Faculty Profiles - Kazuhiro Uda

Papers - Kazuhiro Uda

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Clinical characteristics and treatment of IMP-type carbapenemase-producing Enterobacteriaceae bacteremia: Case series and literature review. Reviewed International journal

Keiko Soneda, Kazuhiro Uda, Kotaro Araki, Takatsugu Murakoshi, Yuki Yuza, Osamu Saito, Kazue Kinoshita, Hiroshi Higuchi, Yuho Horikoshi

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 29 ( 1 ) 26 - 32 2022.9

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

BACKGROUND: Several carbapenemases have been identified globally in Enterobacteriaceae. In Japan, IMP-type carbapenemase is the most prevalent, although cases of carbapenemase-producing Enterobacteriaceae (CPE) bacteremia are still scarce. The present case series and literature review aimed to elucidate the clinical characteristics and treatment strategies for IMP-type CPE bacteremia. METHODS: Clinical data on pediatric cases of IMP-type CPE bacteremia at the Tokyo Metropolitan Children's Medical Center between 2010 and 2020 were collected, and a review of past studies of IMP-type CPE bacteremia has been provided. RESULTS: Five pediatric episodes of IMP-type CPE bacteremia were identified. Our review of previous literature on IMP-type CPE bacteremia revealed 24 adult patients, but no pediatric patients. All 29 cases had underlying diseases, and 23 (79%) received combination therapy. The median duration of antibiotic therapy was 14 days (interquartile range: 9-14 days). The overall mortality rate was 38% (11/29). The mortality rates associated with monotherapy and combination therapy were 67% (4/6) and 30% (7/23), respectively. CONCLUSIONS: We report the first case series of IMP-type CPE bacteremia in children. Our review of past studies suggests that combination therapy might lead to better survival outcomes in patients with IMP-type CPE bacteremia. Further research is needed to establish an optimal treatment strategy for IMP-type CPE bacteremia.

DOI： 10.1016/j.jiac.2022.09.003

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Neck Pain with Abdominal Distention in a Patient with Systemic Lupus Erythematosus. Reviewed International journal

Kazuhiro Uda, Kenji Shigehara, Masato Yashiro

Gastroenterology 2022.8

Terry's nails in an infant with liver cirrhosis. Reviewed International journal

Kazuhiro Uda, Mitsuru Tsuge, Kenji Shigehara, Masato Yashiro, Hirokazu Tsukahara

Archives of disease in childhood 107 ( 5 ) 485 - 485 2022.5

Infantile primary sternal osteomyelitis due to group B Streptococcus. Reviewed International journal

Koichiro Okumura, Shun Sakatani, Hanako Funakoshi, Kazuhiro Uda, Hiroshi Hataya

Pediatrics international : official journal of the Japan Pediatric Society 64 ( 1 ) e15030 2022.1

Change in use of pediatric oral antibiotics in Japan, pre- and post-implementation of an antimicrobial resistance action plan. Reviewed International journal

Noriko Iwamoto, Naho Morisaki, Kazuhiro Uda, Masashi Kasai, Eiichi N Kodama, Norio Ohmagari, Isao Miyairi

Pediatrics international : official journal of the Japan Pediatric Society 64 ( 1 ) e15197 2022.1

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

BACKGROUND: Most antimicrobials are prescribed to outpatients, making outpatient antibiotic prescription an important target for antibiotic stewardship. A national antimicrobial resistance (AMR) action plan was developed in 2016 by the Japanese government with various antimicrobials steawardship activities for pediatric outpatients. We aimed to evaluate changes in antibiotic use pre- and post-implementation of the AMR action plan. METHODS: All antimicrobials prescribed to pediatric outpatients in Japan from 2011 to 2018 were retrospectively analyzed using data from a national database. Antimicrobials dispensed for patients aged ≤19 years were reviewed. Antimicrobial use was surveyed by age, year of use, type of antimicrobial prescribed, and prescribing facility. Five cities were selected as pilot areas to investigate the variations, based on the clinical specialties of the prescribing physicians. RESULTS: Antimicrobial usage varied with age. Specifically, usage decreased post-AMR in patients aged ≤8 years and increased in those aged >15 years. Further, antimicrobial prescriptions tended to decrease after 2016 in primary care clinics and hospitals. In the pilot areas of the study, 35% of all oral antimicrobials were prescribed in otolaryngology departments, and 8% were prescribed in dermatology clinics. Notably, antimicrobial prescriptions from both departments showed an upward trend from 2011 to 2018. CONCLUSION: The use of antimicrobial agents decreased in children younger than 8 years in pediatric clinics, hospitals, and internal medicine clinics. However, use increased in children older than 15 years and in other specialty clinics. Settings with an increasing use of antimicrobials are potential targets for the next antibiotic stewardship program and should be investigated in detail.

