The trends and prevalence of antimicrobial susceptibility of pathogens vary by country, region, and time. Long-term regular surveillance is required to investigate trends in the antimicrobial resistance of various isolated bacterial pathogens. We report the results of a nationwide surveillance on the antimicrobial susceptibility of bacterial respiratory pathogens in Japan conducted by the Japanese Society of Chemotherapy, the Japanese Association for Infectious Diseases, and the Japanese Society for Clinical Microbiology. The isolates were collected from clinical specimens obtained from adult patients who visited a collaborating medical facility between June 2019 and December 2020 and were diagnosed with respiratory tract infections by a physician. Antimicrobial susceptibility testing was performed in a centralized laboratory according to the methods recommended by the Clinical and Laboratory Standards Institute. Susceptibility testing was performed for 932 strains (201 Staphylococcus aureus, 158 Streptococcus pneumoniae, 6 S. pyogenes, 136 Haemophilus influenzae, 127 Moraxella catarrhalis, 141 Klebsiella pneumoniae, and 163 Pseudomonas aeruginosa) collected from 32 facilities in Japan. The proportions of methicillin-resistant S. aureus and penicillin-resistant S. pneumoniae were 35.3% and 0%, respectively. In H. influenzae, 16.2% and 16.9% were beta-lactamase-producing ampicillin resistant and beta-lactamase-negative ampicillin resistant, respectively. Extended-spectrum beta-lactamase-producing K. pneumoniae accounted for 5.0% of all K. pneumoniae infections. Carbapenemase-producing K. pneumoniae and multi-drug-resistant P. aeruginosa with metallo-beta-lactamase were not detected in this study. This surveillance will be a useful reference for treating respiratory infections in Japan and will provide evidence to enhance the appropriate use of antimicrobial agents.

An outbreak of serotype 19A Streptococcus pneumoniae occurred among the residents of a relief facility. Pneumonia developed in 5 of 99 residents (attack rate, 5.1%). We obtained pharyngeal specimens from non-onset residents, and S. pneumoniae was isolated from 6 individuals (6.4%), 5 of whom had serotype 19A.

The nationwide surveillance on antimicrobial susceptibility of bacterial respiratory pathogens from the patients in Japan was conducted by the Japanese Society of Chemotherapy, the Japanese Association for Infectious Diseases, and the Japanese Society for Clinical Microbiology in 2016. The isolates were collected from clinical specimens obtained from well-diagnosed adult patients with respiratory tract infections during the period between February 2016 and August 2016 by three societies. Antimicrobial susceptibility testing was conducted at the central reference laboratory according to the method recommended by Clinical Laboratory Standards Institute. Susceptibility testing was evaluated in 1062 strains (143 Staphylococcus aureus, 210 Streptococcus pneumoniae, 17 Streptococcus pyogenes, 248 Haemophilus influenzae, 151 Moraxella catarrhalis, 134 Klebsiella pneumoniae, and 159 Pseudomonas aeruginosa). Ratio of methicillin-resistant S. aureus was 48.3%, and those of penicillin-susceptible S. pneumoniae was 99.5%. Among H. influenzae, 14.1% of them were found to be β-lactamase-producing ampicillin-resistant strains, and 41.1% to be β-lactamase-non-producing ampicillin-resistant strains. Extended spectrum β-lactamase-producing K. pneumoniae and multi-drug resistant P. aeruginosa with metallo β-lactamase were 4.5% and 0.6%, respectively.

