Clinical Characteristics of Invasive Methicillin-Resistant Staphylococcus aureus at General Hospital in the Central Region of Japan from July 2014 to June 2015

Methicillin-resistant Staphylococcus aureus is crucial pathogen caused severe invasive infection disease. This study was conducted to find out the prevalence and antimicrobial susceptibility pattern of invasive Methicillin-resistant Staphylococcus aureus isolates at general hospital in the central region of Japan from July 2014 to June 2015. Methicillin-resistant Staphylococcus aureus was identified by standard laboratory procedure. Antimicrobial susceptibility testing was performed by micro dilution assay according to CLSI recommendation. Invasive Methicillin-resistant Staphylococcus aureus disease was defined as isolation of bacteria from a normally sterile body site. One hundred seventy-one methicillin-resistant Staphylococcus aureus were isolated among which 95 (55.6%) were from inpatient and 76 (44.4%) were from outpatient. The age incidence of (0 - 1) years, (1 - 10) years, (11 - 40) years, (41 - 60) years and >60 years age groups were 18 (10.5%), 41 (24.0%), 15 (8.8%), 5 (2.9%), and 92 (53.8%) respectively. There was significant difference of age distribution between invasive and noninvasive disease in 0 - 1 years group and 11 - 40 years age group. Positive samples were received mostly from the pediatrics (56/32.7%), respiratory medicine (25/14.6%) and general medicine (25/14.6%). We also found the significant differences of department between invasive and noninvasive disease in pediatrics, dermatology, and surgery. Arbekacin, teicoplanin, and vancomycin were the most active antibiotics with 100% susceptible rates in our study. Our study revealed that erythromycin and gentamicin were more antimicrobial effective in invasive disease than in noninvasive disease significantly. Methicillin-resistant Staphylococcus aureus infection spreads worldwide easily and inadequate use of antibiotics contributes to uptake of their new antimicrobial resistance. Continuous antimicrobial surveys are need for guiding policy on the adequate use of antibiotics to reduce the morbidity and mortality.

Clinical Characteristics of Vaginal Discharge Associated Streptococcus pyogenes at General Japanese Hospital

Streptococcus pyogenes (S. pyogenes) is popular pathogen caused various infectious disease. This study was conducted to find out the recent clinical characteristics of S. pyogenes isolates from vaginal discharge at Japanese hospital. S. pyogenes was identified by standard laboratory procedure. Antimicrobial susceptibility testing was performed by microdilution assay according to CLSI recommendation. Total 61 S. pyogenes were isolated from vaginal discharge. The major age incidence among 0 - 10 years age group was 14 (23%), among 21 - 30 years age group, 7 (11.5%), among 31 - 40 years age group, 13 (21.3%), among 51 - 60 years age group, 8 (13.1%), and among 61 - 70 years age group, 11 (18%). The numbers of ciprofloxacin and clarithromycin no-susceptible S. pyogenes from 0 - 10, 31 - 40, and 61-70 years age group were higher than those from other groups. The numbers of clindamycin and minocycline no susceptible S. pyogenes from 0 - 10, and 21 - 40 years age group were higher than those from other group. Furthermore, our study revealed that clarithromycin was completely ineffective in 21 - 30 years age group (p S. pyogenes because the trend of infectious disease epidemiology is always changing drastically.

Clinical Characteristics of Respiratory Tract-Associated Streptococcus pyogenes at General Japanese Hospital in 2014

Streptococcus pyogenesis most popularpathogen caused respiratory tract infection disease. This study was conducted to find out the recent clinical characteristics of Streptococcus pyogenes isolates from respiratory tract at Japanese hospital in 2014. Streptococcus pyogenes was identified by standard laboratory procedure. Antimicrobial susceptibility testing was performed by micro dilution assay according to CLSI recommendation. Respiratory tract isolates were defined as isolation from pharynx, nasal discharge, tonsillar, and sputum. Total one hundred sixty-one Streptococcus pyogenes were isolated among which 136 were from respiratory tract and 25 were from non- respiratory tract. Respiratory tract-associated Streptococcus pyogenes was isolated among which 102 were from male and 59 were from female. The age incidence among 0 - 1 years age group was 8, among 1 - 18 years age group, 131 (p < 0.01), among 19 - 64 years age group, 17 (p < 0.01), and in 65-years it was 5. Although we investigated the relationship between season and bacterial isolation, we did not find any significant differences between respiratory tract and no respiratory tract isolation. However, our study revealed that clarithromycin was less antimicrobial effective in respiratory tract disease than in no respiratory tract disease significantly (p < 0.01). Although several antibiotics such as penicillin are still effective against Streptococcus pyogenes, incidence of Streptococcus pyogenes infection is not decreasing worldwide. Our study suggests the need for continuous epidemiological surveillance of Streptococcus pyogenes.

