研究者詳細 - 川村　英樹

論文 - 川村　英樹

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大岡唯祐, 蘭牟田直子, 西順一郎, 森田喜紀, 今村真理, 重久朋史, 上野伸広, 相星壮吾, 山本真実, 新川奈緒美, 川村英樹, 馬場洋一, 柿澤広美, 伊藤武, 後藤恭宏, 林哲也 . 2018年のSalmonella enterica serovar Oranienburg菌血症集積事例株と同一クローン由来株による新たな感染事例と各地の食品取り扱い従事者からの同クローンの分離 . 病原微生物検出情報月報44 ( 8 ) 127 - 128 2023年8月

記述言語：日本語出版者・発行元：国立感染症研究所

Salmonella enterica serovar Oranienburg菌血症感染事例のクローン分離を行った。患者由来株は2022年7月の鹿児島県内における散発症例2例から分離された株、食品取り扱い従事者由来株は2019年に食品取り扱い従事者検便から分離された8株を供試した。食品取り扱い従事者糞便由来2019年分離株7株(福岡県3株、宮崎県1株、熊本県1株、大阪府1株、兵庫県1株)と2022年鹿児島県患者由来2株は2018年菌血症集積事例株との株間のSNP数が約4.7Mbpのゲノム配列のなかで18塩基以内であり、2018～2022年までの約4年間で生じる変異頻度から同一クローン由来と推定された。その他の食品取り扱い従事者糞便由来1株は上記の株と39塩基以上のSNP数があり、2018年の菌血症集積事例株およびその派生株とはまったく異なる系統に分類された。

川村英樹 . Special feature コロナ禍で浮き彫りとなった高齢者施設･精神科病院の感染対策 ■高齢者施設の感染対策 ❹換気対策(エアロゾル感染対策)を含めた経路別予防策 . 感染対策ICTジャーナル18 ( 3 ) 179 - 184 2023年7月

Ichiki K., Ooka T., Shinkawa T., Inoue S., Hayashida M., Nakamura D., Akimoto M., Yoshimitsu M., Kawamura H., Nakamura M., Obama Y., Gotoh Y., Hayashi T., Nishi J., Ishitsuka K. . Genomic and phylogenetic characterization of Elizabethkingia anophelis strains: The first two cases of life-threatening infection in Japan . Journal of Infection and Chemotherapy29 ( 4 ) 376 - 383 2023年4月

記述言語：日本語出版者・発行元：Journal of Infection and Chemotherapy

Objective: Elizabethkingia anophelis causes meningitis, bloodstream infections, and respiratory infections in immunocompromised individuals. We examined two E. anophelis strains isolated from the first life-threatening cases caused by this species in Japan to determine the phylogenetic origin and genomic features of them. Methods: We performed whole genome-based analysis to clarify the genetic relationship for the two strains (EK0004 and EK0079) and Elizabethkingia sp. strains isolated from worldwide and to characterize the genomic features such as the prevalence of virulence- and antimicrobial resistance (AMR)-related genes. Patients: A 29-year-old man with hepatosplenic T-cell lymphoma and a 52-year-old man with systemic lupus erythematosus developed fatal bacteremia and meningitis due to E. anophelis, respectively. Results: Two strains, EK0004 and EK0079, were genetically different but most closely related to the strains isolated from the largest outbreak in Wisconsin, USA from 2015 to 2016, and the strain isolated from cerebrospinal fluid of a patient in Florida, USA in 1982, respectively. The two strains contained AMR-related genes such as those encoding for an extended-spectrum β-lactamase and multiple metallo-β-lactamases and several virulence-related genes such as capsular polysaccharide synthesis gene clusters. Conclusions: Although further functional analyses are required to understand the virulence of these clones, these finding suggests that enough caution of E. anophelis infection in immunocompromised patients is required since the number of infections by this species is increasing outside Japan.

