Procalcitonin (PCT) and C-reactive protein serve as biomarkers of infection in patients with sepsis/bacteremia. The present study assessed the clinical characteristics of 280 patients with suspected sepsis who were admitted to Tohoku Medical and Pharmaceutical University Hospital between January 2012 and December 2013. Among the patients, 133 and 147 were positive and negative for PCT, respectively. Patients who were PCT positive were older and more frequently male, had reduced levels of platelets and albumin, and increased levels of aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, creatinine, and C-reactive protein. Patients who were PCT positive had significantly higher blood culture positivity compared with those who were PCT negative, and the sensitivity and specificity of PCT for detecting positive blood cultures were 74.5% and 59.1%, respectively. Escherichia coli was detected in PCT-positive patients, whereas Staphylococcus epidermidis and Staphylococcus lugdunensis were frequently detected in PCT-negative patients. Levels of PCT were higher in the patients infected with gram-negative rods than those with gram-positive cocci. Furthermore, extended-spectrum β-lactamase (ESBL)-producing bacteria cases showed higher levels of PCT than those of non-ESBL cases. These results suggest that PCT may be a useful biomarker of sepsis, and it might serve as a strong tool to detect patients with severe gram-negative rod bacteremia including ESBL-producing bacteria cases early due to its relative high sensitivity.

Objective: Rare disease Background: Mycobacterium abscessus is one of the most important mycobacteria, but its associated peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) appears relative rare, and the treatment regimen of the antibiotics are still unclear. Case Report: A 38-year-old female with chronic glomerulonephritis on CAPD who was diagnosed with M. abscessus-associated peritonitis. Symptoms exacerbated despite treatment with a 3-antibiotic regimen combining clarithromycin, imipenem/cilastatin (IPM/CS), and minocycline (MINO). However, after changing IPM/CS and MINO to linezolid (LZD), her condition and inflammation improved, and she was able to be maintained on oral tedizolid (TZD). Conclusions: Oxazolidinones such as LZD and TZD might be candidate antibiotics for the treatment of M. abscessus-associated diseases with chronic renal failure due to their immunomodulatory effects and non-renal excretion.

Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (TOF-MS) is now widely used to detect pathogens in clinical settings in Japan. Here, we report the ability of TOF-MS to detect bacteria from blood culture (BC) broths, and compare the efficacy of TOF-MS to that of conventional culture methods. Bacteria were correctly detected from 63 monomicrobial samples within 80 minutes; results matched those obtained by conventional BC methods, although the conventional methods took 2–3 days. In addition to the 63 monomicrobial samples, another three polymicrobial samples were tested; notably, the infecting bacteria were not correctly identified in two of these three samples. To better assess the TOF-MS detection of polymicrobial samples, we tested various ratios of mixed broth samples, including combinations of the bacteria that we were unable to detect in clinical samples. Combinations of Enterobacter cloacae and Pseudomonas aeruginosa were correctly detected at a culture ratio of 2:1, but not in the 3:1 mixture. These results suggested that TOF-MS is a strong tool for the rapid and correct detection of pathogens from monomicrobial BC samples, though results need to be carefully checked when handling known or suspected polymicrobial samples.

Background Exophiala dermatitidis is an environmental black fungus that rarely causes respiratory infections, yet its pathophysiological features and treatment regimens have not been established. Case Series Two cases of exacerbations of chronic bronchitis and sinusitis due to E. dermatitidis infection in Japan are presented. Both patients were women, and non-tuberculous Mycobacterium (NTM) infection was suspected based on chest radiological findings, but E. dermatitidis was detected from bronchial lavage fluid and nasal mucus, respectively. Both cases were successfully treated by antifungal agents such as liposomal amphotericin B, voriconazole, and itraconazole, but clarithromycin, rifampicin, ethambutol, and sitafloxacin for NTM were not effective. Conclusion E. dermatitidis can become a respiratory pathogen, especially in patients with chronic sinobronchial syndrome.

Background: Mycobacterium abscessus frequently causes severe infections, yet its pathophysiological features and treatment regimens have not been established. Case Report: We present five cases of severe pneumonia due to Mycobacterium abscessus infection in Japan. All cases were diabetic patients, with possible acceleration to pneumonia due to co-infection with other microorganisms. However, following a short period of hospitalization and combination therapy with intravenous imipenem/cilastatin and amikacin, all the cases were successfully treated as outpatients with oral clarithromycin and sitafloxacin. Conclusion: M. abscessus infections can become severe in the presence of diabetes mellitus and co-infection with other chronic infectious organisms. Sitafloxacin might be a key drug in the treatment of M. abscessus infection in future.