The nationwide surveillance on antimicrobial susceptibility of bacterial respiratory pathogens from the patients in Japan was conducted by Japanese Society of Chemotherapy, the Japanese Association for Infectious Diseases, and the Japanese Society for Clinical Microbiology in 2014. The isolates were collected from clinical specimens obtained from well-diagnosed adult patients with respiratory tract infections during the period between January 2014 and April 2015 by three societies. Antimicrobial susceptibility testing was conducted at the central reference laboratory according to the method recommended by Clinical Laboratory Standards Institute. Susceptibility testing was evaluated in 1534 strains (335 Staphylococcus aureus, 264 Streptococcus pneumoniae, 29 Streptococcus pyogenes, 281 Haemophilus influenzae, 164 Moraxella catarrhalis, 207 Klebsiella pneumoniae, and 254 Pseudomonas aeruginosa). Ratio of methicillin-resistant S. aureus was 43.6%, and those of penicillin-susceptible S. pneumoniae was 100%. Among H. influenzae, 8.2% of them were found to be beta-lactamase-producing ampicillin-resistant strains, and 49.1% to be beta-lactamase-non-producing ampicillin-resistant strains. Extended spectrum beta-lactamase-producing K. pneumoniae and multi-drug resistant P. aeruginosa with metallo beta-lactamase were 9.2% and 0.4%, respectively. (c) 2019 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Author(s) Izumikawa, Koichi; Akamatsu, Suguru; Kageyama, Akiko; Okada, Kiyomi; Kazuyama, Yukumasa; Takayanagi, Noboru; Nakamura, Shigeki; Inoue, Yuichi; Higashiyama, Yasuhito; Fukushima, Kiyoyasu; Ishida, Tadashi; Sawai, Toyomitsu; Yoshimura, Kunihiko; Nakahama, Chikara; Ohmichi, Mitsuhide; Kakugawa, Tomoyuki; Nishioka, Yasuhiko; Aoki, Nobuki; Seki, Masafumi; Kakeya, Hiroshi; Yamamoto, Yoshihiro; Yanagihara, Katsunori; Kohno, Shigeru

The nationwide surveillance on antimicrobial susceptibility of bacterial respiratory pathogens from the patients in Japan was conducted by Japanese Society of Chemotherapy, Japanese association for infectious diseases and Japanese society for Clinical Microbiology in 2012.The isolates were collected from clinical specimens obtained from well-diagnosed adult patients with respiratory tract infections during the period between January and December in 2012 by three societies. Antimicrobial susceptibility testing was conducted at the central reference laboratory according to the method recommended by Clinical Laboratory Standard Institutes.Susceptibility testing was evaluated in 1236 strains (232 Staphylococcus aureus, 225 Streptococcus pneumoniae, 16 Streptococcus pyogenes, 231 Haemophilus influenzae, 147 Moraxella catarrhalis, 167 Klebsiella pneumoniae and 218 Pseudomonas aeruginosa). Ratio of methicillin-resistant S. aureus was 51.3%, and those of penicillin-intermediate S. pneumoniae was 0.4%. Among H. influenzae, 5.6% of them were found to be beta-lactamase-producing ampicillin-resistant strains, and 37.2% to be beta-lactamase-non-producing ampicillin-resistant strains. Extended spectrum beta-lactamase-producing K. pneumoniae and multidrug resistant P. aeruginosa with metallo beta-lactamase were 4.2% and 3.2%, respectively.Continuous national surveillance is important to determine the actual situation of the resistance shown by bacterial respiratory pathogens to antimicrobial agents. (C) 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

The Japanese Association for Infectious Diseases (JAID) and Japanese Society of Chemotherapy (JSC) announced the "Guide for the Use of Antimicrobial Drugs" in 2001 and the "Guidelines for the Use of Antimicrobial Drugs" in 2005. Subsequently, the "The JAID/JSC guide to clinical management of infectious diseases 2011" was published. With its revision, guidelines were newly prepared.

The nationwide surveillance on antimicrobial susceptibility of bacterial respiratory pathogens from patients in Japan, was conducted by Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases and Japanese Society for Clinical Microbiology in 2010.The isolates were collected from clinical specimens obtained from well-diagnosed adult patients with respiratory tract infections during the period from January and April 2010 by three societies. Antimicrobial susceptibility testing was conducted at the central reference laboratory according to the method recommended by Clinical and Laboratory Standard Institutes using maximum 45 antibacterial agents.Susceptibility testing was evaluable with 954 strains (206 Staphylococcus aureus, 189 Streptococcus pneumoniae, 4 Streptococcus pyogenes,182 Haemophilus influenzae, 74 Moraxella catarrhalis,139 Klebsiella pneumoniae and 160 Pseudomonas aeruginosa). Ratio of methicillin-resistant S. aureus was as high as 50.5%, and those of penicillin-intermediate and -resistant S. pneumoniae were 1.1% and 0.0%, respectively. Among H. influenzae, 17.6% of them were found to be beta-lactamase-non-producing ampicillin (ABPC)-intermediately resistant, 33.5% to be beta-lactamase-non-producing ABPC-resistant and 11.0% to be beta-lactamase-producing ABPC-resistant strains. Extended spectrum beta-lactamase-producing K. pneumoniae and multi-drug resistant P. aeruginosa with metallo beta-lactamase were 2.9% and 0.6%, respectively.Continuous national surveillance of antimicrobial susceptibility of respiratory pathogens is crucial in order to monitor changing patterns of susceptibility and to be able to update treatment recommendations on a regular basis. (C) 2015, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

