Analysis of chest radiographs of culture positive Legionella pneumonia in Japan, 1980-1990. Working Party for Legionellosis, Japanese Ministry of Health and Welfare]

We analyzed the initial and follow-up chest radiographs of 28 patients with culture-positive Legionella pneumonia, and developed a scoring system to quantitate the severity of radiological findings for pneumonia. Intrapulmonary shadows were observed on the initial chest radiograph in 26 patients, but pleural effusion was noted in only one. In one patient the initial chest radiograph had probably been obtained too early to reveal any pulmonary change. Alveolar shadows were noted on the initial radiograph in 21 (81%) patients, and interstitial shadows in 5 (19%). In ten (38%) patients shadows were present in both lung fields. Shadows were prominent in the middle and lower lung fields. A cavity was noted in only one patient, and pleural effusion was also noted at some time during the clinical course in 19 (70%). A large amount of pleural effusion was observed in four patients. The average pneumonia severity score was 3.3 in the 9 patients who survived, and 5.1 in the 17 who died (p > 0.05). The mortality rate was 53% in the 17 patients with pneumonia severity score of 5 or less and 89% in the 9 patients with a score of 6 or more (p > 0.05). Twelve patients died within one week after the initial chest radiograph was obtained. There were no differences among patients with community-acquired infection with or without underlying disease and those with nosocomial infection in characteristic and extension of shadow, presence of pleural effusion, or pneumonia score. The chest radiograph of Legionella pneumonia include bilateral shadow findings characteristic, pleural effusion and rapid progression of shadow, and are clinically useful for diagnosis.     

Evaluation of a multi-hospital cooperative study on the efficacy and safety of panipenem/betamipron (PAPM/BP) on elderly patients of respiratory infections

The efficacy and safety of Panipenem/Betamipron (PAPM/BP) on elderly patients of respiratory infections was examined at 17 hospitals in a cooperative study. Among the 95 case, we examined the efficacy of the medication in 86 cases, and the safety in all 95 cases. Efficacy was confirmed in 81.3% of pneumonia patients, 57.7% of secondary-infection patients of chronic respiratory diseases, and 74.4% of the total. No significant difference was observed among each group according to age, comparing patients > or = 65 years old grouped by 5 years, or when broadly comparing groups < 75 years and > or = 75 years of age. The microbiological efficacy was 100% for Streptococcus pneumoniae, 80% for Staphylococcus aureus, 80% in Klebsiella pneumoniae; therefore, a very good disappearance rate of symptoms could be obtained in all major respiratory etiologic agents except Pseudomonas aeruginosa. In this study, we also examined other factors considered to affect the course of treatment for elderly patients of infectious diseases, namely the presence of absence of underlying diseases, the distinctness of infectious symptoms, the patient's condition before the appearance of infectious symptoms, and previous history of treatment with antimicrobial agents. For safety, the incidence rate of side effects was 14.7%, which was similar to the 16.9% in the developmental study. These two findings were also similar in content. No significant difference was observed among each age group, comparing patients > or = 65 years old grouped by 5 years, or comparing groups < 75 years and > or = 75 years of age. From the above evaluation, we consider PAPM/BP to be an effective drug for normal adult patients as well as elderly patients of respiratory infections.     

Susceptibilities of Enterococcus faecium, PRSP and MRSA to RP59500 and their correlations with those to other drugs]

Investigations on emergence of vancomycin-resistant Enterococcus faecium (VREF) which has recently been attracting attention, especially in the Western countries, have been conducted in Japan. A total of 1,239 isolates of E. faecium were collected from 19 institutions during the period of April 1995 and June 1996, in the purpose of evaluating susceptibilities to variety of antimicrobial agents, including RP59500 and vancomycin (VCM), and detecting vancomycin-resistant genes (van genes). Susceptibilities of penicillin-resistant Streptococcus pneumoniae (PRSP) and methicillin-resistant Staphylococcus aureus (MRSA) were also studied. As a result, 2 isolates of E. faecium were found to be moderately resistant to VCM showing MIC of 8 micrograms/ml though the final identification in species level and the detection of van genes by PCR method have not been completed. On the other hand there detected no MRSA nor PRSP showing moderately resistant or resistant to VCM. It was concluded that RP59500 and VCM possessed favorable activity against clinically isolated E. faecium, PRSP and MRSA. Among other species of enterococci, moderately resistant strains to VCM showing MIC of 8 micrograms/ml were detected; 10 isolates of E. gallinarum, 4 of E. casseliflavus and 2 of E. flavescens. In those isolates, vanC1 and vanC2 were detected by PCR, and vanB was also detected in a isolates of E. gallinarum simultaneously.     

Survey of antibiotic resistance in Pseudomonas aeruginosa by The Tokyo Johoku Association of Pseudomonas Studies

Pseudomonas aeruginosa resistance (minimum inhibitory concentration [MIC], ≥16 μg/ml defined as resistant) to meropenem, imipenem, panipenem, piperacillin, ceftazidime, cefozopran, cefoperazone, sulbactam/cefoperazone, amikacin, and tobramycin, as well as cross-resistance profiles, were investigated in P. aeruginosa strains isolated at eight hospitals in the Johoku area, Tokyo, during November 1998. Overall, 8.3% of isolates were imipenem-resistant and 4.6% were ceftazidime-resistant. However, the incidence of antibiotic-resistant P. aeruginosa was distinctly different at each hospital. P. aeruginosa resistance to imipenem ranged from (MIC) 1 to 64 μg/ml (MIC₉₀ 32 μg/ml), and its resistance to ceftazidime ranged from 2 to more than 128 μg/ml (MIC₉₀, 64 μg/ml). Meropenem (MIC range, ≤0.25 to 16 μg/ml) was more active than panipenem (MIC range, 2 to 64 μg/ml). Cefozopran was more active than piperacillin, cefoperazone, or sulbactam/cefoperazone, but many strains were resistant to cefoperazone (17/57). Our analysis found cross-resistance to many beta-lactams, but the degree of cross-resistance was very variable. Received: October 27, 2000 / Accepted: April 10, 2001     

Anaerobic bacteria in biliary disease in elderly patients.

Gallbladder bile from 52 elderly subjects who had undergone biliary tract surgery was examined for the presence of bacteria. Twelve patients had sterile bile, 18 specimens of bile yielded anaerobes as well as aerobes, and 22 yielded aerobic bacteria only. Escherichia coli was the most commonly isolated organism (30 strains). Bacteroides fragilis was the most frequently encountered anaerobic bacterium and was found in 15 patients. The Klebsiella-Enterobacter group was the second most commonly isolated group and B. fragilis was third. Clostridium perfringens was recovered in 10 specimens of bile. Anaerobic bacteria were recovered more frequently in patients with ductal obstruction. The relatively frequent isolation of anaerobes, especially of B. fragilis, in this study may be related to the anaerobic techniques used, to the age of the patients, and to the high incidence of pigment stones among the subjects.