Faculty Profiles - HAGIYA Hideharu

Papers - HAGIYA Hideharu

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Panophthalmitis caused by Streptococcus dysgalactiae subsp. equisimilis: A case report and literature review Reviewed International journal

Hideharu Hagiya, Takuya Semba, Takeshi Morimoto, Norihisa Yamamoto, Hisao Yoshida, Kazunori Tomono

Journal of Infection and Chemotherapy 24 ( 11 ) 936 - 940 2018

Language：English Publishing type：Research paper (scientific journal) Publisher：Elsevier B.V.

Lancefield group G β-hemolytic Streptococcus dysgalactiae subspecies equisimilis (SDSE) has become a leading causative pathogen of invasive streptococcal infection. In this report, we describe a case of disseminated SDSE infection complicated by endogenous endophthalmitis, resulting in panophthalmitis and blindness. A 65-year-old man who underwent mitral valve replacement surgery two months previously was hospitalized due to high fever and right visual loss. A systemic investigation revealed endophthalmitis complicated by mediastinal abscess, prosthetic infective endocarditis, cerebral emboli and hemorrhage, and multiple arthritis. The patient underwent various surgeries, including vitrectomy, mediastinal lavage, mitral valve replacements, joint lavages, as well as an intensive antibiotic treatment. His general condition gradually improved, but the ocular infection developed to panophthalmitis, which ultimately required ophthalmectomy. A literature review regarding Group G-associated endogenous endophthalmitis suggested that the disease occurs in elderly people, is frequently complicated with endocarditis, and yields poor visual prognosis regardless of appropriate antibiotic treatment and surgical therapies. In this aging society, invasive infections with SDSE should be much more recognized among medical practitioners in order to improve patient prognosis.

DOI： 10.1016/j.jiac.2018.04.012

Ceftriaxone-induced Neurotoxicity in a Patient after Pancreas-Kidney Transplantation. Reviewed

Hideharu Hagiya, Koji Miyawaki, Norihisa Yamamoto, Hisao Yoshida, Akihiro Kitagawa, Tadafumi Asaoka, Hidetoshi Eguchi, Yukihiro Akeda, Kazunori Tomono

Internal medicine (Tokyo, Japan) 56 ( 22 ) 3103 - 3107 2017.11

Language：English Publishing type：Research paper (scientific journal)

Ceftriaxone is a widely used third-generation cephalosporin showing advantageous pharmacokinetic properties and a broad antimicrobial spectrum. We herein report a case of ceftriaxone-induced neurotoxicity in a 56-year-old man on hemodialysis. Seven days after initiating high-dose ceftriaxone, the patient developed impaired consciousness along with facial myoclonus and sporadic phonation. The symptoms clearly disappeared shortly after withdrawal of the drug. Ceftriaxone is considered a safe antibiotic for patients with renal insufficiency, since it is excreted via both haptic and renal pathways. Physicians should note that antibiotic-associated encephalopathy may develop in patients administered ceftriaxone, especially in those complicated with renal dysfunction.

DOI： 10.2169/internalmedicine.8774-16

Durability of immunity by hepatitis B vaccine in Japanese health care workers depends on primary response titers and durations Reviewed International journal

Nori Yoshioka, Matsuo Deguchi, Hideharu Hagiya, Masanori Kagita, Hiroko Tsukamoto, Miyuki Takao, Hisao Yoshida, Norihisa Yamamoto, Yukihiro Akeda, Yoshiko Nabetani, Ikuhiro Maeda, Yoh Hidaka, Kazunori Tomono

PLOS ONE 12 ( 11 ) e0187661 2017.11

Language：English Publishing type：Research paper (scientific journal) Publisher：PUBLIC LIBRARY SCIENCE

