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Biomedical subjects

Yoshio Takesue

Publications and source records attributed to Yoshio Takesue.

At least 19 recordsLinked to original sources
PubMed2006

Effect of antibiotic heterogeneity on the development of infections with antibiotic-resistant gram-negative organisms in a non-intensive care unit surgical ward.

BACKGROUND: Heterogeneous antibiotic use has been suggested to limit the emergence of resistance, but determining the optimal strategy is difficult. METHODS: We developed a new strategy, termed "periodic antibiotic monitoring and supervision" (PAMS) program in a non-ICU surgical ward. The 2-year prospective study was divided into a 1-year observation period and a 1-year PAMS period. The use of four major classes of antibiotics in empirical therapy for Gram-negative rod (GNR) infections was supervised. During the PAMS program, recommended, restricted, and off-supervised classes of antibiotics were changed every 3 months according to the usage pattern of the antibiotics in the preceding term. RESULTS: Cefepime (45.5%) and imipenem/cilastatin (39.4%) were the most common antibiotics of choice during the observation period. The use of these antibiotics decreased significantly during the PAMS period, and that of fluoroquinolones and extended-spectrum penicillin/beta-lactamase inhibitor increased (4.8% vs. 21.4% and 2.4% vs. 21.4%, P<0.01 respectively). Outcome analysis demonstrated a tendency toward reduction in the incidence of resistant GNR infections (P=0.079) and that of Pseudomonas aeruginosa (P=0.053). The incidence of resistant Gram-positive core infections did not decrease. Analysis of antibiotic susceptibility to GNR revealed no significant beneficial results for any antibiotics. CONCLUSIONS: As significant changes were not observed, the PAMS program is not generally applicable and heterogeneous antibiotic use as a way of reducing infections with resistant GNR in non-ICU surgical wards was not established.

Anti-Bacterial Agents↗
PubMed2006

Double intussusceptions in the small intestine caused by metastatic renal cell carcinoma: report of a case.

Renal cell carcinoma (RCC) may metastasize to almost any organ, but it is unlikely to be a direct cause of intussusception. We report a case of double enteric intussusceptions caused by metastatic RCC in a 64-year-old man. The patient presented with intermittent abdominal pain and diarrhea 11 years after undergoing a radical nephrectomy. Abdominal computed tomography (CT) showed two enhanced masses with the "target" sign, suggesting enteric intussusceptions. We performed partial enterectomy, and histological examination confirmed that the tumors had originated from RCC. To our knowledge, this is the first report of metastases from RCC manifesting as synchronous intraluminal polypoid tumors serving as the lead points of two intussusceptions in the small intestine. Thus, the possibility of multiple tumor metastases in the small intestine, with or without intussusceptions, should be considered in patients with recurrent RCC.

Carcinoma, Renal Cell↗
PubMed2006

[Bacteria isolated from surgical infections and its susceptibilities to antimicrobial agents--special references to bacteria isolated between April 2003 and March 2004].

