Numerically, the most significant difference between children and adults is body weight. Humans are not born with complete physiological functions, and our body functions mature with growth. Assuming adult renal function to be 100%, glomerular filtration rate only reaches approximately 25%-40% of adult function at birth. Renal function reaches approximately 90% of adult function in the first year after birth and is comparable to adult function in the second year after birth. This review will discuss energy metabolism of living organisms, maturation from children to adults, pharmacokinetics in children, and describes antimicrobial chemotherapy in children.
Catheter-associated urinary tract infections (CAUTI) account for 10%-20% of healthcare-associated infections. In the prevention of CAUTI, it is important that the urethral catheter is inserted carefully, and residual urine is measured after removal of the urethral catheter. It is often difficult to determine the diagnosis of CAUTI in the elderly due to the lack of symptoms. Prior to the administration of an antimicrobial agent, the urethral catheter should be exchanged with a new one, and blood culture and urine culture data should be reported consistently. Treatment with antimicrobial agents should be selected based on the severity of CAUTI. qSOFA scores are useful in evaluating the severity. In this report, approaches to CAUTI are discussed from the urologists' perspective.
The outbreak of the novel coronavirus disease (COVID-19) has completely changed our lives and forced us to revise our previous lifestyles. In this study, we collaborated with NHK to visually determine the risk of infection in a buffet-style restaurant using fluorescent paint. We found that the virus spread through indirect contact with high-frequency contact surfaces such as tableware. Furthermore, the transmission of the virus was minimized by implementing appropriate measures such as maintaining hand hygiene. Cooperation in society is essential because COVID-19 is an infectious disease that can spread not only in cities but also in hospitals. In the future, visualizing and spreading awareness about infection control through the efforts of media and infectious disease specialists will become increasingly important.
From April 21, 2020, 10 febrile individuals were recorded on the second floor of a 4-storey long-term care facility. SARS-CoV-2 PCR test confirmed that 9 were positive, and they were admitted to our hospital. On April 27 of the same year, PCR tests were performed, and positive results were obtained for, 21 residents, 1 short stay, and 6 staff members. Of these, 22 positive cases were quarantined on the second floor, and the negative cases were moved to the third and fourth floors. We performed zoning on the second and third floors and constructed a virtual ward on the electronic medical record in the hospital so that examinations and medication infusions could be ordered, and the resident's condition could be grasped at the hospital. Blood and urine tests were conducted at the facility, and if it was determined that a close examination was necessary, they were transferred to the hospital.
A second PCR test was performed on 69 people on May 13, 2020, and 15 people from the second floor were positive, as well as three from the third floor who were then moved to the second floor. From May 27 to June 19, 2020, the PCR test was repeated four times, and it was determined that all residents were negative twice in a row and that the cluster had converged. During this period, six people died due to complications, such as pneumonia and multiple organ failure, with a mortality rate of 14.3%.
Because the severity of novel coronavirus infections (COVID-19) is known to be higher among older adults, infection control countermeasures for long-term care welfare facilities for this population are an urgent issue. We conducted a questionnaire survey among 285 facilities in Tochigi to determine the current status of their infection control for COVID-19, including the extent to which countermeasures are implemented and what are lacking, and to consider the necessary support for them. The response rate was 44.9%, and analysis of the results showed that the following problems need to be solved immediately: many facilities do not have external advisors for daily consultation; there is a lack of personal protective equipment, disinfectants, and infection prevention and control manuals for COVID-19 in 42.2% of the facilities; and there is a failure to isolate residents with fever in 30.5% of the facilities. In addition, it was found that many facilities were unsure on how to respond to COVID-19 outbreaks in their facilities, and that there was a need for external support, such as human resources, in the event of a COVID-19 spread in their facilities.
We examined the antibody prevalence of epidemic viral diseases among the employees (618) in our hospital using antibody titers measured for all of them. As a result, it was found that approximately 70% of the employees should take measures such as investigation of vaccination history and additional vaccination though no one had negative antibody titers of all viral infections.
