研究者詳細 - 宮崎　泰可

Coronavirus disease 2019 in a patient with pulmonary fibrosis and emphysema: An autopsy report 査読あり

Kudo R., Kawaguchi T., Kimura M., Rikitake Y., Iwao C., Rikitake M., Iwao K., Aizawa A., Kariya Y., Matsuda M., Miyauchi S., Takajo I., Sato Y., Asada Y., Miyazaki T., Umekita K.

Heliyon 9 ( 11 ) e22221 2023年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Heliyon

Various diseases (e.g., hypertension and diabetes) are risk factors for the exacerbation of coronavirus 2019 (COVID-19). Patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) tend to develop severe COVID-19. Patients with severe COVID-19 present with acute respiratory distress syndrome (ARDS), and many COVID-19-related ARDS survivors eventually develop fibrosis. However, the appropriate management of patients with COVID-19 and ILD and post-COVID-19 ILD remains unclear. Thus, a better understanding of the pathology that exacerbates COVID-19 in patients with ILD is needed. We report the autopsy results of a patient with COVID-19 and combined pulmonary fibrosis and emphysema, whose lung organization and fibrosis progressed after the acute phase of infection. Histopathological findings suggest that fatal pulmonary fibrosis persists after the negative conversion of SARS-CoV-2. Elucidating the cause of death by autopsy may help determine therapeutic strategies in patients with COVID-19 and ILD. Vaccination and early administration of anti-inflammatory drugs or antifibrotic agents may be crucial for preventing disease progression and fatal lung fibrosis. This report aims to clarify the histopathological features of COVID-19 in patients with ILD via autopsy and discuss treatment strategies.

DOI： 10.1016/j.heliyon.2023.e22221

A high α1-antitrypsin/interleukin-10 ratio predicts bacterial pneumonia in adults with community-acquired pneumonia: a prospective cohort study. 査読あり

Miyazaki T, Fukushima K, Hashiguchi K, Ide S, Kobayashi T, Sawai T, Yatera K, Kohno Y, Fukuda Y, Futsuki Y, Matsubara Y, Koga H, Mihara T, Sasaki E, Ashizawa N, Hirayama T, Takazono T, Yamamoto K, Imamura Y, Kaku N, Kosai K, Morinaga Y, Yanagihara K, Mukae H

Pneumonia (Nathan Qld.) 15 ( 1 ) 16 2023年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

DOI： 10.1186/s41479-023-00118-4

A rare case of concomitant Lambert-Eaton myasthenic syndrome and syndrome of inappropriate antidiuretic hormone secretion in a patient with small cell lung carcinoma. 査読あり

Oda Y, Tsubouchi H, Ishii N, Kitamura A, Moriyama E, Mitsutome E, Sakai K, Shiomi K, Yanagi S, Miyazaki T.

Respir Med Case Rep. 49 101930 2023年10月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Respiratory Medicine Case Reports

Small cell lung carcinoma (SCLC) is a neuroendocrine carcinoma with a poor prognosis and is a common cause of paraneoplastic syndromes. Paraneoplastic syndromes are characterized by neurological and endocrinological problems in patients with malignancy and are often associated with difficulty in induction of chemotherapy. Here we report the case of a patient with SCLC concomitant with two paraneoplastic syndromes, syndrome of inappropriate antidiuretic hormone secretion (SIADH) and Lambert–Eaton myasthenic syndrome (LEMS), who was treated with a platinum-doublet chemotherapy regimen. A 66-year-old male patient presented with a 1-month history of progressive proximal muscle weakness, ataxia gait and 5 kg of body weight loss. The laboratory tests revealed hyponatremia due to SIADH and the existence of antibodies against P/Q-type voltage-gated calcium channels. The nerve conduction study showed a low amplitude of compound muscle action potential (0.38 mv), a 34% decrement on 3-Hz stimulation, and a 1939% increment after maximum voluntary contraction in 10 seconds (7.75 mv). The endobronchial ultrasound transbronchial needle aspiration biopsy revealed the pathological findings of SCLC. A 2-cycle chemotherapy regimen of irinotecan plus cisplatin resulted in temporary tumor shrinkage that lasted 2 months, but the improvement of proximal muscle weakness and hyponatremia were maintained over the tumor re-progression period after chemotherapy. Although paraneoplastic syndromes accelerate the decrease in performance status, chemotherapy for SCLC may improve symptoms related to paraneoplastic syndromes and could be considered in similar cases.

