[Background] The obstetric practice guidelines in Japan, implemented first in 2008, were revised in 2014. Finally, the 2017 edition addresses the prevention of Group B streptococcal (GBS) infections in infants. The incidences of GBC Early-Onset Disease (EOD) and Late-Onset Disease (LOD) in newborns determined in the 2011-2015 survey in Japan were 0.09 and 0.12 newborns/1,000 births, respectively. The Obstetrics and Gynecology Clinical Practice Guideline ―Obstetrics Edition 2017 recommends vaginal-rectal culture screening at 35-37 weeks of gestation and administration of intrapartum antibiotic prophylaxis at delivery to pregnant women who are positive for GBS colonization. Selective media are also recommended for culture of GBS. No actual survey has been conducted since the guidelines were formulated.
[Purpose] To conduct questionnaire surveys to determine the GBS screening test methods adopted at obstetric facilities.
[Methods] Research Electronic Data Capture (REDCap), a data collection management system developed by Vanderbilt University, was used to collect the information. Through the REDCap system, the delivery facilities responded to 11 questions, including the sample collection time, sample collection site, culture method used, and use of prophylactic antibiotics.
[Results] Responses obtained from 237 of 430 facilities (55.5%) indicated the following : 50 did not culture samples from 35 weeks of gestation or later ; 141 did not collect samples from both the vagina and anus as recommended in the 2017 Guideline ; 127 adopted the direct culture method ; 64 used enrichment media. At 214 facilities (90.3%), intrapartum antibiotic prophylaxis was administered at delivery for women who were found to be positive for GBS colonization.
[Discussion] Guidelines in Japan and the US recommend that pregnant women in whom vaginal-rectal cultures at 35-37 weeks of gestation are positive for GBS be administered appropriate intrapartum intravenous antibiotic prophylaxis. Of all the facilities, 77 (32.5%) followed the guideline, including 20 university hospitals, 41 general hospitals, and 16 gynecology and pediatric hospitals. Of these 77 facilities, 15 (6.3%) used selective enrichment media for GBS screening as recommended by the US guideline.
[Conclusion] Better guideline adherence for appropriate GBS screening of pregnant women in Japan is needed to minimize the incidence of GBS-EOD.

A 53-year-old man was admitted with fever and generalized malaise.
Computed tomography (CT) revealed slight swelling of the right pectoralis major muscle. He was diagnosed as having pyomyositis. Blood and abscess fluid cultures were positive for Staphylococcus schleiferi (S. schleiferi). Empiric antibiotic therapy was initiated with intravenous ceftriaxone (CTRX). However, the highgrade fever persisted, and the right chest wall became swollen. On day 4, CT demonstrated abscesses in the right pectoralis major muscle and the front of the right thoracic cavity. The abscesses were drained and intravenous sulbactam/ampicillin (SBT/ABPC) treatment was initiated. With this treatment, although the abscesses became smaller, the high fever persisted. On day 10, CT revealed another abscess in the back of the right thoracic cavity, which was also drained. After the second drainage, the patientʼs condition improved and his serum CRP level decreased. He was discharged on day 24 of hospitalization. Pyomyositis is a bacterial infection of the skeletal muscle, and the quadriceps muscles are the most frequently affected. There have been 5 reports of adult cases of pyomyositis of the pectoralis major muscle in Japan, and the causative organism in all 5 cases was Staphylococcus aureus (S. aureus) . S. schleiferi is a beta-hemolytic, coagulasevariable colonizer of small animals that can cause opportunistic infection in humans. This is the first report of pyomyositis of the pectoralis major muscle caused by S. schleiferi in a Japanese patient.

We successfully treated a patient on maintenance hemodialysis who was diagnosed as having prosthetic valve endocarditis (PVE) caused by Streptococcus salivarius (S. salivarius) with low penicillin susceptibility, using the combination of ceftriaxone with gentamicin at a synergy dose. The patient, a 73-year-old man with end-stage renal disease on maintenance hemodialysis, was referred to our department after 3 days of treatment with oral amoxicillin for fever and chills. Two initial blood cultures were positive for S. salivarius. Transesophageal echocardiography (TEE) performed at admission to our hospital revealed a 0.6-cm vegetation attached to the aortic prosthetic valve. The patient was diagnosed as having PVE caused by S. salivarius, and initiated on treatment with intravenous ampicillin at the dose of 2g every 12 hours with concurrent intravenous gentamycin administration at the dose of 50mg after the commencement of each hemodialysis session. Sensitivity testing revealed intermediate resistance of the causative organism to penicillin and ampicillin. Therefore, the therapy was switched to intravenous ceftriaxone 2g every 24 hours for 6 weeks, with concurrent gentamicin administration at 50mg after the commencement of hemodialysis session. However, gentamicin needed to be discontinued after 18 days because of hearing loss. A repeat TEE at discharge of the patient confirmed disappearance of the vegetation on the prosthetic valve. We conclude that decisions regarding therapeutic and prophylactic interventions for infective endocarditis caused by S. salivarius should be made taking into account the possibility of penicillin resistance of the causative organism.

We report the case of a 78-year-old male patient with decompensated liver cirrhosis who died from exacerbation of the liver cirrhosis after recovery from severe fever with thrombocytopenia syndrome (SFTS). The patient visited our hospital with complaints of fever, appetite loss, diarrhea and lightheadedness. Laboratory examination revealed leukopenia, thrombocytopenia, elevation of the liver enzyme levels, and hyponatremia. The patient was diagnosed as having SFTS by RT-PCR. He gradually recovered with supportive treatment and was discharged on day 68 after admission. However, he was readmitted 30 days later with generalized weakness and behavioral abnormalities. He died on day 135 after readmission due to progression of liver failure. This case suggests the need for further investigation to clarify the long-term course after recovery from SFTS and the influence of SFTS on pre-existing comorbidities.