DOI： 10.1016/j.jiac.2023.01.005

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川村英樹 . 特集ポストコロナ時代の感染症診療第II章　感染症診療各論 [7]泌尿器･生殖器感染症 1　膀胱炎 . 診断と治療111 ( 13 ) 167 - 170 2023年3月

Ooka T, Gotoh Y, Hatanaka S, Yoshimori M, Nishitarumizu K, Kojo K, Kosakamoto H, Sameshima K, Kuroki Y, Chibana N, Doi Y, Yoshino S, Harada T, Seto K, Ikeda T, Miyanohara H, Nakayama K, Gokuden M, Imuta N, Kawamura H, Ogura Y, Hayashi T, Nishi J . A Salmonella enterica Serovar Oranienburg Clone Caused a Cluster of Bacteremia Cases in Persons With No Recognizable Underlying Diseases in Japan. . Open forum infectious diseases10 ( 1 ) ofac695 2023年1月

記述言語：英語出版者・発行元：Oxford University Press (OUP)

<jats:title>Abstract</jats:title>
<jats:sec>
<jats:title>Background</jats:title>
<jats:p>Salmonella enterica subspecies enterica serovar Oranienburg (SO) is a foodborne pathogen but rarely causes systemic infections such as bacteremia. Between July and September 2018, bacteremia cases caused by SO were identified in 12 persons without any underlying medical conditions in the southern Kyushu area of Japan.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>Randomly amplified polymorphic DNA (RAPD) analysis was performed to investigate the genetic similarity of the 12 bacteremia-related strains and other Japanese isolates. Furthermore, a series of whole-genome sequence (WGS)–based phylogenetic analyses was performed with a global SO strain set (n = 1648).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>The resolution power of RAPD was insufficient to investigate the genetic similarity between the bacteremia-related strains and other strains. WGS-based phylogenetic analyses revealed that the bacteremia-related strains formed a tight cluster along with 2 strains isolated from asymptomatic carriers in 2018 in the same area, with a maximum within-cluster single-nucleotide polymorphism (SNP) distance of 11. While several strains isolated in the United States and the United Kingdom were found to be closely related to the bacteremia-related strains, 2 strains isolated in 2016 in the southern Kyushu area were most closely related, with SNP distances of 4–11 and 5–10, and had the same plasmids as the bacteremia-related strains.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>The 12 bacteremia cases identified were caused by a single SO clone. As none of the bacteremia patients had any underlying diseases, this clone may be prone to cause bacteremia. Although further analyses are required to understand its virulence, particular attention should be given to this clone and its close relatives in the surveillance of nontyphoidal salmonellae.</jats:p>
</jats:sec>

DOI： 10.1093/ofid/ofac695

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Kawamura H., Imuta N., Ooka T., Shigemi A., Nakamura M., Mougi K., Obama Y., Fukuyama R., Arimura S., Murata N., Tominaga H., Sasaki H., Nagano S., Taniguchi N., Nishi J. . Impact of control measures including decolonization and hand hygiene for orthopaedic surgical site infection caused by MRSA at a Japanese tertiary-care hospital . Journal of Hospital Infection 2023年

記述言語：日本語出版者・発行元：Journal of Hospital Infection

Background: Meticillin-resistant Staphylococcus aureus (MRSA) is the most common pathogen in orthopaedic surgical site infections (SSIs). However, few studies have investigated the transmission process of orthopaedic MRSA SSI. Aim: To investigate the transmission process of orthopaedic MRSA SSI using epidemiological and molecular analyses and to determine a method to prevent MRSA SSI in nosocomial orthopaedic surgery. Methods: Active MRSA surveillance, preoperative decolonization and contact precautions for MRSA-positive cases was performed at our institution. Changes in epidemic strains were evaluated and the possibility of transmission from patients in an orthopaedic ward of a Japanese tertiary-care hospital was assessed by genotyping stored MRSA strains. In addition, data on the prevalence of MRSA SSI, MRSA colonization, and use of an alcohol antiseptic agent (mL/patient-days) during 2005–2022 were retrospectively assessed. Findings: SCCmec type II strain in the SSI group decreased over time, associated with fewer outbreaks. Even during a period of high infection rates, no cases of transmission-induced SSI from nasal MRSA carriers were identified. The infection rate correlated negatively with the use of an alcohol antiseptic agent (r = −0.82; P < 0.0001). Two cases among five nasal carriers developed MRSA SSI caused by strains different from those related to nasal colonization. Conclusion: The infection control measures for transmission from the hospital reservoirs including strict adherence to hand hygiene and decolonization of carriers is likely to be important for the prevention of orthopaedic MRSA SSI. However, the need for contact precautions for decolonized nasal carriers might be low.

