小児のmethicillin-resistant Staphylococcus aureus（MRSA）感染症治療の第一選択はいずれの疾患でもバンコマイシン（VCM）が推奨されているが，実臨床では副作用等で使用できない場合も経験する．しかし，小児において実際に抗MRSA薬が各疾患に対してどのように使用されているか，まとまった報告は少ない．そこで小児専門施設である当院における2016年から2020年の抗MRSA薬の使用状況を後方視的に検討した．併せて同期間に検出されたMRSAの感受性についても検討した．5年間では計464名に抗MRSA薬が投与されており，いずれの年でもVCMのdays of therapy（DOT）が高かった．疾患別では，血流感染症ではVCM，次いでダプトマイシンが，運動器系の感染症および中枢神経感染症ではVCMについでリネゾリドが選択されていた．MICについては，年によって感受性の比較的悪い株が多く検出されるなど年ごとの違いは認められるものの，経時的な悪化/改善傾向は確認されなかった．小児においても，VCMを第一選択としながらもそれが使用できない場合には，疾患に応じて抗MRSA薬の使い分けを検討していく必要があると思われた．

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.