Objective: This study aimed to identify factors that should be focused on by the antimicrobial stewardship team for treating patients with sepsis, by investigating the mortality of patients with sepsis within 30 days and the mortality-related factors in our hospital over a 10-year period from the perspective of appropriate antimicrobial use. Methods: Factors associated with 30-day mortality were investigated using hierarchical multiple logistic regression in 1406 patients with pathogen-identified sepsis in Hirosaki University Hospital. These factors were clinical data, microbiological data, antimicrobials used in empiric and definitive therapies, presence/absence of ineffective use, underdosing as evaluated using Monte Carlo simulation, and practice of de-escalation. Results: The ineffective use of antimicrobials in empiric therapy and the underdosing and ineffective use in definitive therapy were significantly associated with 30-day mortality (odds ratio [OR] = 2.70, 3.72, and 3.65, respectively). Multiple blood culture sampling was inversely associated with these inappropriate antimicrobial uses. Every year, the 30-day mortality rate has been decreasing, in line with the increase in multiple blood culture sampling and de-escalation; the inappropriate use of antimicrobials has also decreased. Conclusion: Multiple blood culture sampling, proper choice of antimicrobial, and using an adequate dose in definitive therapy could decrease the 30-day mortality rate in patients with sepsis and these factors could be supported by the antimicrobial stewardship team.

Background Spread of vancomycin-resistant Enterococcus (VRE) is a global concern as a significant cause of healthcare-associated infections. A series of VR E faecium (VREf) outbreaks caused by clonal propagation due to interhospital transmission occurred in six general hospitals in Aomori prefecture, Japan. Methods The number of patients with VREf was obtained from thirty seven hospitals participating in the local network of Aomori prefecture. Thirteen hospitals performed active screening tests for VRE. Whole genome sequencing analysis was performed. Results The total number of cases with VREf amounted to 500 in fourteen hospitals in Aomori from Jan 2018 to April 2021. It took more than three years for the frequency of detection of VRE to return to pre-outbreak levels. The duration and size of outbreaks differed between hospitals according to the countermeasures available at each hospital. Whole genome sequencing analysis indicated vanA -type VREf ST1421 for most samples from six hospitals. Conclusions This was the first multi-jurisdictional outbreak of VREf sequence type 1421 in Japan. In addition to strict infection control measures, continuous monitoring of VRE detection in local medical regions and smooth and immediate communication among hospitals are required to prevent VREf outbreaks.

Emergence and spread of multidrug-resistant organisms (MDRO) is an urgent social and public health problem. Here, we carried out an epidemiological survey to clarify the geographical characteristics and factors influencing the prevalence of MDRO. Data on the prevalence of MDRO in 47 prefectures in Japan were extracted from the Japanese Nosocomial Infection Surveillance, a nationwide database for infection control. Potential factors for MDRO were analyzed using data selected from the pharmacological, medical service, infection control, environmental, social, and food-related categories, based on the characteristics of each organism and the correlations between them and MDRO prevalence. Statistical data for potential factors were obtained from public domains. The use of antibiotics was found to be correlated with the prevalence of penicillin-resistant Streptococcus pneumoniae, 3rd-generation cephalosporin- and fluoroquinolone-resistant Escherichia coli, and methicillin-resistant Staphylococcus aureus. Negative correlation between the consumption of food such as kelp and fermented soybeans that facilitate the growth of lactic acid bacteria and the prevalence of 3rd-generation cephalosporin- and fluoroquinolone-resistant E. coli suggested an association between the intestinal microflora and MDRO colonization. In addition to the use of antibiotics, lifestyle, food culture, and social factors such as tobacco smoking, average atmospheric temperature, prevalence of three-generation households, ratio of elderly population, average duration of tourist stay, chicken and fermented soybean consumption, and the competency of healthcare services may also affect MDRO prevalence.

