[Fourteen Cases of Implanted Central Venous Access Port-Related Bloodstream Infection].

We conducted a clinical study involving cases of central venous(CV)port-related infection in Tokyo Rosai Hospital. Fourteen patients with suspected CV port-related infection at Tokyo Rosai Hospital between April 2015 and January 2017 were observed. Identical bacterial types were detected from 2 sets of blood cultures and cultures from the catheter tip, and a definitive diagnosis was made. Data on patient background, causative bacteria, quick sequentialorgan failure assessment (qSOFA)score, CV port placement period, presence or absence of local inflammatory findings, and prognosis were analysed. The causative bacteria were coagulase-negative Staphylococcus(CNS)in 7 cases(50%), Staphylococcus aureus in 3(21%), and Candida in 4(29%). Most CNS-infected cases(71%)exhibited a qSOFA score of 1 or less at the examination time, which indicated that even if bacteremia occurred in CNS cases, organopathy might not occur easily. Local inflammatory findings were found in only 3 CNS cases. Cases without local inflammatory findings showed methicillin-resistant Staphylococcus aureus(MRSA)(18%)or Candida(36%)at high proportions, indicating that treatments might be difficult.

[A Case of Brain Abscess Caused by Nocardia farcinica in which the Test Results for Drug Susceptibility Conflicted with the Actual Clinical Course].

Sulfamethoxazloe-trimethoprim is one of the most frequently used antibiotics in the treatment of Nocardia infection. However, in vitro studies have shown an increase in sulfonamide resistance among Nocardia species. Here, we present a case with a brain abscess caused by Nocardia farcinica in which the test results for drug susceptibility to sulfonamide conflicted with the actual clinical course. A 74-year-old woman with autoimmune hepatitis who has being treated with oral prednisolone (16 mg/day) was admitted because of headaches and fever. A CT scan and MRI revealed a brain abscess that had ruptured into the lateral ventricle. She was empirically treated with antibiotics, but her condition did not resolve. Therefore, the abscess was drained surgically. Gram and Kinyoun stains for pus revealed a modified acid-fast branching filamentous bacterium consistent with Nocardia species. The pathogen was identified as Nocardia farcinica based on its 16S rRNA sequence. Consequently, the patient was treated with sulfamethoxazole -trimethoprim and amikacin. However, susceptibility testing (broth microdilution method) showed that the strain was completely resistant to sulfamethoxazole-trimethoprim. We therefore changed the therapeutic regimen to imipenem-cilastatin and amikacin, but her symptoms worsened and the treatment was thought to have failed. She was then re-treated with sulfamethoxazole- trimethoprim, and her symptoms resolved. Some reports have suggested that interpreting the results of Nocardia susceptibility testing may be difficult especially the susceptibility of Nocardia to sulfamethoxazole-trimethoprim. The present case suggests a confliction between susceptibility testing and the clinical course of a patient with Nocardia infection.

Wandering pneumonia caused by dabigatran.

We herein describe the case of a 74-year-old man who experienced pulmonary consolidation and chest pain following administration of dabigatran, a novel oral anticoagulant. The consolidation settled spontaneously in another lung area, a condition sometimes referred to as "wandering pneumonia." Although we did not find specific pathological evidence of interstitial lung disease on transbronchial lung biopsy, a lung opacity spontaneously disappeared following discontinuance of dabigatran, and there was no recurrence. There are no other reports of dabigatran-induced lung injury, except alveolar hemorrhage and eosinophilic pneumonia. We should consider that any novel drug could cause various types of pulmonary injuries.