研究者詳細 - 安田　満

Misc - 安田　満

分割表示 155 件中 61 - 80 件目／全件表示 >>

Clinical efficacy of sitafloxacin 100 mg twice daily for 7 days for patients with non-gonococcal urethritis

Satoshi Takahashi, Ryoichi Hamasuna, Mitsuru Yasuda, Shin Ito, Kenji Ito, Shuichi Kawai, Takamasa Yamaguchi, Takashi Satoh, Kenichi Sunaoshi, Koichi Takeda, Nobukazu Suzuki, Shinichi Maeda, Hirofumi Nishimura, Souichirou Fukuda, Tetsuro Matsumoto

Journal of Infection and Chemotherapy ( Japanese Society for Cancer Chemotherapy ) 19 ( 5 ) 941 - 945 2013年

To clarify the clinical efficacy of STFX for patients with non-gonococcal urethritis (NGU), including chlamydial urethritis and Mycoplasma genitalium-positive urethritis, this study included male patients with NGU who were 20 years old or older. The pathogens, including Chlamydia trachomatis, M. genitalium and Ureaplasma urealyticum, were detected by nucleic acid amplification tests and the patients were treated with sitafloxacin 100 mg twice daily for 7 days. Microbiological and clinical efficacies were assessed for the patients with NGU posttreatment. Among the 208 patients enrolled in this study, data for a total of 118 patients could be analyzed. The median age was 32 (20-61) years. The median duration from the completion of treatment to the second visit was 21 (14-42) days. There were 68 pathogen-positive NGU cases and 50 with NGU without any microbial detection. Microbiological cure was achieved in 95.6 % of the pathogen-positive NGU patients. Total clinical cure was achieved in 91.3 % (105/115). In this study, STFX was able to eradicate 95.7 % of C. trachomatis, 93.8 % of M. genitalium and 100 % of U. urealyticum. The results of our clinical research indicate that the STFX treatment regimen should become a standard regimen recommended for patients with NGU. In addition, this regimen is recommended for patients with M. genitalium-positive NGU. © 2013 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases.

Nationwide surveillance of bacterial pathogens from patients with acute uncomplicated cystitis conducted by the Japanese surveillance committee during 2009 and 2010: Antimicrobial susceptibility of Escherichia coli and Staphylococcus saprophyticus

Hiroshi Hayami, Satoshi Takahashi, Kiyohito Ishikawa, Mitsuru Yasuda, Shingo Yamamoto, Shinya Uehara, Ryoichi Hamasuna, Tetsuro Matsumoto, Shinichi Minamitani, Akira Watanabe, Aikichi Iwamoto, Kyoichi Totsuka, Junichi Kadota, Keisuke Sunakawa, Junko Sato, Hideaki Hanaki, Taiji Tsukamoto, Hiroshi Kiyota, Shin Egawa, Kazushi Tanaka, Soichi Arakawa, Masato Fujisawa, Hiromi Kumon, Kanao Kobayashi, Akio Matsubara, Seiji Naito, Katsunori Tatsugami, Takamasa Yamaguchi, Shin Ito, Mototsugu Kanokogi, Harunori Narita, Hiromi Kawano, Takahide Hosobe, Kazuo Takayama, Toru Sumii, Akira Fujii, Takashi Sato, Takamine Yamauchi, Masanobu Izumitani, Hirofumi Chokyu, Hideari Ihara, Kikuo Akiyama, Masaru Yoshioka, Satoshi Uno, Koichi Monden, Motonori Kano, Shinichi Kaji, Shuichi Kawai, Kenji Ito, Hisato Inatomi, Hirofumi Nishimura, Toshihiro Ikuyama, Shohei Nishi, Koichi Takahashi, Yukihiro Kawano, Satoshi Ishihara, Kengo Tsuneyoshi, Shinji Matsushita, Takashi Yamane, Takaoki Hirose, Shigeru Fujihiro, Katsuhisa Endo, Yasuhiko Oka, Koh Takeyama, Takahiro Kimura, Tetsuji Uemura

Journal of Infection and Chemotherapy ( Japanese Society for Cancer Chemotherapy ) 19 ( 3 ) 393 - 403 2013年