DOI： 10.1016/j.rmcr.2023.101930

多施設電子カルテデータベースを用いた肺がん患者における薬物治療効果の評価：非構造化データの自然言語処理査読あり

荒木賢二, 松元信弘, 東郷香苗, 米本直裕, 大木恵美子, 徐凌華, 長谷川義行, 井上裕文, 竹本涼太, 宮崎泰可

医療情報学 43 ( 4 ) 137 - 147 2023年10月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：一般社団法人日本医療情報学会

　多施設の電子カルテなどの電子健康記録（EHR）データベースを用いて，肺がん患者の薬物治療効果を非構造化データより自然言語処理で抽出する方法を検討した．具体的には，宮崎大学の電子カルテデータベースならびにライフデータイニシアティブのEHRデータベースを用いて，薬物治療を受けた肺がん患者を対象とした後ろ向き研究を行った．まず，宮崎大学のデータにおいて，評価者が抽出した薬物治療効果（奏効，安定，進行）の判定に関わる文章から自然言語処理によりキーワードを特定した．臨床上重要なキーワードは，奏効では「縮小」，「効果」，「著変」，「改善」などで，「縮小」は感度，特異度ともに高かった．これらのキーワードはEHRデータベースで体系的に評価した場合でも認められた．この結果から，多施設の大規模EHRカルテデータベースの非構造化データを用いて，肺がん患者の薬物治療効果を抽出できる可能性が示された．

DOI： 10.14948/jami.43.137

Screening and Synthesis of Tetrazole Derivatives that Inhibit the Growth of Cryptococcus Species 査読あり

Nakada N., Miyazaki T., Mizuta S., Hirayama T., Nakamichi S., Takeda K., Mukae H., Kohno S., Tanaka Y.

ChemMedChem 18 ( 18 ) e202300157 2023年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：ChemMedChem

Cryptococcosis has become a major health problem worldwide and caused morbidity and mortality in immunocompromised patients, especially those infected with human immunodeficiency virus (HIV). Despite the global distribution of cryptococcosis, the number and types of the available antifungals are limited, and the treatment outcomes in HIV patients are generally poor. In this study, we screened a compound library and identified one tetrazole derivative as an efficient inhibitor of Cryptococcus neoformans and Cryptococcus gattii. We further designed and synthesized a series of tetrazole derivatives and determined their structure-activity relationship, demonstrating that tetrazole backbone-containing compounds could be developed as novel antifungal drugs with distinct mechanisms against Cryptococcus spp. Our findings provide a starting point for novel target identification and structural optimization to develop a distinct class of therapeutics for patients with cryptococcosis.

DOI： 10.1002/cmdc.202300157

Community-Acquired Pneumonia Incidence in Adults Aged 18 Years and Older in Goto City, Japan: A Prospective Population-Based Study 査読あり

Miyazaki T., Hirano K., Ichihara K., Gonzalez E., Gessner B.D., Isturiz R.E., Zhang P., Gray S., Pride M., van der Linden M., Jodar L., Maeda T., Kohno S., Arguedas A.

