Search

We describe a 55-year-old man with acute myelogenous leukemia who developed breakthrough Trichosporon asahii fungemia during 5 days of micafungin treatment. Although the patient's clinical condition improved considerably after the start of voriconazole treatment, blood culture results remained positive for T. asahii for 3 days, and fever persisted for 7 days thereafter. The patient achieved complete hematological remission, and he received successful consolidation chemotherapy without developing Trichosporon infection with the prophylactic use of voriconazole therapy. This case report illustrates that voriconazole may be useful in the treatment of disseminated T. asahii infection in neutropenic patients. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) has made significant progress in recent years, and many medical fields are attempting to introduce AI technology into clinical practice. Currently, much research is being conducted to evaluate that AI can be incorporated into surgical procedures to make them safer and more efficient, subsequently to obtain better outcomes for patients. In this paper, we review basic AI research regarding surgery and discuss the potential for implementing AI technology in gastric cancer surgery. At present, research and development is focused on AI technologies that assist the surgeon's understandings and judgment during surgery, such as anatomical navigation. AI systems are also being developed to recognize in which the surgical phase is ongoing. Such a surgical phase recognition systems is considered for effective storage of surgical videos and education, in the future, for use in systems to objectively evaluate the skill of surgeons. At this time, it is not considered practical to let AI make intraoperative decisions or move forceps automatically from an ethical standpoint, too. At present, AI research on surgery has various limitations, and it is desirable to develop practical systems that will truly benefit clinical practice in the future., Competing Interests: No potential conflict of interest relevant to this article was reported., (Copyright © 2023. Korean Gastric Cancer Association.)

A total of 1085 strains of Acinetobacter sp. obtained from 280 medical institutions in the Chugoku and Shikoku areas of Japan were investigated between 2011 and 2013. Among these strains, 20 (1.84 %) showing meropenem or imipenem resistance with a MIC of >4 μg ml- 1 were detected. Of these 20 strains, the bla(OXA-23) gene was detected in 17 strains isolated from the same institution. The PFGE patterns of the 17 strains were separated into two clusters, and multi-locus sequence typing showed the sequence types (STs) to be ST2 and ST246. This investigation demonstrated that A. baumannii ST2 of international clone II, which has rarely been isolated in Japan, has not yet spread nationwide.

Extended-spectrum beta-lactamases, plasmid-mediated AmpC beta-lactamases (PABLs), and plasmid-mediated metallo-beta-lactamases confer resistance to many beta-lactams. In Japan, although several reports exist on the prevalence of extended-spectrum beta-lactamases and metallo-beta-lactamases, the prevalence and characteristics of PABLs remain unknown. To investigate the production of PABLs, a total of 22,869 strains of 4 enterobacterial species, Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, and Proteus mirabilis, were collected during six 6-month periods from 17 clinical laboratories in the Kinki region of Japan. PABLs were detected in 29 (0.13%) of 22,869 isolates by the 3-dimensional test, PCR analysis, and DNA sequencing analysis. PABL-positive isolates were detected among isolates from 13 laboratories. Seventeen of 13,995 (0.12%) E. coli isolates, 8 of 5,970 (0.13%) K. pneumoniae isolates, 3 of 1,722 (0.17%) K. oxytoca isolates, and 1 of 1,182 (0.08%) P. mirabilis isolates were positive for PABLs. Of these 29 PABL-positive strains, 20 (69.0%), 6 (20.7%), 2 (6.9%), and 1 (3.4%) carried the genes for CMY-2, DHA-1, CMY-8, and MOX-1 PABLs, respectively. Pattern analysis of randomly amplified polymorphic DNA and pulsed-field gel electrophoretic analysis revealed that the prevalence of CMY-2-producing E. coli strains was not due to epidemic strains and that 3 DHA-1-producing K. pneumoniae strains were identical, suggesting their clonal relatedness. In conclusion, the DHA-1 PABLs were predominantly present in K. pneumoniae strains, but CMY-2 PABLs were predominantly present in E. coli strains. The present findings will provide significant information to assist in preventing the emergence and further spread of PABL-producing bacteria.

A total of 19,753 strains of gram-negative rods collected during two 6-month periods (October 2000 to March 2001 and November 2001 to April 2002) from 13 clinical laboratories in the Kinki region of Japan were investigated for the production of metallo-beta-lactamases (MBLs). MBLs were detected in 96 (0.5%) of the 19,753 isolates by the broth microdilution method, the 2-mercaptopropionic acid inhibition test, and PCR and DNA sequencing analyses. MBL-positive isolates were detected in 9 of 13 laboratories, with the rate of detection ranging between 0 and 2.6% for each laboratory. Forty-four of 1,429 (3.1%) Serratia marcescens, 22 of 6,198 (0.4%) Pseudomonas aeruginosa, 21 of 1,108 (1.9%) Acinetobacter spp., 4 of 544 (0.7%) Citrobacter freundii, 3 of 127 (2.4%) Providencia rettgeri, 1 of 434 (0.2%) Morganella morganii, and 1 of 1,483 (0.1%) Enterobacter cloacae isolates were positive for MBLs. Of these 96 MBL-positive strains, 87 (90.6%), 7 (7.3%), and 2 (2.1%) isolates carried the genes for IMP-1-group MBLs, IMP-2-group MBLs, and VIM-2-group MBLs, respectively. The class 1 integrase gene, intI1, was detected in all MBL-positive strains, and the aac (6')-Ib gene was detected in 37 (38.5%) isolates. Strains with identical PCR fingerprint profiles in a random amplified polymorphic DNA pattern analysis were isolated successively from five separate hospitals, suggesting the nosocomial spread of the organism in each hospital. In conclusion, many species of MBL-positive gram-negative rods are distributed widely in different hospitals in the Kinki region of Japan. The present findings should be considered during the development of policies and strategies to prevent the emergence and further spread of MBL-producing bacteria.