The Japanese surveillance committee conducted the first nationwide surveillance of antimicrobial susceptibility patterns of uropathogens responsible for female acute uncomplicated cystitis at 43 hospitals throughout Japan from April 2009 to November 2010. In this study, the causative bacteria (Escherichia coli and Staphylococcus saprophyticus) and their susceptibility to various antimicrobial agents were investigated by isolation and culturing of bacteria from urine samples. In total, 387 strains were isolated from 461 patients, including E. coli (n = 301, 77.8 %), S. saprophyticus (n = 20, 5.2 %), Klebsiella pneumoniae (n = 13, 3.4 %), and Enterococcus faecalis (n = 11, 2.8 %). S. saprophyticus was significantly more common in premenopausal women (P = 0.00095). The minimum inhibitory concentrations of 19 antibacterial agents used for these strains were determined according to the Clinical and Laboratory Standards Institute manual. At least 87 % of E. coli isolates showed susceptibility to fluoroquinolones and cephalosporins, and 100 % of S. saprophyticus isolates showed susceptibility to fluoroquinolones and aminoglycosides. The proportions of fluoroquinolone-resistant E. coli strains and extended-spectrum β-lactamase (ESBL)-producing E. coli strains were 13.3 % and 4.7 %, respectively. It is important to confirm the susceptibility of causative bacteria for optimal antimicrobial therapy, and empiric antimicrobial agents should be selected by considering patient characteristics and other factors. However, the number of isolates of fluoroquinolone-resistant or ESBL-producing strains in gram-negative bacilli may be increasing in patients with urinary tract infections (UTIs) in Japan. Therefore, these data present important information for the proper treatment of UTIs and will serve as a useful reference for future surveillance studies. © 2013 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases.

A questionnaire survey of antimicrobial prophylaxis to prevent perioperative infection in urological field in Japan

Yoshikazu Togo, Rikiya Taoka, Shingo Yamamoto, Yoshiki Hiyama, Teruhisa Uehara, Jiroh Hashimoto, Yuichiro Kurimura, Satoshi Takahashi, Taiji Tsukamoto, Jun Miyazaki, Hiroyuki Nishiyama, Hiroshi Kiyota, Satoshi Yazawa, Mototsugu Oya, Mitsuru Yasuda, Takashi Deguchi, Kiyohito Ishikawa, Kiyotaka Hoshinaga, Minori Matsumoto, Katsumi Shigemura, Kazushi Tanaka, Soichi Arakawa, Masato Fujisawa, Koichiro Wada, Shinya Uehara, Toyohiko Watanabe, Hiromi Kumon, Kanao Kobayashi, Akio Matsubara, Masahiro Matsumoto, Takehiko Sho, Ryoichi Hamasuna, Tetsuro Matsumoto, Hiroshi Hayami, Takashi Yamane, Masayuki Nakagawa

Japanese Journal of Urology ( Japanese Urological Association ) 104 ( 4 ) 579 - 588 2013年

(Purpose): To survey the present condition of administration method of the antimicrobial prophylactic (AMP) agents for the perioperative infection in Japan on revising "The Japanese guidelines for prevention of perioperative infections in urologic field (2006)". (Patients and methods): With the approval of the Japanese Urological Association (JUA) in 2011, all of the principal urological training institutions certified by JUA (n = 836) were encouraged to participate to survey their adherence to the JUA guidelines (published in 2006) for AMP to prevent perioperative infection in urological field, and 446 (53.3%) institutions responded to the questionnaire. (Results): The rates of following the JUA guidelines of, "completely", "mainly", "not too much", and "not at all" were 6.5%, 69.7%, 22.0% and 1.6%, respectively. The guidelines were followed for open clean operations in 48.5%, open clean-contaminated operations in 66.4%, open contaminated operations in 61.8%, laparoscopic clean operations in 54.1%, laparoscopic clean-contaminated operations in 61.2%, transurethral resection of bladder tumor in 71.5%, transurethral resection of prostate in 68.9%, ureteroscopy and transurethral ureterolithotomy in 68.2%, prostate biopsy in 43.2%, and cystoscopy were in 42.2%, respectively. However, in terms of duration of AMP administration, the longer duration than those recommended by the guidelines were observed for clean surgery, transurethral resection of bladder tumor, ureteroscopy and transurethral ureterolithotomy, prostate biopsy, and cystoscopy. (Conclusions): In terms of kinds of AMP, the guidelines were almostly followed in all operative procedures. However, the duration of AMP administration were longer than those recommended by the guidelines. On revision of "Japanese guidelines for prevention of perioperative infections in urologie field (2006)", these data would be taken into consideration to avoid dissociation between the guidelines and the practical side in the urologists. © 2013 The Japanese Urological Association.