CHEST Pulmonary 1 ( 2 ) 2023年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：CHEST Pulmonary

Background: Few studies have measured the burden of community-acquired pneumonia (CAP) and pneumococcal vaccine-type CAP in Japan after the introduction of the 23-valent pneumococcal polysaccharide vaccine into the adult national immunization program for individuals aged ≥ 65 years in 2014. In this study, we estimated the incidences of CAP and Streptococcus pneumoniae CAP among Japanese adults between 2015 and 2020. Research Question: What are the incidences of CAP and S pneumoniae CAP among Japanese adults? What are the common pneumococcal serotypes detected in patients with S pneumoniae CAP? Study Design and Methods: This prospective population-based multicenter active surveillance study enrolled adults ≥ 18 years of age with clinically and radiologically confirmed CAP in Goto City, Japan. S pneumoniae was detected using standard-of-care blood and sputum cultures, BinaxNOW (Abbott), and serotype-specific urinary antigen detection assays. Results: A total of 2,103 patients with CAP were enrolled; 84% were aged ≥ 65 years and 6.7% died during the study. The annual CAP, S pneumoniae CAP, 13-valent pneumococcal conjugate vaccine (PCV13) serotype CAP, and 20-valent pneumococcal conjugate vaccine (PCV20) serotype CAP incidences per 100,000 population were 1,280, 227, 63, and 110, respectively. S pneumoniae was detected in 17.8% of all patients with CAP by any detection method, with 4.9%, 5.5%, and 8.6% of cases of CAP resulting from PCV13, 15-valent pneumococcal conjugate vaccine, and PCV20 serotypes, respectively. Applying Goto's incidence and case fatality rate to the Japanese population, assuming PCV20 has the same vaccine efficacy and duration of protection as PCV13 and if licensed in Japan for the prevention of CAP, the inclusion of PCV20 in the national immunization program for adults ≥ 65 years of age could prevent 29,036 cases of CAP and 2,275 CAP-related deaths per year. Interpretation: Given the substantial burden of preventable pneumococcal disease, introduction of pneumococcal conjugate vaccines in Japanese adults may be of merit.

DOI： 10.1016/j.chpulm.2023.100007

Safety and efficacy of 5-aminolevulinic acid phosphate/iron in mild-to-moderate coronavirus disease 2019: A randomized exploratory phase II trial 査読あり

Tanaka T., Tashiro M., Ota K., Fujita A., Sawai T., Kadota J., Fukuda Y., Sumiyoshi M., Ide S., Tachikawa N., Fujii H., Hibino M., Shiomi H., Izumida M., Matsui K., Yamauchi M., Takahashi K., Yamanashi H., Sugimoto T., Akabame S., Umeda M., Shimizu M., Hosogaya N., Kosai K., Takeda K., Iwanaga N., Ashizawa N., Hirayama T., Takazono T., Yamamoto K., Imamura Y., Miyazaki T., Kobayashi Y., Ariyoshi K., Mukae H., Yanagihara K., Kita K., Izumikawa K.

Medicine (United States) 102 ( 34 ) 2023年8月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Medicine (United States)

Background: 5-aminolevulinic acid (5-ALA), a natural amino acid that is marketed alongside sodium ferrous citrate (SFC) as a functional food, blocks severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) proliferation in vitro and exerts anti-inflammatory effects. In this phase II open-label, prospective, parallel-group, randomized trial, we aimed to evaluate the safety and efficacy of 5-ALA in patients with mild-to-moderate coronavirus disease 2019. Methods: This trial was conducted in patients receiving 5-ALA/SFC (250/145 mg) orally thrice daily for 7 days, followed by 5-ALA/SFC (150/87 mg) orally thrice daily for 7 days. The primary endpoints were changes in SARS-CoV-2 viral load, clinical symptom scores, and 5-ALA/SFC safety (adverse events [AE] and changes in laboratory values and vital signs). Results: A total of 50 patients were enrolled from 8 institutions in Japan. The change in SARS-CoV-2 viral load from baseline was not significantly different between the 5-ALA/SFC (n = 24) and control (n = 26) groups. The duration to improvement was shorter in the 5-ALA/SFC group than in the control group, although the difference was not significant. The 5-ALA/SFC group exhibited faster improvement rates in "taste abnormality,""cough,""lethargy,"and "no appetite"than the control group. Eight AEs were observed in the 5-ALA/SFC group, with 22.7% of patients experiencing gastrointestinal symptoms (decreased appetite, constipation, and vomiting). AEs occurred with 750/435 mg/day in 25.0% of patients in the first phase and with 450/261 mg/day of 5-ALA/SFC in 6.3% of patients in the second phase. Conclusion: 5-ALA/SFC improved some symptoms but did not influence the SARS-CoV-2 viral load or clinical symptom scores over 14 days. The safety of 5-ALA/SFC in this study was acceptable. Further evaluation using a larger sample size or modified method is warranted.