The rate of our employees with a positive antibody titer meeting the measles criteria was 46.1% of the total. It showed that the risk of an outbreak was high if the measles was brought to our institution. However, more than 90% of the employees with a positive antibody titer met the chickenpox criteria, making it possible to release a small number of employees with being susceptible to chicken pox from taking charge of patients with herpes zoster and disseminated herpes zoster. There was no gender difference in the prevalence of rubella antibody titers. The rate of our employees with a positive antibody titer meeting the mumps criteria was 59.3% of the total, the second lowest after measles, while a concern had been growing about a possibility of an infection spread in the hospital next to measles.
As a result of investigating a vaccination history of the employees in their 20s whose antibody titers did not meet the criteria, we confirmed that 66.7% of the employees had vaccination for measles and 56.5% for rubella. This suggested the presence of vaccine failure, including primary and secondary vaccine failure. It is important to investigate both antibody titer and vaccination history to confirm the status of acquisition of immunity. In the future, we need to review the vaccination history of all employees and recommend vaccinations based on the results.
Childhood cancers are associated with a high risk of infection due to the pathophysiology and adverse effects of anticancer drugs. Although vancomycin (VCM) is often used for treating cancer-associated infections, there are limited studies on VCM dosing in childhood cancers. Therefore, we retrospectively investigated VCM dosing administered to pediatric patients with cancer at Nagano Children's Hospital. The trough values of the dose were compared with pharmacists' therapeutic drug monitoring (TDM) intervention and the revised antimicrobial TDM guidelines. Between April 2011 and March 2017, pediatric patients with cancer aged 1-12 years who were administered VCM were enrolled in the study. The daily dose, number of doses, trough value of VCM, and serum creatinine level at the start and end of VCM administration were compared.
The average daily doses significantly increased from 45.8 mg/kg/day at the beginning to 61.8 mg/kg/day at the end of therapy in 29 patients aged 1-6 years. The number of doses significantly increased from 3 to 4 times daily. The trough value of VCM significantly increased from 5.0 μg/mL to 10.0 μg/mL. The serum creatinine level remained unchanged from 0.21 mg/dL to 0.20 mg/dL. In nine patients aged 7-12 years, the daily dose increased from 46.1 mg/kg/day to 60.0 mg/kg/day. The number of doses remained unchanged 4 times a day. The trough value increased significantly from 6.5 μg/mL to 10.2 μg/mL. However, the serum creatinine level remained unchanged from 0.24 mg/dL to 0.25 mg/dL.
In pediatric patients with cancer, VCM doses to reach the target value of a trough concentration of 10 μg/mL or more were started with an administration of 61.8 mg/kg/day (15.5 mg/kg, every 6 h) for children aged 1-6 years and 60.0 mg/kg/day (15.0 mg/kg, every 6 h) according to the revised guidelines for those aged 7-12 years. VCM might reach the target trough value by further TDM.
The guidelines recommended formulary restriction and pre-authorization and prospective audit and feedback. In Japan, there are some reports of intervention and feedback for all injectable antibiotics from large hospitals, but none from middle-sized hospitals. This study aimed to assess the impact of prospective audit and feedback for all injectable antibiotics of antimicrobial stewardship (AS) pharmacists in changes of antibiotic agents in middle-sized hospitals. The days of therapy per 1,000 patient-days (DOT/1000pd) of all injectable antibiotics significantly decreased from 248.6 to 217.1 (12.7%) after intervention. Furthermore, DOT/1000pd of anti-pseudomonas agents significantly decreased from 60.0 to 35.5 (40.8%). All antibiotic costs were reduced by about 50,000 yen (18.4%) monthly. A hospital policy to optimize antimicrobial prescription introduced by AS pharmacists decreased antibiotic consumption, especially wide-spectrum agents.