A prospective multi-institutional analysis according to the "Japanese guidelines for prevention of perioperative infections in urological field"

Koichiro Wada, Shinya Uehara, Shinichiro Kira, Masahiro Matsumoto, Takehiko Sho, Yuichiro Kurimura, Jiro Hashimoto, Teruhisa Uehara, Takashi Yamane, Sojun Kanamaru, Yoshikazu Togo, Rikiya Taoka, Akira Takahashi, Yusuke Yamada, Akira Yokomizo, Mitsuru Yasuda, Kazushi Tanaka, Ryoichi Hamasuna, Satoshi Takahashi, Hiroshi Hayami, Toyohiko Watanabe, Koichi Monden, Hiroshi Kiyota, Takashi Deguchi, Seiji Naito, Taiji Tsukamoto, Soichi Arakawa, Masato Fujisawa, Shingo Yamamoto, Hiromi Kumon, Tetsuro Matsumoto

Japanese Journal of Urology ( Japanese Urological Association ) 104 ( 3 ) 505 - 512 2013年

(Objective) The "Japanese guidelines for prevention of perioperative infections in urological field" was edited by the Japanese Urological Association in 2007. They are the first Japanese guidelines for antimicrobial prophylaxis specifically to prevent perioperative infections in the urological field. We report here the results of a multicenter prospective study conducted to examine the validity and usefulness of these guidelines. (Patients and methods) The subjects were 513 patients who had undergone urological surgeries between July and September 2008 at 10 nationwide university institutions in the Japanese Society of UTI Cooperative Study Group. These surgeries were transurethral resection of bladder (TURBT), transurethral resection of prostate (TURP), adrenalectomy, nephrectomy, nephroureterectomy, radical prostatectomy and total cystectomy. Analysis was performed on patient information, surgical procedures, types and durations of administration of prophylactic antibiotic agents, and the presence of surgical site infections (SSI) and remote infections (RI). (Results) Of 513 patients, 387 (75.4%) were administered prophylactic antibiotic agents according to the guidelines. In these patients, the incidences of SSI and RI were 5.9% and 4.1%, respectively. Multivariate analysis showed that significant factors for SSI were the surgical risk (according to the ASA physical status classification system), diabetes, and operation time, and that the only significant factor for RI was the operation time. (Conclusions) More large-scale study and evidences are necessary in order to demonstrate the validity and usefulness of these guidelines.© 2013 The Japanese Urological Association.

Outcome measurement of extensive implementation of antimicrobial stewardship in patients receiving intravenous antibiotics in a Japanese university hospital

T. Niwa, Y. Shinoda, A. Suzuki, T. Ohmori, M. Yasuda, H. Ohta, A. Fukao, K. Kitaichi, K. Matsuura, T. Sugiyama, N. Murakami, Y. Itoh

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE ( WILEY-BLACKWELL ) 66 ( 10 ) 999 - 1008 2012年10月

Background: Antimicrobial stewardship has not always prevailed in a wide variety of medical institutions in Japan. Methods: The infection control team was involved in the review of individual use of antibiotics in all inpatients (6348 and 6507 patients/year during the first and second annual interventions, respectively) receiving intravenous antibiotics, according to the published guidelines, consultation with physicians before prescription of antimicrobial agents and organisation of education programme on infection control for all medical staff. The outcomes of extensive implementation of antimicrobial stewardship were evaluated from the standpoint of antimicrobial use density, treatment duration, duration of hospital stay, occurrence of antimicrobial-resistant bacteria and medical expenses. Results: Prolonged use of antibiotics over 2 weeks was significantly reduced after active implementation of antimicrobial stewardship (2.9% vs. 5.2%, p < 0.001). Significant reduction in the antimicrobial consumption was observed in the second-generation cephalosporins (p = 0.03), carbapenems (p = 0.003), aminoglycosides (p < 0.001), leading to a reduction in the cost of antibiotics by 11.7%. The appearance of methicillin-resistant Staphylococcus aureus and the proportion of Serratia marcescens to Gram-negative bacteria decreased significantly from 47.6% to 39.5% (p = 0.026) and from 3.7% to 2.0% (p = 0.026), respectively. Moreover, the mean hospital stay was shortened by 2.9 days after active implementation of antimicrobial stewardship. Conclusion: Extensive implementation of antimicrobial stewardship led to a decrease in the inappropriate use of antibiotics, saving in medical expenses, reduction in the development of antimicrobial resistance and shortening of hospital stay.

