The antimicrobial activity of various antibiotics against clinical bacterial isolates recovered from patients with infectious diseases at the medical facilities in the Kanto region between March and September 2006 was evaluated. A total of 1030 clinical isolates were available for susceptibility tests: 420 aerobic Gram-positive organisms, 520 aerobic Gram-negative organisms, 30 anaerobic Gram-positive organisms and 60 anaerobic Gram-negative pathogens. Antimicrobial susceptibility data for Streptococcus pneumoniae and Haemophilus influenzae isolates from pediatric and adult patients were analyzed separately.
Panipenem (PAPM), imipenem (IPM), meropenem (MEPM), biapenem (BIPM), doripenem (DRPM), cefozopran (CZOP), cefepime (CFPM), and sulbactam/cefoperazone (SBT/CPZ) were used as test antibiotics.
PAPM, IPM and DRPM exhibited excellent in vitro antibacterial activities against methicillin-susceptible Staphylococcus, with all isolates exhibiting a MIC of ≤0.06μg/mL. Against Streptococcus including penicillin-resistant S. pneumoniae, PAPM demonstrated the strongest antibacterial activity among the carbapenems with a MIC range of ≤0.06 to 0.12μg/mL.
Against Enterobacteriaceae, MEPM showed the strongest antibacterial activity, and PAPM had comparable activity to IPM. Against the extended-spectrum β-lactamase producing Escherichia coli, Klebsiella species and Proteus species, the MICs for the cephems were high, however, those for the carbepenems were low. Against H. influenzae, PAPM had comparable activity to IPM.
With respect to anaerobes, each of the carbapenems tested demonstrated almost the same strong antibacterial activity.
In conclusion, 13 years has passed since PAPM was launched in 1993, PAPM still maintains potent antibacterial activity and is considered an effective antimicrobial agent for various types of infectious diseases.

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Purpose: This study was designed to elucidate the present situation of diagnosis and treatment for mycosis in the field of emergency and critical care medicine following presentation of the diagnosis and treatment guidelines for deep mycosis (in February, 2003).
Methods: In patients (administered antimycotics or who have pyrexia showing no response to any antimicrobial drug), medically examined and suspected of having had a fungal infection at 15 medical institutions throughout Japan, participating in the Japanese Society for the Study of Critical Care for Mycosis during the period from May 2003 through August 2004 and with facilities for emergency and critical care medicine, patient background, risk factors, contents of treatment, and patient outcomes were totaled and assessed.
Results: The subjects of this assessment were 125 patients consisting of 87 (69.6%) men and 38 (30.4%) women. Their mean age was 59.6 years, and 36.8% were 70 years of age or older. Intravascular catheterization was conducted in 78.4% of the 125 subjects. Antimycotics were administered to 89 patients, and the frequencies of fluconazole (FLCZ) for the initial administration and during the period of data registration were the highest (74.2% and 80.9%, respectively). The frequency with which a carbapenem antimicrobial drug was administered prior to antimycotics was the highest (41.6%). Blood culture was conducted in 85 patients (68.0%), monitoring culture in 108 (86.4%). Fungi were detected in 10 patients (11.8%) with blood culture and 72 (66.7%) with monitoring culture. The frequency of Candida albicans detection was the highest, 50.0% (5/10), with blood culture. With monitoring culture as well, the frequency ofC. albicansdetection was the highest, 55.6% (40/72). Alleviation of fever at the completion of registration was recognized in 65.6%. The survival rates at the completion of and at 28 days after the start of data registration of were 78.4% and 69.6%, respectively.
Conclusion: Many patients in the field of emergency and critical care medicine had risk factors for deep mycosis; 11.8% and 66.7% of our 125 subjects were positive on blood and monitoring cultures, respectively. The majority of the fungi detected belonged to theCandidagroup, and FLCZ was the most frequently used antimycotic.

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Purpose: This study was designed to investigate the influence of “The diagnosis and treatment guidelines for deep mycosis” (hereinafter referred to as “the Guidelines”) in Japan on the diagnosis and treatment of deep mycosis in the field of emergency and critical care medicine and their influences on patient outcomes.
Methods: In patients (administered antimycotics or who had pyrexia showing no response to any antimicrobial drug) medically examined and suspected of having had a fungal infection at 15 medical institutions throughout Japan, participating in the Japanese Society for the Study of Critical Care for Mycosis during the period from May 2003 through August 2004 and with facilities for emergency and critical care medicine, patient background, risk factors, awareness of the Guidelines, diagnosis, contents of treatment, and outcomes were investigated. On the basis of the data pertaining to these items, whether or not the course of diagnosis and treatment for each patient conformed to the diagnosis and treatment recommended in the Guidelines was retrospectively evaluated. Whether or not the treatment had been conducted with antimycotics and the doses recommended in the Guidelines, was also investigated, and outcomes were assessed according to conformity and non-conformity to the Guidelines.
Results: Of the 125 subjects assessed, 55.2% responded that they were conscious of the Guidelines. The subjects who had indications for the Guidelines included 10 (8.0%), who were definitely diagnosed as having had mycosis, 3 (2.4%) who were diagnosed as having had clinical mycosis, and 35 (28.0%) who were suspected of having had mycosis. In the remaining 77 (61.6%), whether their conditions were non-mycosis or mycosis could not be determined. The treatment conformed to the Guidelines in 25 subjects (20.0%), but did not in 23 (18.4%). In 77 subjects (61.6%), whether or not the condition had been mycosis could not be determined. The number of the patients in whom whether or not the treatment had conformed to the Guidelines could be determined was decreased and there was a marked influence of administration of antimycotics, which was based on the assumption that “gpyrexia with no response to broad-spectrum antimicrobial drugs persists for at least 3 days” hin the Guidelines, was given as the reason. There was no significant difference in outcomes (survival or death) at the end of the study based on whether or not the subject had been conscious of the Guidelines or whether or not the contents of treatment conformed to the Guidelines. The number of days that treatment was administered in the ICU was greater in the treatment conforming to the Guidelines than in that not conforming to the Guidelines, but the difference did not reach statistical significance.
Conclusion: The Guidelines were recognized at the time of treatment by more than half of the patients registered, but there were actually only a few patients in whom the diagnosis and treatment conformed to the Guidelines. One possible reason is considered to be that there was a marked influence of one item of the Guidelines, i.e. “gpyrexia without response to broad-spectrum antimicrobial drugs persists for at least 3 days” h, in patients with suspected mycosis, who receive empirical treatment, in terms of the reason. Future examination is considered to be needed regarding the validity of this item.

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