Journal of Infection and Chemotherapy最新文献

{"title":"Effectiveness of intramuscular spectinomycin in difficult-to-treat Mycoplasma genitalium urethritis in four cases","authors":"Yuichiro Nagase ,&nbsp;Kayoko Hayakawa ,&nbsp;Taketo Kubo ,&nbsp;Nobumasa Okumura ,&nbsp;Sho Saito ,&nbsp;Norio Ohmagari","doi":"10.1016/j.jiac.2025.102775","DOIUrl":"10.1016/j.jiac.2025.102775","url":null,"abstract":"<div><h3>Objectives</h3><div>Recently, <em>Mycoplasma genitalium</em> (MG) has been reported to have developed antimicrobial resistance. Sequential or combination therapy with doxycycline and fluoroquinolones has been effective in treating difficult-to-treat MG infections. However, therapeutic options are limited when these treatments fail. Hence, this study aimed to evaluate the effectiveness of spectinomycin, which has only been reported in a single case.</div></div><div><h3>Methods</h3><div>This retrospective observational study included patients ≥18 years who were diagnosed with MG infection and received at least one intramuscular injection of spectinomycin between December 2019 and May 2024 at the department of infectious diseases of the National Center for Global Health and Medicine.</div></div><div><h3>Results</h3><div>Four patients met the inclusion criteria. All patients were men and aged between 29 and 62 years, and had received a 7-day course of spectinomycin treatment. All patients had urethritis due to MG and experienced their first episode of MG infection. Two patients were men who had sex with men, one of whom was HIV-positive. All the patients had a history of multiple antimicrobial treatments. MG resistance gene test results were available in three patients. 23SrRNA and <em>parC</em> but not gyrA mutations were detected in all three patients. Three patients received oral doxycycline with spectinomycin for 7 days. After 7 days of spectinomycin treatment, three of the four patients tested negative for MG and were considered clinically and microbiologically effective. No adverse effects of spectinomycin were observed in any patient.</div></div><div><h3>Conclusions</h3><div>A7-day spectinomycin intramuscular injection therapy may a useful option for treating refractory MG urethritis.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 9","pages":"Article 102775"},"PeriodicalIF":1.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711126","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 validity of oral switch therapy from intravenous antibiotics in the treatment of urosepsis: A propensity matching score analysis at a single center","authors":"Nobuhiro Asai ,&nbsp;Wataru Ohashi ,&nbsp;Yuichi Shibata ,&nbsp;Daisuke Sakanashi ,&nbsp;Hideo Kato ,&nbsp;Mao Hagihara ,&nbsp;Hiroshige Mikamo","doi":"10.1016/j.jiac.2025.102774","DOIUrl":"10.1016/j.jiac.2025.102774","url":null,"abstract":"<div><h3>Introduction</h3><div>Urosepsis is still a critical condition originating from a urinary tract infection. Although physicians often try to switch oral antibiotics from IV, there was no evidence to support switching to oral in the treatment of urosepsis.</div></div><div><h3>Patients and methods</h3><div>We retrospectively reviewed all patents with urosepsis to evaluate whether switching antibiotic therapy from IV to oral is as effective as IV antibiotic therapy during 2020–2022. Also, poor prognostic factor for 30- and in-hospital death were analyzed. Based on the antibiotic treatment, patients were divided into a switch and IV groups. Propensity-score matching (PSM) was used to balance the potential confounders, and 63 patients were selected in each group.</div></div><div><h3>Results</h3><div>A total of 208 patients were enrolled in the study. Sixty-seven patients were treated by switch therapy (switch group), while 101 patients were treated by IV therapy (IV group). After PSM, 63 patients were selected from each group, and the baseline characteristics were well-balanced. There were no differences in 7-, 30-day mortality, duration of hospital stay or antibiotic treatments between them. We analyzed poor prognostic factor for 30-and in-hospital death among them. The CCI score (≥3) was independent poor prognostic factor for 30-day death, and higher CCI score and higher SOFA score (≥4) were independent poor prognostic factor for in-hospital death.</div></div><div><h3>Conclusion</h3><div>Switching from IV to oral antibiotics is safe and effective in the treatment of urosepsis, contributing to shortening the duration of admission.