Sensitivities of major causative organisms isolated from patients with acute uncomplicated cystitis against various antibacterial agents: results of subanalysis based on the presence of menopause

Tetsuro Matsumoto, Ryoichi Hamasuna, Kiyohito Ishikawa, Satoshi Takahashi, Mitsuru Yasuda, Hiroshi Hayami, Kazushi Tanaka, Tetsuro Muratani, Koichi Monden, Soichi Arakawa, Shingo Yamamoto

JOURNAL OF INFECTION AND CHEMOTHERAPY ( SPRINGER JAPAN KK ) 18 ( 4 ) 597 - 607 2012年08月

We investigated whether the presence of menopause influenced the species and distribution of causative bacteria isolated from patients with acute uncomplicated cystitis (the most common urinary tract infection), and we also investigated the sensitivity of the isolated species to antibacterial agents. Using multivariate analysis, we also investigated risk factors for infection with quinolone-resistant Escherichia coli, because its frequency has increased and it is now a clinical problem in Japan. Six hundred and thirty-four strains were isolated from 489 premenopausal patients (mean age 32.3 +/- A 10.1 years). Major causative bacteria detected were Escherichia coli (65.0 %), Enterococcus faecalis (12.0 %), Streptococcus agalactiae (5.5 %), and Klebsiella pneumoniae (1.6 %). From 501 postmenopausal patients (mean age 68.7 +/- A 10.29 years), 657 strains were isolated, and the major causative bacteria detected were E. coli (61.5 %), E. faecalis (13.7 %), K. pneumoniae (5.2 %), and S. agalactiae (4.0 %). The sensitivities to fluoroquinolones (FQs) and cephems of E. coli isolated from premenopausal patients were both a parts per thousand yen90 %, while the sensitivities to FQs of E. coli isolated from postmenopausal patients were about 5 % lower. In regard to infection with quinolone-resistant E. coli (minimal inhibitory concentration of levofloxacin [LVFX] a parts per thousand yen4 mu g/mL), significant risk factors were observed in patients with more than two episodes of cystitis within a year (p = 0.0002), patients to whom antibacterial agents were used previously for this episode of cystitis (p = 0.0175), and patients who had a history of FQ administration within 1 month. Although the species and distribution of causative bacteria of acute uncomplicated cystitis were the same regardless of the presence of menopause, the sensitivities to FQs of E. coli detected in postmenopausal patients were significantly lower than those in the premenopausal women. The major risk factors for infection with quinolone-resistant E. coli were a history of FQ administration and the morbidity of cystitis rather than the menopausal status. It was considered that taking an appropriate history including the morbidity of cystitis and history of FQ administration, and the appropriate selection of an antibacterial agent, would be important when empirical therapy is required.

Management of Pharyngeal Gonorrhea Is Crucial To Prevent the Emergence and Spread of Antibiotic-Resistant Neisseria gonorrhoeae

Takashi Deguchi, Mitsuru Yasuda, Shin Ito

ANTIMICROBIAL AGENTS AND CHEMOTHERAPY ( AMER SOC MICROBIOLOGY ) 56 ( 7 ) 4039 - 4040 2012年07月

速報，短報，研究ノート等（学術雑誌）

Antimicrobial chemotherapy of Mycoplasma genitalium-positive non-gonococcal urethritis

Takashi Deguchi, Shin Ito, Noriyasu Hagiwara, Mitsuru Yasuda, Shin-ichi Maeda

EXPERT REVIEW OF ANTI-INFECTIVE THERAPY ( TAYLOR & FRANCIS LTD ) 10 ( 7 ) 791 - 803 2012年07月

書評論文，書評，文献紹介等

Mycoplasma genitalium is an important pathogen of acute non-gonococcal urethritis (NGU) in men and plays a significant role in persistent or recurrent NGU. In the management of patients with M. genitalium-positive NGU, eradication of the mycoplasma from the urethra is necessary to prevent persistent or recurrent NGU. Therefore, M. genitalium should be considered for antimicrobial chemotherapy of NGU. This article reviews the in vitro antimicrobial activities of antibiotics against M. genitalium and the efficacies of various antibiotic regimens against M. genitalium-positive NGU, including the doxycycline and azithromycin regimens recommended as first-line treatments for NGU in the guidelines. Selection of macrolide-resistant M. genitalium by treatment with the single-dose regimen of 1-g azithromycin and mechanisms of macrolide resistance in M. genitalium are discussed. The effectiveness of the moxifloxacin regimen against persistent or recurrent NGU, unsuccessfully treated with azithromycin and/or doxycycline regimens, is emphasized.