Clinical impact of gastrointestinal endoscopy on the early detection of pharyngeal squamous cell carcinoma: A retrospective cohort study

BACKGROUND In recent years,with the growing availability of image-enhanced gastrointestinal endoscopy,gastroenterologists have contributed to the early detection of pharyngeal squamous cell carcinomas(SCC).AIM To clarify the clinical characteristics of pharyngeal SCCs detected by gastrointestinal endoscopy.METHODS This is a retrospective cohort study conducted in a single-center,a university hospital in Japan.We retrospectively assessed the clinical records of 522 consecutive patients with oropharyngeal or hypopharyngeal SCC who were examined in our hospital between 2011 and 2018.The lesions were classified into two groups:Group GE(detected by gastrointestinal endoscopy)and Group non-GE(detected by means other than gastrointestinal endoscopy).The clinical characteristics were compared between the two groups.Continuous data were compared using the Mann–Whitney U test.Pearson’sχ2 test or Fisher's exact test was used to analyze the categorical data and compare proportions.The Kaplan–Meier method was used to estimate the cumulative patient survival rates.RESULTS In our study group,the median age was 65 years and 474 patients(90.8%)were male.One hundred and ninety-six cases(37.5%)involved the oropharynx and 326 cases(62.5%)involved the hypopharynx.Three hundred and ninety-five cases(75.7%)had some symptoms at the time of diagnosis.One hundred and forty-five(27.8%)cases had concurrent ESCC or a history of ESCC.One hundred and sixtyfour(31.4%)cases were detected by gastrointestinal endoscopy and classified as Group GE.The proportions of asymptomatic cases,cTis-1 cases and cases with no lymph node metastasis were significantly higher in Group GE than Group non-GE(61.6%vs 7.3%,P<0.001,32.9%vs 12.0%,P<0.001 and 69.5%vs 19.0%,P<0.001).Endoscopic laryngo-pharyngeal surgery or endoscopic submucosal dissection were performed in only 0.6%of the lesions in Group non-GE but in 21.3%of the lesions in Group GE(P<0.001).Overall survival was significantly longer in Group GE than in Group non-GE(P=0.018).The 2-year and 4-year survival rates were 82.5%and 70.7%in Group GE,and 71.5%and 59.0%in Group non-GE,respectively.CONCLUSION Gastrointestinal endoscopy plays an important role in the early detection and improving the prognosis of pharyngeal SCCs.

Development of an Enteric Bacterial Enrichment Broth and Its Performance for Isolation of Clinically Significant Bacterial Pathogens from Stool

Background: Early detection and accurate identification of foodborne pathogen outbreaks is an important public health function. Increased clinical adoption of multiplex PCR assays or culture independent diagnostic tests (CIDT) correlates to more stool specimens sent to public health laboratories (PHL) for characterization. Isolation and confirmation of enteric bacterial pathogens can prove difficult to consistently recover. The purpose of this study was to evaluate the performance of a broad-use laboratory developed enrichment broth for isolation of Campylobacter, Salmonella, Shigella, and Yersinia strains from stool specimens. Methods: The study compared differences in positivity rates among media and enrichment combinations at specific time points. Comparison of direct inoculation (DI), enrichment using a lab-developed Enteric Bacterial Enrichment (EBE) broth and gold-standard isolation methods were conducted to test current utility of this established practice with stool specimens heat injured and non-injured. Results: A total of 234 spiked stool samples, 175 non-injured and 59 heat injured, were tested with varying bacterial concentrations. For non-injured stools, direct inoculation performed better for Campylobacter and Yersinia than enrichment. Conversely, Salmonella and Shigella recovery and limit of detection increased with enrichment. Campylobacter had the highest percent recovery while Shigella being the lowest from direct plating at 6-hour and 24-hour enrichment periods. Among broths, EBE performed the best for Yersinia and similar to Selenite broth for Salmonella and Shigella. Generally, heat injured stool had a significantly lower percent of recovery than non-heat injured with a higher limit of detection across organisms. Conclusion: Our data suggest there is an only utility for targeted enrichment of CIDT positive Salmonella stool specimens. We highlight the difficulties of formulating an enrichment broth capable of supporting a variety of enteric pathogens with standardized incubation. Increasing demands on PHL infrastructure warrant further examination of enhancing organism isolation and cost analyses for CIDT positive specimens.

