Journal of Infection and Chemotherapy最新文献

{"title":"Patient-month modeling for longitudinal blood culture contamination surveillance during a major healthcare-system disruption: a single-center interrupted time-series study.","authors":"Kohei Hasegawa, Junji Kumasawa, Kaya Aonuma","doi":"10.1016/j.jiac.2026.103107","DOIUrl":"https://doi.org/10.1016/j.jiac.2026.103107","url":null,"abstract":"<p><strong>Introduction: </strong>Blood culture contamination (BCC) is an important diagnostic quality indicator, but crude temporal comparisons may be misleading when repeated sampling within patients is not considered. We evaluated longitudinal changes in BCC rates before, during, and after the COVID-19 pandemic using patient-month Poisson generalized estimating equations (GEE).</p><p><strong>Methods: </strong>This single-center retrospective study included blood culture sets obtained at a tertiary hospital in Japan from April 2017 to June 2025. Eligible episodes had at least two sets drawn within 24 h. Interrupted time-series analysis estimated incidence rate ratios (IRRs) for level and slope changes at pandemic and post-reclassification transitions, with the number of sets as an offset and adjustment for seasonality and within-patient correlation.</p><p><strong>Results: </strong>Among 85,955 blood culture sets, 84,213 sets from 41,732 episodes in 23,705 patients were analyzed. Crude BCC rates were 1.05%, 1.55%, and 1.49% in the prepandemic, pandemic, and post-reclassification periods. No significant overall level or slope changes were observed: prepandemic-to-pandemic level-change IRR, 1.23 (95% CI, 0.93-1.62); slope-change IRR, 1.00 (95% CI, 0.99-1.01); pandemic-to-post-reclassification level-change IRR, 0.88 (95% CI, 0.68-1.14); and slope-change IRR, 0.99 (95% CI, 0.98-1.01). Exploratory subgroup analyses suggested setting-specific post-reclassification changes in the intensive care unit. Sensitivity analyses were generally consistent, although the Omicron-era breakpoint analysis suggested sensitivity to breakpoint specification.</p><p><strong>Conclusion: </strong>Patient-month Poisson GEE-based analysis showed that crude increases in BCC rates were not accompanied by statistically significant overall level or slope changes after accounting for repeated patient-level sampling and seasonality. Crude BCC trends should therefore be interpreted cautiously in longitudinal microbiology surveillance.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 11","pages":"103107"},"PeriodicalIF":1.7,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiological Characteristics of Pertussis in Hainan Province, 2023-2025.","authors":"Wenli Li, Yajing Huang, Changrong Guan, Zhenwang Fu, Xuexia Zeng","doi":"10.1016/j.jiac.2026.103105","DOIUrl":"https://doi.org/10.1016/j.jiac.2026.103105","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the epidemiological characteristics of pertussis in Hainan Province from 2023 to 2025, describe the outbreak trajectory and patterns of population susceptibility, and provide evidence for optimizing pertussis prevention and control strategies.</p><p><strong>Methods: </strong>Clinically diagnosed and confirmed pertussis cases reported in Hainan Province between January 1, 2023, and December 31, 2025, were retrieved from the China Information System for Disease Control and Prevention; suspected cases were excluded, yielding a total of 2,927 eligible cases.Descriptive epidemiological methods were used to analyze the temporal, geographic, and population distributions of the cases; piecewise linear regression was employed to characterize monthly trends in case counts; and multivariable logistic regression was performed to identify risk factors for hospitalization.