OBJECTIVE:To compare the utility of Gram staining, a urinary antigen detection kit and a sputum antigen detection kit were examined for the rapid and early detection of pneumococcal pneumonia and lower respiratory infectious diseases.METHODS:A newly developed sputum pneumococcal antigen detection kit (RAPIRUN), Gram staining, and urinary antigen detection kit (BinaxNOW) were comparatively evaluated for their ability to detect Streptococcus pneumoniae in patients with pneumonia or lower respiratory tract infection. Sputum culture results were used as a standard for comparison. Furthermore, the pneumococcus-positive rates in culture and rapid tests were compared using polymerase chain reaction (PCR) as a reference.RESULTS:Of the 169 patients studied, 54 (32.0%) tested positive for S. pneumoniae in culture. S. pneumoniae detection sensitivities for Gram staining, RAPIRUN, and BinaxNOW were 75.9%, 90.7%, and 53.7%, respectively; thus, RAPIRUN had a significantly higher sensitivity than BinaxNOW (p<0.001). For patients with ≥10(5) copies/μg of pneumococcal surface protein A DNA PCR analysis, the detection rates of culture, Gram staining, and RAPIRUN were 85.2%, 72.1%, and 82.0%, respectively, however, the detection rate of BinaxNOW was only 47.5%. Comparisons among 45 patients with culture-positive pneumococcal pneumonia revealed that RAPIRUN had a significantly higher detection rate than BinaxNOW in the mild cases (p<0.006), regardless of the number of days from onset (p<0.03).CONCLUSION:RAPIRUN is a rapid testing kit that detects S. pneumoniae in sputum with a high sensitivity and specificity. It is a particularly more useful detection kit than BinaxNOW for early and mild community-acquired pneumonia in pre-treatment patients whose sputum specimens can be obtained.

Pneumonia cases can vary in both severity and chest X-ray findings. Elevated C-reactive protein (CRP) levels may be an indicator of disease severity. We retrospectively evaluated factors correlated with the extent of chest X-ray infiltration both in community-acquired pneumonia (CAP) and a subgroup of cases with pneumococcal pneumonia. In a clinical study that evaluated the efficacy of sitafloxacin, 137 patients with CAP had been previously enrolled. In our study, 75 patients with pneumococcal pneumonia were identified among these 137 CAP patients. The extent of chest X-ray infiltration was scored and correlations with age, sex, body temperature, white blood cell (WBC) count, and CRP levels were analyzed using multivariate analysis with logistic regression. Significant correlations were observed between the extent of chest X-ray infiltration and CRP levels in both CAP and pneumococcal pneumonia. Our data indicates that CRP is a valuable and informative resource that could reflect the severity of pneumonia in cases of both CAP and pneumococcal pneumonia.