DOI： 10.1016/j.jhin.2023.07.011

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Kawamura H., Arimura S., Saida R., Murata N., Shigemi A., Kodama Y., Nakamura M., Obama Y., Fukuyama R., Hamada Y., Shinkawa N., Sunagawa T., Kamiya H., Junichiro N. . Enhanced measures, including PCR-based screening and syndromic surveillance for nosocomial outbreaks of the COVID-19 Omicron variant, using descriptive epidemiology and whole-genome sequencing in a Japanese tertiary care hospital . Journal of Infection and Chemotherapy30 ( 2 ) 104 - 110 2023年

記述言語：日本語出版者・発行元：Journal of Infection and Chemotherapy

Introduction: In this study, we aimed to analyze the effectiveness of enhanced preventive measures against nosocomial COVID-19 Omicron outbreaks based on those encountered. Methods: We introduced PCR-based screening and syndromic surveillance, in addition to standard and transmission-based precautions, during a COVID-19 outbreak in three wards of Kagoshima University Hospital, a Japanese tertiary care hospital, in February 2022, amid the Omicron variant endemic. Furthermore, we analyzed the descriptive epidemiology and whole-genome sequencing (WGS) of positive SARS-CoV-2 PCR samples from this outbreak. Results: PCR-based screening tests were conducted following the identification of three cases through syndromic surveillance. As a result, 30 individuals tested positive for SARS-CoV-2, including 13 inpatients, five attendant family members, and 12 healthcare workers across the three wards. Notably, no new infections were observed within eight days following the implementation of preventive measures. Among the SARS-CoV-2 genomes analyzed (n = 16; 53.3%), all strains were identified as belonged to BA.1.1 variant. Detailed analysis of descriptive and molecular epidemiology, incorporating single-nucleotide polymorphism analysis of WGS and clarification of transmission links, considering two potential entry routes to the hospital. Conclusions: Introduction of additional preventive measures, including PCR-based screening and syndromic surveillance, in addition to WGS and descriptive epidemiology, is useful for the early intervention of nosocomial outbreaks and for revealing the transmission route of the COVID-19 Omicron variant.

DOI： 10.1016/j.jiac.2023.09.015

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Kanazawa N., Shigemi A., Amadatsu N., Arimura K., Shimono S., Oda K., Chuang V.T.G., Matsumoto K., Kawamura H., Terazono H. . A cohort study of the risk factors and the target AUC to avoid vancomycin-associated acute kidney injury in pediatric patients . Journal of Infection and Chemotherapy 2023年

記述言語：日本語出版者・発行元：Journal of Infection and Chemotherapy

Objectives: In recent years, Vancomycin (VCM) dosing design using area under the concentration-time curve (AUC) has been recommended as a measure of efficacy and safety, but there are fewer reports on pediatric patients than on adults. In this study, we evaluated the threshold of AUC for AKI occurrence in pediatric patients and investigated the factors that contribute to the occurrence of AKI. Methods: Pediatric patients aged 1–15 years on VCM treatment who underwent TDM at Kagoshima University Hospital from April 2016 to March 2022 were included in the computation of AUC using pediatric population pharmacokinetic parameters. Results: The ROC curve showed that the AUC threshold for the risk of developing AKI was 583.0 μg・h/mL, and the AUC-ROC curve was 0.873 (sensitivity 0.930, specificity 0.750). Univariate analysis showed that factors associated with AKI incidence were the duration of VCM administration, ICU admission, and AUCSS. Concomitant medications identified as risk factors for AKI incidence were tazobactam/piperacillin, liposomal amphotericin B, calcineurin inhibitors, contrast agents, and H2-receptor blockers. The multivariate analysis showed that AUC ≧ 583.0 μg・h/mL (odds ratio 20.14, 95% CI 3.52–115.22, p < 0.001) and H2-receptor blockers (odds ratio 8.70, 95% confidence interval = 1.38–54.87, p = 0.02) were independent factors for AKI incidence. Conclusions: We showed that in pediatric patients receiving VCM, the risk of AKI increases as AUC increases. The findings imply that concurrent use of VCM and H2-receptor blockers may increase the risk of AKI.