Clinical Characteristics of Haemophilus influenzae at General Hospital in the Central Region of Japan

Haemophilus influenzae is an important pathogen that caused several infection diseases, such as sinusitis, otitis media, sepsis, and meningitis. This study was conducted to find out the prevalence and antimicrobial susceptibility pattern of Haemophilus influenzae isolates at general hospital in the central region of Japan from December 2015 to January 2016. Haemophilus influenzae was identified by standard laboratory procedure. Antimicrobial susceptibility testing was performed by micro dilution assay according to CLSI recommendation. One hundred ninety-one Haemophilus influenzae were isolated, among which 95 (49.7%) were from male and 96 (50.3%) were from female. The age incidence of (0) years, (≤2) years, (≤5) years, and (6≤) years groups were 22(11.5%), 92(48.2%), 61(31.9%), and 16(8.4%), respectively. Positive samples were received mostly from the nasal discharge (177/92.7%), sputum (6/3.1%), tonsillar (6/3.1%), and pharynx (2/1.0%). Ceftriaxone was the most active antibiotics with 100% susceptible rates, followed by ciprofloxacin (99.5%) and minocycline (99%) in our study. Furthermore, we categorized four patterns: beta lactamase-negative ampicillin-sensitive strain (BLNAS), beta lactamase-negative ampicillin-re- sistant strain (BLNAR), beta lactamase-positive ampicillin resistant strain (BLPAR), and beta lactamase-positive amoxicillin-clavulanic acid-resistant strain (BLPACR) from those ampicillin susceptible results. The numbers of female were significant greater than those of male in BLPAR (p = 0.0336). With respect to antimicrobial susceptible pattern, there was no minocycline and piperacillin resistant strain in both BLNAS and BLNAR (p

Trend of Respiratory Tract-Associated Streptococcus dysgalactiae Subsp. Equisimilius at General Japanese Hospital from 2013 to 2015

Streptococcus dysgalactiae subsp. equisimilius are pathogenic bacteria which cause various infectious diseases from acute pharyngitis to streptococcal toxic shock syndrome. Although Streptococcus dysgalactiae subsp. equisimilius infection has been increasing recently, the recent characteristic investigation of respiratory tract associated Streptococcus dysgalactiae subsp. equisimilius has not been performed in Japan. In this study, we analyzed the relationship between respiratory tract and norespiratory tract associated Streptococcus dysgalactiae subsp. equisimilius by investigating the recent clinical characteristics and antimicrobial susceptible patterns of 98Streptococcus dysgalactiae subsp. equisimilius isolated during 2013-2015 in Japan. There was significant difference of gender between respiratory tract and no respiratory tract associated Streptococcus dysgalactiae subsp. equisimilius. No Streptococcus dysgalactiae subsp. equisimilius from no respiratory tract were found under 18 years-old patients. The prevalence of clindamycin non susceptible Streptococcus dysgalactiae subsp. equisimilius isolates from respiratory tract was significant greater than those from non-respiratory tract. We also analyzed the relationship between respiratory tract associated Streptococcus dysgalactiae subsp. equisimilius and Streptococcus pyogenes in 2014.There was no significant difference of gender between Streptococcus dysgalactiae subsp. equisimilius and Streptococcus pyogenes. The numbers of Streptococcus pyogenes-infected patients were significantly greater than those of Streptococcus dysgalactiae subsp. equisimilius-infected patients in children from 1 to 18 years old. From antimicrobial resistance, we found that the numbers of clarithromycin resistant Streptococcus pyogenes were greater than those of clarithromycin resistant Streptococcus dysgalactiae subsp. equisimilius among respiratory tract isolation. Our results suggest that the clinical and antimicrobial susceptible patterns are useful for screening the respiratory tract associated Streptococcus dysgalactiae subsp. equisimilius infection.

