Emergence of Phytobacter diazotrophicus carrying an IncA/C2 plasmid harboring bla NDM-1 in Tokyo, Japan.

Phytobacter diazotrophicus is an Enterobacterales species that was originally identified as a plant growth-promoting, Gram-negative bacterium. Recently, this species has been recognized as relevant to opportunistic human and nosocomial infections in clinical settings. Its frequent misidentification as other Enterobacterales species from clinical examination occasionally causes a delay in the identification of nosocomial outbreaks. Here, we report the emergence of New Delhi metallo-ß-lactamase (NDM)-producing P. diazotrophicus isolated from hospitalized pediatric patients and hospital environments in Tokyo, Japan. In our case, these isolates were found during an investigation of carbapenem-resistant Enterobacterales in relation to nosocomial infections. Whole-genome sequencing is useful for overcoming the difficulty of species identification. Furthermore, we found that bla NDM-1 was carried by an IncA/C2 plasmid (approximately 170 kbp), which was transferrable from the clinical isolates to the recipient strain Escherichia coli J53. Our study demonstrated that P. diazotrophicus behaves as a carrier of bla NDM-harboring plasmids, potentially disseminating resistance to carbapenems among Enterobacterales. IMPORTANCE Early detection of nosocomial outbreaks is important to minimize the spread of bacteria. When an outbreak is caused by multidrug-resistant bacteria such as carbapenem-resistant Enterobacterales, a delay in findings makes it difficult to control it because such bacteria often spread not only among human patients but also in hospital environments. Phytobacter diazotrophicus, an Enterobacterales species that has recently been found to be relevant to clinical settings, is often misidentified as other bacteria in clinical laboratories. Here, we found NDM-producing P. diazotrophicus in hospitalized pediatric patients and their environment in Tokyo, Japan. Given that the isolates carried bla NDM-1-harboring transferrable plasmids, the influence of such bacteria could be greater with the mediation of horizontal transfer of carbapenem resistance. Our findings suggest that P. diazotrophicus should be recognized as an NDM-carrier, for which more attention should be paid in clinical settings.

Transmission of COVID-19 in Nightlife, Household, and Health Care Settings in Tokyo, Japan, in 2020.

Importance: There have been few studies on the heterogeneous interconnection of COVID-19 outbreaks occurring in different social settings using robust, surveillance epidemiological data. Objectives: To describe the characteristics of COVID-19 transmission within different social settings and to evaluate settings associated with onward transmission to other settings. Design, Setting, and Participants: This is a case series study of laboratory-confirmed COVID-19 cases in Tokyo between January 23 and December 5, 2020, when vaccination was not yet implemented. Using epidemiological investigation data collected by public health centers, epidemiological links were identified and classified into 7 transmission settings: imported, nightlife, dining, workplace, household, health care, and other. Main Outcomes and Measures: The number of cases per setting and the likelihood of generating onward transmissions were compared between different transmission settings. Results: Of the 44 054 confirmed COVID-19 cases in this study, 25 241 (57.3%) were among male patients, and the median (IQR) age of patients was 36 (26-52) years. Transmission settings were identified in 13 122 cases, including 6768 household, 2733 health care, and 1174 nightlife cases. More than 6600 transmission settings were detected, and nightlife (72 of 380 [18.9%]; P < .001) and health care (119 [36.2%]; P < .001) settings were more likely to involve 5 or more cases than dining, workplace, household, and other settings. Nightlife cases appeared in the earlier phase of the epidemic, while household and health care cases appeared later. After adjustment for transmission setting, sex, age group, presence of symptoms, and wave, household and health care cases were less likely to generate onward transmission compared with nightlife cases (household: adjusted odds ratio, 0.03; 95% CI, 0.02-0.05; health care: adjusted odds ratio, 0.57; 95% CI, 0.41-0.79). Household settings were associated with intergenerational transmission, while nonhousehold settings mainly comprised transmission between the same age group. Among 30 932 cases without identified transmission settings, cases with a history of visiting nightlife establishments were more likely to generate onward transmission to nonhousehold settings (adjusted odds ratio, 5.30 [95% CI, 4.64-6.05]; P < .001) than those without such history. Conclusions and Relevance: In this case series study, COVID-19 cases identified in nightlife settings were associated with a higher likelihood of spreading COVID-19 than household and health care cases. Surveillance and interventions targeting nightlife settings should be prioritized to disrupt COVID-19 transmission, especially in the early stage of an epidemic.

[Implementation status of community Directly Observed Therapy Short-course (dots) practice in medical facilities designated for tuberculosis treatment in the Tama area].

OBJECTIVES: We conducted a survey of tuberculosis (TB) treatment and community Directly Observed Therapy, Short-course (DOTS) practice of doctors at the medical facilities designated for TB treatment in the Tama area, Tokyo, to determine the current status and issues of community DOTS and to enhance cooperation between public health centers and medical institutions. METHODS: A self-administered questionnaire was sent by postal mail to 500 medical institutions selected through stratified random sampling in each public health center region. RESULTS: We received 287 (57.4%) replies. Of these, 169 (58.9%) had not treated TB patients in the previous 2 years. A total of 48.8% of the doctors were aware of DOTS, and 2.8% were currently conducting DOTS, while 18.7% wanted to conduct DOTS. In contrast, 51.2% had barriers to conducting DOTS, and 27.2% had no plans to conduct DOTS. Knowledge of DOTS was correlated with the future possibility of conducting DOTS and with the use of medication diaries. Doctors in private clinics had lower participation rates in seminars compared to those doctors in hospitals. CONCLUSION: In order to expand DOTS it is necessary to provide private doctors with educational tools with which doctors can update their knowledge of TB treatment.

[Health status of precarious workers in "Toshikoshi Haken Mura (Dispatch Workers' New Year Village)"].

In Japan, the liquidity of employment is progressing rapidly. Due to the global recession which started in 2008, large-scale unemployment of precarious workers, including dispatch workers, is expected in 2009. In recent studies, it has been suggested that the unstable employment status itself may affect the health conditions of such workers. At the end of 2008, "Toshikoshi Haken Mura" (Dispatch Workers' New Year Village) was established in central Tokyo as a shelter for about 500 workers who had lost their jobs and accommodation. We participated in health consultations and medical checkups conducted by the Tokyo Metropolitan Government on January 8-10, 2009 to investigate the health conditions of the "villagers". Eighty-nine people attended health consultations and medical checkups (mean age, 48 yr). Physical complaints in the order of prevalence were as follows: respiratory (cough, 43%; sputum, 36%), low-grade fever (16.9%), musculoskeletal (13.5%), dermal (5.6%), digestive (3.4%), neurological (3.4%) and others including mental complaint (10.1%) such as anxiety, insomnia, and depression. During individual consultations, we found many cases who had had difficulty in getting medical consultations and whose treatment had been discontinued. Moreover, the rate of getting periodic medical examination remained low at 23.8% (among 84 people). Health problems of precarious workers have not been sufficiently recognized; however, there were cases whose poor health was indeed related to unstable employment. Studies on the health effects of temporary work should have higher prioritizes in the occupational health field.