Background
Health care workers (HCWs) are frequently exposed to hepatitis B virus (HBV) infection. The efficacy and safety of immunization with the hepatitis B (HB) vaccine are well recognized, but the durability of immunity and need for booster doses in those with secondary vaccine response failure remains controversial.
Methods
This was a retrospective cohort study performed at Osaka University Hospital, Japan. We examined antibodies against HB surface antigen (anti-HBs) titers annually after immunization for previously non-immunized HCWs. Primary responders were categorized by their sero-positive durations as short responders (those whose anti-HBs titers declined to negative range within 3 years), and long responders (those who retained positive anti-HBs levels for 3 years and more). We re-immunized short responders with either single or 3-dose boosters, the long responders with a single booster when their titers dropped below protective levels, and examined their sero-protection rates over time thereafter.
Results
From 2001 to 2012, data of 264 HCWs with a median age of 25.3 were collected. The rate of anti-HBs positivity after primary vaccination were 93.0% after three doses (n = 229), 54.5% after two doses (n = 11), and 4.2% after a single dose (n = 24). Of 213 primary responders, the anti-HBs levels of 95 participants (44.6%) fell below the protective levels, including 46 short responders and 49 long responders. HCWs with higher initial anti-HBs titers after primary vaccination had significantly longer durations of sero-positivity. For short responders, 3-dose booster vaccination induced a longer duration of anti-HBs positivity compared to a single-dose booster, whereas for long responders, a single-dose booster alone could induce prolonged anti-HBs positivity.
Conclusion
Our preliminary data suggested that it may be useful to differentiate HB vaccine responders based on their primary response durations to maintain protective levels of anti-HBs efficiently. A randomized, prospective, large-scale study is warranted to support our findings.

DOI： 10.1371/journal.pone.0187661

Prevalence of, and risk factors for, carriage of carbapenem-resistant Enterobacteriaceae among hospitalized patients in Japan Reviewed International journal

N. Yamamoto, R. Asada, R. Kawahara, H. Hagiya, Y. Akeda, R. K. Shanmugakani, H. Yoshida, S. Yukawa, K. Yamamoto, Y. Takayama, H. Ohnishi, T. Taniguchi, T. Matsuoka, K. Matsunami, I. Nishi, T. Kase, S. Hamada, K. Tomono

JOURNAL OF HOSPITAL INFECTION 97 ( 3 ) 212 - 217 2017.11

Language：English Publishing type：Research paper (scientific journal) Publisher：W B SAUNDERS CO LTD

Background: The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) has been reported to be lower in Japan than in many other countries. However, extensive surveillance for CRE carriage has not been performed in Japan.
Aim: To investigate the prevalence of CRE carriage in Japan among convalescent patients considered to be at high risk of being CRE carriers using an improved selective culture medium.
Methods: A cross-sectional survey was conducted in 22 acute care hospitals (ACHs) and 21 long-term care hospitals (LTCHs) in northern Osaka from December 2015 to January 2016. Patients who used incontinence aids, an enteral feeding tube or a urinary catheter were enrolled. Faecal specimens were examined using the newly developed M-ECC for imipenemase (IMP)-producing CRE, which is the most prevalent form of CRE in Japan. The positive isolates were analysed by polymerase chain reaction and sequencing. Risk factors associated with carriage were analysed by logistic regression.
Findings: Among 1507 patients, 184 (12.2%) carried CRE. The percentage of positive patients was significantly higher in LTCHs (14.9%) than in ACHs (3.6%) (P<0.001). Risk factors for CRE carriage were longer hospital stay [odds ratio (OR) 2.59; 95% confidence interval (CI) 1.87-3.60], enteral feeding (OR 3.03, 95% CI 2.08-4.42) and antibiotic exposure (OR 2.00, 95% CI 1.40-2.87). Among the 233 CRE isolates identified, 223 were IMP producers; the remaining isolates did not produce carbapenemase.
Conclusions: This is the first Japanese report to demonstrate the significant spread of CRE in both ACHs and LTCHs using an improved selective medium. A coordinated regional approach may help to prevent further spread. (C) 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jhin.2017.07.015

Perimandibular abscess associated with bisphosphonate-related osteonecrosis of the jaw. Reviewed

Kazuki Ocho, Masaya Iwamuro, Hideharu Hagiya, Soichiro Ibaragi, Fumio Otsuka

Journal of general and family medicine 18 ( 5 ) 305 - 306 2017.10

Genetic characterization of bla(NDM)-harboring plasmids in carbapenem-resistant Escherichia coli from Myanmar Reviewed International journal

Yo Sugawara, Yukihiro Akeda, Noriko Sakamoto, Dan Takeuchi, Daisuke Motooka, Shota Nakamura, Hideharu Hagiya, Norihisa Yamamoto, Isao Nishi, Hisao Yoshida, Kazuhisa Okada, Khwar Nyo Zin, Mya Mya Aye, Kazunori Tonomo, Shigeyuki Hamada

