Journal of Infection and Chemotherapy最新文献

{"title":"Humoral and cellular immune responses to mRNA COVID-19 vaccinations in the elderly: A longitudinal study in Japan","authors":"Kiyoyasu Fukushima ,&nbsp;Toru Kubo ,&nbsp;Yuta Ito ,&nbsp;Yoshie Oda ,&nbsp;Yohsuke Nagayoshi ,&nbsp;Minoru Fukuda ,&nbsp;Takahiro Takazono ,&nbsp;Noriho Sakamoto ,&nbsp;Hiroshi Mukae","doi":"10.1016/j.jiac.2025.102695","DOIUrl":"10.1016/j.jiac.2025.102695","url":null,"abstract":"<div><h3>Objectives</h3><div>This study examined the durability of humoral and cell-mediated immune responses to COVID-19 mRNA vaccines over six months, focusing on age-related changes.</div></div><div><h3>Methods</h3><div>SARS-CoV-2 uninfected Japanese subjects aged 20–99 who received two doses of mRNA COVID-19 vaccine were recruited. SARS-CoV-2 Spike IgG antibody (IgG) level in the serum and the levels of interferon (IFN)-γ in blood stimulated with SARS-CoV-2 specific antigens by QuantiFERON (QFN) SARS-CoV-2 assay were measured.</div></div><div><h3>Results</h3><div>The IgG levels of 138 subjects declined significantly with age and time post-vaccination <em>(p &lt; 0.001).</em> For participants aged 70 and above (n = 80), the IFN-γ levels, an indicator of cell-mediated immunity, also significantly declined over time (p &lt; 0.05). However, in those under 70 (n = 58), the IFN-γ levels were maintained at three- and six months post-vaccination. There was no significant difference in IFN-γ levels between three- and six months post-vaccination for all 138 subjects, including CD4⁺ and CD8⁺ T cell counts. No correlation was observed between IgG antibody levels and secreted IFN-γ values. Multivariate regression analysis revealed a significant correlation between IgG levels and age. In contrast, IFN-γ levels were associated with CD4⁺ T cell counts, CD8⁺ T cell counts, and Performance Status Scores but not with age.</div></div><div><h3>Conclusions</h3><div>The findings suggest that while humoral immunity (IgG levels) decreases with age and time, cell-mediated immunity (IFN-γ levels) is relatively preserved in individuals under 70 up to six months post-vaccination. However, this immune response is significantly attenuated in older adults aged 70 and above, indicating age-related immunosenescence in long-term immunity following COVID-19 vaccination.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 6","pages":"Article 102695"},"PeriodicalIF":1.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795628","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":"Development of Traceable International Standard Materials Using Sequence-Customized Lentivirus, Modeled on SARS-CoV-2 Nucleic Acid Amplification Tests, and Validation through a Pilot External Quality Assessment","authors":"Mizuki Sugawara Itano ,&nbsp;Kotaro Aoki ,&nbsp;Haruka Nakagawa Kamura ,&nbsp;Yoshikazu Ishii ,&nbsp;Kazuhiro Tateda","doi":"10.1016/j.jiac.2025.102694","DOIUrl":"10.1016/j.jiac.2025.102694","url":null,"abstract":"<div><h3>Background</h3><div>International standardization and quality control of nucleic acid amplification tests (NAATs) require traceable, full-process control materials aligned with international standards. We proposed a protocol for producing sequence-customized, traceable full-process controls, validated for stability and utility through a pilot external quality assessment (EQA) using SARS-CoV-2 NAATs as a model.</div></div><div><h3>Methods</h3><div>The concatenated SARS-CoV-2 NAATs target sequence was synthesized as a DNA fragment. A recombinant lentiviral material was generated using the Lentiviral High Titer Packaging Mix (pLVSIN-CMV Neo Vector, Takara Bio). Stability was evaluated after one freeze-thaw cycle at -80°C followed by incubation at 4°C or 25°C for seven days. The reference SARS-CoV-2 reverse transcription-quantitative PCR was standardized internationally using the WHO international standard material (National Institute for Biological Standards and Control). A pilot EQA of SARS-CoV-2 NAAT was conducted in 31 laboratories using high, low, and negative lentiviral materials.