400 beds or more had ICT; however, less than 50% of the hospitals with 399 beds or less had ICT. The coverage of full-time specialist for infection control remained at a low level. Collection and analysis of information such as the prevalence of multi-drug resistant microorganisms and the consumption of antibiotics remained at a low level. More than 88% of the facilities hoped for a regional infection control network system to improve infection control activities. Reciprocal help in case of outbreak, education, lectures, sharing rules on infection control, making guidelines and teaching materials for infection control, analysis of infection control-related epidemiological data and getting suggestions and recommendations from authorized infection control specialists were included in the strongly required functions of the network.
No preview · Article · Aug 2009 · Rinsho byori. The Japanese journal of clinical pathology
[Show abstract][Hide abstract] ABSTRACT: Linezolid exhibits a broad spectrum of activity against Gram-positive cocci, including Methicillin-resistant Staphylococcus aureus (mRSA) and vancomycin-resistant enterococci (VRe). However, recent studies have already reported the emergence of linezolid-resistant mRSA or VRe. the purpose of this study is to evaluate not only the efficacy of linezolid for the treatment of nosocomial mRSA infections but also the effect of a notification policy of linezolid use. the charts of inpatients who had been treated with linezolid were reviewed for clinical outcome. After introduction of the notification policy of linezolid use, the clinical success rate was 73.3%, and the rate of appropriate linezolid use was 80%, whereas the success rate was 14.2% and the appropriate use rate was 14.3% before the policy. in conclusion, appropriate use controlled by a notification policy of antibiotics use is essential for prevention of the emergence and spread of linezolid-resistant bacteria, and for proper demonstration of its antibacterial ability.
No preview · Article · Mar 2009 · Journal of chemotherapy (Florence, Italy)
[Show abstract][Hide abstract] ABSTRACT: An 81-year-old man was admitted to the hospital with a severe sore throat and a low grade fever. A chest radiograph showed bilateral diffuse reticulonodular shadows. By fluorescent stain for mycobacteria, his sputum smear showed acid-fast bacteria. The initial polymerase chain reaction (PCR) of his sputum revealed Mycobacterium intracellulare (M. intracellulare), but not Mycobacterium tuberculosis (M. tuberculosis). However, a repeat PCR was performed because M. tuberculosis could not be ruled out due to his clinical symptoms and chest imaging. The second PCR detected both M. intracellulare and M. tuberculosis. From the standpoint of infection control, this case illustrates the possibility that M. tuberculosis could be a threat if a second PCR is not done. While PCR is a useful exam for diagnosing M. tuberculosis, it can produce false negative results. Therefore, for diagnosing tuberculosis, particularly in a case such as the present case, a second PCR, which is not normally necessary, should be done.
No preview · Article · Jan 2008 · Internal Medicine
[Show abstract][Hide abstract] ABSTRACT: Abuse of antibiotics results in unfavorable consequences in healthcare associated infection control, such as emergence of multiple-resistant bacteria, and increased medical cost and nosocomial infection. In 2003, we had an outbreak of Methicillin-resistant Staphylococcus aureus (MRSA) in a surgical ward of Akita University Hospital. With the aim of preventing inappropriate use of antibiotics during perioperative period, a guideline for usage of antibiotics, which is made by surgeons themselves, was introduced, and a notification policy of the antibiotic use for MRSA was also applied in 2004. In this study, we evaluated the influence of the antibiotic restriction on changes in antibiotics consumption, prevalence of multiple-drug-resistant pathogens, and their susceptibility to antibiotics. The notification policy reduced the cost and amount of antibiotics and the prevalence of multiple-drug-resistant pathogens, such as MRSA and Pseudomonas aeruginosa. The susceptibility of bacteria, such as Staphylococcus aureus, MRSA, Serratia marcescens and Pseudomonas aeruginosa, to antibiotics showed a remarkable improvement. The introduction of notification policy for usage of antibiotics has a favorable influence on the infection control in hospitals and re education of doctors.
No preview · Article · Apr 2007 · Rinsho byori. The Japanese journal of clinical pathology
[Show abstract][Hide abstract] ABSTRACT: Infection Control Committee (ICC) of Akita University Hospital was established in 1980's, when methicillin-resistant Staphylococcus aureus (MRSA) spread in teaching hospitals in Japan. After 20 years from the establishment of ICC, we needed to shake up some of the outdated infection control systems. Infection Control Team (ICT) was established in 2002 to reinforce ICC. ICT was consisted of five infection control doctors (ICD), two infection control nurses (ICN), two medical technicians in bacteriological division of clinical laboratory, one pharmacist and three administrative officials in the hospital. Monitoring of multiple drug-resistant pathogens, antibiotic use, surgical site infections and bloodstream infections are mandatory. Personnel training and educational activity are also required. After the establishment of ICT, inappropriate use of antibiotics and prevalence of MRSA were dramatically decreased. The hospital saved more than 30,000,000 yen annually. However, with a great regret, we experienced an outbreak of MRSA in a department of our hospital in 2003. MRSA infection was judged as a cause of death in three patients in the outbreak. MRSA was thought to transmit via medical personnel since pulsed-field gel electrophoresis revealed common genotype in 11 out of 15 patients studied. Prevention of healthcare-associated infections is a crucial in the management of hospitals. In this paper, we verified the efforts to control the outbreak and analyzed factors interfering infection control activities. A crucial role of a clinical laboratory in controlling healthcare associated infections was also discussed.
No preview · Article · Mar 2005 · Rinsho byori. The Japanese journal of clinical pathology
[Show abstract][Hide abstract] ABSTRACT: Medical costs associated with hospital-acquired infection is a critical problem for hospital management. The introduction of the Diagnosis Procedure Combination (DPC) system requires the re-evaluation of the cost-effectiveness of any medical procedure including the usage of antibiotics. Achieving high cost-effectiveness and quality of medical service are essential for hospitals to survive the current changes in medical systems. Inappropriate use of antimicrobial agents results in unnecessary exposure to medication, persistent or progressive infection, emergence of resistance, and increased costs. We undertook an observational pre and post-intervention study to assess whether a comprehensive antimicrobial management program developed by the new ICT installed 2002 in Akita University Hospital could reduce the use of antibiotics. Annual total amounts of antibiotics and anti-MRSA antibiotics, and the number of patients undergoing long-term treatment with antibiotics, fell dramatically. This ICT approach thus reduced antibiotic costs, contributed to infection control, and improved the quality of antibiotic prescription.
No preview · Article · Jan 2005 · Rinsho byori. The Japanese journal of clinical pathology