PLOS ONE 12 ( 9 ) e0184720 2017.9

Language：English Publishing type：Research paper (scientific journal) Publisher：PUBLIC LIBRARY SCIENCE

The bacterial enzyme New Delhi metallo-beta-lactamase hydrolyzes almost all beta-lactam antibiotics, including carbapenems, which are drugs of last resort for severe bacterial infections. The spread of carbapenem-resistant Enterobacteriaceae that carry the New Delhi metallo-beta-lactamase gene, bla(NDM), poses a serious threat to public health. In this study, we genetically characterized eight carbapenem-resistant Escherichia coli isolates from a tertiary care hospital in Yangon, Myanmar. The eight isolates belonged to five multilocus-sequence types and harbored multiple antimicrobial-resistance genes, resulting in resistance against nearly all of the antimicrobial agents tested, except colistin and fosfomycin. Nine plasmids harboring bla(NDM) genes were identified from these isolates. Multiple bla(NDM) genes were found in the distinct Inc-replicon types of the following plasmids: an IncA/C-2 plasmid harboring bla(NDM-1) (n = 1), IncX3 plasmids harboring bla(NDM-4) (n = 2) or bla(NDM-7) (n = 1), IncFII plasmids harboring bla(NDM-4) (n = 1) or bla(NDM-5) (n = 3), and a multireplicon F plasmid harboring bla(NDM-5) (n = 1). Comparative analysis highlighted the diversity of the bla(NDM)-harboring plasmids and their distinct characteristics, which depended on plasmid replicon types. The results indicate circulation of phylogenetically distinct strains of carbapenem-resistant E. coli with various plasmids harboring bla(NDM) genes in the hospital.

DOI： 10.1371/journal.pone.0184720

PCR-Dipstick Chromatography for Differential Detection of Carbapenemase Genes Directly in Stool Specimens Reviewed International journal

Rathina Kumar Shanmugakani, Yukihiro Akeda, Norihisa Yamamoto, Noriko Sakamoto, Hideharu Hagiya, Hisao Yoshida, Dan Takeuchi, Yo Sugawara, Takuya Kodera, Mitsuo Kawase, Warawut Laolerd, Narong Chaihongsa, Pitak Santanirand, Yoshikazu Ishii, Shigeyuki Hamada, Kazunori Tomono

ANTIMICROBIAL AGENTS AND CHEMOTHERAPY 61 ( 6 ) 2017.6

Language：English Publishing type：Research paper (scientific journal) Publisher：AMER SOC MICROBIOLOGY

A PCR-dipstick chromatography technique was designed and evaluated for differential identification of blaNDM, blaKPC, blaIMP, and blaOXA-48 carbapenemase genes directly in stool specimens within 2 h. It is a DNA-DNA hybridization-based detection system where PCR products can be easily interpreted by visual observation without electrophoresis. The PCR-dipstick showed high sensitivity (93.3%) and specificity (99.1%) in directly detecting carbapenemase genes in stool specimens compared with multiplex PCR for genomic DNA of the isolates from those stool specimens.

DOI： 10.1128/AAC.00067-17

Mycoplasma hominis periaortic abscess following heart-lung transplantation Reviewed International journal

Hideharu Hagiya, Hisao Yoshida, Norihisa Yamamoto, Keigo Kimura, Akiko Ueda, Isao Nishi, Yukihiro Akeda, Kazunori Tomono

TRANSPLANT INFECTIOUS DISEASE 19 ( 3 ) 2017.6

Language：English Publishing type：Research paper (scientific journal) Publisher：WILEY

We report the first case of Mycoplasma hominis periaortic abscess after heart-lung transplantation. The absence of sternal wound infection delayed the diagnosis, but the patient successfully recovered with debridement surgeries and long-term antibiotic therapy. Owing to the difficulty in detection and the intrinsic resistance to beta-lactams, M.hominis infections are prone to being misdiagnosed and undertreated. M.hominis should be suspected in cases where conventional microbiological identification and treatment approaches fail.

