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Carbapenems have an overall broad antibacterial spectrum and should be protected against from the acquisition of drug resistance. The clinical advantages of carbapenem in cases of pneumonia have not been certified and the need for antipseudomonal antimicrobial agents to treat healthcare-associated pneumonia (HCAP) remains controversial. We introduced an antimicrobial stewardship program for carbapenem and tazobactam/piperacillin use and investigated the effects of this program on the clinical outcomes of 591 pneumonia cases that did not require intensive care unit management, mechanical ventilation or treatment with vasopressor agents [221 patients with community-acquired pneumonia (CAP) and 370 patients with HCAP]. Compared with the pre-intervention period, age, comorbidities and the severity and etiology of pneumonia did not differ during the intervention period. Carbapenems were rarely used during the intervention period in cases of pneumonia (CAP: 12% vs. 1%, HCAP: 13% vs. 1%), while antipseudomonal beta-lactam use was reduced from 33% to 8% among cases with HCAP. This reduction in the rate of carbapenem administration did not have an impact on the prognosis in the cases of CAP, and the in-hospital mortality was lower among the patients with HCAP during the intervention period (15% vs. 5%, p = 0.013). The causes of death in the cases of HCAP were not directly related to pneumonia during the intervention period. The current study shows that carbapenem use can be avoided in cases of CAP or HCAP that are not in a critical condition. The frequent use of antipseudomonal beta-lactams does not improve the clinical outcomes of HCAP.

Bacteroides fragilis is a rare causative agent of spondylodiscitis. The pathophysiology of B. fragilis in spondylodiscitis remains largely unclear because of its rare occurrence. We herein report a case of spondylodiscitis complicated by an epidural abscess and meningitis; B. fragilis was detected in the blood of the patient. Moreover, the patient had a splenic abscess that was confirmed on magnetic resonance imaging. The patient completely recovered with antimicrobial therapy alone.

The purpose of this study was to examine whether various postures and gait can be determined using a wearable triaxial accelerometer under simulated hospital conditions. [Subjects and Methods] Ten healthy adults were recruited for this study. A triaxial accelerometer was attached to their left thorax. The experimental tasks were: 1) the basic postures of supine, sitting and standing, 2) changing the reclining angle while lying in a bed, and 3) walking and moving in a wheelchair. [Results] The Y-axis accelerations of sitting, standing and lying in bed with a reclination angle > 60 degrees were lower than that of the lying posture. The triaxial composite acceleration during walking was higher than that of moving a wheelchair, and increased as the walking speed increased. [Conclusion] An upright posture could be determined by a Y-axis acceleration of less than-0.7 G, and walking and wheelchair movement could be determined by a triaxial composite acceleration of more than 1.3 G.