Purpose: To analyze the quality of infection control activities, bacteriological data relevant to infection control was evaluated through the microbiological data warehouse networking hospitals in two medical regions. Methods: Data regarding bacterial test results of 19 hospitals were extracted from two microbiological laboratory information data bases. The rate of MRSA among total S. aureus was used as a general indicator of infection control activities. The occupancy rate of nasal or pharyngeal swabs among MRSA-positive bacteriological samples was used as an indicator of attention paid for infection control in intensive care wards. The number of blood culture sets per examined patient was utilized as an indicator for life-long vocational education on updated medical practice relevant to infectious diseases. Results: The rate of MRSA was significantly higher in secondary private hospitals. The occupancy rate of nasal or pharyngeal swabs was significantly higher in tertiary hospitals. The average number of blood culture set per examined patient were 1.55, 1.54 and 1.39 in tertiary, secondary public and secondary private hospitals, respectively; however, there were no statistical differences between groups. Conclusions: Data bases of microbiological test results shared by hospital laboratories are useful for evaluating regional infection control activities.

Bacillus cereus is a gram-positive rod-type bacterium that forms endospores and is distributed throughout various environments. It rarely causes disease in humans except for cases of food poisoning. However, infection with B. cereus in newborns and immunocompromised individuals can cause severe sepsis. Inappropriate catheter insertion and environmental contamination, including that of linen, are thought to be routes of transmission. Pseudo-outbreaks of B. cereus caused by poor hospital linen management have been reported and are important issues in hospitals. The number of Bacillus spp.-positive blood culture specimens increased in "A" ward of our hospital. Consequently, the hospital's infection control team was asked to determine the cause of the increase.We performed environmental research in the "A" ward and the entire hospital. In addition, we investigated the current status of B. cereus derection in five core hospitals in the North Tohoku region.In our hospital, B. cereus was detected in towels before use. When the timeline of contamination was investigated, we found that the towels had already been contaminated at the time they were delivered to our hospital. The linen washing contractor was unconcerned with laundry disinfection. As a result of our findings, disposable towels were introduced. This resulted in a decrease in Bacillus spp.-positive blood culture specimens. Among the five core hospitals in the North Tohoku region, the hospitals outsourcing laundry to contractors without bacteriological monitoring had a significantly higher rate of B. cereus-positive blood cultures than those of three other hospitals with infection control policies for towel management.The increase in Bacillus spp.-positive blood culture specimens in our hospital was a result of towel contamination. Based on these findings, we suggest that proper linen management(including that of towels) is crucial for infection control as well as the quality control of bacteriological tests.

BACKGROUND:A number of outbreaks caused by Bacillus species have been reported to date. Outbreaks reported in the last decade have predominantly arisen in Japanese hospitals.AIM:To elucidate factors contributing to these real or pseudo outbreaks by Bacillus species, and to evaluate the rate of Bacillus species-positive blood culture samples in Japan.METHODS:A systematic review of the literature was performed. Reports including data on outbreaks caused by Bacillus species were searched for in PubMed, Google Scholar and Evidence-based Medicine BMJ from inception through 10 Aug 2014. Japanese nationwide data on bacteriological tests were collected from Japan Nosocomial Infections Surveillance. Regional bacteriological data for Akita prefecture were collected using the Akita Regional Network for Infection Monitoring/Control System.FINDINGS:Contamination of reusable towels was suspected as a cause for the high rate of Bacillus-positive blood cultures in Japan. The rate of Bacillus species in blood cultures was much higher in Japan than in reports from other countries.CONCLUSIONS:The high contamination rate of blood culture samples by Bacillus species in Japan is a matter of concern for infection control and medical treatment. Bacteriological investigation of reusable towels should be considered in hospitals with a high frequency of Bacillus-positive blood cultures.

