Bacterial infectious diseases, which are largely considered to be controlled by antimicrobials, remain a major cause of death worldwide. Vigorous infection control activities are essential for the prevention and control of healthcare-associated infections caused by multidrug-resistant bacteria such as MRSA. The infection control activities have become vigorous from the beginning of this century, and the prevalence of MRSA has begun to decrease. However, the emergence of multidrug-resistant bacteria cannot be solely prevented olely by infection control activities restricted to healthcare facilities. The more appropriate use of antimicrobials for livestock, fish, and plants is necessary to solve this problem from the international viewpoint. The spread of multidrug-resistant bacteria represents a serious global problem. Infection control should be achieved based on interdisciplinary and international viewpoints. Educating people about infection control and developing public awareness are becoming increasingly important.
Since Swann Report was publicized, it has been pointed out that the antimicrobial resistant bacteria originated from food-producing animals (FPA). Japanese Veterinary Antimicrobial Resistance Monitoring System was established to monitor antimicrobial usage and emergence of antimicrobial resistant bacteria in FPA in 1999 by the Ministry of Agriculture, Forestry and Fisheries (MAFF). Food Safety Commission of Japan assesses risks to human health posed by antimicrobial resistant bacteria contained in food, on the basis of the scientific evidence. After risk assessment of antimicrobials for FPA, MAFF carries out risk management actions to reduce antimicrobial resistant bacteria in FPA in Japan. At present, livestock-associated methicillin-resistant Staphylococcus aureus ST398 which was the bacteria of the topic in Europe do not isolated from FPA in Japan. And Escherichia coli with plasmids carrying colistin resistant gene, mcr-1 was often isolated from diseased swine, but not from humans. According to a Japanese action plan on antimicrobial resistance, it will strengthen cooperation between medical and veterinary systems on control measure based on One Health concept.
Appropriate use of disinfectants is crucial for controlling infections. The three key factors that influence the efficacy of disinfection are "concentration", "temperature", and "time". Spaulding's Classification of Medical Devices categorizes medical devices into three classes: critical, semicritical or noncritical, based on the risk of infection associated with their use. Disinfectants are classified as high, intermediate, or low-level, according to their toxicity and antimicrobial spectrum. To achieve optimal disinfection practices, medical staff need to understand the characteristics of disinfectants and the devices being disinfected, and to use disinfectants after considering the three key factors. To ensure the appropriate use of disinfectant, ICT staff should check especially on the following topics: waterless antiseptic agents; differences between handwashing and antiseptic hand rub; disinfectant spraying; disinfection of enteral feeding sets; antiseptics for the prevention of catheter-related bloodstream infections; and antiseptics to prevent contamination of blood culture specimens.
Diabetes mellitus is a group of chronic metabolic disorders, in which there are high blood sugar levels over a prolonged period. Diabetes can cause many complications, resulting in deterioration of quality of life and shortening of life span. The number of patients with diabetes and health expenditure on diabetes keeps increasing. Thus, it is important to control a variety of complications of diabetes. Among them, dermatologists mainly deal with skin infections and diabetic foot, which can lead to death of patients or amputation of the leg. It is better not only for dermatologists to know about those complications for but also other medical staff. This review highlights the current knowledge of skin infections in patients with diabetes and diabetic foot.
Enterovirus is a small RNA virus classified in the family picornaviridae. Genus enterovirus includes polioviruses, echoviruses, coxsackieviruses A and B, and enteroviruses. The most common manifestation is a nonspecific febrile illness. Other manifestations include pharyngitis, herpangina, hand-foot-mouth disease, nonspecific exanthema, aseptic meningitis, acute hemorrhagic conjunctivitis, encephalitis/encephalopathy, acute flaccid paralysis, myopericarditis, and pleurodynia. In this article, etiology, epidemiology, clinical manifestation, diagnosis test, control measures, and treatment of enterovirus infection in children are discussed.
This study's final purpose is applying deep-UV treatment, which has strong bactericidal effects. In this paper, we investigated the bactericidal effect of deep UV in near field to organism as one of the methods. We comparatively reviewed data pertaining to deep UV exposure of a rat wound infected with Escherichia coli. As a result, it was observed that 90% killing of E. coli could be attained by exposure to 670 mJ/cm2 of deep UV, and there were no adverse effects on the rat's skin wound. From this, it was found that despite exposure to doses which have bactericidal effect on E. coli, there were no adverse effects to the rat's wound. In the present study, design engineers understood new engineering technology and considered its medical application with a medical scientist and conducted the experimental tests.
Clostridium difficile (CD) causes CD-associated diarrhea and often causes an outbreak due to horizontal transmission. The sensitivity and specificity of detection of a rapid enzyme immunoassay, which is usually used for detection of CD, was recently improved. We tried to improve the sensitivity of detection in CD by changing the examination method, and as a result, the diagnostic accuracy of CD-associated diarrhea improved. Despite the improvement of the sensitivity of detection, the spread of CD infection was observed. Next, we tried to improve the daily environmental cleaning. Conventionally, we used the wipes immersed in quaternary ammonium compounds for daily environmental cleaning, and when CD infection was confirmed, the environmental surface around the patients was disinfected with sodium hypochlorite. We introduced a complex-type chlorine-based disinfectant cleaner, which contains potassium peroxymonosulfate as the main component (RUBYSTA®, RST) in the ward of the main department of rheumatic disease and evaluated the effectiveness of the products for 2 years. As a result, we observed no horizontal transmission of CD after introduction of RST. It was suggested that the improvement of the detection methods of CD and environmental cleaning are effective in reduction of horizontal transmission of CD.
Antimicrobial stewardship programs (ASPs) are essential to optimize the prescription of antibiotics. In this study, we introduced restriction of 4th cephems and prospective audit of carbapenems. The days of therapy per 1000 patient-days of 4th cephems significantly decreased from 51.87 to 28.09 after restriction of 4th cephems, and those of carbapenems significantly decreased from 9.35 to 3.80 after prospective audit of carbapenems. All antibiotic costs were reduced by 400,000 yen (18%) monthly. The susceptibility of Pseudomonas aeruginosa showed no difference between the pre- and post-introduction. A hospital policy to optimize antimicrobial prescription introduced by pharmacist decreased the days of therapy per 1000 patient-days of 4th cephems and carbapenems and antibiotic costs.