DOI： 10.1111/ped.15197

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Acute Inguinal Bacterial Lymphadenitis in Infants Younger Than 1 Year of Age. Reviewed International journal

Reiko Yatabe, Kazuki Iio, Kazuhiro Uda, Hiroshi Hataya

The Pediatric infectious disease journal 40 ( 11 ) e450-e451 2021.11

Language：English Publishing type：Research paper (scientific journal) Publisher：Ovid Technologies (Wolters Kluwer Health)

We examined 17 infants under age 1 year with inguinal bacterial lymphadenitis; 8 had a prior episode of omphalitis or an umbilical procedure, and one-third were afebrile and initially received the misdiagnosis of incarcerated hernia. Our findings suggested a possible association between inguinal bacterial lymphadenitis in infants and umbilical problems.

DOI： 10.1097/INF.0000000000003262

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Change in clinical practice variations for antibiotic prescriptions across different pediatric clinics: A Japan's nationwide observational study. Reviewed International journal

Yusuke Okubo, Hiroki Nariai, Karin B Michels, Robert J Kim-Farley, Akihiro Nishi, Onyebuchi A Arah, Noriko Kinoshita, Kazuhiro Uda, Isao Miyairi

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 27 ( 11 ) 1621 - 1625 2021.11

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

BACKGROUND: In 2016, the Japanese government set the National Action Plan on antimicrobial resistance to reduce antibiotic prescriptions. However, the trends and variations of antibiotic prescription patterns in a routine healthcare setting during the fiscal year 2013-2018 across different clinics at a national level are unclear. METHODS: This retrospective cohort study included all clinics with >100 pediatric outpatients with infectious diseases per month during the fiscal year 2013-2018 using a national database in Japan. We investigated the trends in antibiotic prescription rates and their patterns and variations across different clinics over the six years following the 2019 World Health Organization Access, Watch, Reserve antibiotic groups, and Amoxicillin Index. RESULTS: A total of 2278 clinics with 94,414,170 infectious disease-related visits were eligible for the study. Most clinics showed higher Watch percentages (median 85.4%; IQR, 68.5-95.1) than Access percentages (median, 13.8%; IQR, 4.2-30.7) and Amoxicillin Index (median, 13.3%; IQR, 3.9-30.4). The introduction of the Action Plan changed annual absolute reductions in the antibiotic prescription rates from -16.0 DOTs/1000 visitors (95%CI, -16.4-15.6) to -239.3 per 1000 visitors (95%CI, -240.0-238.6). However, these impacts were heterogeneous across clinics. From 2013 to 2018, 41.4% reduced the antibiotic prescription rates by >33.3% (median, -1035.5 DOTs/1000 visitors; IQR, -1519.4-680.2), 18.7% did not change the rates (median, -40.3 DOTs/1000 visitors; IQR, -168.4-68.6), and 7.3% increased the rates by >10% (499.5 DOTs per 1000 visitors; IQR, 232.6-837.5). CONCLUSIONS: We observed the National Action Plan's impacts and extensive prescription variations across different pediatric clinics. However, one-fourth of clinics did not improve antibiotic prescription patterns even after introducing the Action Plan.

DOI： 10.1016/j.jiac.2021.07.020

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小児専門医療施設で2020年に経験したコロナウイルス感染症2019の臨床像 Reviewed

宇田和宏, 榊原裕史, 谷口公啓, 樋口浩, 木下和枝, 堀越裕歩, 舟越葉那子, 芝田明和, 鈴木知子, 幡谷浩史

日本小児科学会雑誌 125 ( 10 ) 1426 - 1433 2021.10

Identification of B.1.346 Lineage of SARS-CoV-2 in Japan: Genomic Evidence of Re-entry of Clade 20C. Reviewed