DOI： 10.1111/tid.12697

Nosocomial transmission of carbapenem-resistant Klebsiella pneumoniae elucidated by single-nucleotide variation analysis: a case investigation Reviewed International journal

Hideharu Hagiya, Kotaro Aoki, Yukihiro Akeda, Noriko Sakamoto, Norihisa Yamamoto, Hisao Yoshida, Isao Nishi, Yoshikazu Ishii, Kazunori Tomono

INFECTION 45 ( 2 ) 221 - 225 2017.4

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER HEIDELBERG

Identifying transmission route of antimicrobial-resistant pathogen is essential for appropriate infection control strategy in healthcare facilities. We report the utility of single-nucleotide variation analysis in tracing nosocomial transmission of antimicrobial-resistant pathogens by describing a pseudo-outbreak case of carbapenem-resistant Klebsiella pneumoniae. The present case highlights that infection control strategy should encompass pathological dissection rooms, neglected but potentially highly contaminated places in hospitals.

DOI： 10.1007/s15010-017-0986-3

Endoscopic Manifestations and Clinical Characteristics of Cytomegalovirus Infection in the Upper Gastrointestinal Tract Reviewed

Masaya Iwamuro, Eisei Kondo, Takehiro Tanaka, Hideharu Hagiya, Seiji Kawano, Yoshiro Kawahara, Fumio Otsuka, Hiroyuki Okada

ACTA MEDICA OKAYAMA 71 ( 2 ) 97 - 104 2017.4

Language：English Publishing type：Research paper (scientific journal) Publisher：OKAYAMA UNIV MED SCHOOL

We retrospectively analyzed the cases of 14 patients (9 women, 5 men, mean age: 51.6 years) with cytomegalovirus (CMV) involvement in the esophagus, stomach, and/or duodenum diagnosed at a single center, to determine their endoscopic features and clinical backgrounds. Thirteen patients (92.9%) had hematologic disease; the other had rheumatoid arthritis. Of the former, 12 patients underwent allogeneic hematopoietic stem cell transplantation, and 9 of these patients had graft-versus-host disease (GVHD) before undergoing esophagogastroduodenoscopy (EGD). All 14 patients had been taking one or more immunosuppressive agents including cyclosporine (n=10), corticosteroids (n= 9), mycophenolic acid (n= 6), tacrolimus (n=3), and methotrexate (n=1). Tests for CMV antigenemia were positive in 11 patients (78.6%). EGD examinations revealed esophageal (n=3), gastric (n=9), and duodenal involvement (n=6). Macroscopically, esophageal lesions by CMV infection presented as redness (n=1), erosions (n=1), and ulcers (n=1). Gastric lesions manifested as redness (n=7), erosions (n=3), exfoliated mucosa (n=2), and verrucous erosions (n=1). Mucosal appearances in the duodenum varied: redness (n=2), ulcers (n=2), multiple erosions (n=2), single erosion (n=1), edema (n=1). CMV was detected even in the intact duodenal mucosa (n=1). In conclusion, physicians must recall the relevance of CMV infection when any mucosal alterations exist in the upper gastrointestinal tract of immunosuppressed patients.

DOI： 10.18926/AMO/54977

Risk factors for Propionibacterium acnes infection after neurosurgery: A case-control study Reviewed International journal

Yuto Haruki, Hideharu Hagiya, Yu Takahashi, Hideyuki Yoshida, Kazuki Kobayashi, Tadato Yukiue, Nobushige Tsuboi, Tetsuhiro Sugiyama

JOURNAL OF INFECTION AND CHEMOTHERAPY 23 ( 4 ) 256 - 258 2017.4

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE BV

Propionibacterium acnes is increasingly known as a causative organism for post-neurosurgical infection; however, no clinical studies have examined the risk factors associated with P. acnes infections. Clinical data obtained from 14 cases of P. acnes infection and 28 controls infected with other pathogens were analyzed. Craniotomy, malignancy, and prolonged duration of operation were significantly associated with the onset of P. acnes infection. No fatal cases were reported. (C) 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jiac.2016.10.003

Development of selective medium for IMP-type carbapenemase-producing Enterobacteriaceae in stool specimens Reviewed International journal

Norihisa Yamamoto, Ryuji Kawahara, Yukihiro Akeda, Rathina Kumar Shanmugakani, Hisao Yoshida, Hideharu Hagiya, Naohiro Hara, Isao Nishi, Satomi Yukawa, Rumiko Asada, Yumi Sasaki, Kazuhiro Maeda, Noriko Sakamoto, Shigeyuki Hamada, Kazunori Tomono

BMC INFECTIOUS DISEASES 17 ( 1 ) 229 - 229 2017.3

Language：English Publishing type：Research paper (scientific journal) Publisher：BIOMED CENTRAL LTD