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 9","pages":"Article 102774"},"PeriodicalIF":1.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711125","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":"Exploring the correlation between time to positivity and positive culture bottle count in Staphylococcus aureus bacteremia: Implications for metastatic lesion development","authors":"Kazuhiro Ishikawa,&nbsp;Satoru Sekiya,&nbsp;Nobuyoshi Mori","doi":"10.1016/j.jiac.2025.102773","DOIUrl":"10.1016/j.jiac.2025.102773","url":null,"abstract":"<div><h3>Background</h3><div>The correlations between time to positivity (TTP) in blood cultures, the number of positive bottles, and their associations with mortality rates and metastatic lesion formation in <em>Staphylococcus aureus</em> (<em>S. aureus</em>) bacteremia remain unclear. This study aimed to evaluate the impact of these factors on the severity, mortality, and frequency of metastatic lesions.</div></div><div><h3>Patients and methods</h3><div>We retrospectively analyzed patients with <em>S. aureus</em> bacteremia who were admitted to our facility.</div></div><div><h3>Results</h3><div>A total of 317 patients were included in this study, with an average age of 70.3 years (standard deviation [SD]: 17.0); 62.5 % were male, and 22.4 % of cases involved methicillin-resistant <em>Staphylococcus aureus</em> infections. The average TTP was 19.9 h (SD: 11.9). No significant differences were observed in mortality or severity with respect to TTP or number of positive bottles. Further investigation into the relationship with metastatic lesions revealed that the TTP for patients with intravascular infections was significantly shorter, averaging 16.81 h (SD: 5.68), compared to 23.45 h (SD: 13.84) in patients with bacteremia. The TTP for bone and joint infections was significantly shorter, averaging 17.88 h (SD: 8.26). A weak correlation was observed between TTP and the number of metastatic lesions (r = 0.203). Additionally, a weak correlation was found between TTP and the number of positive bottles (r = 0.544).</div></div><div><h3>Conclusion</h3><div>TTP and bottle count did not predict the severity or mortality of <em>S. aureus</em> bacteremia in our study. However, positivity with a shorter TTP, particularly around or below 20 h, warrants further evaluation for intravascular and bone infections.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 9","pages":"Article 102773"},"PeriodicalIF":1.9,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695464","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":"Vaccination strategies for transplantation in Japan (solid organ transplantation and hematopoietic stem cell transplantation)","authors":"Takeshi Tanaka ,&nbsp;Satoshi Kakiuchi ,&nbsp;Ayumi Fujita ,&nbsp;Masato Tashiro ,&nbsp;Koichi Izumikawa","doi":"10.1016/j.jiac.2025.102772","DOIUrl":"10.1016/j.jiac.2025.102772","url":null,"abstract":"<div><div>The management of infectious diseases in immunocompromised patients represents a critical component of managing severe and refractory conditions, with early diagnosis and prompt therapeutic intervention serving as fundamental principles. Vaccine-preventable disease (VPD) management is equally essential. From a health economics perspective, this approach is pivotal in preventing potentially intractable scenarios. This article reviews immunization strategies in adult patients undergoing solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) in Japan, two distinct categories of immunocompromised individuals. Although many recommended vaccines overlap between these groups, the timing and significance of vaccination prophylaxis differ. Patients who undergo SOT remain immunocompromised long-term, whereas those who have received HSCT experience a period of immune reconstitution following the cessation of immunosuppressive therapy. Additionally, numerous recommended vaccinations must be completed within a defined timeframe, and their management is more complex than that for immunocompetent individuals. Recently, several new vaccines, such as those for Severe.</div><div>Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), recombinant zoster, pneumococcal (Pneumococcal conjugate vaccine (PCV)15, 20, 21), and Respiratory syncytial virus (RSV), have been introduced. Recommended vaccination guidance varies across countries, combining established and new information, although some updates may not yet be incorporated. This article provides an overview of current vaccination guidance for SOT and HSCT recipients, highlighting country-specific issues in Japan as well as common challenges faced globally, and proposes optimal strategies for future vaccination policies in Japan.