Clinical and microbiological outcomes in treatment of men with non-gonococcal urethritis with a 100-mg twice-daily dose regimen of sitafloxacin

Shin Ito, Mitsuru Yasuda, Kensaku Seike, Takashi Sugawara, Tomohiro Tsuchiya, Shigeaki Yokoi, Masahiro Nakano, Takashi Deguchi

JOURNAL OF INFECTION AND CHEMOTHERAPY ( SPRINGER TOKYO ) 18 ( 3 ) 414 - 418 2012年06月

Several microorganisms cause non-gonococcal urethritis (NGU). Failure to eradicate Mycoplasma genitalium from the urethra could be associated with persistent or recurrent urethritis; thus, the choice of antibiotics with activities potent enough to eradicate M. genitalium is crucial in the treatment of NGU. In in vitro studies, sitafloxacin has been shown to be highly active against Chlamydia trachomatis and M. genitalium. We treated 89 males with NGU, including 15 patients with persistent or recurrent NGU and 1 patient with post-gonococcal urethritis, with a 100-mg twice-daily dose regimen of sitafloxacin to assess its efficacy against NGU. We examined first-void urine samples for the presence of C. trachomatis, M. genitalium, Ureaplasma parvum, and Ureaplasma urealyticum. After treatment, we evaluated 73 patients for clinical outcomes and 44 for microbiological outcomes. Symptoms were alleviated in 62 (84.9%) patients, who were judged clinically cured. Microorganisms detected before treatment were eradicated in 42 (95.5%) patients, who were judged microbiologically cured. Regarding microbiological outcomes of specific microorganisms, eradication rates of C. trachomatis (n = 33), M. genitalium (n = 11), and U. urealyticum (n = 10) were 100%, 100%, and 80.0%, respectively. In all 5 patients with M. genitalium-positive persistent or recurrent NGU who had experienced treatment failures with antibiotics, the mycoplasma was eradicated. These results suggested that the sitafloxacin regimen used, which was effective on both M. genitalium and C. trachomatis infections, could be useful as an appropriate option as first- and second-line treatment of NGU.

Uncommon occurrence of mutations in the gyrB gene associated with quinolone resistance in clinical isolates of Neisseria gonorrhoeae [1]

T. Deguchi, M. Yasuda, M. Nakano, S. Ozeki, E. Kanematsu, Y. Kawada, T. Ezaki, I. Saito

Antimicrobial Agents and Chemotherapy 40 2437 - 2438 2012年03月

Prevalence of genital mycoplasmas and ureaplasmas in men younger than 40 years-of-age with acute epididymitis

Shin Ito, Tomohiro Tsuchiya, Mitsuru Yasuda, Shigeaki Yokoi, Masahiro Nakano, Takashi Deguchi

INTERNATIONAL JOURNAL OF UROLOGY ( WILEY-BLACKWELL ) 19 ( 3 ) 234 - 238 2012年03月

Objectives: Acute epididymitis is often associated with urethritis. Mycoplasma genitalium and Ureaplasma urealyticum have been considered as pathogens of urethritis. The aim of the present study was to determine the prevalence of these microorganisms in men with acute epididymitis. Method: A total of 56 men younger than 40 years-of-age with acute epididymitis were enrolled in the present study between January 2006 and June 2010. First-void urine specimens were subjected to culture of aerobic bacterial species, and examined for the presence of Chlamydia trachomatis, M. genitalium, M. hominis, U. parvum and U. urealyticum by polymerase chain reaction-based assays. Urethral swabs were cultured for Neisseria gonorrhoeae. Results: The number and percentage of patients positive for each microorganism were as follows: Gram-negative bacilli, 2% and 3.6%; Gram-positive cocci, 23% and 41.1%; N. gonorrhoeae, 3% and 5.4%; C. trachomatis, 28% and 50.0%; M. genitalium, 5% and 8.9%; M. hominis, 6% and 10.7%; U. parvum, 6% and 10.7%; and U. urealyticum, 5% and 8.9%. Among 25 men with non-chlamydial non-gonococcal epididymitis, who were negative for Gram-negative bacilli, M. genitalium or U. urealyticum was detected in one man each (4.0%), and M. hominis and/or U. parvum was detected in five (20.0%). Conclusion: In men younger than 40 years-of-age with acute epididymitis, C. trachomatis is a major pathogen. The prevalence of genital mycoplasmas and ureaplasmas are lower, and the role of genital mycoplasmas and ureaplasmas in the development of acute epididymitis remains to be determined.