DOI： 10.1016/j.jiac.2023.10.025

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Morioka H., Ohge H., Nagao M., Kato H., Kokado R., Yamada K., Yamada T., Shimono N., Nukui Y., Yoshihara S., Sakamaki I., Nosaka K., Kubo Y., Kawamura H., Fujikura Y., Kitaura T., Sunakawa M., Yagi T. . Appropriateness of surgical antimicrobial prophylaxis in Japanese university hospitals . Journal of Hospital Infection129 189 - 197 2022年11月

記述言語：日本語出版者・発行元：Journal of Hospital Infection

Background: Surgical antimicrobial prophylaxis (SAP) is one of the major purposes of antimicrobial use. Aim: To determine the adherence to the Japanese SAP guidelines in Japanese university hospitals. Methods: This was a retrospective cohort study including 15 general hospitals and one dental university hospital. Up to three cases of 18 designated surgeries were evaluated regarding adherence to Japanese SAP guidelines: selection of antibiotics, timing of administration, re-dosing intervals, and duration of SAP. When all items were appropriate, surgery was defined as ‘appropriate’. Findings: In total, 688 cases (22–45 cases per surgery) were included. The overall appropriateness was 46.8% (322/688), and the appropriateness of each surgery ranged from 8.0% (2/25, cardiac implantable electronic device implantation) to 92.1% (35/38, distal gastrectomy). The appropriateness of each item was as follows: pre/intraoperative selections, 78.5% (540/688); timing of administrations, 96.0% (630/656); re-dosing intervals, 91.6% (601/656); postoperative selection, 78.9% (543/688); and duration of SAP, 61.4% (423/688). The overall appropriateness of hospitals ranged from 17.6% (9/51) to 73.3% (33/45). The common reasons for inappropriateness were the longer duration (38.5%, 265/688) and choice of antibiotics with a non-optimal antimicrobial spectrum before/during, and after surgery (19.0%, 131/688 and 16.9%, 116/688, respectively), compared to the guideline. Conclusions: Adherence to the guidelines differed greatly between the surgeries and hospitals. Large-scale multi-centre surveillance of SAP in Japanese hospitals is necessary to identify inappropriate surgeries, factors related to the appropriateness, and incidences of surgical site infections.

DOI： 10.1016/j.jhin.2022.06.017

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Oka K., Matsumoto A., Tetsuka N., Morioka H., Iguchi M., Ishiguro N., Nagamori T., Takahashi S., Saito N., Tokuda K., Igari H., Fujikura Y., Kato H., Kanai S., Kusama F., Iwasaki H., Furuhashi K., Baba H., Nagao M., Nakanishi M., Kasahara K., Kakeya H., Chikumi H., Ohge H., Azuma M., Tauchi H., Shimono N., Hamada Y., Takajo I., Nakata H., Kawamura H., Fujita J., Yagi T. . Clinical characteristics and treatment outcomes of carbapenem-resistant Enterobacterales infections in Japan . Journal of Global Antimicrobial Resistance29 247 - 252 2022年6月