This communication is in regards to Results section and Tables 3 and 5 of Watanabe et al. (2012), which has been found to contain errors. The subsection titled “Streptococcus pneumoniae” under the Results section is corrected as follows with the corrected section marked in bold: The susceptibilities of the 127 strains of S. pneumoniae to PCG revealed that 119 strains (93.7%), 8 strains (6.3%), and 0 strains (0.0%) were identified as penicillin-susceptible (PSSP), penicillin-intermediate (PISP), and penicillin-resistant strains (PRSP), respectively, with the breakpoint for PCG defined by the CLSI standards. However, with the previous susceptibility criteria for S. pneumoniae strains, 71 strains (55.9%), 34 strains (26.8%), and 22 strains (17.3%) were classified as susceptible (MIC of PCG ≤0.06 μg/ml), intermediate (MIC of PCG 0.125–1 μg/ml), and resistant (MIC of PCG ≥2 μg/ml) strains, respectively. Among the β-lactams, CCL, CAZ, and CMZ showed high MIC90s (64, 8, and 16 μg/ml, respectively), while many of the other β-lactams, except for the carbapenems, showed potent activities, with MIC90s of 1.0–4.0 μg/ml. All five carbapenems showed strong activities (MIC90 ≤ 0.25 μg/ml) against all S. pneumoniae strains, regardless of their different susceptibilities to PCG. Fluoroquinolones also showed potent activities against most of the strains with MIC90s of ≤0.25–4 μg/ml, although 7 strains (2.6%) were found to be resistant to LVFX. The glycopeptides (VCM and TEIC) and TEL showed strong activities (MIC90 ≤ 0.5 μg/ml). Aminoglycosides were substantially less active, with MIC90s of 8.0–64.0 μg/ml. High frequencies of resistance against the macrolide antibiotics, EM, CAM, and AZM, were shown, with MIC90s ≥128 μg/ml (Table 3). For Tables 3 and 5, readers are referred to the corrected tables in this corrigendum. The corrected values in Table 3 are marked in bold. The last three rows of Table 5 (data for Antibacterial agent of VCM, TEIC and LZD) are deleted.Table 3Antibacterial susceptibility of Streptococcus pneumoniae.Antibacterial agentAll trains, n = 127PSSP, n = 119PISP, n = 8MIC(μg/mL)MIC(μg/mL)MIC(μg/mL)50%90%Range50%90%Range50%90%RangePCG≤0.062≤0.06 to 4≤0.062≤0.06 to 2444ABPC≤0.062≤0.06 to 8≤0.062≤0.06 to 4282 to 8SBT/ABPC≤0.064≤0.06 to 8≤0.062≤0.06 to 4482 to 8CVA/AMPC≤0.061≤0.06 to 8≤0.061≤0.06 to 2180.5 to 8PIPC≤0.062≤0.06 to 4≤0.061≤0.06 to 4241 to 4TAZ/PIPC-1≤0.062≤0.06 to 4≤0.062≤0.06 to 4241 to 4TAZ/PIPC-2≤0.062≤0.06 to 4≤0.062≤0.06 to 4241 to 4CCL1640.25 to 1281.0640.25 to 1286412816 to 128CFDN0.254≤0.06 to 320.254≤0.06 to 168324 to 32CFPN0.251≤0.06 to 320.251≤0.06 to 22320.5 to 32CDTR0.1250.5≤0.06 to 40.1250.5≤0.06 to 20.540.5 to 4CEZ0.1254≤0.06 to 160.1252≤0.06 to 84164 to 16CMZ0.516≤0.06 to 320.58≤0.06 to 3216328 to 32CTM0.254≤0.06 to 160.254≤0.06 to 88164 to 16CAZ480.125 to 64480.125 to 3216648 to 64CTRX0.251≤0.06 to 80.251≤0.06 to 2180.5 to 8CFPM0.51≤0.06 to 80.51≤0.06 to 2281 to 8CZOP0.251≤0.06 to 160.251≤0.06 to 22161 to 16IPM≤0.060.25≤0.06 to 0.5≤0.060.125≤0.06 to 0.50.250.50.125 to 0.5PAPM≤0.06≤0.06≤0.06 to 0.25≤0.06≤0.06≤0.06 to 0.25≤0.060.25≤0.06 to 0.25MEPM≤0.060.25≤0.06 to 0.5≤0.060.25≤0.06 to 0.50.250.50.125 to 0.5BIPM≤0.060.25≤0.06 to 0.5≤0.060.25≤0.06 to 0.50.250.50.125 to 0.5DRPM≤0.060.25≤0.06 to 0.5≤0.060.125≤0.06 to 0.50.250.50.125 to 0.5FRPM≤0.060.25≤0.06 to 1≤0.060.25≤0.06 to 0.50.2510.125 to 1GM482 to 16482 to 164164 to 16TOB16164 to 3216164 to 3216328 to 32AMK326416 to 128326416 to 128326432 to 64ABK16328 to 6416328 to 64166416 to 64EM≥256≥256≤0.06 to ≥256≥256≥256≤0.06 to ≥256≥256≥256≤0.06 to ≥256CAM≥128≥128≤0.06 to ≥128≥128≥128≤0.06 to ≥128≥128≥128≤0.06 to ≥128AZM≥128≥128≤0.06 to ≥128≥128≥128≤0.06 to ≥128≥128≥128≤0.06 to ≥128TEL≤0.060.25≤0.06 to 2≤0.060.25≤0.06 to 2≤0.060.5≤0.06 to 0.5CPFX12≤0.06 to 6412≤0.06 to 64120.25 to 2LVFX12≤0.06 to 6412≤0.06 to 64110.5 to 1TFLX0.1250.25≤0.06 to ≥320.1250.25≤0.06 to ≥320.1250.25≤0.06 to 0.25MFLX0.1250.25≤0.06 to 80.1250.25≤0.06 to 80.1250.250.125 to 0.25PZFX241 to 128241 to 128242 to 4GRNX≤0.06≤0.06≤0.06 to 2≤0.06≤0.06≤0.06 to 2≤0.06≤0.06≤0.06MINO816≤0.06 to 64816≤0.06 to 64816≤0.06 to 16CLDM64≥256≤0.06 to ≥25664≥256≤0.06 to ≥256128≥256≤0.06 to ≥256VCM0.250.50.125 to 0.50.250.50.125 to 0.50.50.50.25 to 0.5TEIC≤0.060.125≤0.06 to 0.125≤0.060.125≤0.06 to 0.125≤0.060.125≤0.06 to 0.125LZD110.125 to 2110.125 to 2120.5 to 2Susceptibilities of the 127 strains of S. pneumoniae to 42 antimicrobial agents were studied. The number of strains and proportion of PSSP, PISP, and PRSP are 119 (93.7%), 8 (6.3%), and 0 (0.0%), respectively. Open table in a new tab Table 5Antibacterial susceptibility of Moraxella catarrhalis.Antibacterial agentMIC(μg/mL)50%90%RangePCG1632≤0.06–64ABPC816≤0.06–32SBT/ABPC0.1250.25≤0.06–0.5CVA/AMPC0.250.25≤0.06–0.5PIPC216≤0.06–32TAZ/PIPC-1≤0.06≤0.06≤0.06TAZ/PIPC-20.1250.125≤0.06–0.125CCL280.125–32CFDN0.250.5≤0.06–1CFPN0.51≤0.06–4CDTR0.51≤0.06–2CEZ4160.125–64CMZ0.51≤0.06–4CTM120.25–4CAZ0.250.5≤0.06–2CTRX12≤0.06–4CFPM14≤0.06–8CZOP28≤0.06–8IPM≤0.060.125≤0.06–0.25PAPM≤0.06≤0.06≤0.06–0.125MEPM≤0.06≤0.06≤0.06BIPM≤0.06≤0.06≤0.06–0.125DRPM≤0.06≤0.06≤0.06FRPM0.50.5≤0.06–1AZT240.125–8GM0.1250.125≤0.06–0.25TOB0.250.25≤0.06–0.5AMK0.51≤0.06–2ABK0.1250.25≤0.06–0.5EM0.1250.25≤0.06–0.5CAM0.1250.25≤0.06–0.5AZM≤0.06≤0.06≤0.06TEL0.1250.25≤0.06–0.25CPFX≤0.06≤0.06≤0.06–0.125LVFX≤0.06≤0.06≤0.06–2TFLX≤0.06≤0.06≤0.06MFLX≤0.06≤0.06≤0.06–0.5PZFX≤0.06≤0.06≤0.06–2GRNX≤0.06≤0.06≤0.06–0.25MINO0.1250.25≤0.06–1CLDM240.5–8Susceptibilities of the 70 strains of M. catarrhalis to 40 antimicrobial agents were studied. Open table in a new tab Susceptibilities of the 127 strains of S. pneumoniae to 42 antimicrobial agents were studied. The number of strains and proportion of PSSP, PISP, and PRSP are 119 (93.7%), 8 (6.3%), and 0 (0.0%), respectively. Susceptibilities of the 70 strains of M. catarrhalis to 40 antimicrobial agents were studied.

