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A 75-year-old woman with aplastic anemia was admitted to our university hospital because of a dry cough that had persisted for a month. Chest computed tomography showed a mass shadow with a central low attenuation area in the lower lobe of the left lung. Filamentous fungus resembling Aspergillus fumigatus was cultured from the specimens obtained by transthoracic needle aspiration biopsy and bronchoalveolar lavage. The initial diagnosis was a lung abscess due to A. fumigatus, although the patient did not respond well to antifungal agents. Subsequently, the filamentous fungus was identified as Aspergillus viridinutans by sequence analysis of the β-tubulin gene, and the patient was successfully treated with combination therapy along with granulocyte colony-stimulating factor. The incidence of A. viridinutans infection is very rare. A. viridinutans is morphologically similar to A. fumigatus; however, the response to antifungal agents is generally worse than that observed in A. fumigatus infections. Therefore, the selection of agents and supplemental therapy is of vital importance in cases of A. viridinutans infection.

The control of hospital-acquired infections is a matter of social concern, especially in the proper use of antimicrobial agents. The fundamentals of treatment for infectious diseases involve the exact identification of the responsible bacteria, and the minimum essential use of narrow-spectrum antimicrobial agents for the identified bacteria. We tested the antimicrobial susceptibility of 13 species which belong to the gram-negative rod type and isolated 50 or more strains at Tottori University Hospital in 2001. We evaluated the susceptibility pattern for every species, and have proposed a plan for the sensible use of narrow-spectrum antimicrobial agents. The resistant frequency in the present study was equal to or lower than previously reported. We think that it is possible to use narrow-spectrum antimicrobial agents more often, because the susceptible frequency to these agents was fairly high for some species. It is not too much to say that the history of the development of antimicrobial agents has been a road to broad-spectrum. Though the proper use of antimicrobial agents seems to go against this view, we should remain farsighted. Not only is the publicity of proper use indispensable but excellent surveillance is also highly necessary. We hope for the establishment of a good surveillance system gifted with simplicity, universality, high reproduction and continuity.