</p><p><strong>Results: </strong>The incidence of pertussis in Hainan Province exhibited an outbreak-and-decline pattern from 2023 to 2025, increasing from 4.29 per 100,000 population in 2023 to 22.26 per 100,000 in 2024 before declining to 1.37 per 100,000 in 2025, with a statistically significant difference across the three years (χ² = 2,888.2, P < 0.001).Piecewise linear regression showed that the monthly number of cases increased significantly during the ascending phase (β = 21.82, P < 0.001) and decreased significantly during the descending phase (β = -11.41, P < 0.001).The age distribution shifted significantly toward older children: the proportion of infants aged <1 year decreased from 43.1% to 27.3%, whereas that of individuals aged ≥1 year increased from 56.9% to 72.7%.Among cases with complete severity records after July 2024, infants aged 0-2 months had the highest risk of hospitalization and accounted for 90.0% of intensive care unit admissions.</p><p><strong>Conclusion: </strong>This study shows that the 2024 pertussis outbreak in Hainan was followed by a rapid decline in 2025, with a shift toward older children and a persistently high hospitalization risk in infants aged 0-2 months. These findings support strengthening surveillance in schools and childcare institutions and evaluating the effectiveness of the 6-year DTaP booster policy, while maintaining maternal and infant protection strategies.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"103105"},"PeriodicalIF":1.7,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Isavuconazole.","authors":"Yuto Kizaki, Satoshi Yuyama, Ikko Hirata, Ryokan Funakoshi","doi":"10.1016/j.jiac.2026.103102","DOIUrl":"https://doi.org/10.1016/j.jiac.2026.103102","url":null,"abstract":"<p><strong>Purpose: </strong>Isavuconazole (ISCZ) has demonstrated therapeutic efficacy for invasive fungal infections (IFIs); however, evidence supporting its prophylactic use remains limited. This study aimed to evaluate the real-world effectiveness and safety of ISCZ prophylaxis in patients with hematological malignancies at high risk for IFIs.</p><p><strong>Methods: </strong>This retrospective study evaluated patients at high risk for IFI who received ISCZ as prophylaxis at our institution from June 2023 to June 2025. The primary outcome measure was the incidence of breakthrough IFI (bIFI) within 100 days after ISCZ initiation. The secondary outcome measures were the treatment continuation rate, mortality rate, adverse events, and changes in liver and kidney function.</p><p><strong>Results: </strong>Overall, 38 patients (median age, 67 years; median body weight, 54.1 kg) were evaluated. Most patients (97.4%) were treated in the hematology-oncology department. The median duration of ISCZ administration was 119 days. Treatment continuation/completion was achieved in 44.7% of the patients. No deaths attributable to IFI were observed during the study period. No breakthrough IFIs were identified within 100 days after ISCZ initiation, and no Grade ≥3 adverse events were definitively attributed to ISCZ.</p><p><strong>Conclusions: </strong>In this cohort, no breakthrough IFIs occurred within 100 days after ISCZ prophylaxis initiation. Although Grade 3 or higher adverse events occurred, their causal relationship with ISCZ could not be definitively established in this retrospective study. These findings provide real-world data on ISCZ prophylaxis in patients at high risk for IFIs. Further validation in multicenter prospective studies is needed.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"103102"},"PeriodicalIF":1.7,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appropriate administration of tazobactam/piperacillin for urinary and genital tract infections based on antibiotic susceptibility testing: a single-center retrospective analysis.","authors":"Yuichiro Hishikawa, Yoshiki Hiyama, Naotaka Nishiyama, Kentaro Nagaoka, Yoshihiro Yamamoto, Hiroshi Kitamura","doi":"10.1016/j.jiac.2026.103108","DOIUrl":"https://doi.org/10.1016/j.jiac.2026.103108","url":null,"abstract":"<p><strong>Objective: </strong>Tazobactam/piperacillin (TAZ/PIPC) is a broad-spectrum antimicrobial agent. However, improper administration may contribute to antimicrobial resistance (AMR). The objectives of this study were to evaluate the appropriateness of TAZ/PIPC administration for UGTI based on antibiotic susceptibility testing and to elucidate the patients for whom alternative antibiotics can be utilized as the initial empiric therapy.