Tendency of isolated bacteria from infections in general surgery during the period from April 2004 to March 2005 were investigated in a multicenter study in Japan, and the following results were obtained. In this series, 645 strains including 17 strains of Candida spp. were isolated from 226 (79.0%) of 286 patients with surgical infections. Three hundred and seventeen strains were isolated from primary infections, and 345 strains were isolated from postoperative infections. From primary infections, anaerobic Gram-positive bacteria and anaerobic Gram-negative bacteria were predominant, while aerobic Gram-positive bacteria were predominant from postoperative infections. The isolation rate of aerobic Gram-positive bacteria, such as Enterococcus spp. and Staphylococcus aureus were higher from both types of infections. Among anaerobic Gram-positive bacteria, the isolation rate of Peptostreptococcus spp. was the highest from both types of infections. Among aerobic Gram-negative bacteria, Escherichia coli was the most predominantly isolated from primary infections, followed by Pseudomonas aeruginosa, Klebsiella pneumoniae and Citrobacter freundii in this order, and from postoperative infections, P. aeruginosa was the most predominantly isolated, followed by E. coli, E. cloacae, and K. pneumoniae. Among anaerobic Gram-negative bacteria, the isolation rate of Bacteroides fragilis group was the highest from both primary infections followed by Bilophila wadsworthia. While the isolation rate of B. fragilis group was also the highest from postoperative infections, the following bacteria were Bacteroides thetaiotaomicron and B. wadsworthia in this order. In this series, we noticed no vancomycin-resistant Gram-positive cocci, but a few strains of moderately arbekacin-resistant MRSA. Carbapenem-resistant P. aeruginosa but not multidrug-resistant was seen in 13.3 per cents. Also cefazolin-resistant E. coli probably producing extended spectrum beta-lactamase was seen in 7.0 per cents. We should be carefully followed up the facts that an increasing isolation rates of B. fragilis group and B. wadsworthia which were resistant to both penicillins and cephems.

Anti-Bacterial Agents↗
PubMed2006

[Therapeutic antimicrobial agents for postoperative infections: appropriate use of antibiotics from the viewpoint of pharmacokinetic/pharmacodynamic theory].

Pharmacokinetic/pharmacodynamic (PK/PD) parameters can be used predict the potential for bacterial eradication with antimicrobial therapy. The validity of these parameters is supported by both animal and clinical studies. Two major patterns of antimicrobial activities are time-dependent killing and concentration-dependent killing. Time-dependent killing is characteristic of beta-lactams. The major PK/PD parameter correlating with efficacy is a serum concentration of 50-60% for cephalosporins and 3040% for carbapenems in the dosing interval, and these concentrations are the susceptibility limits for the dosing regimens used. It is recommended that these types of antibiotic be administered 3-4 times per day. Concentration-dependent killing is characteristic of aminoglycosides. The major PK/PD parameter correlating with the efficacy of these agents is the 24-h area under the curve or peak serum level. This type of antibiotic should be administered as the total daily dose once daily.

Anti-Bacterial Agents↗
PubMed2005

Bacterial translocation: not a clinically relevant phenomenon in colorectal cancer.

The aim of this study was to identify the risk factors for bacterial translocation and to determine the clinical significance of bacterial translocation in patients with colorectal cancer. Mesenteric lymph node sampling was performed to identify the presence of bacterial translocation in 75 patients with colorectal cancer undergoing laparotomy. Bacterial translocation was identified in 29 patients (39%), with the most common organism being Escherichia coli (31%). Three factors for bacterial translocation were identified, including a preoperative low peripheral lymphocyte count, metastasis to lymph nodes, and invasion depth (= T3). Stepwise regression analysis, however, selected only = T3 [odds ratio (OR) 4.0, 95% confidence interval (CI) 1.2-13.5]. Altogether, 35% of patients with bacterial translocation developed septic complications, compared with 20% in patients without bacterial translocation. In the multivariate analysis, bacterial translocation was not an independent risk factor for infection, with an OR of 1.8 (95% CI 0.56-5.96). Systemic inflammatory response syndrome developed on the first day in 62% of patients with bacterial translocation, compared with 50% of patients without bacterial translocation. Adjusting for the other factors, bacterial translocation was not a significant risk factor in the occurrence of systemic inflammatory response syndrome after surgery (OR 1.1, 95% CI 0.37-3.29). We concluded that in patients with colorectal cancers bacterial translocation does occur and is increased in patients with deep invasion. However, it appears to be of no clinical significance.

Adolescent↗
PubMed2005

Current status of diagnosis and treatment of invasive fungal infections in Japan: the influence of the new Japanese guidelines.

