It is not uncommon for children with severe infectious diseases to show acute kidney injury, but it is rare for these patients to have Mycoplasma pneumoniae pneumonia.
After experiencing a child who had acute kidney injury with M. pneumoniae pneumonia, this study focused on renal dysfunction in patients with this infection and investigated retrospectively from medical records, the relationship of this condition with antimicrobial drug treatment. The diagnosis of M. pneumoniae pneumonia was made from clinical symptoms, chest X-ray photographs and serologic antibody rise in paired sera.
Based on the diagnostic criteria described above, 230 patients with M. pneumoniae pneumonia, who had visited the Department of Pediatrics, Hakujikai Memorial Hospital, Adachi-ku, Tokyo from April 2015 to March 2016, were investigated for their serum creatinine levels. The patients ranged in age from 8 months to 15 years, and the male-female ratio was 1：1.05 (112 boys and 118 girls). Eighty eight children were not receiving antimicrobial agents when they visited this hospital. However, 63 patients received β-lactams, 43 macrolides, 33 new quinolones, and 3 tetracyclines.
Only 4 of the 230 patients received tosufloxacin tosylate, and they were found to have more than twice the reference value of the serum creatinine level based on the criteria of the Acute Kidney Injury (AKI) Practice Guidelines 2016. Uemura et al showed the reference serum creatine levels of Japanese children. None of the cases exceeding 1.5 times the reference serum creatinine levels were suspected of abnormal variability in the groups of children without antibiotic administration, β-lactams, macrolides, or tetracyclines. Among the new quinolone drugs, tosufloxacin tosilate was administrated to 32 patients. In 2009, tosufloxacin tosilate fine granules was approved in Japan for pediatric patients, and in 2017, the indication was expanded to children with M. pneumoniae pneumonia. However, new quinolone drugs are rarely prescribed for children worldwide, and experience of their use is small. Therefore, it is thought by this study that attention to renal function is necessary for the use of new quinolone drugs.
Methicillin-susceptible Staphylococcus aureus (MSSA) remains a major cause of morbidity and mortality in the healthcare setting. However, no single agent of anti-staphylococcal penicillin is available in Japan. The European Society of Cardiology (ESC) guidelines 2015 recommend antimicrobial combination empiric therapy using ampicillin (ABPC), cloxacillin (MCIPC) and gentamycin for native valve infective endocarditis (NVE). A fixed-dose combination drug of ABPC and MCIPC (ABPC/MCIPC) is the only product which contains anti-staphylococcal penicillin. There are few reports for empiric therapy using ABPC/MCIPC, similar to the empiric therapy for NVE patients according to the ESC guidelines, in Japan. To evaluate the susceptibility, safety and clinical outcome of empiric therapy for NVE using ABPC/MCIPC, a retrospective investigation was performed. NVE was defined according to the modified Duke criteria. Patients aged over 18 years with NVE, and who were given intravenous ABPC/MCIPC (24g/day), were included in the study between January 2015 and August 2017 at Juntendo University Hospital (1023-bed university hospital).
Eight patients were included. Five out of 8 patients were male. The median age was 68.5 (34 to 76) years. Blood cultures were positive for MSSA (n=2), viridians group streptococci (n=3), and others (n=3). Except for one case, all organisms were susceptible to ABPC and/or MCIPC. Six out of 8 patients were treated with ABPC/MCIPC as empiric therapy for 2-6 days (median；3.5 days). Two out of eight developed phlebitis due to ABPC/MCIPC. On the other hand, two with MSSA continued to be given ABPC/MCIPC as definitive therapy. In one, however, administration was discontinued due to acute renal failure and exanthema on day 12. The antimicrobial regimen was then changed to vancomycin with ceftriaxone.
These results suggested the high safety of ABPC/MCIPC treatment for NVE patients as empiric therapy, although the results are in a small number of cases from a single hospital. On the other hand, we could not confirm the safety of high-dose ABPC treatment as definitive therapy over the longer term. Further studies are required to evaluate the safety of long-term ABPC/MCIPC treatment on NVE patients in Japan.
Although biosafety in laboratories is very important, the risk of laboratory-acquired infection is usually undervalued. We report herein on two cases of laboratory-acquired infection caused by enterohemorrhagic Escherichia coli (EHEC) during student training in our hospital. We have to recognize laboratories are at risk of infection and reconsider the infection control rule.
A 74-year-old man with chronic renal failure on hemodialysis for 8 years, was admitted to our hospital because of fever and chills. Cefcapene pivoxil 300mg/day was administrated after blood culture was performed, and the fever was relieved immediately. On the third day, gram negative spiral rods were detected in the blood cultures of the first day, so he was hospitalized. Gram staining of the blood cultures revealed the presence of spiral-shaped gram-negative rods. As that pathogen was initially suspected as being Helicobacter cinaedi（H. cinaedi）or Campylobacter fetus（C. fetus）, the patient received empiric antibiotic therapy with intravenous meropenem 0.5g/day, followed by oral amoxicillin 500mg/day. As he remained afebrile and his CRP levels decreased after antibiotic therapy, he was discharged on the 15th day. MALDI-TOF and PCR identified this spiral-shaped bacteria as H. cinaedi 4 weeks after initiation of therapy, he had negative surveillance of blood cultures and documented clearance of bacteremia. He was treated with 28 days of antimicrobial therapy from clearance of the bacteremia. No recurrences were noted about 9 months until he died from metastatic pancreatic cancer.