Activities and the understanding of infection control in healthcare facilities have improved in the past decade since a certification system for medical personnel, such as infection control nurse and infection control doctor, were introduced in Japan. These specialists are distributed among tertiary general hospitals, while many small and mid-scale hospitals have no infection control specialists. In 2012, the Japanese Ministry of Health, Labour and Welfare launched a new strategy for further improvement of infection control by supporting a regional network of infection control activities. Through the infection control network, small or mid-scaled hospitals can utilize infection control specialists in tertiary general hospitals, enter educational programs on infection control and consult in cases of nosocomial infection outbreaks. As part of the regional infection control network, we established an information network system, named ReNICS, to share the bacteriological test results of the hospitals in Akita prefecture. ReNICS offers epidemiological data on bacteria identified in the region. We can identify the spread of multi-drug resistant bacteria and can roughly estimate the quality of infection control activities in each facility. As a similar information network is being prepared in Hirosaki University Hospital Infection Control Center in Aomori, a prefecture neighboring Akita, we discussed the roles of university hospitals for a regional infection control network.

Interferon-gamma release assays (IGRAs) can be positive in patients infected with Mycobacterium kansasii (M. kansasii), which carries some of Mycobacterium tuberculosis specific antigens adopted for IGRAs. Our aim is to evaluate positive rate and factors associated with positive IGRAs in patients with M. kansasii pulmonary infection.We retrospectively investigated 105 M. kansasii cases in which IGRAs were performed before or ≦14 days after treatment initiation. Clinical characteristics including a history of tuberculosis, radiographic features and laboratory data were collected from medical records.Positive rate of each IGRA was 25.9% (15/58) in QuantiFERON TB-Gold (QFT-G), 31.8% (7/22) in QuantiFERON-TB Gold In Tube (QFT-GIT), and 33.3% (7/21) in T-SPOT. TB (T-SPOT). After excluding cases having a history of tuberculosis, positive rate of each IGRA decreased to 19% (8/42) in QFT-G, 20% (3/15) in QFT-GIT, and 18.8% (3/16) in T-SPOT. The multivariate analysis revealed that only previous tuberculosis was significantly associated with positive IGRAs (odds ratio, 4.758; 95% confidence interval, 1.73–13.05; p = 0.002).Positive rates of IGRAs were low in patients with M. kansasii, especially in those without previous tuberculosis. M. kansasii pulmonary infection alone might induce less interferon-gamma production with the antigens.

As part of an initiative to expand the activities of the Clinical Laboratory Division at Hirosaki University School of Medicine & Hospital, the Central Blood Center, which is located within the division, began providing blood collection services to outpatients in collaboration with the nursing department from April 2000. The number of blood samples collected has tended to rise each year, and while the aim has been to enhance pre-consultation tests, the increase in the number of such tests has led to an increase in the number of associated incidents. Two recent illustrative cases are: (1) a patient becoming angry about the long wait caused by a doctor's oversight regarding a test order, and (2) oversight concerning a test due to the time lag between a revised test order time and the time the patient arrived at the hospital. A factor contributing to both cases was the busy work schedule of doctors. Ensuring that patients are satisfied with their treatment requires institutional measures; therefore, it is necessary to explore methods for reducing human error in the support service for consultations. The present study introduces representative cases, and examines their contexts and measures for dealing with them.

In recent years, hospital infections due to bacterial species such as MRSA (methicillin-resistant Staphylococcus aurus) and VRE (vancomycin resistant Enterococcus), have become a social problem and there have been increases in the number of elderly people and compromised hosts having impaired immunity In consideration of this, we tested the sterilization effect of ETHACOTT®commercial alcohol-impregnated cotton swabs whose alcohol content is equivalent to ethanol for disinfection. It was very effective against non-clinical species of bacteria when itssterilization effect was comparable with 70% isopropanol. We therefore examined its antibacterial effectiveness under controlled conditions in order to determine the best way of using of ETHACOTT®.We also studied the effect of changing the ethanol concentration and cotton swab volume on sterilization capability using bacteria isolated in clinical practice at Hirosaki University Hospital. In bacteriological analysis, we found that for optimum effect, the swabs should be used within 5 days, noting decreased antibacterial effectiveness after seven days when in the package and after 3 hours when left in an open jar. The effectiveness of ETHACOTT® was observed to vary with the bacterial species, being particularly ineffective against MRSA and VRE.We will report these results to the infection control center of Hirosaki University Hospital in order to establish standard guidelines for use of ETHACOTT®.