One year after the release of the Japanese "Guidelines for the Diagnosis and Treatment of Deep-Seated Mycosis" we conducted a survey of clinicians to determine the extent to which the new guidelines had penetrated clinical practice, and compared these results with those of a previous survey. The responses to the current survey regarding the diagnosis and treatment had changed from those of the previous survey to reflect the new recommendations, showing that the guidelines have had an effect on clinical practice. However, the current survey highlights a need to provide more practical information in the guidelines for use in the clinical settings. In particular, physicians expect the guidelines to proactively provide more information about the features of both current and new drugs. In addition, an effective drug against the genus Aspergillus is eagerly awaited. However, because it is difficult to differentiate among filamentous fungi, there is a need for a drug with broad-spectrum coverage against filamentous fungi. Investigation of combination therapy consequently becomes necessary. Definitive diagnoses of invasive fungal infection are too scarce at the national level. The cooperation of clinicians for organizing more definitive diagnoses would be appreciated when the guidelines are revised.

Antifungal Agents↗
PubMed2005

Hepatic regeneration promotes engraftment of intraportally transplanted islet cells.

BACKGROUND: With the current donor shortage, future success with islet transplantation is incumbent upon the ability to use single-donor islets. Manipulating the recipient graft environment may allow the use of fewer islets to achieve insulin independence. METHODS: Isolated pancreatic islets from a single donor were intraportally transplanted to streptozotocin-diabetic rats immediately after 70% partial hepatectomy (HxPIT1, n = 12). Plasma glucose concentrations were monitored for 30 days; intravenous glucose tolerance tests and serum insulin concentrations were obtained at the second and fourth weeks; morphologic studies were performed on insulin-immunostained sections of the liver. RESULTS: from HxPIT1 rats were compared to those from rats transplanted with single-donor islet grafts (PIT1, n = 10) and double-donor islet grafts (PIT2, n = 7). Results Hyperglycemia was ameliorated in HxPIT1 and PIT2 rats after transplantation but not in PIT1 rats. Glucose tolerance and insulin secretion in the HxPIT1 group were superior to the PIT1 group and equivalent to those in the PIT2 group. Morphologically, the sizes of the grafted islets and individual beta cells from HxPIT1 rats were larger than those from PIT1 rats. CONCLUSIONS: In streptozotocin-diabetic rats, islet transplantation performed in regenerating liver results in improved insulin secretion and serum glucose control, even in the face of a limited number of islets.

Animals↗
PubMed2005

Intracellular cytokine patterns of peripheral blood T cells as a useful indicator of activeness of Crohn's disease.

Recently, the alteration of peripheral T cells has become a focus of attention in research on Crohn's disease (CD). To examine the characteristics of peripheral T cells in CD patients, we analyzed the expression of a memory T cell marker (CD45RO(Bright)CD3+) and the cytokine production by peripheral helper and cytotoxic T cells in patients with CD. With the use of monensin to prevent the secretion of cytokines under stimulation, we measured the count of intracellular cytokine-positive cells for production of interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, interleukin (IL)-2, IL-4, IL-6, IL-10, and granulocyte-macrophage colony stimulating factor (GM-CSF) in the peripheral T cell population using flow-cytometry. The counts of lymphocytes, T cells, and helper T cells in patients with CD were significantly lower than in normal volunteers. Although no difference in the counts of lymphocytes, total T cells, helper and cytotoxic T cells was observed, the counts of intracellular cytokine producing helper T cells in IFN-gamma, TNF-alpha or GM-CSF were significantly higher in active cases than in quiescent cases. These results suggest that stable CD patients are immunosuppressive, and activation of some kinds of T-cells, especially Th1-associated cytokine producing T-cells, correlate with disease progression. Th1-associated cytokine analysis of peripheral T cells may be one of the useful markers to evaluate the activeness of Crohn's disease.

Adult↗
PubMed2005

[Bacteria isolated from surgical infections and its susceptibilities to antimicrobial agents--special references to bacteria isolated between April 2003 and March 2004].