DOI： 10.1097/MD.0000000000034858

Evaluation of a Novel FKS1 R1354H Mutation Associated with Caspofungin Resistance in Candida auris Using the CRISPR-Cas9 System. 査読あり

Kiyohara M, Miyazaki T, Okamoto M, Hirayama T, Makimura K, Chibana H, Nakada N, Ito Y, Sumiyoshi M, Ashizawa N, Takeda K, Iwanaga N, Takazono T, Izumikawa K, Yanagihara K, Kohno S, Mukae H

Journal of fungi (Basel, Switzerland) 9 ( 5 ) 2023年4月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Fungi

Outbreaks of invasive infections, with high mortality rates, caused by multidrug-resistant Candida auris have been reported worldwide. Although hotspot mutations in FKS1 are an established cause of echinocandin resistance, the actual contribution of these mutations to echinocandin resistance remains unknown. Here, we sequenced the FKS1 gene of a caspofungin-resistant clinical isolate (clade I) and identified a novel resistance mutation (G4061A inducing R1354H). We applied the clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9 system to generate a recovered strain (H1354R) in which only this single nucleotide mutation was reverted to its wild-type sequence. We also generated mutant strains with only the R1354H mutation introduced into C. auris wild-type strains (clade I and II) and analyzed their antifungal susceptibility. Compared to their parental strains, the R1354H mutants exhibited a 4- to 16-fold increase in caspofungin minimum inhibitory concentration (MIC) while the H1354R reverted strain exhibited a 4-fold decrease in caspofungin MIC. In a mouse model of disseminated candidiasis, the in vivo therapeutic effect of caspofungin was more closely related to the FKS1 R1354H mutation and the virulence of the strain than its in vitro MIC. The CRISPR-Cas9 system could thus aid in elucidating the mechanism underlying drug resistance in C. auris.

DOI： 10.3390/jof9050529

Echinocandin Resistance in Candida auris Occurs in the Murine Gastrointestinal Tract Due to FKS1 Mutations. 査読あり

Hirayama T, Miyazaki T, Sumiyoshi M, Ito Y, Ashizawa N, Takeda K, Iwanaga N, Takazono T, Yamamoto K, Izumikawa K, Yanagihara K, Makimura K, Tsukamoto K, Kohno S, Mukae H

Antimicrobial agents and chemotherapy 67 ( 4 ) e0124322 2023年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Antimicrobial agents and chemotherapy

Candida auris is resistant to multiple antifungal agents. This study investigated its antifungal susceptibility and explored FKS1 mutations across the isolates from mice enterically colonized with wild-type C. auris and treated with echinocandin. Resistant C. auris with FKS1 mutations, including S639F, S639Y, D642Y, R1354H, or R1354Y, were isolated and found to be micafungin- and caspofungin-resistant in vivo; however, the MICs of isolates with mutation in R1354 remained below the micafungin breakpoint in vitro.

DOI： 10.1128/aac.01243-22

Developing Artificial Intelligence Models for Extracting Oncologic Outcomes from Japanese Electronic Health Records 査読あり

Araki K., Matsumoto N., Togo K., Yonemoto N., Ohki E., Xu L., Hasegawa Y., Satoh D., Takemoto R., Miyazaki T.