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 9","pages":"Article 102772"},"PeriodicalIF":1.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618611","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":"Rare Capnocytophaga sputigena bacteremia in a patient with acute lymphoblastic leukemia","authors":"Haruki Naruse ,&nbsp;Tomoya Maeda ,&nbsp;Noriyuki Watanabe ,&nbsp;Mieko Tokano ,&nbsp;Sachie Koyama ,&nbsp;Sachi Tanaka ,&nbsp;Yoshitada Taji ,&nbsp;Norihito Tarumoto ,&nbsp;Naoki Takahashi ,&nbsp;Kotaro Mitsutake ,&nbsp;Yasuhiro Ebihara","doi":"10.1016/j.jiac.2025.102771","DOIUrl":"10.1016/j.jiac.2025.102771","url":null,"abstract":"<div><div><em>Capnocytophaga sputigena</em>, a species of bacteria resident in the human oral cavity, <u>can rarely</u> cause opportunistic infections in immunocompromised patients. The present case concerns a 40-year-old man with acute lymphoblastic leukemia, diagnosed in 2001, who underwent two hematopoietic stem cell transplants and had experienced relapses and remissions over nearly a 20-year period. Because his acute lymphoblastic leukemia was refractory, he was no longer receiving active treatment and was instead managed with supportive care. Under these circumstances, he developed febrile neutropenia with stomatitis, and <em>C. sputigena</em> was detected in blood culture. Cefepime was ineffective, but the patient's symptoms improved with tazobactam/piperacillin. The isolate was found to harbor the resistance genes <em>Capnocytophaga sputigena</em> β-lactamase-1 (CSP-1), <em>cfxA</em>3, and <em>erm</em>(F). The simultaneous presence of both CSP-1 and cfxA3 genes is rare. Since standard drug susceptibility testing for <em>C. sputigena</em>has not yet been established, it is important to establish a standard drug susceptibility test for the appropriate treatment of <em>C. sputigena</em>. And physicians should consider the possibility that <em>C. sputigena</em> may be the causative microorganism in febrile neutropenia associated with oral mucosal injury.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 9","pages":"Article 102771"},"PeriodicalIF":1.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618610","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 feasibility study for personalized phage therapy against drug-resistant bacteria in Japan","authors":"Kayoko Hayakawa ,&nbsp;Kotaro Kiga ,&nbsp;Shinjiro Ojima ,&nbsp;Kotaro Chihara ,&nbsp;Azumi Tamura ,&nbsp;Wakana Yamashita ,&nbsp;Tomohiro Nakamura ,&nbsp;Aa Haeruman Azam ,&nbsp;Wenhan Nie ,&nbsp;Yuta Sato ,&nbsp;Jun Sakai ,&nbsp;Kohei Kondo ,&nbsp;Yoshimasa Takahashi ,&nbsp;Koichi Watashi ,&nbsp;Sho Saito ,&nbsp;Yuki Moriyama ,&nbsp;Masami Kurokawa ,&nbsp;Kazuhisa Mezaki ,&nbsp;Hirotake Ohashi ,&nbsp;Yasukata Ohashi ,&nbsp;Norio Ohmagari","doi":"10.1016/j.jiac.2025.102770","DOIUrl":"10.1016/j.jiac.2025.102770","url":null,"abstract":"<div><h3>Introduction</h3><div>Personalized phage therapy is used in Europe and the United States to treat intractable infections caused by drug-resistant bacteria. This pilot study aimed to acquire feasibility data for clinical trials of individualized phage therapy in Japan.</div></div><div><h3>Methods</h3><div>An observational study was conducted from August 2023 to September 2024 in adults with drug-resistant bacterial infections and treatment failure or recurrence/relapse following antimicrobial therapy. Phages with activity against the detected bacteria were then identified from the environment and an existing phage library.</div></div><div><h3>Results</h3><div>Thirty patients with drug-resistant bacterial infections were enrolled. Of these, six (20 %) died within 30 days of detection. The most commonly detected bacteria were methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) (n = 10, 33.3 %) and carbapenem-resistant <em>Pseudomonas aeruginosa</em> (CRPA) (n = 5, 16.7 %). The most common nontuberculous mycobacterium (NTM) was <em>Mycobacterium avium</em> (n = 4, 13.3 %), followed by <em>Mycobacterium abscessus</em> (n = 2, 6.7 %). In terms of infection types, respiratory tract infections were the most common (n = 13, 43.3 %), followed by bone and joint infections (n = 6, 20 %) and skin and soft tissue infections (n = 6, 20 %). Phages with a titer of 10⁸ PFU/ml or higher could be prepared for 26 out of 30 strains (86.7 %). Phages against CRPA were more readily identified from the environment than for MRSA and NTM. A phage against CRPA was purified to a lipopolysaccharide concentration of 0.023 EU/10⁸ PFU.