Cutibacterium acnes is a low-virulence skin commensal that can cause late-onset prosthetic graft infections. We report the case of a 60-year-old man with diabetes who presented with fever and bilateral chest pain 10 months after an ascending aortic graft replacement. Computed tomography revealed right-sided pleural effusion and perigraft fluid collections; extended incubation of the pleural fluid and blood samples revealed C. acnes. Seven weeks after the intravenous antibiotic therapy, the patient underwent mediastinal irrigation, explantation of the infected graft, replacement with a rifampicin-soaked prosthesis, and omental flap coverage. Extended incubation of intraoperative specimens resulted in C. acnes in both samples. Following four additional weeks of intravenous antibiotic therapy, long-term oral amoxicillin suppression was initiated. At one-year follow-up, the patient remained clinically stable without evidence of recurrence. This case highlights the importance of extended incubation, vigilant diagnostic evaluation, and combined surgical and antimicrobial management in delayed C. acnes vascular graft infections. We also reviewed relevant literature on C. acnes prosthetic vascular infections to contextualize this case.

BACKGROUND:Rapid antimicrobial susceptibility testing (RAST) by direct disk-diffusion (DD) on positive blood cultures can shorten the time to optimize therapy for bloodstream infections. Since 2014, we have implemented an in-house RAST-DD protocol for gram-negative bacilli based on CLSI M100-S23. METHODS:Positive blood cultures processed between April and September 2024 were tested using our in-house RAST-DD method (12-antimicrobial panel including cefmetazole [CMZ]) and compared with broth microdilution interpreted according to CLSI M100-ED29. Categorical agreement (CA) and error rates-very major (VME), major (ME), and minor (mE)-were calculated. We also assessed the effects of applying updated CLSI criteria and rapid species identification, and evaluated the clinical utility of CMZ for extended-spectrum β-lactamase (ESBL)-producing Enterobacterales. RESULTS:Among 234 g-negative isolates (206 Enterobacterales, 28 glucose non-fermenters), most agents showed high CA, but VMEs occurred for cefepime and ceftriaxone, and MEs for cefazolin and tazobactam/piperacillin among Enterobacterales. Applying CLSI M100-ED29 susceptible dose-dependent criteria and rapid identification reduced VMEs and mEs (CA 93.8%, VME 0.1%, ME 5.4%, mE 0.6%). CMZ achieved 100% CA for Enterobacterales excluding chromosomal AmpC producers and supported carbapenem-sparing treatment in several ESBL-producing Escherichia coli bacteremia cases with favorable outcomes. CONCLUSIONS:The in-house RAST-DD method demonstrated reliable performance for gram-negative bacilli. Updating interpretive criteria and incorporating rapid identification reduced interpretive errors. Inclusion of a CMZ disk in the RAST panel may support carbapenem-sparing therapy for ESBL-producing Enterobacterales.

Abstract Background Contamination of blood cultures can result in unnecessary testing and the unwarranted use of antimicrobials.Quality control is essential to prevent these outcomes, with the contamination rate serving as a key quality indicator. Various criteria exist for assessing contamination prevalence. While these criteria enable independent computation of contamination rates by the laboratory, they can differ significantly from clinician judgments. But recent advancements, such as improved blood culture bottles, new disinfectants, the use of mass spectrometers, and the rise in immunosuppressed patients and intravascular device users, may have influenced these divergences. Table1 laboratory judgement : Use CLSI criteria"If multiple sets are submitted at the same time or within 24 hours and only one set is positive for the following target organisms"Coagulase-negative staphylococci,Propionibacterium acnes,Microccus spp,Viridans-group streptococci,Corynebacterium spp,Bacillus spp,Aerococcus spp" Methods Over a four-year period starting in 2018, we conducted a retrospective cohort study on patients with multiple-set blood cultures submitted at our hospital. This study differentiated contamination from true bacteremia, as defined by the laboratory and as assessed by infectious disease specialists. The definition of contamination by the laboratory followed the criteria of CLSI. Abbreviation IQR = interquartile range. a:Cases judged as contamination by the laboratory but clinically judged as true bacteremia b:Cases judged as contamination by the laboratory and clinically Results Of the 23,472 blood culture submissions, 18,851 involved multiple sets. Of these, 3,003 cases tested positive in at least one set. The laboratory identified 459 cases as contamination, while clinicians identified 365 cases. The contamination rates were 2.4% and 1.9%, respectively. Discrepancies were notably higher among patients with haematological malignancies, neutropenia, those with intravascular devices, and when multiple bacteria were concurrently detected, particularly in cases involving Staphylococcus epidermidis. Conclusion It has been reported that there is little difference between the judgment of contamination between the judgment of the laboratories and the clinicians, however, in the present study a large discrepancy in contamination rates was observed. This may be related to patients’background in our hospital where a large number of patients with haematological malignancies and neutropenia, and patients with intravascular devices were hospitalized ,and the clinical side tended to treat such patients as having true bacteremia. The possibility of a divergence in contamination rates as a quality indicator should be considered in such facilities. Disclosures Hiroshi Morioka, MD-PhD, SHIMADZU CORPORATION: Advisor/Consultant Mitsutaka Iguchi, n/a, SHIMADZU CORPORATION: Advisor/Consultant Keisuke Oka, MD-PhD, SHIMADZU CORPORATION: Advisor/Consultant Tetsuya yagi, MD-PhD, SHIMADZU CORPORATION: Advisor/Consultant