Advances in Therapy 40 ( 3 ) 934 - 950 2023年3月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Advances in Therapy

Introduction: A framework that extracts oncological outcomes from large-scale databases using artificial intelligence (AI) is not well established. Thus, we aimed to develop AI models to extract outcomes in patients with lung cancer using unstructured text data from electronic health records of multiple hospitals. Methods: We constructed AI models (Bidirectional Encoder Representations from Transformers [BERT], Naïve Bayes, and Longformer) for tumor evaluation using the University of Miyazaki Hospital (UMH) database. This data included both structured and unstructured data from progress notes, radiology reports, and discharge summaries. The BERT model was applied to the Life Data Initiative (LDI) data set of six hospitals. Study outcomes included the performance of AI models and time to progression of disease (TTP) for each line of treatment based on the treatment response extracted by AI models. Results: For the UMH data set, the BERT model exhibited higher precision accuracy compared to the Naïve Bayes or the Longformer models, respectively (precision [0.42 vs. 0.47 or 0.22], recall [0.63 vs. 0.46 or 0.33] and F1 scores [0.50 vs. 0.46 or 0.27]). When this BERT model was applied to LDI data, prediction accuracy remained quite similar. The Kaplan–Meier plots of TTP (months) showed similar trends for the first (median 14.9 [95% confidence interval 11.5, 21.1] and 16.8 [12.6, 21.8]), the second (7.8 [6.7, 10.7] and 7.8 [6.7, 10.7]), and the later lines of treatment for the predicted data by the BERT model and the manually curated data. Conclusion: We developed AI models to extract treatment responses in patients with lung cancer using a large EHR database; however, the model requires further improvement.

DOI： 10.1007/s12325-022-02397-7

Real-world treatment response in Japanese patients with cancer using unstructured data from electronic health records 査読あり

Araki K., Matsumoto N., Togo K., Yonemoto N., Ohki E., Xu L., Hasegawa Y., Inoue H., Yamashita S., Miyazaki T.

Health and Technology 13 ( 2 ) 253 - 262 2023年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Health and Technology

Purpose: We generated methods for evaluating clinical outcomes including treatment response in oncology using the unstructured data from electronic health records (EHR) in Japanese language. Methods: This retrospective analysis used medical record database and administrative data of University of Miyazaki Hospital in Japan of patients with lung/breast cancer. Treatment response (objective response [OR], stable disease [SD] or progressive disease [PD]) was adjudicated by two evaluators using clinicians’ progress notes, radiology reports and pathological reports of 15 patients with lung cancer (training data set). For assessing key terms to describe treatment response, natural language processing (NLP) rules were created from the texts identified by the evaluators and broken down by morphological analysis. The NLP rules were applied for assessing data of other 70 lung cancer and 30 breast cancer patients, who were not adjudicated, to examine if any difference in using key terms exist between these patients. Results: A total of 2,039 records in progress notes, 131 in radiology reports and 60 in pathological reports of 15 patients, were adjudicated. Progress notes were the most common primary source data for treatment assessment (60.7%), wherein, the most common key terms with high sensitivity and specificity to describe OR were “reduction/shrink”, for SD were “(no) remarkable change/(no) aggravation)” and for PD were “(limited) effect” and “enlargement/grow”. These key terms were also found in other larger cohorts of 70 patients with lung cancer and 30 patients with breast cancer. Conclusion: This study demonstrated that assessing response to anticancer therapy using Japanese EHRs is feasible by interpreting progress notes, radiology reports and Japanese key terms using NLP.