Kodai Abe, Takako Shimura, Toshiki Takenouchi, Yuka W Iwasaki, Hirotsugu Ishizu, Yoshifumi Uwamino, Shunsuke Uno, Jun Gotoh, Natsuo Tachikawa, Yuriko Takeuchi, Junpei Katayama, Hiroyuki Nozaki, Susumu Fujii, Shikou Seki, Morio Nakamura, Kazuhiro Uda, Takahiko Misumi, Jun Ishihara, Kenichiro Yamada, Toshio Kanai, Shinji Murai, Kazuhiro Araki, Tamotsu Ebihara, Haruhiko Siomi, Naoki Hasegawa, Yuko Kitagawa, Masayuki Amagai, Makoto Suematsu, Kenjiro Kosaki

The Keio journal of medicine 70 ( 2 ) 44 - 50 2021.6

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

SARS-CoV-2 whole-genome sequencing of samples from COVID-19 patients is useful for informing infection control. Datasets of these genomes assembled from multiple hospitals can give critical clues to regional or national trends in infection. Herein, we report a lineage summary based on data collected from hospitals located in the Tokyo metropolitan area. We performed SARS-CoV-2 whole-genome sequencing of specimens from 198 patients with COVID-19 at 13 collaborating hospitals located in the Kanto region. Phylogenetic analysis and fingerprinting of the nucleotide substitutions were performed to differentiate and classify the viral lineages. More than 90% of the identified strains belonged to Clade 20B, which has been prevalent in European countries since March 2020. Only two lineages (B.1.1.284 and B.1.1.214) were found to be predominant in Japan. However, one sample from a COVID-19 patient admitted to a hospital in the Kanto region in November 2020 belonged to the B.1.346 lineage of Clade 20C, which has been prevalent in the western United States since November 2020. The patient had no history of overseas travel or any known contact with anyone who had travelled abroad. Consequently, the Clade 20C strain belonging to the B.1.346 lineage appeared likely to have been imported from the western United States to Japan across the strict quarantine barrier. B.1.1.284 and B.1.1.214 lineages were found to be predominant in the Kanto region, but a single case of the B.1.346 lineage of clade 20C, probably imported from the western United States, was also identified. These results illustrate that a decentralized network of hospitals offers significant advantages as a highly responsive system for monitoring regional molecular epidemiologic trends.

DOI： 10.2302/kjm.2021-0005-OA

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Mycobacterium avium complex peritonitis in a pediatric patient on peritoneal dialysis: A case report. Reviewed International journal

Shunsuke Yokota, Kentaro Nishi, Sho Ishiwa, Kazuhiro Uda, Kensuke Shoji, Koichi Kamei

Medicine 100 ( 24 ) e26321 2021.6

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

INTRODUCTION: Peritonitis due to Mycobacterium avium complex (MAC) is a rare but life-threatening complication in patients on peritoneal dialysis (PD). However, optimal therapeutic regimen, treatment duration, and appropriate timing of kidney transplantation (KT) after treatment are unknown. SYMPTOMS: We herein report a 4-year-old boy on PD due to end-stage kidney disease resulting from bilateral hypoplastic kidneys. He was admitted for peritonitis complaining fever, abdominal pain, and cloudy peritoneal effluent on PD after accidentally biting and opening the PD catheter while in the bath. Initial treatment with vancomycin and ceftazidime for 2 weeks was successful, although peritonitis recurred 37 days after discharge. DIAGNOSIS: Mycobacterial culture was positive 9 days after readmission, and MAC was grown in the PD culture on day 30. We diagnosed him with MAC peritonitis that occurred on PD. INTERVENTIONS: Clarithromycin, ethambutol, and rifampicin were initiated. The PD catheter was removed, and hemodialysis was initiated with a cuffed catheter inserted in the internal jugular vein. Follow-up observation for 8 months after the cessation of 1-year anti-mycobacterial therapy confirmed no recurrence of MAC infection, and the patient received living-donor KT from his father. OUTCOMES: His renal function was stable, with no recurrence of MAC peritonitis at 2 years after the KT. CONCLUSION: To the best of our knowledge, this is the first report of a patient who successfully underwent KT after receiving treatment for MAC peritonitis. One-year anti-mycobacterial therapy, PD catheter removal, 8-month observation after the cessation of therapy led the successful KT, although further investigation is warranted to confirm the efficacy of this approach.