Catheter-related bloodstream infections (CRBSIs) caused by Lactobacillus spp. and Lacticaseibacillus spp. are rare, and their clinical course and optimal treatment remain uncertain. In this report, we present a 46-year-old male patient who experienced clinically diagnosed Lacticaseibacillus paracasei CRBSI on four separate occasions, despite receiving systemic administration of antibiotics and antimicrobial lock therapy. The patient did not develop L. paracasei bacteremia after catheter removal. This case report furthers our knowledge of CRBSI caused by Lactobacillus and related genera and highlights the need for further research.

Since the coronavirus disease 2019 (COVID19) pandemic started, various medications and vaccinations have been developed. However, the healthcare capacity was still exceeded during the period of rapid increase in COVID19 cases, which hinderered timely and appropriate treatment, leading to the deterioration of patient outcomes.1,2 Healthcare stakeholders have faced difficulties in deciding which cases should be prioritized to receive the limited but essential inpatient care. In Japan, local public health centers and specialized facilities manage patient placement and admit patients with a high risk of disease progression or those who have already developed respiratory failure, to appropriate medical institutions. However, because COVID19 can suddenly become severe,3 overor undertriage can often happen. Some patients are admitted to tertiary medical institutions despite not requiring oxygen supplementation, while other cases become seriously ill at home or in isolation facilities. Although some scoring systems have been published to estimate the risk of severe disease in patients with COVID19,4– 6 an objective and simple index that predicts disease progression as early as possible (before critical illness) is needed. We comprehensively investigated a total 71 humoral factors as predictive markers of COVID19, and discovered that chemokine ligand 17 (CCL17), interferon lambda 3 (IFNλ3), interleukine 6 (IL6), interferoninducible protein 10 (IP10), and CXC motif chemokine ligand 9 (CXCL9) potentially signal disease progression.7Among these biomarkers, CCL17 and IFNλ 3 are already approved and covered by the national health insurance in Japan. Therefore, these examinations can be widely available at general medical institutions. However, it is still unclear if these markes can predict oxygen demand and disease progression in the early phase of COVID19 in the clinical setting. In this study, we attempted to determine whether these and some other markers can accurately predict the subsequent oxgen demand and progression of disease in patients with earlystage COVID19 who do not require supplemental oxygen.

In November 2021, the World Health Organization designated a new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant of concern, Omicron (PANGO lineage B.1.1.529). We report on the first 2 cases of breakthrough coronavirus disease 2019 (COVID-19) caused by Omicron in Japan among international travelers returning from the country with undetected infection. The spread of infection by Omicron were considered.

Despite the increase in COVID-19 cases globally, the number of cases in Japan has been relatively low, and an explosive surge in the prevalence has not occurred. In March 2020, the Ministry of Health, Labour and Welfare (MHLW) in Japan recommended the original criteria for polymerase chain reaction (PCR) testing, although there was a lack of evidence for appropriate targets for COVID-19 testing. This study aimed to evaluate the COVID-19 positive ratio and pre-screening criteria in Tokyo immediately after the insurance-covered SARS-CoV-2 PCR testing became available in Japan. We subjected 277 individuals with mild symptoms in metropolitan Tokyo (positive: 9.0%) from March 9 to 29, 2020, to SARS-CoV-2 PCR testing. The results revealed that 25 (9.0%) of them were PCR-positive. The sensitivity and specificity of the MHLW criteria were 100% and 10.7%, respectively. When the criteria excluded nonspecific symptoms, fatigue, and dyspnea, the sensitivity slightly decreased to 92%, and the specificity increased to 22.2%. The specificity was highest when the fever criterion was ≥37.5°C for ≥4 days, and exposure/travel history, including age and underlying comorbidities, was considered. Our findings suggest that the MHLW criteria, including the symptoms and exposure/travel history, may be useful for COVID-19 pre-screening.