記述言語：日本語出版者・発行元：Journal of Global Antimicrobial Resistance

Objectives: The dissemination of difficult-to-treat carbapenem-resistant Enterobacterales (CRE) is of great concern. We clarified the risk factors underlying CRE infection mortality in Japan. Methods: We conducted a retrospective, multicentre, observational cohort study of patients with CRE infections at 28 university hospitals from September 2014 to December 2016, using the Japanese National Surveillance criteria. Clinical information, including patient background, type of infection, antibiotic treatment, and treatment outcome, was collected. The carbapenemase genotype was determined using PCR sequencing. Multivariate analysis was performed to identify the risk factors for 28-day mortality. Results: Among the 179 patients enrolled, 65 patients (36.3%) had bloodstream infections, with 37 (20.7%) infections occurring due to carbapenemase-producing Enterobacterales (CPE); all carbapenemases were of IMP-type (IMP-1: 32, IMP-6: 5). Two-thirds of CPE were identified as Enterobacter cloacae complex. Combination therapy was administered only in 46 patients (25.7%), and the 28-day mortality rate was 14.3%. Univariate analysis showed that solid metastatic cancer, Charlson Comorbidity Index ≥3, bloodstream infection, pneumonia, or empyema, central venous catheters, mechanical ventilation, and prior use of quinolones were significant risk factors for mortality. Multivariate analysis revealed that mechanical ventilation (OR: 6.71 [1.42–31.6], P = 0.016), solid metastatic cancers (OR: 5.63 [1.38–23.0], P = 0.016), and bloodstream infections (OR: 3.49 [1.02–12.0], P = 0.046) were independent risk factors for 28-day mortality. Conclusion: The significant risk factors for 28-day mortality in patients with CRE infections in Japan are mechanical ventilation, solid metastatic cancers, and bloodstream infections.

DOI： 10.1016/j.jgar.2022.04.004

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Hashimoto N., Kimura T., Hamada Y., Niwa T., Hanai Y., Chuma M., Fujii S., Matsumoto K., Shigemi A., Kawamura H., Takahashi Y., Takesue Y. . Candidates for area under the concentration–time curve (AUC)-guided dosing and risk reduction based on analyses of risk factors associated with nephrotoxicity in vancomycin-treated patients . Journal of Global Antimicrobial Resistance27 12 - 19 2021年12月

記述言語：日本語出版者・発行元：Journal of Global Antimicrobial Resistance

Objectives:: Compared with vancomycin trough concentration (Cmin)-guided dosing, area under the concentration–time curve (AUC)-guided dosing is associated with decreased acute kidney injury (AKI). However, whether Cmin-guided or AUC-guided dosing should be used in patients other than those with serious MRSA infections remains uncertain. The purposes of this multicentre study were to identify risk factors for early- and late-phase vancomycin-induced AKI and to identify candidates for AUC-guided dosing, rather than Cmin-guided dosing, who require a more accurate dose titration to reduce the AKI risk. Methods:: A multivariate logistic regression analysis was applied to identify risk factors for AKI. Additionally, the cut‑off day for AKI onset, cut-off Cmin for AKI, safe Cmin for reduced AKI risk and probability of AKI were calculated. Results:: In total, 8.4% (159/1882) of patients developed AKI. AKI occurred within the first 7 days of therapy (early phase) in the vast majority of patients. Significant risk factors for AKI during the early phase were identified as Cmin > 20 mg/L, ICU stay, concurrent diuretic or piperacillin/tazobactam use, and pre-existing renal dysfunction. A temporarily elevated Cmin (>15–20 mg/L) was not associated with a greater risk of AKI. In patients with risk factors, the cut-off Cmin for AKI and the estimated safe Cmin for reduced AKI risk were 18.8–21.0 mg/L and <11.7–13.5 mg/L, respectively. Conclusion:: Patients with known AKI risk factors require a low target Cmin. The presence of several risk factors for AKI may indicate a need for more accurate dose titration using AUC-guided dosing.

DOI： 10.1016/j.jgar.2021.07.018

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Ishiguro N., Ito Y.M., Iwasaki S., Nagao M., Kawamura H., Kanai S., Nukui Y., Tokuda K., Miyara T., Igari H., Yamada K., Chikumi H., Sano C., Koike R., Yagi T., Murakami N. . Three-day regimen of oseltamivir for post-exposure prophylaxis of influenza in hospital wards: a study protocol for a prospective, multi-center, single-arm trial . BMC Infectious Diseases21 ( 1 ) 887 2021年12月