</p><p><strong>Methods: </strong>Patients diagnosed with UGTI at the University of Toyama Hospital between January 2022 and December 2024 who received TAZ/PIPC as initial empirical therapy were analyzed retrospectively. The appropriateness of alternative agents was determined by assessing bacterial culture and antimicrobial susceptibility results.</p><p><strong>Results: </strong>Sixty-two UGTI episodes were analyzed. TAZ/PIPC utilization appeared appropriate in 91.9% of cases. Enterococcus faecalis and Pseudomonas aeruginosa were isolated more frequently in UGTI with devices or ileal urinary diversions compared to UGTI without devices. For patients with ileal urinary diversions or devices, the differences in the appropriateness rates of TAZ/PIPC versus CFPM, CTRX, and SBT/ABPC were higher than those for patients without devices. In patients without devices, the appropriateness rates of TAZ/PIPC, CFPM, CTRX, and SBT/ABPC were 96.7% (29/30), 86.7% (26/30), 83.3% (25/30), and 80.0% (24/30), respectively. Multivariate logistic regression analysis revealed that only the presence of an ileal urinary diversion, a urethral catheter, or a ureteral stent was a risk factor for the inappropriateness (p < 0.05) for CFPM, CTRX, and SBT/ABPC.</p><p><strong>Conclusion: </strong>Based on antibiotic susceptibility testing, TAZ/PIPC may be considered for UGTI using devices or ileal urinary diversions. However, alternative antibiotics may be considered for UGTIs without indwelling devices.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"103108"},"PeriodicalIF":1.7,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics of Necrotizing Soft Tissue Infection Among Patients with High LRINEC Scores.","authors":"Masafumi Kameoka, Tomofumi Ogoshi, Naoto Fujii, Yuta Takasu, Keita Nagira, Shinji Tanishima, Hiroki Chikumi, Hideki Nagashima, Masato Homma, Takahiro Ueda","doi":"10.1016/j.jiac.2026.103104","DOIUrl":"https://doi.org/10.1016/j.jiac.2026.103104","url":null,"abstract":"<p><strong>Background: </strong>The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is a widely used adjunctive diagnostic tool for necrotizing soft tissue infection (NSTI). However, patients with high LRINEC scores do not uniformly have NSTI and often represent a diagnostic gray zone requiring urgent differentiation from other severe soft tissue infections. This study aimed to clarify the clinical characteristics of NSTI among patients with high LRINEC scores.</p><p><strong>Methods: </strong>We retrospectively reviewed patients hospitalized for severe soft tissue infections with sepsis between January 2014 and December 2023 with LRINEC scores ≥6, classified as NSTI (n = 11) or non-NSTI (n = 9). Non-NSTI cases were limited to severe cellulitis with bacteremia requiring intensive care. Clinical findings, laboratory parameters, imaging findings, and vasopressor use within 24 hours after hospital arrival were compared.</p><p><strong>Results: </strong>Patients with LRINEC had significantly higher white blood cell counts and serum creatinine levels. Fluid collection along the fascia and gas formation on CT were more frequent in the NSTI group. Mean blood pressure at presentation did not differ between groups; however, vasopressor use within 24 hours after hospital arrival was significantly more common in the NSTI group, suggesting early hemodynamic deterioration or greater disease severity CONCLUSIONS: In patients with high LRINEC scores, NSTI was associated with marked inflammatory response, renal dysfunction, specific CT findings and early hemodynamic instability. Early vasopressor requirement should be interpreted primarily as a marker of early hemodynamic deterioration or disease severity, rather than a diagnostic characteristic specific to NSTI.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"103104"},"PeriodicalIF":1.