Voriconazole (VRCZ), a broad-spectrum triazole, is served in two dosage forms-injection and oral. VRCZ is difference dosage of oral and intravenous administration writing a medical package insert in Japan.

6mg/kg intravenous injection (IV) twice daily for the first day as initial loading dose, followed by 3-4mg/kg IV twice daily between meals is recommended. 300mg orally twice daily for first day as initial loading dose, followed by 150-200mg orally twice daily between meals is recommended. Patients weighing over 40kg, 200mg orally twice daily between meals is recommended. Patients weighing under 40kg, 100mg orally twice daily between meals is recommended, increase to 150mg twice daily if inadequate response. This study evaluated VRCZ through concentration and oral dosage in the 23 cases which administered VRCZ to analysis for TDM in Aichi University Hospital. Superman rank correlation coefficient was calcuated to examine relationships amoong variables. The level of statistical significance was set at p=0.05. All data were analyzed and processed on JMP^® 8 (SAS Institute Japan). There waws a significant positive correlation between VRCZ trough concentration and dose/weight (r=0.47 p＜0.05).

In this result, VRCZ oral dosage is appropriate to administer and dose/weight (mg/kg) twice a day as same as IV.

We developed and evaluated of multiplex real-time PCR assay for detection of vancomycin resistant genes (vanA, vanB, vanC1 and vanC2/C3) using the new, fully automated BD MAX platform. Ct value analyses of real-time PCR simultaneous repeatability test have showed the usefulness; coefficient of variation; CV (%) ere determined 2,09%, 1.72%, 1.41% and 1.52% with vanA, vanB, vanC1 and vanC2/C3, respectively. We also evaluated with 43 strains of enterococci were characterized by conventional PCR method; 4/4 for vanA-positive, 14/14 for vanB-positive, 1/1 for vanB plus vanC1-positive, 6/6 for vanC1-positive. 4/4 for vanC2/C3-positive and 14/14 for all-van gene-negative strains were identified correctly. This assay was automatically performing before and after PCR operations previously done manually by operator, such as DNA extraction, sample dispensing and gel electrophoresis or the ethidium bromide dyeing. As result, work burden and the risk of the contamination were largely reduced and were shortened to about half for measurement time. We conclude that this assay could greatly contribute to efficient and rapid detection of vancomycin-resistant genes.

Bacteria isolated from surgical infections during the period from April 2010 to March 2011 were investigated in a multicenter study in Japan, and the following results were obtained.

In this series, 631 strains including 25 strains of Candida spp. were isolated from 170 (81.7%) of 208 patients with surgical infections. Four hundred and twenty two strains were isolated from primary infections, and 184 strains were isolated from surgical site infection. From primary infections, anaerobic Gram-negative bacteria were predominant, followed by aerobic Gram-negative bacteria, while from surgical site infection aerobic Gram-positive bacteria were predominant, followed by anaerobic Gram-negative bacteria. Among aerobic Gram-positive bacteria, the isolation rate of Enterococcus spp. such as Enterococcus faecalis, Enterococcus faecium, and Enterococcus avium was highest, followed by Streptococcus spp. such as Streptococcus anginosus and Staphylococcus spp. such as Staphylococcus aureus, in this order, from primary infections, while Enterococcus spp. such as E. faecalis and E. faecium was highest, followed by Staphylococcus spp. such as S. aureus from surgical site infection. Among aerobic Gram-negative bacteria, Escherichia coli was the most predominantly isolated from primary infections, followed by Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter cloacae, and Pseudomonas aeruginosa in this order, and from surgical site infection, E. coli and P. aeruginosa were most predominantly isolated, followed by E. cloacae and K. pneumoniae. Among anaerobic Gram-positive bacteria, the isolation rates of Parvimonas micra, Eggerthella lenta, Streptococcus constellatus, Gemella morbillorum, and Collinsella aerofaciens were the highest from primary infections, and the isolation rate from surgical site infection was generally low. Among anaerobic Gram-negative bacteria, the isolation rate of Bilophila wadsworthia was the highest from primary infections, followed by, Bacteroides fragilis and Bacteroides ovatus, and from surgical site infection, B. fragilis was most predominantly isolated, followed by Bacteroides thetaiotaomicron, in this order. In this series, vancomycin-resistant MRSA (methicillin-resistant S. aureus), vancomycin-resistant Enterococcus spp. and multidrug-resistant P. aeruginosa were not observed.