Antimicrobials are commonly used to treat acute respiratory tract infection in adults. Furthermore, their overuse has raised concern. We conducted a field survey study that included 170 medical institutions from January 2008 to June 2010. The purpose of this study was to clarify the relationship between the rate of antimicrobial use and patient outcomes with each indication. The study included 1753 patients diagnosed with acute respiratory tract infection. Antimicrobials were used for treatment of 1420 of these patients, whereas 333 cases were not treated with antimicrobials. After 3 days of treatment, patients administered antimicrobials experienced a higher improvement rate than those who did not receive antimicrobial treatment (92.2% vs. 83.3%, p < 0.0001). However, after 7 days of treatment, the rates of improvement for patients in both groups were similar (95.0% and 93.4%, respectively, p = 0.2391). In addition, according to the criteria for the usage of antimicrobials described in the Japanese Respiratory Society guidelines for the management of respiratory tract infection in adults, the patients were classified into the 3 categories (6 indication factors for antimicrobial use): Grade 1, ≤ 2 factors; Grade 2, 3-4 factors; Grade 3, 5-6 factors). The indication factors considered were the following: 1) temperature; 2) purulent sputum or nasal discharge; 3) tonsillar enlargement and tonsillolith/white puss; 4) middle otitis/sinusitis; 5) inflammatory reaction; and 6) high-risk patients. The results indicate that the improvement observed after 3 days of treatment in Grade 2 and Grade 3 patients was significantly higher with antimicrobial treatment than without antimicrobial treatment. In conclusion, the administration of antimicrobials is not recommended in younger patients with no underlying disease. However, the use of antimicrobials is required in patients with a higher relative risk that corresponds to the presence of ≥ 3 of the 6 indication factors for antimicrobial use.