</div></div><div><h3>Conclusion</h3><div>Personalized phages can be prepared for intractable infections caused by drug-resistant bacteria. These results support the conduct of clinical trials to implement personalized phage therapy in Japan.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 9","pages":"Article 102770"},"PeriodicalIF":1.9,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608581","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":"Atypical intracerebral hemorrhage and internal jugular vein thrombosis in meningovascular neurosyphilis","authors":"Motohiro Okumura ,&nbsp;Kenichi Sakuta ,&nbsp;Taku Gomi ,&nbsp;Yuya Yamaguchi ,&nbsp;Hideyuki Shimizu ,&nbsp;Satoshi Matsushima ,&nbsp;Yasuyuki Iguchi","doi":"10.1016/j.jiac.2025.102769","DOIUrl":"10.1016/j.jiac.2025.102769","url":null,"abstract":"<div><div>A previously healthy 63-year-old man presented with sudden-onset headache and left-sided clumsiness. Computed tomography revealed a linear hematoma extending from the cerebellar vermis to the left cerebellar hemisphere. Brain magnetic resonance imaging revealed an incidental thrombus occlusion of the left internal jugular vein. Based on his history of unprotected sexual intercourse, mild cognitive impairment, laboratory findings, and cerebrospinal fluid tests, he was diagnosed with meningovascular neurosyphilis. Treatment with intravenous penicillin G resulted in the resolution of both hemorrhage and venous thrombosis, emphasizing the need to consider meningovascular neurosyphilis as a differential diagnosis for unexplained hemorrhagic stroke.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 8","pages":"Article 102769"},"PeriodicalIF":1.9,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144580713","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 case of acute myeloid leukemia with Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis successfully treated by cord blood transplantation","authors":"Natsumi Yoda ,&nbsp;Takafumi Tsushima ,&nbsp;Chiharu Kimeda ,&nbsp;Kazusuke Tanaka ,&nbsp;Kosuke Matsuo ,&nbsp;Rena Matsumoto ,&nbsp;Sonoko Shimoji ,&nbsp;Yoshikazu Utsu ,&nbsp;Shin-Ichi Masuda ,&nbsp;Ken-Ichi Imadome ,&nbsp;Nobuyuki Aotsuka","doi":"10.1016/j.jiac.2025.102767","DOIUrl":"10.1016/j.jiac.2025.102767","url":null,"abstract":"<div><div>Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory life-threatening syndrome. Epstein-Barr virus (EBV) infection is a common cause of HLH. Occasionally, HLH develops with malignancies such as lymphoma. Concurrent cases of acute myeloid leukemia (AML) and EBV-associated HLH (EBV-HLH) are very rare, and the treatment has not been established. Hematopoietic stem cell transplantation (HSCT) is the only curative treatment for refractory HLH and high-risk AML. Consequently, HSCT would be a good treatment for cases of HLH and high-risk AML coexistence. A 66-year-old man was diagnosed with high-risk AML. After induction chemotherapy, he experienced prolonged pancytopenia, high fever, and elevated liver enzymes. A high EBV viral load was found, and he was diagnosed with EBV-HLH, with EBV infecting CD8⁺ T-cells. EBV-HLH was resolved by treatment with corticosteroids. Meanwhile, some hemophagocytosis remained after consolidation chemotherapy, and EBV-DNA in whole blood was positive. The patient received cord blood transplantation to treat both AML and EBV-HLH. His AML achieved complete remission, and the hemophagocytosis was in remission. However, his EBV viral load increased again 53 days after transplantation. Then, the EBV infection occurred in B-cells, and there was no relapse of hemophagocytosis. In conclusion, both AML and HLH were successfully treated by transplantation. This report highlights treatment strategies in specific cases of AML and EBV-HLH coexistence.