Valienamine (Fig. 1), an intermediate formed by the microbial degradation of validamycins by several soil bacteria such as Pseudomonas deni-trificans1) and Flavobacteriun: saccharophilum2), is a pseudo-sugar analog of D-glucose with the same configuration. In aqueous solution it is expected to assume a half-chair conformation, as shown in Fig. 1.
We established a surveillance system for vascular-access associated infections (VAIs) in 2008. This study evaluated the epidemiology of VAIs in our surveillance system to identify risk factors of VAIs using data submitted from 29 participating hospitals between 2008 and 2013. A total of 350 VAIs were observed of which 75, 33, 12, 205 and 25 were associated with arteriovenous (AV) shunt, AV graft, superˆcialization of the brachial artery, non-cuŠed catheter and cuŠed catheter, respectively. Incidences of VAIs per 1,000 dialysis sessions were 0.08, 0.76, 0.26, 12.16 and 1.15, respectively, and comparable to those reported in the United States. Patients with catheters were more likely to develop bloodstream infections, and the majority of pathogens were Stapylococcus aureus including methicillin-resistant strains. Non-cuŠed catheter was the major risk factor for VAIs. Other risk factors identiˆed in patients with catheters included diabetes and catheter indwelling at the femoral site. We observed a decreasing trend of VAI incidence over time, which we think was the result of quality improvement in each hospital. Future directions include implementation of infection prevention strategy based on these results, as well as investigation of additional risk factors.
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