The adequacy of sitafloxacin clinical dose regimens was assessed by comparing the efficacy of the administration of 100 mg sitafloxacin once daily (100 mg qd group) and 50 mg sitafloxacin twice daily (50 mg bid group). Patients with respiratory tract infections caused by pneumococci were orally treated with sitafloxacin (100 mg qd or 50 mg bid) for 7 days. The clinical efficacy, pneumococci eradication rate, safety, and pharmacokinetic and pharmacodynamic indices of the two groups were then assessed. The clinical efficacy was 93.5 % in both groups. The pneumococci eradication rate was 98.2 % in the 100 mg qd group and 92.7 % in the 50 mg bid group. The mean of the free AUC0-24h divided by the minimum inhibitory concentration (MIC) (fAUC0-24h/MIC) did not differ significantly between the 100 mg qd (103.24) and the 50 mg bid groups (105.25). The mean of the free C peak divided by the MIC (fC peak/MIC) was higher in the 100 mg qd group (10.19) than in the 50 mg bid group (6.53). The pathogen eradication rate was 98.9 % (89/90) when the fAUC0-24h/MIC was greater than 30, and the eradication rate was 98.9 % (89/90) when the fC peak/MIC was greater than 2. The incidences of adverse drug reactions were 33.7 % in the 100 mg qd group and 40.4 % in the 50 mg bid group. No obvious differences in the efficacy and safety were observed between the dosage groups. For cases in which a sufficiently high C peak is necessary to ensure the susceptibility of the pathogens to the drug, 100 mg sitafloxacin once daily should be administered.

We evaluated the clinical and bacteriological efficacy of oral sitafloxacin (STFX) in clinically diagnosed community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae. Additionally, we cultured these patient samples to test the minimal inhibitory concentrations (MICs) of levofloxacin (LVFX), moxifloxacin (MFLX), STFX, and penicillin G (PCG), as well as identified mutations in the quinolone resistance determinant regions (QRDRs) in LVFX-resistant strains. This study is a nested cohort from a prospective, multicenter clinical trial consisting of 139 patients with community-acquired pneumonia (CAP), from which 72 were included in this study. After diagnosis of CAP caused by S. pneumoniae, STFX (50 mg twice daily, or 100 mg once daily) was orally administered for 7 days. Sixty-five patient sputum samples were then cultured for MIC analysis. In a LVFX-resistant strain that was identified, mutations in the QRDRs of the gyrA, gyrB, parC, and parE genes were examined. Of 72 patients eligible for this study, S. pneumoniae was successfully cultured from the sputum of 65 patients, and only 7 patients were diagnosed by urinary antigen only. Clinical improvement of CAP was obtained in 65 of the 69 clinically evaluable patients (65/69, 94.2 %). Eradication of S. pneumoniae was observed in 62 patients of the 65 bacteriologically evaluable patients (62/65, 95.4 %). Additionally, STFX showed the lowest MIC distribution compared with LVFX, MFLX, and PCG, and no major adverse reactions were observed. STFX treatment in patients with CAP caused by S. pneumoniae was found to be highly effective both clinically (94.2 %) and bacteriologically (95.4 %).