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 8","pages":"Article 102767"},"PeriodicalIF":1.9,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575637","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":"HIV-associated neurocognitive dysfunction in the Chugoku-Shikoku region of Japan: A cross-sectional study","authors":"Hisafumi Kihara ,&nbsp;Aya Nakao ,&nbsp;Tatsuya Konishi ,&nbsp;Jun Yamanouchi ,&nbsp;Takumi Nishida ,&nbsp;Miho Nakamura ,&nbsp;Seisho Takeuchi ,&nbsp;Yutaka Sato ,&nbsp;Yumi Akamatsu ,&nbsp;Hidetoshi Tani ,&nbsp;Hideho Wada ,&nbsp;Emi Tokui ,&nbsp;Michiko Kawata ,&nbsp;Takashi Kaimen ,&nbsp;Shuji Ozaki ,&nbsp;Chie Iketani ,&nbsp;Kentaro Kawabe ,&nbsp;Kiyonori Takada","doi":"10.1016/j.jiac.2025.102768","DOIUrl":"10.1016/j.jiac.2025.102768","url":null,"abstract":"<div><h3>Introduction</h3><div>Although combination antiretroviral therapy (cART) is widely used, HIV-associated neurocognitive disorder (HAND) remains a significant challenge for people living with HIV. This study aimed to investigate the characteristics of HAND among HIV patients in the Chugoku-Shikoku region of Japan using the CoCoBattery, a unified neurocognitive test employed in a nationwide multicenter prospective cross-sectional study on HAND.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted in seven general hospitals from January 2019 to March 2023, including 103 HIV patients. HAND was classified into HIV-associated dementia (HAD), mild neurocognitive disorder (MND), and asymptomatic neurocognitive impairment (ANI, asymptomatic HAND) based on the Frascati criteria. Multivariable logistic regression analysis was performed to identify factors associated with HAND and asymptomatic HAND.</div></div><div><h3>Results</h3><div>Among the 103 patients, 62 (60.2 %) were diagnosed with HAND, including 11 (10.7 %) with HAD, 16 (15.5 %) with MND, and 35 (34.0 %) with ANI. No significant differences in baseline characteristics were observed between the HAND and non-HAND groups. However, a positive association was observed between an HIV-RNA copy number ≥200 copies/mL and asymptomatic HAND (adjusted odds ratio (OR): 11.15; 95 % confidence interval (CI): 1.13–297.17). Notably, 10 ANI patients exhibited neurocognitive impairment equivalent to HAD.</div></div><div><h3>Conclusions</h3><div>ANI accounted for a large proportion of HAND cases and included patients with significant neurocognitive impairment. Elevated HIV-RNA copy numbers were associated with ANI, highlighting the need for careful monitoring and support for these patients, even in the absence of subjective symptoms.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 8","pages":"Article 102768"},"PeriodicalIF":1.9,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575638","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":"Optimization of voriconazole dosage via population pharmacokinetic analysis based on the albumin–bilirubin (ALBI) score of patients with liver dysfunction","authors":"Shunsuke Nashimoto ,&nbsp;Mitsuru Sugawara ,&nbsp;Yoh Takekuma","doi":"10.1016/j.jiac.2025.102766","DOIUrl":"10.1016/j.jiac.2025.102766","url":null,"abstract":"<div><h3>Introduction</h3><div>Voriconazole (VRCZ) is an antifungal agent used to treat refractory fungal infections. Its dosage is adjusted based on the individual liver function. In this study, we aimed to establish a population pharmacokinetic analysis model based on the albumin–bilirubin (ALBI) score to objectively assess the liver function using only albumin and total bilirubin levels as covariates.</div></div><div><h3>Methods</h3><div>In total, 126 plasma samples of 16 patients with liver dysfunction who received oral VRCZ between 2012 and 2022 were analyzed in this study. Phoenix NLME software was used for population pharmacokinetic analysis, and Monte Carlo simulations were performed to determine the optimal dosing regimen to achieve the target blood VRCZ concentration.</div></div><div><h3>Results</h3><div>Blood VRCZ concentration was described using a one-compartment model with lag time. In the final model, objective function was significantly decreased upon ALBI score incorporation into clearance. Monte Carlo simulations showed that the optimal dosing schedules were 100 mg twice daily, 75 mg twice daily, and 50 mg twice daily for ALBI scores of −3, −2, and −1, respectively. Notably, for an ALBI score of 0, target blood VRCZ concentration was exceeded, even a dosing regimen of 50 mg twice daily.</div></div><div><h3>Conclusion</h3><div>To the best of our knowledge, this study is the first to incorporate the ALBI score into a population pharmacokinetic model for VRCZ. Our simulation results suggest that the maintenance dose should be reduced based on the ALBI score. Furthermore, our findings highlight the potential use of the ALBI score for optimal drug dosage design.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 8","pages":"Article 102766"},"PeriodicalIF":1.9,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564776","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}