A 49-year-old man was admitted to our hospital in late March 2020, 6 days after onset of coronavirus disease 2019 (COVID-19). He received remdesivir in a clinical study. Oxygen supplementation was not required. Defervescence occurred 12 days after onset, and he was discharged 21 days after symptom onset. In mid-May 2020, he noticed alopecia on his head. He started taking self-imported minoxidil 5 mg/day and finasteride 1 mg/day in June 2020, and was still taking these medications at the time of writing. Alopecia began to improve in August 2020. Figure 1 shows the condition of his hair 3 months and 1 year after COVID-19. This course is consistent with telogen effluvium, a type of alopecia that occurs several months after various physical and psychological burdens (Paus and Cotsarelis, 1999Paus R. Cotsarelis G. The biology of hair follicles.N Engl J Med. 1999; 341: 491-497Crossref PubMed Scopus (1005) Google Scholar). Previous studies have reported alopecia of varying severity in three patients (Rizzetto et al., 2020Rizzetto G. Diotallevi F. Campanati A. Radi G. Bianchelli T. Molinelli E. et al.Telogen effluvium related to post severe Sars-Cov-2 infection: clinical aspects and our management experience.Dermatol Ther. 2020; 34e14547PubMed Google Scholar) and 10 patients (Mieczkowska et al., 2021Mieczkowska K. Deutsch A. Borok J. Guzman A.K. Fruchter R. Patel P. et al.Telogen effluvium: a sequela of COVID-19.Int J Dermatol. 2021; 60: 122-124Crossref PubMed Scopus (44) Google Scholar) after COVID-19. Our case did not need supplemental oxygen, but the psychological burden of isolation, limited information about COVID-19 (Kutsuna, 2020Kutsuna S. Coronavirus disease 2019 (COVID-19): research progress and clinical practice.Glob Health Med. 2020; 2: 78-88Crossref PubMed Google Scholar), anxiety about the illness becoming severe, and prejudice of people following hospital discharge may have triggered alopecia. The medications may have contributed slightly to the improvement seen, but rapid progression is inconsistent to androgenic alopecia. Further research will enhance our understanding of the pathogenesis of alopecia after COVID-19. None declared. This work was supported by the Health, Labour and Welfare Policy Research Grants, Research on Emerging and Re-emerging Infectious Diseases and Immunization (Grant No. 20HA1006) and Japan's National Centrefor Global Health and Medicine (Grant No. 20A2003D).

Introduction: Among patients with coronavirus disease 2019 (COVID-19), the factors that affect anti severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody production remain unclear. This study aimed to identify such factors among patients convalescing from COVID-19. Methods: This study comprised patients who had been diagnosed with COVID-19 between January 1 and June 30, 2020 and gave consent for anti-SARS-CoV-2 spike protein antibody measurement using enzyme linked immunosorbent assay during their acute and/or convalescent phases. Factors related to elevated antibody titers and the relationship between the days from disease onset and the development of antibody titers were assessed. Results: A total of 84 participants enrolled in the study. Nineteen participants had antibody titers measured during the convalescent phase only, and 65 participants had antibody titers measured during the acute and convalescent phases. The antibody titers peaked in weeks 5 and 6. The stepwise multivariate log-normal analysis revealed that male sex (P = 0.04), diabetes mellitus (P = 0.03), and high C reactive protein levels during the disease course (P < 0.001) were associated with elevated IgG antibodies. Glucocorticoid use was not associated with antibody titers. Conclusion: The study found that high values of maximum CRP levels during the acute phase, male sex, and diabetes mellitus were associated with elevated antibody titers. Antibody titers tended to be highest in the first 5 or 6 weeks after the onset of symptoms. (c) 2021 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Remdesivir is an antiviral drug that results in clinical improvement after five days of treatment and accelerates recovery by 31%. No studies have discussed the pharmacokinetic analysis of remdesivir in patients with severe COVID-19 requiring extracorporeal membrane oxygenation (ECMO). A 63-year-old American man who underwent mechanical ventilation and ECMO for severe COVID-19 was administered remdesivir for ten days. The loading dosage was 200 mg at 7 PM on day 12 and 100 mg daily at 0:00 PM from day 13-21, administered within 1 h. The pharmacokinetic analysis was performed. The serum creatinine concentration was within the normal range of 0.5-0.7 mg/dL during treatment. According to the pharmacokinetic analysis, the plasma concentrations of remdesivir and GS-441524 4 h after administration (C-4) were 662 ng/mL and 58 ng/mL, respectively, and the concentrations 18 h after administration (C-18) were 32 ng/mL and 44 ng/mL, respectively. Therefore, the half-life of remdesivir and GS-441524 was 3.2 and 35.1 h, respectively. Monitoring the plasma concentrations of remdesivir and GS-441524 in patients undergoing ECMO may be necessary. (C) 2021 The Author(s). Published by Elsevier Ltd.