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive performance of single-trough Bayesian estimation for vancomycin across body mass index categories using Practical Antimicrobial Therapeutic Drug Monitoring (PAT) version 4.0.","authors":"Kaori Arai, Kengo Ohashi, Yasutaka Shinoda, Nao Hotta, Tomoko Matsuoka, Reiko Yano, Eiseki Usami","doi":"10.1016/j.jiac.2026.103089","DOIUrl":"https://doi.org/10.1016/j.jiac.2026.103089","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated whether body mass index (BMI) affects the predictive performance of single-trough Bayesian estimation for vancomycin (VCM) using Practical Antimicrobial Therapeutic Drug Monitoring (PAT) version 4.0.</p><p><strong>Methods: </strong>This retrospective single-center study included adult patients who received VCM between April 2020 and March 2023 with at least two trough concentrations measured. Patients were categorized as underweight (BMI <18.5 kg/m²), normal-weight (18.5 ≤ BMI <25 kg/m²), or overweight (BMI ≥25 kg/m²). Using posterior parameters from the initial therapeutic drug monitoring (TDM) assessment, the second trough was predicted and compared with the observed value. Predictive performance was assessed by mean prediction error (ME), mean absolute error (MAE), and Spearman's rank correlation. Prediction deviation was defined as an observed-to-predicted ratio outside 0.8-1.2; associated factors were identified by logistic regression. Sensitivity analyses used continuous BMI, restriction to patients with stable renal function, and ΔSCr instead of ΔCLcr.</p><p><strong>Results: </strong>Among 190 patients (45 underweight, 101 normal-weight, 44 overweight), BMI ranged from 14.2 to 49.3 kg/m², with 18 patients ≥30 kg/m² and 7 ≥35 kg/m². ME and MAE did not differ among BMI groups; correlation coefficients were 0.595, 0.617, and 0.711. Overall, 37.4% showed prediction deviation. Deviation was associated with variation in renal function, but not with BMI category, and this pattern persisted in sensitivity analyses.</p><p><strong>Conclusions: </strong>In this cohort, BMI did not significantly affect the predictive performance of single-trough Bayesian estimation. Clinically relevant deviations occurred in approximately one-third of patients, indicating limitations of single-trough prediction, particularly when renal function is unstable.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"103089"},"PeriodicalIF":1.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A phase 1, randomized, double-blind, placebo-controlled study to evaluate the safety, tolerability, pharmacokinetics, and pharmacodynamics of sipavibart in healthy Japanese adults.","authors":"Hiroshi Okada, Takumi Shinbo, Hyosung Kim, Yoshinori Noda, Takashi Eto","doi":"10.1016/j.jiac.2026.103078","DOIUrl":"https://doi.org/10.1016/j.jiac.2026.103078","url":null,"abstract":"<p><strong>Background: </strong>Sipavibart, a recombinant human immunoglobulin G1-based monoclonal antibody against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein, is approved in Japan for prevention of COVID-19 in immunocompromised individuals. This phase 1 study evaluated the safety and pharmacokinetics (PK) of sipavibart in Japanese individuals.</p><p><strong>Methods: </strong>Healthy Japanese adults (18-55 years) were enrolled into one of three cohorts, and randomized to sipavibart 300 mg intramuscularly (IM) or placebo (Cohort 1), sipavibart 600 mg IM or placebo (Cohort 2), or sipavibart 1200 mg intravenously (IV) or placebo (Cohort 3). Participants were followed for approximately 1 year post-administration. Safety/tolerability (occurrence of adverse events [AEs]), PK, pharmacodynamics (PD; neutralizing response against SARS-CoV-2 variants), and immunogenicity (development of anti-drug antibodies [ADAs]) were assessed.</p><p><strong>Results: </strong>Twenty-four individuals (56% male) were randomized, with eight participants (sipavibart, n = 6; placebo, n = 2) in each cohort. Through Day 91 (primary safety endpoint), AEs were reported in five participants (27.8%) in the total sipavibart group and one (16.7%) in the pooled placebo group. There were no deaths, serious or treatment-related AEs, or AEs leading to discontinuation. PK parameters indicated consistent exposure across sipavibart administration routes and doses. Neutralizing antibody titers against all tested SARS-CoV-2 variants increased over time. A linear PK/PD relationship was observed across serum sipavibart concentrations for the SARS-CoV-2 variants tested. No participants developed treatment-emergent ADAs.