Prevalence and Antimicrobial Susceptibility Pattern of Streptococcus pneumoniae at General Hospital in the Central Region of Japan from December 2013 to February 2014

Streptococcus pneumonia infection is important cause of morbidity and mortality. This study was conducted to find out the prevalence and antimicrobial susceptibility pattern of Streptococcus pneumoniae isolates at general hospitalin the central region of Japan from December 2013 to February 2014. Streptococcus pneumoniae was identified by standard laboratory procedure. Antimicrobial susceptibility testing was performed by micro dilution assay according to CLSI recommendation. One hundred fifty-three Streptococcus pneumoniae were isolated among which 80 (52.2%) were males and 73 (47.8%) were females. Nasal discharge (134%/87.6%) contributed more than other biological materials. The age incidence of (0 - 1) years, (1 - 10) years, (11 - 40) years, (41 - 60) years and >60 years age groups were 26 (17.0%), 110 (71.9%), 3 (2.0%), 10 (6.5%), and 4 (2.6%) respectively. Positive samples were received mostly from the pediatrics (137%/89.5%), respiratory medicine (12%/7.8%) and lowest from gastroenterology (1%/0.6%) and neurology (1/ 0.6%) department. Vancomycin and rifampicin were the most active antibiotics with 100% susceptibility rates. The next best were levofloxacin, penicillin G and ceftriaxone. Our study revealed that 82 Streptococcus pneumonia isolates had multidrug resistant ability (53.6%). Streptococcus pneumoniae infection spreads among community easily and inappropriate use of antibiotics contributes to their resistance. Continuous antimicrobial susceptible surveys are essential to guide policy on the adequate use of antibiotics to reduce the morbidity and mortality and reduce the emergency of antimicrobial resistance.

LicT Modulates Biofilm Formation of Streptococcus pyogenes

Streptococcus pyogenes frequently causes purulent infections in humans. Biofilm formation is an important virulence property of S. pyogenes because of decreased susceptibility of bacteria to antibiotic treatment. Biofilm is composed of various types of matrix including glycocalyx which is an important exocellular matrix material related to bacterial sugar metabolism. A putative antiterminator protein, LicT (Spy0571), is one of the components of the glucose-independent β-gluco-side-specific phosphotransferase system (PTS). Although the PTS, a carbohydrate metabolic system, may play a role in biofilm formation, the relationship between LicT and biofilm formation has not yet been elucidated. Here, we evaluated whether LicT affected biofilm formation in modified chemically defined medium (CDMM) supplemented with glucose or β-glucoside:salicin. We created licT- and licT-complemented mutant strains from S. pyogenes 1529. Although the licT mutant strain tended to have higher growth rate than wild-typestrain in CDMM with glucose, it had a significant lower growth rate than the wild-type strain in CDMM with salicin. In addition, the licT mutant exhibited lower biofilm formation in CDMM containing salicin than the wild-type strain by 96 well plate analysis and confocal laser scanning microscopic analysis. Our results suggest that LicT plays an important role in biofilm formation of S. pyogenes.

Description of United States Military Nurses Deployed to Afghanistan &Iraq, 2001-2015

Since 2001, US military forces have been engaged in Afghanistan and in Iraq. During fifteen years of conflict in both operations US troops have incurred a total of 52,022 wounded and 6857 deaths. The aim of this analysis is to describe the characteristics of US military nurses that deployed to these combat theatres. Data for this retrospective analysis were provided by the US Department of Defense, Defense Manpower Data Center and describes characteristics military nurses that deployed to Afghanistan, Iraq, or both between September 1, 2001 and July 31, 2015. A total of 6326 nurses deployed during this period;3296 nurses deployed to Afghanistan and 2683 nurses deployed to Iraq. Fifty-five percent of deployed nurses were male. The majority of deployed nurses were white (32.9%) followed by Hispanic (22.9%) and black nurses (14.5%). Most deployed nurses had a baccalaureate nursing degree (88.9%) and 9% deployed nurses had an advanced degree. Most deployed nurses were classified as general nurses (66.6%). Further research is needed to examine in detail the impacts of deployments upon nurses.