記述言語：日本語出版者・発行元：BMC Infectious Diseases

Background: In a previous retrospective observational study, a 3-day regimen of oseltamivir as post-exposure prophylaxis (PEP) for preventing transmission of influenza in wards was shown to be comparable to 7- to 10-day regimens provided index cases were immediately separated from close contacts. In order to confirm the efficacy of a 3-day regimen, we started to conduct a prospective, multi-center, single-arm trial. Methods: This study is a prospective, multi-center, single-arm study designed by the Sectional Meeting of Clinical Study, Japan Infection Prevention and Control Conference for National and Public University Hospitals. Index patients with influenza are prescribed a neuraminidase inhibitor and are discharged immediately or transferred to isolation rooms. The close contacts are given oseltamivir as 75 mg capsules once daily for adults or 2 mg/kg (maximum of 75 mg) once daily for children for 3 days as PEP. All close contacts are monitored for development of influenza for 7 days after starting PEP. Discussion: A 3-day regimen of oseltamivir as PEP has advantages over 7- to 10-day regimens in terms of costs, medication adherence and adverse effects. Trial registration The Institutional Review Board of Hokkaido University Hospital for Clinical Research, 015-0518, registered on November 11, 2016. UMIN Clinical Trials Registry, UMIN000024458, disclosed on October 31, 2016. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000027881. Japan Registry of Clinical Trials, jRCTs011180015, disclosed on March 14, 2019. https://jrct.niph.go.jp/latest-detail/jRCTs011180015.

DOI： 10.1186/s12879-021-06602-w

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Nana Nakada‐Motokawa, Taiga Miyazaki, Takashi Ueda, Yuka Yamagishi, Koichi Yamada, Hideki Kawamura, Hiroshi Kakeya, Hiroshi Mukae, Hiroshige Mikamo, Yoshio Takesue, Shigeru Kohno . Modified Pitt bacteremia score for predicting mortality in patients with candidaemia: A multicentre seven‐year retrospective study conducted in Japan . Mycoses64 ( 12 ) 1498 - 1507 2021年10月

記述言語：日本語出版者・発行元：Wiley

Background: Several severity indexes have been reported for critically ill patients. The Pitt bacteremia score (PBS) is commonly used to predict the risk of mortality in patients with bacteraemia. Objectives: To develop a scoring system for predicting mortality in candidaemia patients. Methods: Medical records at five Japanese tertiary hospitals were reviewed. Factors associated with mortality were analysed using logistic regression modelling. The discriminatory power of scoring models was evaluated by assessing the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results: In total, 422 candidaemia patients were included. Higher PBS, dialysis and retainment of central venous catheter were independent risk factors for all-cause 30-day mortality. However, among the five PBS components, fever was not associated with mortality; therefore, we developed a modified version of the PBS (mPBS) by replacing fever with dialysis. AUC for PBS and mPBS were 0.74 (95% confidence interval [CI]: 0.68–0.80) and 0.76 (95% CI: 0.71–0.82), respectively. The increase in predictive ability of mPBS for 30-day mortality was statistically significant as assessed by NRI (0.24, 95% CI: 0.01–0.46, p =.04) and IRI (0.04, 95% CI: 0.02–0.06, p =.0008). When patients were stratified by mPBS into low (scores 0–3), moderate (4–7) and high risk (≥8), there were significant differences among the survival curves (p <.0001, log-rank test), and 30-day mortality rates were 13.8% (40/290), 36.8% (28/76) and 69.4% (34/49), respectively. Conclusions: mPBS can be a useful tool for predicting mortality in candidaemia patients.