</p><p><strong>Conclusions: </strong>Single IM and IV doses of sipavibart were well tolerated in healthy Japanese adults, with a linear PK/PD relationship across tested SARS-CoV-2 variants.</p>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":" ","pages":"103078"},"PeriodicalIF":1.7,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical pharmacist-led implementation of an intravenous-to-oral antimicrobial switch protocol: A prospective Quasi-experimental study","authors":"Fatma Gul Yumrucu ,&nbsp;Emre Kara ,&nbsp;Leyla Yumrukaya ,&nbsp;Hatice Yagmur Zengin ,&nbsp;Selen Yegenoglu ,&nbsp;Ahmet Cagkan Inkaya ,&nbsp;Gokhan Metan ,&nbsp;Omrum Uzun","doi":"10.1016/j.jiac.2026.102925","DOIUrl":"10.1016/j.jiac.2026.102925","url":null,"abstract":"<div><h3>Objectives</h3><div>In antimicrobial therapy, early intravenous-to-oral switch (IVOS) is recommended for eligible patients to minimize complications and optimize pharmacoeconomic outcomes. This study aimed to evaluate the impact of a clinical pharmacist-led multimodal intervention strategy on IVOS rates.</div></div><div><h3>Methods</h3><div>A prospective before-and-after study was conducted between January and June 2024, including observation and intervention periods. Hospitalized adults receiving IV antimicrobials were included. A two-round expert panel was convened prior to data collection to identify the criteria for IVOS. During the observation period, IV antimicrobial utilization patterns were monitored without intervention. The intervention period involved the implementation of a standardized IVOS protocol, targeted education for infectious disease physicians, and switch recommendations for eligible treatments. The primary endpoint was the difference in IVOS rates between study periods among eligible treatments.</div></div><div><h3>Results</h3><div>Among 962 IV antimicrobial courses evaluated, 213 (22.1%) met the eligibility criteria for IVOS. Among patients who met IVOS eligibility criteria, the proportion undergoing overall IVOS increased from 29.0% in the observation period to 54.0% in the intervention period (p &lt; 0.001). Among 113 IVOS-eligible cases, pharmacists recommended switching in 57 (50.4%), with a 59.6% physician acceptance rate (34/57). No significant differences were observed between periods for: microbiological cure rates, <em>Clostridioides difficile</em> infection incidence, intensive care unit admission rates, antimicrobial reinitiation within 48 h of treatment cessation, 15- and 30-day readmission and mortality rates. Antimicrobial costs decreased significantly from $15,600.30 (all-parenteral baseline) and $14,997.40 (adjusted baseline) to $8333.81 post intervention.</div></div><div><h3>Conclusions</h3><div>The intervention was associated with a substantial increase in overall IVOS among eligible patients, supporting its effectiveness in promoting timely de-escalation from intravenous therapy. Clinical pharmacist-led initiatives optimize appropriate switching and antimicrobial utilization in stewardship.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 3","pages":"Article 102925"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of recombinant human thrombomodulin in a pediatric case of COVID-19–associated coagulopathy: A case report","authors":"Fumihiro Ochi ,&nbsp;Kozo Nagai ,&nbsp;Shiori Ukita ,&nbsp;Ayuko Yoshida ,&nbsp;Mika Kawabe ,&nbsp;Tomozo Moritani ,&nbsp;Naoko Nakano ,&nbsp;Eiichi Yamamoto ,&nbsp;Hisamichi Tauchi","doi":"10.1016/j.jiac.2026.102926","DOIUrl":"10.1016/j.jiac.2026.102926","url":null,"abstract":"<div><div>Coronavirus disease 2019 (COVID-19)–associated coagulopathy (CAC) is a known extrapulmonary complication of severe acute respiratory syndrome coronavirus 2 infection, primarily studied in adults. As a result, pediatric data are limited, and management strategies remain under investigation. Recombinant human soluble thrombomodulin (rh-TM), an