From October 2004 to September 2005, we collected the specimen from 319 patients with lower respiratory tract infections in 12 institutions in Japan, and investigated the susceptibilities of isolated bacteria to various antibacterial agents and patients' characteristics. Of 383 strains that were isolated from specimen (mainly from sputum) and assumed to be bacteria causing in inflammation, 381 strains were examined. The breakdown of the isolated bacteria were: Staphylococcus aureus 87, Streptococcus pneumoniae 80, Haemophilus influenzae 78, Pseudomonas aeruginosa (non-mucoid) 35, P. aeruginosa (mucoid) 9, Klebsiella pneumoniae 15, Moraxella subgenus Branhamella catarrhalis 30, etc. Of 87 S. aureus strains, those with 2 microg/mL or less of MIC of oxacillin (methicillin-sensitive S. aureus: MSSA) and those with 4 microg/mL or more of MIC of oxacillin (methicillin-resistant S. aureus: MRSA) were 40 (46.0%) and 47 (54.0%) strains, respectively. Against MSSA, imipenem had the most potent antibacterial activity and inhibited the growth of all the strains at 0.063 microg/mL. Against MRSA, vancomycin showed the most potent activity and inhibited the growth of all the strains at 1 microg/mL. Arbekacin (ABK) also showed the potent activity and its MIC90 was 2 microg/mL. Carbapenems showed the most potent activities against S. pneumoniae and inhibited the growth of all the strains at 0.25-0.5 microg/mL. Cefozopran (CZOP) also had a preferable activity (MIC90: 1 microg/mL) and inhibited the growth of all the strains at 2 microg/mL. In contrast, there were high-resistant strains (MIC: 128 microg/mL or more) for ABK (2.5%), erythromycin (37.5%), and clindamycin (38.8%). Against H. influenzae, levofloxacin showed the most potent activity and inhibited the growth of all the strains at 0.125 microg/mL. Meropenem showed the most potent activity against P. aeruginosa (mucoid) and inhibited the growth of all the strains at 2 microg/mL. Against P. aeruginosa (non-mucoid), amikacin (AMK) had the most potent activity and its MIC90 was 4 microg/mL. The activity of CZOP against the non-mucoid type also was preferable and its MIC90 was 8 microg/mL. Against K. pneumoniae, CZOP, cefmenoxime, cefpirome, flomoxef were the most potent activity and inhibited the growth of all the strains at 0.063 microg/mL. Also, all the agents generally showed a potent activity against M. (B.) catarrhalis and the MIC90 of them were 4 microg/mL or less. The approximately half the number (57.0%) of the patients with respiratory infection were aged 70 years or older. Bacterial pneumonia and chronic bronchitis accounted for 50.8% and 23.8% of all the respiratory infection, respectively. The bacteria frequently isolated from the patients with bacterial pneumonia were S. aureus (21.6%), S. pneumoniae (24.7%) and H. influenzae (20.1%). S. aureus (20.9%), S. pneumoniae (16.1%), and H. influenzae (16.1%) also were relatively frequently isolated from the patients with chronic bronchitis. Before the drug administration, the bacteria frequently isolated from the patients were S. pneumoniae (22.3%) and H. influenzae (25.1%). The bacteria relatively frequently isolated from the patients treated with macrolides were P. aeruginosa and the isolation frequency was 43.5%.

Introduction: The Japanese Respiratory Society Guidelines for the Management of Community-Acquired Pneumonia (CAP) in Adults (JRS 2005) was published as a revision of the Basic Concept for the Management of CAP in Adults (JRS 2000). To evaluate the JRS 2005 criteria for differentiating between disease types and assessing the status of antimicrobial agent use in initial treatment, we conducted a prospective survey.Subjects and methods: The survey was conducted from July 2006 to March 2007 as a nationwide joint study by 200 institutions. The study subjects included patients aged ?16 years of age who had CAP, and patients who met the inclusion criteria were consecutively enrolled. Disease type differentiation based on JRS 2005 and JRS 2000 was conducted. Disease type diagnosis was also performed based on test results. The sensitivity and specificity of disease type differentiation were calculated. The antimicrobial agents used in the initial treatment were classified as recommended or non-recommended based on JRS 2005. The validity of non-recommended antimicrobial agent use was investigated.Results: A total of 1875 patients were analyzed. Differentiation of atypical pneumonia using the JRS 2005 criteria had higher sensitivity and lower specificity than differentiation using the JRS 2000 criteria. The antimicrobial agents recommended by JRS 2005 were used as initial treatment in a low number of cases. The efficacy of the recommended antimicrobial agents was similar to that of the non-recommended agents.Conclusions: JRS 2005 is advantageous in terms of reducing the number of items used in disease type differentiation. The recommended antimicrobial agents used for the initial treatment are believed to be appropriate. (C) 2012 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.