Objectives: To alleviate the overflow of coronavirus disease 2019 (COVID-19) patients in hospitals, less invasive and simple criteria are required to triage the patients. We evaluated the relationship between COVID-19 severity and fatty liver on plain computed tomography (CT) scan performed on admission. Methods: In this retrospective cohort study, we considered all COVID-19 patients at a large tertiary care hospital between January 31 and August 31, 2020. COVID-19 severity was categorized into severe (moderate and severe) and non-severe (asymptomatic and mild) groups, based on the Japanese National COVID-19 guidelines. Fatty liver was detected on plain CT scan. Multivariate logistic regression analysis was performed to evaluate factors associated with severe COVID-19. Results: Of 222 patients (median age: 52 years), 3.2%, 58.1%, 20.7%, and 18.0% presented with asymptomatic, mild, moderate, and severe COVID-19, respectively. Although 59.9% had no fatty liver on plain CT, mild, moderate, and severe fatty liver occurred in 13.1%, 18.9%, and 8.1%, respectively. Age and presence of fatty liver were significantly associated with severe COVID-19. Conclusion: Our study showed that fatty liver on plain CT scan on admission can become a risk factor for severe COVID-19. This finding may help clinicians to easily triage COVID-19 patients.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease caused by Dabie bandavirus (formerly SFTS virus, SFTSV). Its manifestations during the convalescent phase have not been widely described. We report a patient presenting with hematospermia, fatigue, myalgia, alopecia, insomnia, and depression during the recovery phase of SFTS. Since these symptoms are widely observed in patients with viral hemorrhagic fevers, there might be common mechanisms between SFTS and other viral hemorrhagic fevers. Close monitoring may be required during the recovery phase of SFTS.

Background: The coronavirus disease 2019 (COVID-19) continues to spread around the world. In addition to community-acquired infections, nosocomial infections are also a major social concern. The likelihood of environmental contamination and transmission of the virus based on disease severity is unknown.Methods: We collected nasopharyngeal, environmental and air samples from patients with COVID-19 admitted to the National Centre for Global Health and Medicine between Jan-uary 29th and February 29th, 2020. The patients were classified by severity of disease. The collected samples were tested using severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) real-time reverse transcription polymerase chain reaction (real-time RT-PCR).Results: SARS-CoV-2 was not detected in a subset of 11 air samples. Of the 141 environ-mental samples collected from three patient bays and two single rooms, four samples tested positive for SARS-CoV-2 by real-time RT-PCR. Detections were made on the surface of a stethoscope used in the care of a patient with severe disease, on the intubation tube of a patient classified as critical (and on ventilator management), and on the surface of a gown worn by the nurse providing care.Conclusions: Regardless of the patients' disease severity, SARS-CoV-2 was detected on very few environmental surfaces. However, detection of SARS-CoV-2 on stethoscopes used in the care of multiple patients and on the surface of gowns worn by clinical staff indicates that medical devices may be linked to the spread of infection.& COPY; 2020 The Authors. Published by Elsevier Ltd on behalf of The Healthcare Infection Society.This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Objective In fever clinics screening coronavirus disease (COVID-19), there could be patients with lifethreatening diseases that physicians should not overlook. We exploratorily investigated the final diagnosis among non-COVID-19 hospitalized patients who visited the fever clinic. Methods This was a retrospective, observational, and single-centered study conducted in the National Center for Global Health and Medicine (NCGM), Tokyo, Japan. We conducted a retrospective chart review of patients who visited the fever clinic in the NCGM from 11 March 2020 to 24 April 2020. Patients Patients who met the following clinical criteria visited the fever clinic in the NCGM: (1) body temperature >37.5 degrees C, (2) any symptoms consistent with COVID-19 or (3) referral from local healthcare facilities. In the fever clinic, all patients who met the above criteria had severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test with nasopharyngeal swab specimens. Patients with severe symptoms or an unstable condition were sent to an outpatient clinic for infectious diseases for further evaluation and treatment. Results Among 1,470 patients who visited the fever clinic, 84 patients were hospitalized, and 45 of them were diagnosed as having COVID-19. Among the remaining 39 non-COVID-19 patients. there were nine patients with life-threatening diseases. The life-threatening diseases included acute heart failure, septic shock, pneumocystis pneumonia, peritonsillar abscess, and necrotizing fasciitis. Conclusion Physicians should evaluate each patient carefully while considering other life-threatening conditions even in such a COVID-19 pandemic era.