DOI： 10.1111/myc.13380

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Ueda T. . Change in antimicrobial susceptibility of pathogens isolated from surgical site infections over the past decade in Japanese nation-wide surveillance study . Journal of Infection and Chemotherapy27 ( 7 ) 931 - 939 2021年7月

記述言語：日本語出版者・発行元：Journal of Infection and Chemotherapy

Inappropriate antimicrobial therapy for surgical site infections (SSIs) can lead to poor outcomes and an increased risk of antibiotic resistance. A nationwide survey was conducted in Japan from 2018 to 2019 to investigate the antimicrobial susceptibility of pathogens isolated from SSIs. The data were compared with those obtained in 2010 and 2014–2015 surveillance studies. Although the rate of detection of extended-spectrum β-lactamase producing strains of Escherichia coli was increased from 9.5% in 2010 to 23% in 2014–2015, the incidence decreased to 8.7% in 2018–2019. Although high susceptibility rates were detected to piperacillin/tazobactam (TAZ), the geometric mean MICs were substantially higher than to meropenem (2.67 vs 0.08 μg/mL). By contrast, relatively low geometric mean MICs (0.397 μg/mL) were demonstrated for ceftolozane/TAZ. Although the MRSA incidence rate decreased from 72% in the first surveillance to 53% in the second, no further decrease was detected in 2018–2019. For the Bacteroides fragilis group species, low levels of susceptibility were observed for moxifloxacin (65.3%), cefoxitin (65.3%), and clindamycin (CLDM) (38.9%). In particular, low susceptibility against cefoxitin was demonstrated in non-fragilis Bacteroides, especially B. thetaiotaomicron. By contrast, low susceptibility rates against CLDM were demonstrated in both B. fragilis and non-fragilis Bacteroides species, and a steady decrease in susceptibility throughout was observed (59.3% in 2010, 46.9% in 2014–2015, and 38.9% in 2018–2019). In conclusion, Japanese surveillance data revealed no significant lowering of antibiotic susceptibility over the past decade in organisms commonly associated from SSIs, with the exception of the B. fragilis group.

DOI： 10.1016/j.jiac.2021.03.010

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Oda K. . Performance of Area under the Concentration-Time Curve Estimations of Vancomycin with Limited Sampling by a Newly Developed Web Application . Pharmaceutical Research38 ( 4 ) 637 - 646 2021年4月

記述言語：日本語出版者・発行元：Pharmaceutical Research

Purpose: Therapeutic drug monitoring guided by the area under the concentration-time curve (AUC-guided TDM) is recommended for vancomycin. However, validated efficient software remains elusive to popularize AUC-guided TDM in Japan. The aim of this study was to validate a newly developed web application, PAT, for AUC estimation. Methods: PAT was developed on the R ver. 3.6.2 platform for use with mobile phones and personal computers. AUC estimated by PAT (AUCPAT) was evaluated against the reference AUC (AUCREF) calculated with the log-linear trapezoidal rule using eight measured concentrations, or against AUC (AUCBM-P) calculated using an evaluated available software with clinical data. Results: Investigating the best sampling points with limited sampling, PAT produced the least bias using two concentrations at 1 h and 11 h after the end of infusion (slope 1.18, intercept −15.57, median AUCPAT/AUCREF 0.93 [range 0.81–1.24]), where only one estimation (6%) was out of the predetermined acceptable range of 0.8–1.2. Employment of only a trough concentration was more biased (AUCPAT/AUCREF range 0.73–1.30 for 11 h, AUCPAT/AUCREF range 0.62–1.40 for 23 h). In comparison with the evaluated software, AUCPAT was not biased against the AUCBM-P (slope 1.04, intercept −15.80, median AUCPAT/AUCBM-P 1.00 [range 0.86–1.10]). Conclusions: The new application using two concentrations was appropriately validated and might be efficient in popularizing the AUC-guided TDM of vancomycin.

DOI： 10.1007/s11095-021-03030-y

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上村晃秀, 眞鍋佳月, 山本真実, 岩切忠文, 濱田結花, 本田俊郎, 川村英樹, 藺牟田直子, 大岡唯祐, 西順一郎 . 薬剤耐性菌検索体制の整備に関する研究(第III報) . 鹿児島県環境保健センター所報 ( 21 ) 65 - 68 2020年12月