Solitary fibrous tumor of the urinary bladder: A case report

Kensaku Seike, Koji Kameyama, Taku Kato, Tomohiro Tsuchiya, Mitsuru Yasuda, Shigeaki Yoko, Masahiro Nakano, Syuji Hayashi, Takashi Deguchi, Yoshinobu Hirose

Acta Urologica Japonica 58 ( 2 ) 105 - 108 2012年02月

A 41-year-old woman with an incidental tumor of the urinary bladder was referred to our hospital. Computed tomography and magnetic resonance imaging showed a tumor in the urinary bladder wall with expansive growth. Under the suspicion of leiomyoma, we performed transurethral resection of the tumor. Pathological examination of tumor specimens revealed pattcrnless arrangements of spindle cells. Immunochemical analysis revealed tumor cells positive for CD34 and bcl-2. The final diagnosis was a solitary fibrous tumor.

In vitro activity of azithromycin against Mycoplasma genitalium and its efficacy in the treatment of male Mycoplasma genitalium-positive nongonococcal urethritis

Noriyasu Hagiwara, Mitsuru Yasuda, Shin-ichi Maeda, Takashi Deguchi

JOURNAL OF INFECTION AND CHEMOTHERAPY ( ELSEVIER SCIENCE BV ) 17 ( 6 ) 821 - 824 2011年12月

Many recent studies have shown that Mycoplasma genitalium is among the pathogens responsible for Chlamydia trachomatis-negative nongonococcal urethritis (NGU). A single 1-g dose of azithromycin (AZM) has been recommended for the treatment of NGU, including M. genitalium-positive NGU, irrespective of whether it is positive or negative for Chlamydia trachomatis. The purpose of this study was to determine the minimal inhibitory concentrations of AZM against Mycoplasma genitalium strains, and to assess its clinical efficacy against Mycoplasma genitalium-positive NGU. Seven Mycoplasma genitalium strains were obtained from the American Type Culture Collection, and susceptibility testing of seven antimicrobial agents was performed using a broth microdilution method. Thirty men with M. genitalium-positive NGU were enrolled in this study and treated with a single 1-g dose of AZM. AZM and clarithromycin (CAM) were highly active against M. genitalium strains. Fluoroquinolone activities were moderate, and of the three fluoroquinolones tested, gatifloxacin (GFLX) and sparfloxacin (SPFX) were more active than levofloxacin (LVFX). In 25 of 30 (83.3%) men treated with a single 1-g dose of AZM, M. genitalium was eradicated from first-void urine samples, as determined by polymerase chain reaction. AZM was highly active against M. genitalium, and a single 1-g dose of AZM for M. genitalium-positive NGU was tolerated in Japan. These findings may be helpful in establishing optimal treatment for M. genitalium-positive NGU.

Evaluation by Monte Carlo simulation of levofloxacin dosing for complicated urinary tract infections caused by Escherichia coli or Pseudomonas aeruginosa