Tendency of isolated bacteria from infections in general surgery during the period from April 2003 to March 2004 were investigated in a multicenter study in Japan, and the following results were obtained. In this series, 455 strains including 14 strains of Candida spp. were isolated from 191(75.2%) of 254 patients with surgical infections. Two hundred and thirty-nine strains were isolated from primary infections, and 216 strains were isolated from postoperative infections. From primary infections, anaerobic Gram-positive bacteria and aerobic Gram-negative bacteria were predominant, while aerobic Gram-positive bacteria were predominant from postoperative infections. The isolation rate of aerobic Gram-positive bacteria, such as Enterococcus spp. and Staphylococcus aureus were higher from both types of infections. Among anaerobic Gram-positive bacteria, the isolation rate of Peptostreptococcus spp. was the highest from both types of infections. Among aerobic Gram-negative bacteria, Escherichia coli was the most predominantly isolated from primary infections, followed by Klebsiella pneumoniae, Enterobacter cloacae and Pseudomonas aeruginosa in this order, and from postoperative infections, E. coli was the most predominantly isolated, followed by P. aeruginosa, E. cloacae, and K. pneumoniae. Among anaerobic Gram-negative bacteria, the isolation rate of Bacteroides fragilis group was the highest from both types of infections. The isolation rate of anaerobic Gram-positive bacteria from primary infections and that of aerobic Gram-positive bacteria from postoperative infections were high in the last several years. In this series, we noticed no vancomycin-resistant Gram-positive cocci, but a few strains of moderately arbekacin-resistant MRSA. Carbapenm-resistant P. aeruginosa was seen in less than 10 per cents. Last year we noticed that there were cefazolin-resistant E. coli producing extended spectrum beta-lactamase, but there was no highly cefazolin-resistant E. coli in this year. In the next series, increase of both anaerobic bacteria and Enterococcus spp. should be carefully followed up.

Anti-Bacterial Agents↗
PubMed2004

Combined assessment of beta-D-glucan and degree of candida colonization before starting empiric therapy for candidiasis in surgical patients.

The purpose of the study was to investigate whether examination for plasma beta-D-glucan, a cell wall constituent of fungi, is useful for selecting surgical patients with Candida colonization who would benefit from empiric antifungal therapy. We administered fluconazole to postoperative patients with Candida colonization who have risk factors for candidemia and complained of persistent fever despite prolonged antibacterial therapy. We then analyzed the clinical outcomes regarding the number of sites colonized with Candida spp. and plasma beta-D-glucan. Of the 32 patients positive for alpha-D-glucan, 15 (46.9%) responded to the empiric therapy; only 9% of those who were negative responded (p < 0.01). In the multiple logistic regression analysis, being positive for alpha-D-glucan was a significant factor predicting response, with an adjusted odds ratio of 12.9 in patients with Candida colonization [95% confidence interval (CI) 2.07-80.73) (p < 0.01). In addition, the number of sites colonized with Candida spp. was a significant factor predicting response, with an estimated exposure odds ratio of 7.57 for those who were colonized at three or more sites compared with those colonized at one site (95% CI 1.20-47.70) (p = 0.031). In patients with Candida colonization, assessment of beta-D-glucan was useful for deciding whether to start empiric therapy for suspected candidiasis in surgical patients.

Adolescent↗
PubMed2004

[Strategy for the treatment of fungal infections in critically ill surgical patients].