DOI： 10.1007/s12553-023-00739-1

肺炎球菌感染症に対する予防戦略　−宮崎県の現状と今後の展望を含めて−

宮崎泰可

宮崎県医師会医学会誌 47 ( 1 ) 7 - 11 2023年3月

記述言語：日本語掲載種別：研究論文（学術雑誌）

Efficacy and safety of isavuconazole against deep-seated mycoses: A phase 3, randomized, open-label study in Japan 査読あり

Kohno S, Izumikawa K, Takazono T, Miyazaki T, Yoshida M, Kamei K, Ogawa K, Taniguchi S, Akashi K, Tateda K, Mukae H, Miyazaki Y, Okada F, Kanda Y, Kakeya H, Suzuki J, Kimura SI, Kishida M, Matsuda M, Niki Y

J Infect Chemother 29 ( 2 ) 163 - 170 2023年2月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Infection and Chemotherapy

Objectives: Isavuconazole is a convenient triazole antifungal agent with a broad antifungal spectrum. A randomized, open-label study (ClinicalTrials.gov, NCT03471988) was conducted to evaluate the efficacy and safety of isavuconazole in Japanese patients with deep-seated mycoses. Patients and methods: In Cohort A, patients with aspergillosis (chronic pulmonary aspergillosis and invasive aspergillosis) were randomized in a 2:1 ratio to isavuconazole or voriconazole, and in Cohort B, patients with cryptococcosis and mucormycosis were assigned to isavuconazole for up to 84 days of treatment. The overall outcome was evaluated according to the clinical, radiological, and mycological responses at Days 42 and 84 and at the end of treatment (EOT). Results: A total of 103 participants were enrolled and received the study drug. The overall response rate of patients with chronic pulmonary aspergillosis in the isavuconazole (52 patients) and voriconazole (27 patients) groups was 82.7% and 77.8% at EOT, respectively. The response rate in patients with cryptococcosis (10 patients, isavuconazole group only) was 90.0%. One of three participants with invasive aspergillosis and one of three participants with mucormycosis responded in the isavuconazole group. In the safety evaluation, the incidence of adverse events in participants with chronic pulmonary aspergillosis was similar in both groups. Adverse drug reactions were reported in 32 (61.5%) patients receiving isavuconazole and 23 (85.2%) patients receiving voriconazole. Conclusions: Isavuconazole showed efficacy and safety in Japanese patients with chronic pulmonary aspergillosis and cryptococcosis, for which the drug is not currently indicated.

DOI： 10.1016/j.jiac.2022.10.010

ELS4 　侵襲性真菌感染症の予防と治療―新規アゾール系薬の使い分けを含めて―

宮崎泰可

日本医真菌学会総会プログラム・抄録集 64.Suppl1 ( 0 ) 91 2023年

担当区分：筆頭著者記述言語：日本語掲載種別：研究論文（その他学術会議資料等）出版者・発行元：日本医真菌学会

DOI： 10.11534/jsmm.64.suppl1.0_91

ES2-2 　多様化する抗真菌薬をどう使うか？

宮崎泰可

日本医真菌学会総会プログラム・抄録集 64.Suppl1 ( 0 ) 95 2023年

担当区分：筆頭著者記述言語：日本語掲載種別：研究論文（その他学術会議資料等）出版者・発行元：日本医真菌学会

DOI： 10.11534/jsmm.64.suppl1.0_95_2

S1-1 新規アゾール系薬の“ 適正使用” をどう判断するか

宮崎泰可

日本医真菌学会総会プログラム・抄録集 64.Suppl1 ( 0 ) 50 2023年

担当区分：筆頭著者記述言語：日本語掲載種別：研究論文（その他学術会議資料等）出版者・発行元：日本医真菌学会

DOI： 10.11534/jsmm.64.suppl1.0_50_1

S10-4 尿検体を用いたアスペルギルス症診断の開発～網羅的蛋白質断片解析技術を用いたアプローチ～

坪内拡伸, 宮崎泰可

日本医真菌学会総会プログラム・抄録集 64.Suppl1 ( 0 ) 68 2023年

担当区分：筆頭著者記述言語：日本語掲載種別：研究論文（その他学術会議資料等）出版者・発行元：日本医真菌学会

DOI： 10.11534/jsmm.64.suppl1.0_68_2

Prospective multicenter survey for Nursing and Healthcare-associated Pneumonia in Japan 査読あり

Imamura Y., Miyazaki T., Watanabe A., Tsukada H., Nagai H., Hasegawa Y., Tomono K., Ito I., Teramoto S., Ishida T., Kadota J.i., Kohno S., Mukae H.