Takashi Deguchi, Kensaku Seike, Mitsuru Yasuda, Tetsuro Matsumoto

JOURNAL OF INFECTION AND CHEMOTHERAPY ( SPRINGER TOKYO ) 17 ( 5 ) 726 - 730 2011年10月

We evaluated, by Monte Carlo simulation, 500-mg once-daily, 100-mg thrice-daily, 200-mg twice-daily, and 200-mg thrice-daily dose regimens of levofloxacin (LVFX), for the ratio of area under the concentration-time curve for 24 h (AUC(0-24)) to minimum inhibitory concentration (MIC) (AUC(0-24)/MIC) and the ratio of maximum plasma concentration (C(max)) to MIC (C(max)/MIC), which predict microbiological outcomes, and the C(max)/MIC, which inhibits fluoroquinolone resistance selection, in complicated urinary tract infections (UTIs) with Escherichia coli or Pseudomonas aeruginosa. Monte Carlo simulation was performed for 10000 cases using the pharmacokinetic data of patients with complicated UTIs and the LVFX MIC distributions for E. coli or P. aeruginosa clinical strains. The probabilities of achieving the AUC(0-24)/MIC target (66.2-67.9%) and the C(max)/MIC target (64.5-67.5%) to eradicate E. coli were similar among the 4 regimens. In eradication of P. aeruginosa, the 200-mg thrice-daily and the once-daily dose regimens produced higher probabilities of achieving the AUC(0-24)/MIC target (57.5%) and C(max)/MIC target (55.1%), respectively. For the probabilities of achieving the C(max)/MIC targets that prevent the emergence of fluoroquinolone resistance, the once-daily dose regimen (66.8%) did not differ from the other multiple-dose regimens (62.3-66.2%) in E. coli, whereas the former regimen (44.2%) was superior to the latter regimens (10.8-31.7%) in P. aeruginosa. The 500-mg once-daily dose regimen of LVFX, which produced the larger AUC(0-24) and higher C(max), could ensure the efficacy of eradication of uropathogens and reduce the risk of fluoroquinolone resistance selection in complicated UTIs.

Infected solitary renal cyst of the graft in a renal transplant recipient: A case report

Kenichiro Ishida, Tomohiro Tsuchiya, Hiromi Kondo, Keita Nakane, Taku Kato, Kensaku Seike, Kousei Miwa, Mitsuru Yasuda, Sigeaki Yokoi, Masahiro Nakano, Takashi Deguchi

Acta Urologica Japonica 57 ( 9 ) 501 - 504 2011年09月

A 59-year-old woman with end-stage renal disease of diabetic nephropathy who had been on maintenance hemodialisis for 4 years, underwent a living-unrelated renal transplantation 6 years ago. She was admitted to our hospital, because of a low grade fever and edema. Ultrasonography revealed the cyst with heterogeneity structure in the upper pole of the transplanted kidney. Magnetic resonance imaging showed a high-intensity cystic mass measuring 68 × 53 mm. As fever and laboratory data did not improve sufficiently by the treatment with antibiotics, echo-guided puncture and drainage were performed for the abnormal structure in the upper pole of the transplanted kidney. In the culture of the purulent aspirate drained from renal cyst, Escherichia coli was isolated. To our knowledge, this is the first report of infected renal cyst of the graft in a renal transplant recipient in the world.

Effect of gatifloxacin against Mycoplasma genitalium-related urethritis: an open clinical trial

Ryoichi Hamasuna, Satoshi Takahashi, Hiroshi Kiyota, Mitsuru Yasuda, Hiroshi Hayami, Soichi Arakawa, Kazunori Tomono, Tetsuro Matsumoto

SEXUALLY TRANSMITTED INFECTIONS ( B M J PUBLISHING GROUP ) 87 ( 5 ) 389 - 390 2011年08月

Objectives Mycoplasma genitalium and Chlamydia trachomatis are the primary pathogens detected from non-gonococcal urethritis (NGU). In this study, the efficacy of gatifloxacin was examined against M genitalium-related urethritis. Methods The study was an open clinical trial evaluating the effectiveness of gatifloxacin with 200 mg doses twice a day for 7 days against male NGU. Results Between March and September 2008, 169 male patients were enrolled, and microbiological and clinical cure rates could be evaluated in 86 patients detected with C trachomatis or M genitalium and in 135 with NGU, respectively. Microbiological cure rates of gatifloxacin against C trachomatis and M genitalium were 100% and 83%, respectively, and the total clinical cure rate was 99%. Conclusion Analysis of in-vivo and in-vitro data from the literature of fluoroquinolone efficacies against M genitalium suggests that a MIC90 of 0.125 mu g/ml or less may be useful for optimal activity against M genitalium infection.

Selection of Mycoplasma genitalium strains harbouring macrolide resistance-associated 23S rRNA mutations by treatment with a single 1 g dose of azithromycin

Shin Ito, Yasushi Shimada, Yuko Yamaguchi, Mitsuru Yasuda, Shigeaki Yokoi, Shin-ichi Ito, Masahiro Nakano, Hiroaki Ishiko, Takashi Deguchi