To improve the outcome of invasive Candida infections, earlier empirical therapy before the establishment of the definitive diagnosis is considered to be necessary. However, appropriate use of empirical therapy for suspected candidiasis in febrile non-neutropenic surgical patients has not been defined. According to the guidelines from the Infectious Diseases Society of America, empirical therapy of suspected candidiasis in this setting should be limited to patients with Candida colonization of multiple sites, multiple other risk factors, and absence of any other causes of fever. A corrected colonization index which takes into account both the density and the degree of colonization of Candida spp. was shown to be the independent factors that predict subsequent candidal infection. It may also be appropriate to commence empirical therapy on the basis of a positive serodiagnostic test. Beta-D glucan is a cell-wall constituent of fungi, which is assumed to be a marker of fungal sepsis. However, it has been shown that beta-D-glucan can also be detected in patients without fungal infections, such as those on haemodialysis, and its positive predictive value is relatively low. The mono-utilization of beta-D-glucan for the assessment of fungal infection should therefore be avoided. The combined assessment of beta-D-glucan and extent of colonization with Candida spp. is believed to have the advantage of lessening the likelihood of a false positive reaction of beta-D-glucan.

Candidiasis↗
PubMed2004

[Bacteria isolated from surgical infections and its susceptibilities to antimicrobial agents--special references to bacteria isolated between April 2002 and March 2003].

Tendency of isolated bacteria from infections in general surgery during the period from April 2002 to March 2003 were investigated in a multicenter study in Japan, and the following results were obtained. In this series, 334 strains were isolated from 131 (75.3%) of 174 patients with surgical infections. One hundred and seventy-one strains were isolated from primary infections, and 163 strains were isolated from post-operative infections. From primary infections, anaerobic Gram-positive bacteria were predominant, while aerobic Gram-positive bacteria were predominant from postoperative infections. Among aerobic Gram-positive bacteria, although the isolation rate of Staphylococcus aureus was the highest, followed by that of Enterococcus faecalis from primary infections, the isolation rate of E. faecalis was the highest from postoperative infections. Among anaerobic Gram-positive bacteria, the isolation rate of Peptostreptococcus spp. was the highest from both types of infections. Among aerobic Gram-negative bacteria, Escherichia coli was the most predominantly isolated from primary infections, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa in this order, and from postoperative infections, E. coli was the most predominantly isolated, followed by P. aeruginosa, Enterobacter cloacae, and Citobacter freundii. Among anaerobic Gram-negative bacteria, the isolation rate of Bacteroides fragilis group was the highest from both types of infections. The isolation rate of aerobic Gram-negative bacteria from primary infections and that of aerobic Gram-positive bacteria from postoperative infections were high in the last several years. We noticed no vancomycin-resistant Gram-positive cocci nor P. aeruginosa producing metallo-beta-lactamase. But we noticed cefazolin-resistant E. coli probably producing extended spectrum beta-lactamase.

Anti-Bacterial Agents↗
PubMed2004

[Appropriate antibiotic prophylaxis and treatment in surgery--comparison of concepts in North America and Japan].

Three principles must be followed to maximize the benefits of antimicrobial prophylaxis (AMP): 1) use an AMP agent that is bactericidal with a spectrum that covers the most probable intraoperative contaminants; 2) the initial dose of AMP agents should be given no more than 30 min before the skin is incised: and 3) maintain effective levels of antibiotics throughout the surgery and until at most a few hours after the incision is closed in the operating room. These recommendations have become standardized in North America and Europe. A few controversies, however, persist in Japan, especially concerning the duration of AMP. Most practitioners recommend that prophylaxis be continued until postoperative day 3 to 4. However, some authors reported that the administration of AMP agents for 3 to 4 days causes the development of resistant strains. It is thus necessary to formulate national guidelines for appropriate AMP which are validated by the results of randomized, controlled trials conducted in Japan. In the treatment of postoperative infections, Gram-stain-based antibiotic selection is necessary and full knowledge of the interrelationships between pharmacokinetics and pharmacodynamics is important for determining effective regimens. The time that serum levels exceed the minimum inhibitory concentration is the most significant parameter determining the efficacy of beta-lactams, whereas the log area under the curve and peak serum level are the major parameters for aminoglycosides and new quinolones, respectively. Careful application of these concepts should allow surgeons to use more optimal dosing regimens in Japan.

Anti-Bacterial Agents↗