出版者・発行元：鹿児島県環境保健センター

鹿児島県内における薬剤耐性菌の状況を把握するため、届出の菌株と協力医療機関で検出された薬剤耐性菌の菌株について薬剤耐性検査および遺伝子型別検査を実施した。2017年1月〜2020年3月に届出のあった薬剤耐性菌菌株66件、医療機関から研究対象として収集した菌株405件を対象とした。届出のあった菌株66件中5件からIMP型のカルバペネマーゼ遺伝子が検出され、さらにダイレクトシークエンス解析によりIMP-1であることを確認した。菌種は5菌種でKlebsiella pneumoniae、Enterobacter hormachei、Serratia属がそれぞれ1件、Acinetobacter属が2件であった。また、医療機関より研究対象として収集した菌株405件中59件からIMP型カルバペネマーゼ遺伝子を検出し、ダイレクトシークエンス解析によりIMP-1であることを確認した。菌種別では腸内細菌科細菌が9菌種12件、Acinetobacter属が4菌種40件、Pseudomonas属菌が2菌種7件であった。

Hamada Y. . Effects of antifungal stewardship using therapeutic drug monitoring in voriconazole therapy on the prevention and control of hepatotoxicity and visual symptoms: A multicentre study conducted in Japan . Mycoses63 ( 8 ) 779 - 786 2020年8月

長崎奈穂, 田中裕之, 徳田浩一, 川村英樹, 児玉祐一, 藺牟田直子, 西順一郎 . ステロイド使用患者の持続ウイルス排泄が伝播に関連したと考えられるノロウイルス胃腸炎集団発生事例 . 日本環境感染学会誌35 ( 1 ) 63 - 68 2020年1月

出版者・発行元：(一社)日本環境感染学会

移植や癌の化学療法中の免疫不全者では、ノロウイルス(NV)排泄期間が長期化することが知られているが、ステロイド薬使用中の患者での排泄遷延が院内感染に関連したという報告はみられない。ステロイド使用患者が多い内科病棟で、201X年3月、患者4名、職員1名のNV胃腸炎の集団発生が起きた。発症者2名がみられた多床室に、1例目の発症から23日前にNV胃腸炎で入院し、症状が軽快したため転棟したステロイド療法中の特発性間質性肺炎の患者が同室していた。この患者のNV持続排泄を評価する目的で、感染性のあるウイルス粒子を検出できる糖鎖固定化金ナノ粒子(SGNP)を用いた高感度ウイルス検査(SGNP-RT-qPCR)を実施したところ、発症から35日経過した時点で陽性であった。したがって、本患者は発症者2名と同室の時期に、下痢症状はないもののNVを排泄していたことが推定され、今回の多発事例の発端となった可能性が示唆された。また、ステロイド薬使用中に発症した他の患者1人も、発症10日目の本法による検査が陽性になった。今回の事例をふまえ、ステロイド治療を受けたNV胃腸炎患者の隔離解除については慎重に行う必要があると考えられた。また、感染性のあるウイルス粒子を検出できるSGNP-RT-qPCR法は、ステロイド薬使用患者や免疫不全者が多い病棟において、院内感染対策に有用性が高いと考えられる。(著者抄録)

川村英樹 . 巻頭言 . 日本外科感染症学会雑誌17 ( 4 ) 166 - 166 2020年

川村英樹 . 外科，救急，集中治療における抗菌薬適正使用支援，その必要性と目的 . 日本外科感染症学会雑誌17 ( 4 ) 178 - 181 2020年

出版者・発行元：一般社団法人日本外科感染症学会

<p>世界的に薬剤耐性菌の拡大が問題となり，我が国でも2016年に「AMR（薬剤耐性）対策アクションプラン」が作成され，成果指標として耐性率や抗菌薬使用量の低下が掲げられている。外科，救急，集中治療においても，メチシリン耐性黄色ブドウ球菌，ESBL産生菌，多剤耐性緑膿菌・アシネトバクター，カルバペネム耐性腸内細菌科細菌などの薬剤耐性菌が問題となっている一方，日常的に使用される術後感染予防抗菌薬や敗血症など重症感染症で多くの抗菌薬が使用され，AMR対策としてインフェクションコントロールチームや抗菌薬適正使用支援チームを核に，抗菌薬適正使用支援活動の充実が求められている。</p>

DOI： 10.24679/gekakansen.17.4_178

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