Due to the significant spread of a new type of coronavirus (SARS-CoV-2) infection (COVID-19) in China, the Chinese government blockaded several cities in Hubei Province. Japanese citizens lost a means of transportation to return back to Japan. The National Center for Global Health and Medicine (NCGM) helped the operation of charter flights for evacuation of Japanese residents from Hubei Province, and this article outlines our experiences. A total of five charter flights were dispatched, and the majority of returnees (793/829 [95.7%]) were handled at NCGM. A large number of personnel from various departments participated in this operation; 107 physicians, 115 nurses, 110 clerical staff, and 45 laboratory technicians in total. Several medical translators were also involved. In this operation, we conducted airborne precautions in addition to contact precautions. Eye shields were also used. The doctors collecting the pharyngeal swab used a coverall to minimize the risk of body surface contamination from secretions and droplets. Enhanced hand hygiene using alcohol hand sanitizer was performed. Forty-eight persons were ultimately hospitalized after the triage at NCGM operation, which was more than the number of persons triaged at the airport (n = 34). Of those hospitalized after NCGM triage, 8.3% (4/48 patients) ultimately tested positive for SARS-CoV-2, significantly higher than the positive rate among subjects not triaged (4/48 [8.3%] vs. 9/745 [1.2%]: p = 0.0057). NCGM participated in a large-scale operation to evacuate Japanese nationals from the COVID-19 epidemic area. We were able to establish a scheme through this experience that can be used in the future.

Coronavirus disease (COVID-19) is associated with pulmonary hypertension due to pulmonary embolism, which affects subsequent outcomes. However, definitive diagnosis of pulmonary hypertension is difficult because of the risk of spreading the infection. Here, we assess the utility of plane computed tomography in noninvasively predicting the clinical severity of COVID-19.

SUBJECTS:Early detection of coronavirus disease 2019 in patients likely to develop severe manifestations enables appropriate interventions, including rapid ICU admission. This study was conducted to determine whether noninvasive urine biomarkers can predict the clinical severity of coronavirus disease 2019.INTERVENTIONS:Not applicable.MEASUREMENTS AND MAIN RESULTS:This is single-center study, national center hospital designated for infectious disease. Fifty-eight patients who tested positive for severe acute respiratory syndrome coronavirus 2 in respiratory specimens through real-time reverse transcription-polymerase chain reaction were retrospectively studied. Urinary β2-microglobulin, liver-type fatty acid-binding protein were serially measured. Serum interferon-γ and monocyte chemotactic protein-1 were also evaluated. The 58 patients were assigned into three groups. Patients requiring intensive care were assigned to the severe group (n = 12). Patients treated with oxygen were assigned to the moderate group (n = 13). Other patients were assigned to the mild group (n = 33). Urine tests revealed that low β2-microglobulin and liver-type fatty acid-binding protein levels were associated with mild disease, whereas high levels were associated with severe disease. In severe cases, liver-type fatty acid-binding protein tended to be persistently high. The resulting cutoff values were β2-microglobulin; severe versus moderate + mild: 2,457 μg/dL (specificity 76.9% and sensitivity 90.0%, area under the receiver operating characteristic curve 85.9%), liver-type fatty acid-binding protein; severe versus moderate + mild: 22.0 μg/gCre (specificity 84.6% and sensitivity 90%, area under the receiver operating characteristic curve 91.8%). Urinary β2-microglobulin and serum interferon-γ/monocyte chemotactic protein-1 showed a similar trend.CONCLUSIONS:Evaluating urinary biomarkers such as β2-microglobulin and liver-type fatty acid-binding protein may allow determination of coronavirus disease 2019 patients with active cytokines and recognition of patients likely to become critically ill and requiring careful observation and early intervention.

We report detection of severe acute respiratory syndrome coronavirus 2 RNA in hemodialysis effluent from a patient in Japan with coronavirus disease and prolonged inflammation. Healthcare workers should observe strict standard and contact precautions and use appropriate personal protective equipment when handling hemodialysis circuitry from patients with diagnosed coronavirus disease.