DOI： 10.1097/MD.0000000000026321

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Whole-Genome Sequencing of Shiga Toxin-Producing Escherichia coli OX18 from a Fatal Hemolytic Uremic Syndrome Case. Reviewed International journal

Kenichi Lee, Atsushi Iguchi, Kazuhiro Uda, Sohshi Matsumura, Isao Miyairi, Kenji Ishikura, Makoto Ohnishi, Junji Seto, Kanako Ishikawa, Noriko Konishi, Hiromi Obata, Ichiro Furukawa, Hiromi Nagaoka, Hirotaka Morinushi, Natsuki Hama, Ryohei Nomoto, Hiroshi Nakajima, Hideaki Kariya, Mitsuhiro Hamasaki, Sunao Iyoda

Emerging infectious diseases 27 ( 5 ) 1509 - 1512 2021.5

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

We report a fatal case of hemolytic uremic syndrome with urinary tract infection in Japan caused by Shiga toxin-producing Escherichia coli. We genotypically identified the isolate as OX18:H2. Whole-genome sequencing revealed 3 potentially pathogenic lineages (OX18:H2, H19, and H34) that have been continuously isolated in Japan.

DOI： 10.3201/eid2705.204162

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Kawasaki Disease Initially Presenting as Cervical Lymphadenopathy. Reviewed International journal

Anna Otani, Kazuki Iio, Kazuhiro Uda, Takahiro Matsushima, Hiroshi Sakakibara, Hiroshi Hataya

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases 27 ( 3 ) e88-e89 2021.4

WU polyomavirus detection in a pediatric liver transplant recipient with interstitial pneumonitis. Reviewed International journal

Kensuke Shoji, Chitose Koyama-Wakai, Kazuhiro Uda, Akinari Fukuda, Seisuke Sakamoto, Mureo Kasahara, Isao Miyairi

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 27 ( 3 ) 530 - 532 2021.3

Language：English

The WU polyomavirus (WUPyV) was detected by real-time PCR in the sputum of a pediatric liver transplant recipient with interstitial pneumonitis. A lower viral load was observed seven months after the initial detection. The case provides circumstantial evidence suggesting a potential role for WUPyV as a respiratory pathogen in immunocompromised children.

DOI： 10.1016/j.jiac.2020.10.016

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A 15-Month-old Boy With Kawasaki Disease-like Symptoms. Reviewed International journal

Hiroshi Hayashi, Kazuhiro Uda, Keiji Akamine, Nanako Kawata, Shogo Akahoshi, Masaki Shimizu, Yuho Horikoshi, Hiroshi Hataya

The Pediatric infectious disease journal 40 ( 2 ) 173 - 174 2021.2

National trends in appropriate antibiotics use among pediatric inpatients with uncomplicated lower respiratory tract infections in Japan. Reviewed International journal

Yusuke Okubo, Kazuhiro Uda, Noriko Kinoshita, Yuho Horikoshi, Isao Miyairi, Nobuaki Michihata, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 26 ( 11 ) 1122 - 1128 2020.11

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

BACKGROUND: Japan was ranked as the worst country of 36 high-income countries in terms of oral antibiotic consumptions for children. Knowing the patterns and variations of antibiotic use for pediatric inpatients with uncomplicated respiratory infections is an important step to promote judicious antibiotic use. METHODS: Discharge records were extracted for children aged between 3 months and 15 years with acute lower respiratory tract infections for the fiscal years 2010-2014 using a national inpatient database in Japan. We investigated the trends in antibiotic use using mixed effect regression models and ascertained variations and clustering of the practice patterns across different hospitals using unsupervised machine learning methodology. RESULTS: A total of 280,298 children were included in the study. Total and broad-spectrum antibiotic use, except for fluoroquinolone, showed decreasing trends from 2010 to 2014. Additionally, the proportions of patients who received no antibiotics or only penicillin increased from 17.1% to 9.9% in 2010 to 24.5% and 13.7% in 2014, respectively. Cluster analysis showed that only one-quarter of hospitals used no antibiotics for 28.8% of children and only penicillin for 53.7% of children. In the remaining clusters of hospitals, the piperacillin, 3rd generation cephalosporins, and penicillin beta-lactamase inhibitors were used for 68.5%, 68.5%, and 69.6% of the patients who received antibiotics. CONCLUSIONS: Slightly increasing trends in narrow-spectrum antibiotics were observed. However, the treatment strategy in only one-quarter of hospitals was consistent with the current recommendations. Hospital level interventions to promote and monitor antibiotic use could be helpful to improve antibiotic use for pediatric inpatients.