SEXUALLY TRANSMITTED INFECTIONS ( B M J PUBLISHING GROUP ) 87 ( 5 ) 412 - 414 2011年08月

Objective A single 1 g dose regimen of azithromycin has been recommended for the treatment of Mycoplasma genitalium infections. The authors evaluated whether this regimen could select M genitalium strains with macrolide resistance after treatment for M genitalium-positive non-gonococcal urethritis. Methods In seven men with non-gonococcal urethritis, who were infected with M genitalium without macrolide resistance-associated mutations but experienced microbiological azithromycin treatment failure, M genitalium DNAs in their post-treatment urine specimens were examined for mutations in the 23S rRNA gene and the ribosomal protein genes of L4 and L22. To assess the relatedness of M genitalium strains before and after treatment, their DNAs in pretreatment and post-treatment urine were genotyped by analysing short tandem repeats of an AGT/AAT unit in the MG309 gene and single nucleotide polymorphisms in the MG191 gene. Results In four of seven patients, M genitalium in post-treatment urine had an A-to-G transition at nucleotide position 2071 or 2072, corresponding to 2058 or 2059 in the 23S rRNA gene of Escherichia coli. In one of the four strains, Pro81Ser in the ribosomal protein L4 accompanied the mutation in the 23S rRNA gene. The genotyping of M genitalium DNAs suggested that these four post-treatment strains were selected from the respective closely related or identical pretreatment strains without macrolide resistance-associated mutations by the treatment. Conclusions The single 1 g dose treatment of azithromycin could select M genitalium strains harbouring macrolide resistance-associated mutations. For M genitalium, this regimen might increase the risk of macrolide resistance selection after treatment.

Japanese guideline for clinical research of antimicrobial agents on urogenital infections: the first edition

Mitsuru Yasuda, Satoshi Takahashi, Hiroshi Kiyota, Kiyohito Ishikawa, Akira Takahashi, Shingo Yamamoto, Soichi Arakawa, Koichi Monden, Tetsuro Muratani, Ryoichi Hamasuna, Hiroshi Hayami, Tetsuro Matsumoto

JOURNAL OF INFECTION AND CHEMOTHERAPY ( SPRINGER TOKYO ) 17 ( 4 ) 579 - 594 2011年08月

その他

Macrolide Resistance-associated 23S rRNA Mutation in Mycoplasma genitalium, Japan

Yasushi Shimada, Takashi Deguchi, Keita Nakane, Mitsuru Yasuda, Shigeaki Yokoi, Shin-ichi Ito, Masahiro Nakano, Shin Ito, Hiroaki Ishiko

EMERGING INFECTIOUS DISEASES ( CENTERS DISEASE CONTROL ) 17 ( 6 ) 1148 - 1150 2011年06月

速報，短報，研究ノート等（学術雑誌）

Nationwide survey of antibacterial activity against clinical isolates from urinary tract infections in Japan (2008)

Tetsuro Matsumoto, Ryoichi Hamasuna, Kiyohito Ishikawa, Satoshi Takahashi, Mitsuru Yasuda, Hiroshi Hayami, Kazushi Tanaka, Hiroshi Kiyota, Tetsuro Muratani, Koichi Monden, Soichi Arakawa, Shingo Yamamoto

INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS ( ELSEVIER SCIENCE BV ) 37 ( 3 ) 210 - 218 2011年03月

In this study, the causative bacteria and their sensitivity to various antimicrobial agents as well as risk factors for quinolone-resistant Escherichia coli were investigated in patients with acute uncomplicated cystitis or complicated cystitis by isolation and culture of bacteria from urine samples. In total, 1312 strains were isolated from 1009 patients with acute uncomplicated cystitis, including E. coli (63.3%), Enterococcus faecalis (12.8%) and Streptococcus agalactiae (4.6%). In addition, 994 strains were isolated from 725 patients with complicated cystitis, including E. coli (36.4%), E. faecalis (19.2%), Klebsiella pneumoniae (5.0%), S. agalactiae (4.7%) and Pseudomonas aeruginosa (4.5%). At least 90% of E. coli isolates from acute uncomplicated cystitis showed sensitivity to fluoroquinolones and cephems, whilst 70.4-88.4% of E. coli isolates from complicated cystitis were sensitive to fluoroquinolones and 85.4-89.5% were sensitive to cephems. Factors associated with quinolone-resistant E. coli included two or more episodes of cystitis within 1 year, failure of quinolone therapy, underlying urinary tract disease, prior quinolone treatment within 1 month and age >= 75 years. It is important to confirm the sensitivity of causative bacteria for optimal antimicrobial therapy, and empirical antimicrobial agents should be selected by considering patient characteristics and other factors. (C) 2011 Published by Elsevier B.V. and the International Society of Chemotherapy.

　前のページ - 次のページ　

1
2
3
4
5
6
7
8

このページの先頭へ▲