Comparative Study of Urosepsis-Associated Escherichia coli in Tertiary Care University Hospital in the Central Region of Japan from 2008 to 2011

Escherichia coli infection is important cause of morbidity and mortality. Urosepsis is most commonly caused by Escherichia coli. It is generally reported to have low mortality rates and favorable outcomes compared with sepsis induced in other organ/ system or tissues. This study was conducted to find out the clinical characteristics of urosepsis-associated Escherichia coli isolates at tertiary care university hospital in the central region of Japan from 2008 to 2011. Escherichia coli was identified by standard laboratory procedure. Antimicrobial susceptibility testing was performed by micro dilution assay according to CLSI recommendation. We analyzed the relationship between medical records appended to clinical species and bacterial data by using a statistical method. Of one hundred five Escherichia coli, fifty-three were from urosepsis and fifty-two were from other disease. The ratio of male to female from urosepsis tended to be lower than that from others. Forty-two isolates were from outpatient and sixty-three were from inpatient. The ratio of inpatient to outpatient from urosepsis was significant lower than that from others. With respect to age, the numbers of elder patients were higher than those of others. Most of the Escherichia coli isolates were from the emergency room followed by urology, and general medicine. The ratio of urosepsis to no urosepsis at urology department was significant higher than that at other departments. With respect to antimicrobial susceptible pattern, the ratio of urosepsis to no urosepsis about only aztreonam resistant was significant higher than that about other antibiotics. We need enough attention to be paid to urosepsis, especially female and elder patients.

Soluble ST2:A new and promising activity marker in ulcerative colitis

AIM:To correlate circulating soluble ST2(sST2) levels with the severity of ulcerative colitis(UC) and serum levels of pro-inflammatory cytokines,and to demonstrate the predictive power of sST2 levels for differentiation between active and inactive UC.METHODS:We recruited 153 patients:82 with UC,26 with Crohn's disease(CD) and 43 disease controls [non-inflammatory bowel disease(IBD)].Subjects were excluded if they had diagnosis of asthma,autoimmune diseases or hypertension.The serum levels of sST2 and pro-inflammatory cytokines [pg/mL;median(25th-75th)] as well as clinical features,endoscopic and histological features,were subjected to analyses.The sST2 performance for discrimination between active and inactive UC,non-IBD and healthy controls(HC) was determined with regard to sensitivity and specificity,and Spearman's rank correlation coefficient(r).To validate the method,the area under the curve(AUC) of receiver-operator characteristic(ROC) was determined(AUC,95% CI) and the total ST2 content of the colonic mucosa in UC patients was correlated with circulating levels of sST2.RESULTS:The serum sST2 value was significantly higher in patients with active [235.80(90.65-367.90) pg/mL] rather than inactive UC [33.19(20.04-65.32) pg/mL],based on clinical,endoscopic and histopathological characteristics,as well as compared with non-IBD and HC(P < 0.001).The median level of sST2 in CD patients was 54.17(35.02-122.0) pg/mL,significantly higher than that of the HC group only(P < 0.01).The cutoff was set at 74.87 pg/mL to compare active with inactive UC in a multicenter cohort of patients.Values of sensitivity,specificity,and ability to correctly classify UC,according to activity,were 83.33%,83.33% and 83.33%,respectively.The AUC of the ROC curve to assess the ability of this molecule to discriminate between active vs inactive UC was 0.92(0.86-0.97,P < 0.0001).The serum levels of sST2 in patients with UC significantly correlated with endoscopic and histo-pathological scores(r = 0.76 and r = 0.67,P < 0.0001,respectively),and with the pro-inflammatory cytokine,tumor necrosis factor-α(r = 0.69 and r = 0.61,respectively,P < 0.0001).Interestingly,we found a direct correlation between total intestinal ST2 content and serum levels of sST2,adjusted to endoscopic activity score in patients with mild(r = 0.44,P = 0.004),moderate(r = 0.59,P = 0.002) and severe disease(r = 0.82,P = 0.002).Only patients with inactive UC showed no significant correlation(r = 0.45,P = 0.267).CONCLUSION:sST2 levels correlated with disease severity and inflammatory cytokines,are able to differentiate active from inactive UC and might have a role as a biomarker.