Vancomycin (VCM) is recommended as the antibiotic of first choice for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the pediatric population. However, in some cases, VCM cannot be used due to side effects or presence of renal failure. Importantly, there are few reports on how anti-MRSA drugs are actually used for infections of each organ system in children. In this study, we retrospectively examined the use of anti-MRSA drugs at our hospital (a pediatric facility) from 2016 to 2020. We also examined the transition of the bacterial susceptibility to MRSA during the same period. A total of 464 patients received anti-MRSA drugs during the study period. The days of therapy (DOT) of VCM were high across all years. VCM, followed by daptomycin, was most often selected for the treatment of bloodstream infections. In contrast, VCM, followed by linezolid, was selected for infections of locomotorium and central nervous system. As for the MICs, there were some differences by years, but no trend of worsening or improvement over time was confirmed. It is necessary to examine the proper use of anti-MRSA drugs according to the organ system involved in the pediatric population.

Alveolar echinococcosis associated with systemic metastatic lesions cannot be treated solely by radical resection but also requires long-term oral albendazole (ABZ) therapy. Adverse effects, such as hepatotoxicity and leukopenia, necessitate discontinuation of ABZ treatment in some patients. We report a case of alveolar echinococcosis in which measurement of blood levels of ABZ was useful. A 31-year-old woman was referred to our hospital after multiple biopsies of paravertebral tumors and vertebral arches failed to confirm the diagnosis. Echinococcosis multiforme was diagnosed based on the results of liver biopsy and serum Western blot assay. Treatment was initiated with ABZ 600mg/day; however, the patient developed mild hepatic impairment, and the ABZ dose was reduced to 400mg/day considering the long-term administration schedule. Serum concentrations of ABZ sulfoxide were measured and were at near-optimal levels. The patient experienced no adverse effects to treatment during the one-year follow-up. Measurement of blood ABZ concentrations should be considered to monitor adverse effects, such as hepatic dysfunction, in patients who receive long-term ABZ therapy.

The effectiveness of interventions by senior resident physicians to optimize blood culture examinations has rarely been reported. We compared the results of blood culture examinations performed before and after an intervention, which consisted of 1) holding a study session on blood culture, 2) informing the monthly contamination rate, 3) feeding back the blood culture results to the doctor who ordered the test, and 4) distributing the institutional manual. After the intervention, the contamination rate decreased from 7.7% to 2.4%, and the proportion of coagulase-negative staphylococci isolated decreased from 34.6% to 15.9%. Additional laboratory testing and antibiotic administration were ordered in 4 patients (30.8%) with suspected contamination. To reduce blood culture contamination, a multifaceted educational approach is essential. Our report highlights the fact that educational activities by senior residents could play a considerable role in promoting the optimization of blood culture examinations.