anticoagulant with anti-inflammatory and antifibrinolytic properties, has shown promise in sepsis-induced coagulopathy; however, it has not been widely studied in children with CAC. A previously healthy 5-year-old girl presented with severe CAC secondary to COVID-19. She initially presented with persistent fever, gastrointestinal and respiratory symptoms, and gingival bleeding. Laboratory evaluation revealed significant coagulopathy characterized by high D-dimer (≥110.3 μg/mL), fibrinogen/fibrin degradation products (328.6 μg/mL), thrombin–antithrombin complex (≥120 ng/mL), and plasmin–α2 plasmin inhibitor complex (7.7 μg/mL), along with thrombocytopenia and prolonged prothrombin time and international normalized ratio and activated partial thromboplastin time. Imaging showed ground-glass opacities on chest computed tomography (CT) and increased ¹⁸F-fluorodeoxyglucose uptake in positron emission tomography–CT. A multidisciplinary treatment regimen was initiated, including intravenous immunoglobulin, remdesivir, rh-TM, corticosteroids, low-dose aspirin, and budesonide inhalation. Levels of coagulation markers gradually normalized, and the patient's clinical symptoms resolved without further complications. She was discharged on day 29 of illness and remained relapse-free after 1 year of follow-up. This case highlights the potential utility of rh-TM as part of a tailored multimodal treatment strategy for pediatric CAC. Early recognition and individualized, stage-specific therapy may contribute to favorable outcomes. However, further studies are warranted to evaluate the safety and efficacy of rh-TM in children with CAC.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 3","pages":"Article 102926"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced guideline-compliant antimicrobial prophylaxis based on preoperative urine culture pathogens reduces bloodstream infection and sepsis following ureteroscopic lithotripsy","authors":"Katsuhiro Onishi ,&nbsp;Hiroshi Morioka ,&nbsp;Masashi Yamamoto ,&nbsp;Daisuke Tsuchimoto ,&nbsp;Mitsuru Nishio ,&nbsp;Yoshie Moriya ,&nbsp;Toru Kimura","doi":"10.1016/j.jiac.2026.102924","DOIUrl":"10.1016/j.jiac.2026.102924","url":null,"abstract":"<div><h3>Introduction</h3><div>Positive preoperative urine culture is a risk factor for infection after ureteroscopic lithotripsy (URSL). However, the effectiveness of tailoring antimicrobial prophylaxis (AP) to pathogens identified in preoperative urine culture remains unclear. This study aimed to evaluate whether three AP strategies reduce bloodstream infections and sepsis following URSL.</div></div><div><h3>Methods</h3><div>This single-center retrospective observational study was conducted between April 2019 and March 2025 at Komaki City Hospital, Japan. AP was classified into three categories: guideline-compliant AP (GC-AP, which do not cover all detected pathogens), pathogen-directed AP (PD-AP, which cover all pathogens but is non-guideline-compliant), and enhanced GC-AP (GC-AP or AP with an extended spectrum of antibiotics to which all pathogens detected in the preoperative urine culture are susceptible). The incidences of bloodstream infections and sepsis after URSL were compared among the three groups. The risk factors for postoperative sepsis were analyzed using multivariable logistic analysis.</div></div><div><h3>Results</h3><div>The enhanced GC-AP group had fewer bloodstream infections than the GC-AP group (0.67% [1/149] vs. 8.11% [6/74], p = 0.0059). No bloodstream infections were observed in the PD-AP group. However, the incidence of sepsis was significantly higher in the PD-AP group than in the enhanced GC-AP group (28.6% [8/28] vs. 10.7% [16/149], p = 0.030). Multivariable analysis showed that enhanced GC-AP significantly reduced the incidence of sepsis after URSL (odds ratio: 0.41, 95% confidence interval: 0.18–0.93, p = 0.023).</div></div><div><h3>Conclusions</h3><div>Enhanced GC-AP reduced bloodstream infections and sepsis after URSL.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 3","pages":"Article 102924"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}