Most investigations on infectious diseases or chemotherapy have been reported by teaching hospitals, such as university hospital, but the first step of treatment of infectious deseases occurs in outpatients clinics in general practice settings or small hospitals. Such institutions treat many newly diagnosed infectious desease patients, and their situations may be valuable for the investigators. I have investigated infections diseases and chemotherapy through clinical experience working at a community hospital from 1975 to 1994 and began making diagnose in 1995 as a general ENT practitioner. In 1979 I reported that major causative pathogens of pediatric acute otitis media were Streptococcus pneumoniae and Haemophilus in fluenzae, not Staphylococcus aureus. In 1988, I encountered the first case of acute otitis media caused by PISP and I discussed the clinical significance of PISP infections with co-investigators. Since 1998, we have been reporting that infectious disease caused by PISP have spread to adults without underlying diseases, mainly to young mothers in their 30 s, and their children are being diagnosed with otitis media & sinusitis caused by PISP as a result of intrafamilial cross contamination. In comparison with 2000 and 2002 susceptibility of Streptococcus pyogenes erythromycin and azithromycin has decreased, with MIC₉₀ valves increasing from 0.1μg/mL to 6.25μg/mL. I have some doubts about the administration of fl uoroquinolones to patients with tonsillitis caused by S. pyogenes. Penicillins should be the first line treatment.

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We studied 99 children who were diagnosed as having acute otitis media (AOM) associated witr influenza A and B virus infection at the Department of Otolaryngology and Pediatrics, Tohoku Rosa: Hospital from February to May, 2001 (2001 Season) and from January to June, 2002 (2002 Season). The incidence of AOM were 10.9% of influenza A and 31.7% of influenza B in 2001 Season, and 18.1% of influenza A and 7.3% of influenza B in 2002 Season. The mean age of AOM were 1.4 years old of influenza A and 3.2 of influenza B in 2001 Season, and 1.7 of influenza A and 2.9 of influenza B in 2002 Season. In children below 2 years of age, the incidence of AOM was higher (38.7%). In 97 cases, 54 isolates of Streptococcus pneumoniae, 34 of Haemophilus influenzae and 64 of Moraxella catarrhalis were recovered from the nasal swab. In contrast, only 11 isolates of S. pneumoniae, 7 of H. influenzae and 3 of M. catarrhalis were recovered from the middle ear effusion (MEE) in 80 cases. In 19 cases of influenza B in 2001 Season in which influenza virus antigen detection from MEE were performed by using detection kit, 17 cases were positive. In 43 cases of influenza A in 2002 Season in which influenza virus antigen detection from MEE were performed by using detection kit, viral culture, or RT-PCR, 10 cases were positive in SOME methods. In 13 cases of influenza B in 2002 Season by detection kit or viral culture, 6 cases were positive, In conclusion, the cases with influenza virus infection were a high risk of AOM especially infant and young children. Our results suggest in some cases of influenza virus infection, the main etiology of AOM is influenza virus.

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Biofilm is defined as the accumulation of microorganisms and their extracellular polymeric substances binding cells and other organic or inorganic materials. Infection associated with an indwelling catheter is a representative urinary biofilm infection. Bacteria in biofilm behave differently from planktonic freefroating bacteria. Biofilm bacteria are protected from antimicrobial chemotherapy and host defense mechanisms, establishing chronic, persistent infection. Management of the local urinary condition and removal of the local underlying disease are the most effective approaches for treating urinary biofilm infection. Ongoing urinary biofilm infection causes numerous problems. We review the role of bacterial biofilm formation in the urinary tract and problems and prospects with urinary biofilm infection.

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In intractable urinary tract infections, antibiotic-resistant bacteria play an important role in addition to the underlying diseases, medical devices such as urinary tract catheters, and biofilm formation. Multidrugresistant (MDR) Pseudomonas aeruginosa resistant to carbapenem, aminoglycoside, and new quinolon commonly used as antipseudomonal antibiotics cannot be treated successfully with existing antibiotics. Production of metallo-β-lactamases is one mechanism in MDR of P. aeruginosa. MDR P. aeruginosa and fluoroquinole-resistant bacteria are clinical concerns in urology and all other medical fields. Since the molecular mechanisms in antibiotic resistance have been identified, resistance inhibitors are in urgent need of development, as well as new antibiotics.

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Urosepsis is a severe life-threatening condition derived from urinary or genital tract infections. Reviewing the literature and analyzing uroseptic patients, we concluded that (1) bacteremia and sepsis are common during urological surgery or maneuvers;(2) the first treatment step for uroseptic patients is elimination of underlying urological diseases or devices, if any; and (3) empiric use of antimicrobial drugs with strong antibiotic activity, such as carbapenems, is justified for critical cases.

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A total of 120 cases of severe renal infection treated between January 2001 and December 2002 at 9 institutions was evaluated retrospectively from the standpoint of the limitations of conservative treatment and indications for surgery. The severe infections comprised 76 cases of hydronephrotic pyelonephritis, 27 cases of pyonephrosis, 14 cases of renal abscess and 3 cases of emphysematous pyelonephritis. Percutaneous nephrostomy was the most common surgical procedure (43.4%), and nephrectomy was rarely selected in the acute phase of infection (2.6%). Hydronephrotic pyelonephritis was well controlled by conservative treatment alone (61%), and its limitations were not very marked. By contrast, although the efficacy of conservative therapy alone for renal abscess was relatively high (43'%), its limitations were more significant. Caution should be exerted to prevent renal abscess developing after surgical treatment of other infections. It developed in 2 cases of hydronephrotic pyelonephritis and 2 cases of pyonephrosis. Surgery was used to treat 96% of the pyonephrosis cases and the only one patient treated conservatively died. Cases of pyonephrosis managed by conservatively were often complicated by septic shock (6 of 8 cases of septic shock). All cases of emphysematous pyelonephritis were treated surgically but they were often associated with septic shock and took a long time (11 days) to resolve. In severe infection of the kidney, hydronephrotic pyelonephritis can be managed conservatively first to prevent from excessive surgical treatment proce. Renal abscess can be managed initially by conservative therapy as well, although the indications for surgery should be always taken into consideration. Emphysematous pyelonephritis and pyonephrosis require surgery.

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