Background: Identification of carbapenemase-producing Enterobacteriaceae (CPE) in faecal specimens is challenging. This fact is particularly critical because low-level carbapenem-resistant organisms such as IMP-producing CPE are most prevalent in Japan. We developed a modified selective medium more suitable for IMP-type CPE.
Methods: Fifteen reference CPE strains producing different types of beta-lactamases were used to evaluate the commercially available CHROMagar KPC and chromID CARBA as well as the newly prepared MC-ECC medium (CHROMagar ECC supplemented with meropenem, cloxacillin, and ZnSO4) and M-ECC medium ( CHROMagar ECC supplemented with meropenem and ZnSO4). A total of 1035 clinical samples were then examined to detect CPE using chromID CARBA and M-ECC medium.
Results: All tested strains producing NDM-,KPC-, and OXA-48-carbapenemases were successfully cultured in the media employed. Although most of the IMP-positive strains did not grow in CHROMagar KPC, chromID CARBA, or MC-ECC, all tested strains grew on M-ECC. When faecal samples were applied to the media, M-ECC medium allowed the best growth of IMP-type CPE with a significantly higher sensitivity (99.3%) than that of chromID CARBA (13.9%).
Conclusions: M-ECC medium was determined as the most favourable selective medium for the detection of IMP-type CPE as well as other types of CPE.

DOI： 10.1186/s12879-017-2312-1

Pancreatic Neuroendocrine Tumor Abnormally Secreting Procalcitonin Reviewed International journal

Hideharu Hagiya, Takahiro Matsui, Tetsuhiro Kitamura, Takanori Inoue, Minoru Shigekawa, Hisao Yoshida, Eiichi Morii, Kazunori Tomono

PANCREAS 46 ( 1 ) E7 - E9 2017.1

Infective thoracic aortic aneurysm caused by Clostridium difficile after endovascular aortic repair Reviewed International journal

Hideharu Hagiya, Keigo Kimura, Akiko Ueda, Isao Nishi, Norihisa Yamamoto, Hisao Yoshida, Kazunori Tomono

JOURNAL OF INFECTION AND CHEMOTHERAPY 23 ( 1 ) 62 - 64 2017.1

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE BV

Clostridium difficile generally causes enterocolitis by producing pathogenic toxins, while extraintestinal infections with C. difficile are extremely rare. Here we report the first documented case of an infective thoracic aortic aneurysm caused by nontoxic C. difficile that occurred after vascular interventions including endovascular aortic repair. The present case illustrates that endovascular interventions may expose patients to the rare infection by yielding the ischemic intestinal tract as an entry site for the pathogen into the bloodstream and providing an anaerobic environment inside the thrombosed aneurysm. (C) 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jiac.2016.08.002

[Series: Diagnosis at a Glance]. Reviewed

Hagiya H, Thiansukhon E, Akeda Y, Oishi K, Tomono K

Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 106 ( 1 ) 127 - 129 2017.1

Successful treatment with glucocorticoid for secondary Fanconi syndrome caused by sarcoidosis Reviewed International journal

Daisuke Omura, Hideharu Hagiya, Yoshihisa Hanayama, Kou Hasegawa, Hiroshi Morinaga, Atsue Kikuta, Hitomi Kataoka, Fumio Otsuka

MODERN RHEUMATOLOGY 27 ( 3 ) 545 - 547 2017

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER

A 77-year-old female with renal dysfunction, hypercalcemia, and hypercalciuria was presented. Systemic investigations including renal biopsy showed that the patient had Fanconi syndrome secondary to renal sarcoidosis. Treatment with 25 mg per day of prednisolone was initiated and her condition improved. Complication of Fanconi syndrome in patients with sarcoidosis is extremely rare. Although the pathological mechanism is still unknown, corticosteroid therapy was effective for ameliorating proteinuria, glycosuria, hypercalciuria, and aminoaciduria.