Journal of Infection and Chemotherapy 28 ( 8 ) 1125 - 1130 2022年8月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Infection and Chemotherapy

Introduction: Nursing and healthcare-associated pneumonia (NHCAP) was proposed by the Japanese Respiratory Society in 2011. However, the clinical characteristics of NHCAP are still unclear. Thus, this study aimed to clarify its clinical characteristics. Methods: This multicenter prospective observational study included 596 patients with NHCAP from 73 centers in Japan between May 2014 and February 2016. Results: Patient background was characterized by an older age (81.5 ± 10.1 years), most patients had complications (94.1%), and many patients had a high probability of aspiration pneumonia (68.6%). Among the isolates, Streptococcus pneumoniae was the most common (12.7%), while Pseudomonas aeruginosa was also isolated at 10.8%. The overall 30-day mortality rate for patients was 11.9%, and the factors affecting mortality were non-ambulatory status, high blood urea nitrogen level, impaired consciousness, and low albumin level. Sulbactam/ampicillin was the most commonly administered antibiotic, including in groups with high severity of illness and high risk of multidrug-resistant (MDR) pathogens. Both the A-DROP and I-ROAD scores were useful in predicting the prognosis of NHCAP. Confirmation of intention to provide do not attempt resuscitation (DNAR) instructions was given to 333 patients (55.9%), and 313 patients agreed to DNAR instructions. Conclusions: NHCAP tends to occur in elderly patients with underlying diseases. The risk of MDR pathogens and the mortality rate are intermediate for community-acquired pneumonia and hospital-acquired pneumonia. As NHCAP is considered an important concept in an aging society, such as in Japan, establishing a treatment strategy that considers not only prognosis but also quality of life would be beneficial.

DOI： 10.1016/j.jiac.2022.03.030

Changing molecular epidemiology and characteristics of MRSA isolated from bloodstream infections: nationwide surveillance in Japan in 2019. 査読あり

Kaku N, Sasaki D, Ota K, Miyazaki T, Yanagihara K

The Journal of antimicrobial chemotherapy 77 ( 8 ) 2130 - 2141 2022年7月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Antimicrobial Chemotherapy

Objectives: Some single-centre studies have reported that MRSA carrying the staphylococcal cassette chromosome mec (SCCmec) type IV has been increasing in bloodstream infections (BSIs) in Japan. Therefore, we conducted nationwide surveillance for MRSA BSIs to investigate the extent of such change across Japan. Methods: We recruited 51 Japanese hospitals from the Japanese Association for Infectious Diseases. MRSA isolates detected in two or more sets of blood cultures were collected between January and September 2019 and subjected to antimicrobial susceptibility testing. WGS was also performed to determine SCCmec and MLST types and detect drug-resistance and virulence genes. Results: Two hundred and seventy MRSA isolates were collected from 45 hospitals. The major combination types were ST8 with SCCmec type IV (ST8-IV) (30.7%), ST1-IV (29.6%), ST2725-IV (9.5%), ST764-II (8.1%) and ST5-II (7.8%). However, there were regional differences among the major types. The most common types in eastern, western and northern Japan were ST1-IV, ST8-IV, and ST5-II and ST764-II, respectively. ST8-IV, ST1-IV and ST2725-IV exhibited greater susceptibility to clindamycin and minocycline than ST764-II and ST5-II, but erm(A) was detected in 93.8% and 100.0% of ST1-IV and ST2725-IV, respectively. Based on drug-resistance and virulence genes, characteristics of ST8-IV were different from those of ST1-IV and ST2725-IV. In addition, there were two major ST8-IV types with different characteristics. Conclusions: This study revealed that SCCmec type IV replaced SCCmec type II in MRSA BSIs. In addition, SCCmec type IV was divided into several types with different characteristics.

DOI： 10.1093/jac/dkac154