DOI： 10.1016/j.jiac.2020.04.025

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Impacts of Primary Care Physician System on Healthcare Utilization and Antibiotic Prescription: Difference-in-Differences and Causal Mediation Analyses. Reviewed International journal

Yusuke Okubo, Nobuaki Michihata, Kazuhiro Uda, Noriko Kinoshita, Yuho Horikoshi, Isao Miyairi

The Pediatric infectious disease journal 39 ( 10 ) 937 - 942 2020.10

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

BACKGROUND: The overutilization of healthcare and overuse/misuse of antibiotics in Japan are responsible for the increase in healthcare expenditure and the development of antimicrobial resistance. The Japanese government started paying incentives to medical facilities for primary care physician registrations, but the impact of this new policy is still unclear. METHODS: We conducted a retrospective cohort study for all pediatric outpatients from April 2015 to December 2016 in Japan, targeting 1.4 million children under 2 years of age. We investigated the effects of primary care physician registration on physician visits, total antibiotic use and admission rates using difference-in-differences (DID) and causal mediation analyses. RESULTS: DID analyses showed that primary care registration policy contributed to increases in total physician visits, total and broad-spectrum antibiotic use and radiologic study utilization, but reduced out-of-hour visits and did not affect hospitalization rates. Similar results were obtained when we adjusted for and matched on potential confounders. Causal mediation analyses found that the greatest pathway was controlled by direct effects of 53.2 DOTs per 1000 person-months (95% CI: 29.1-77.2), indicating that the effect of new health policy that did not mediate increased outpatient visits mostly contributed to the excess use of antibiotics. CONCLUSIONS: The health policy further increased antibiotic use. On April 2018, a new health policy of paying incentives for not prescribing antibiotics to children with respiratory infection or gastroenteritis was initiated. Further studies are needed whether this new health policy can mitigate the overutilization of healthcare and antibiotic use.

DOI： 10.1097/INF.0000000000002762

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Penile cyst. Reviewed International journal

Kazuhiro Uda, Satoko Suzuki, Yujiro Aoki, Hiroshi Sakiyama

Journal of paediatrics and child health 56 ( 8 ) 1317 - 1317 2020.8

A Pediatric Case of Septic Arthritis Caused by Methicillin-Resistant Staphylococcus aureus with Panton-Valentine Leukocidin and Toxic Shock Syndrome Toxin-1. Reviewed

Kazuhiro Uda, Yuki Uehara, Yuh Morimoto, Keiichi Hiramatsu, Isao Miyairi

Japanese journal of infectious diseases 73 ( 3 ) 259 - 262 2020.5

Incidence and aetiology of serious viral infections in young febrile infants. Reviewed International journal

Itaru Hayakawa, Osamu Nomura, Kazuhiro Uda, Yu Funakoshi, Hiroshi Sakakibara, Yuho Horikoshi

Journal of paediatrics and child health 56 ( 4 ) 586 - 589 2020.4

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

AIM: While the incidence and aetiology of serious bacterial infections among febrile infants younger than 90 days old are well studied, those concerning viral infection are not. There are severe life-threatening viral infections requiring immediate intense therapy. The objective of the study is to describe the incidence and aetiology of serious viral infections (SVI) among young febrile infants. METHODS: A retrospective audit was performed covering all the febrile infants younger than 90 days old admitted to a paediatric emergency department in Japan from 2011 to 2013. SVI was defined as a viral illness that may result in permanent organ dysfunctions or life-threatening complications. Diagnostic investigation consisted of urine and blood culture for all infants, cerebrospinal fluid cultures for infants who do not fulfil the low-risk criteria, rapid antigen tests for several viruses in infants with specific symptoms and blood and/or cerebrospinal fluid polymerase chain reaction of possible viruses for infants with fever without a localising source. RESULTS: Of 275 cases, 32 and 45 cases were diagnosed as serious viral and bacterial infections, respectively. Intensive care unit admission occurred for three viral and four bacterial infections. Viral aetiology consisted of respiratory syncytial virus (11 cases), aseptic meningitis (9 cases), enterovirus (6 cases), influenza virus (3 cases), rotavirus (2 cases) and herpes simplex virus-1 (1 case). Respiratory (14 cases), central nervous (12 cases) and circulatory (6 cases) systems were affected. CONCLUSION: SVI was observed in 11.6% of febrile young infants in a paediatric emergency department.

DOI： 10.1111/jpc.14692

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Response to: Significance of prolonged PR interval in infections. Reviewed International journal

K Uda, Y Horikoshi, M Miura

QJM : monthly journal of the Association of Physicians 113 ( 2 ) 152 - 152 2020.2

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Papers - Kazuhiro Uda