DOI： 10.3109/14397595.2014.1002163

Paroxysmal Hypertension Induced by an Insulinoma Reviewed

Ko Harada, Yoshihisa Hanayama, Kou Hasegawa, Masaya Iwamuro, Hideharu Hagiya, Ryuichi Yoshida, Fumio Otsuka

INTERNAL MEDICINE 56 ( 4 ) 413 - 417 2017

Language：English Publishing type：Research paper (scientific journal) Publisher：JAPAN SOC INTERNAL MEDICINE

Insulinoma is a rare, usually benign, pancreatic neuroendocrine tumor. The clinical features of an insulinoma are fasting hypoglycemia with neuroglycopenic symptoms including confusion and unusual behavior, while hypertension is usually not associated with the disease. We herein report a patient with insulinoma who manifested paroxysmal hypertension and neuroglycopenic symptoms. The possible etiology of hypertension induced by an insulinoma is catecholamine release in response to hypoglycemia, which may cause acute hypertension through activation of the sympatho-adrenal system. This case implies that sustained hyperinsulinemia due to insulinoma can be functionally linked to the induction of paroxysmal hypertension.

DOI： 10.2169/internalmedicine.56.7758

Hypersensitivity Pneumonitis Caused by a Home Ultrasonic Humidifier Contaminated with Candida guilliermondii Reviewed

Akemi Ando, Hideharu Hagiya, Takahiro Nada, Kosuke Kimura, Koichi Waseda, Kammei Rai, Yoshihisa Hanayama, Fumio Otsuka

INTERNAL MEDICINE 56 ( 22 ) 3109 - 3112 2017

Language：English Publishing type：Research paper (scientific journal) Publisher：JAPAN SOC INTERNAL MEDICINE

We herein report the first documented case of acute hypersensitivity pneumonitis in which Candida guilliermondii was the possible causative organism. A young Japanese woman presented to our hospital with relapsing respiratory symptoms accompanied by high fever. A detailed interview revealed that the onset of the symptoms occurred shortly after using a humidifier in her home. Her symptoms showed spontaneous improvement soon after admission, and an examination of her bronchoalveolar lavage fluid revealed the specific infiltration of inflammatory cells, which predominantly consisted of lymphocytes. Precipitin testing showed a positive reaction to C. guilliermondii, which was isolated from the home humidifier. Repeated history taking is essential for diagnosing occult respiratory disorders.

DOI： 10.2169/internalmedicine.9055-17

Tramlines Emerging on a Lower Leg Reviewed

Hideharu Hagiya

INTERNAL MEDICINE 56 ( 15 ) 2079 - 2080 2017

Clinical Characteristics of Stenotrophomonas maltophilia Bacteremia: A Regional Report and a Review of a Japanese Case Series Reviewed

Hirotaka Ebara, Hideharu Hagiya, Yuto Haruki, Eisei Kondo, Fumio Otsuka

INTERNAL MEDICINE 56 ( 2 ) 137 - 142 2017

Language：English Publishing type：Research paper (scientific journal) Publisher：JAPAN SOC INTERNAL MEDICINE

Objective Stenotrophomonas maltophilia is an emerging nosocomial pathogen that causes fatal infections in critically ill or immunocompromised patients. S. maltophilia bacteremia (SMB) is a rare condition, and its clinical characteristics in Japanese settings are not well known.
Methods The medical charts of patients with SMB were retrospectively reviewed at two medical facilities (Okayama University Hospital and Tsuyama Chuo Hospital) for seven years. The data were analyzed along with those previously reported from other Japanese facilities.
Result A total of 181 patients (110 men and 71 women) were evaluated. The major underlying diseases included hematologic malignancy (36.5%), solid organ malignancy (25.4%), and neutropenia (31.5%). The recent use of carbapenem was seen in 56.9% of the cases in total, and more than one-third of the patients in our hospitals were treated with carbapenem at the onset of SMB. Of 28 (63.6%) of 44 cases treated for S. maltophilia, those who did not survive were more likely to have been treated with broad-spectrum antibiotics. A multivariate analysis revealed that a higher updated Charlson Comorbidity Index [odds ratio (95% confidence interval), 1.75 (1.11-2.75); p=0.015] and intubation [odds ratio (95% confidence interval), 12.6 (1.62-97.9); p=0.016] were associated with mortality in our cases. Pathogens were often resistant to ceftazidime but susceptible to minocycline, trimethoprim/sulfamethoxazole, and fluoroquinolones. The overall mortality rates within 30 and 90 days were 37.5% and 62.5%, respectively.
Conclusion The clinical characteristics of SMB in Japanese cases were similar to those reported from other countries. Clinicians should be aware that breakthrough infection by S. maltophilia may occur during administration of carbapenem.

DOI： 10.2169/internalmedicine.56.6141

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