</div></div><div><h3>Results</h3><div>The 10⁶-fold dilutions (7.41 x 10³ IU/mL as low-concentration) in 10% FBS/DMEM of the original sequence-customized lentiviral materials were stable for seven days at 4 °C after freeze-thaw. Thirty laboratories reported positive results for high-concentration material, while 27 reported positive results for low-concentration material. GeneXpert (eight laboratories), with Ct values ranging from 22.6-26.7 for high and 32.5-37.0 for low-concentration. One laboratory using FilmArray reported negative results for all materials.</div></div><div><h3>Conclusions</h3><div>The sequence-customized and traceable lentiviral materials demonstrated suitable characteristics for EQA. The EQA results emphasize the importance of NAAT international standardization. These materials would help with NAAT international standardization, internal quality control, and EQA in individual laboratories.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 5","pages":"Article 102694"},"PeriodicalIF":1.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783797","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 questionnaire survey for Japanese parents on intention to vaccinate their children against COVID-19 and influenza","authors":"Taito Kitano ,&nbsp;Takanori Motoki ,&nbsp;Masayuki Onaka ,&nbsp;Masayuki Murata ,&nbsp;Mai Onishi ,&nbsp;Takahiro Mori ,&nbsp;Soshi Hachisuka ,&nbsp;Tenshin Okubo ,&nbsp;Naohiro Yamamoto ,&nbsp;Hiroki Nishikawa ,&nbsp;Rika Suzuki ,&nbsp;Sayaka Yoshida","doi":"10.1016/j.jiac.2025.102693","DOIUrl":"10.1016/j.jiac.2025.102693","url":null,"abstract":"<div><h3>Background</h3><div>Since 2024, coronavirus (COVID-19) and influenza vaccines for children have been voluntarily administered in Japan. Evaluating parental intentions to receive these vaccinations and the reasons for vaccine hesitancy may elucidate issues regarding vaccine confidence. This study aimed to evaluate the intention of parents to vaccinate their children against COVID-19 and influenza.</div></div><div><h3>Methods</h3><div>A questionnaire survey was conducted between July and October 2024. Eligible participants were parents or caregivers of at least one child aged 6 months to 17 years. The questionnaire asked the parents about their intention to vaccinate their children against COVID-19 and influenza for the 2024–2025 season, before and after receiving information about the vaccines, as well as their reasons for not vaccinating.</div></div><div><h3>Results</h3><div>Answers from 213 parents and caregivers of 286 children were included in the study. After reading the vaccine information, 90.1 % of parents intended to vaccinate their children against influenza, while and 9.4 % intended to vaccinate against COVID-19. Of the parents or caregivers, 69.0 % indicated that they would not vaccinate their children with the COVID-19 vaccine, even if it was free. Among those refusing the COVID-19 vaccine, 77.3 % cited safety concerns as the reason for their decision.</div></div><div><h3>Conclusion</h3><div>The intention of parents to vaccinate their children was very high for influenza vaccination. However, only few parents intended to vaccinate their children against the COVID-19 vaccine even after providing medical information. Many parents expressed concerns about the safety of COVID-19 vaccination in children as a reason for not intending to vaccinate.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 5","pages":"Article 102693"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780341","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":"Status of diagnostic test, diagnosis, and treatment of influenza using the national database of health insurance claims and specific health checkups of Japan","authors":"Daisuke Tamura ,&nbsp;Kosuke Iwasaki ,&nbsp;Manami Yoshida ,&nbsp;Yumi Sato ,&nbsp;Shinzo Hiroi ,&nbsp;Eiko Shimizu","doi":"10.1016/j.jiac.2025.102692","DOIUrl":"10.1016/j.jiac.2025.102692","url":null,"abstract":"<div><h3>Background</h3><div>We previously reported the status of diagnostic tests, diagnoses, and prescriptions for influenza in Japan using a large-scale nationwide database, in which the type of health insurance plan was limited and older people were omitted. In this study, we examined the status using a comprehensive Japanese health insurance claims database.</div></div><div><h3>Methods</h3><div>This cross-sectional study used the National Database of Health Insurance Claims and Specific Health Checkups of Japan from April 2009–March 2020. Among the target patients with at least one record of any tests, diagnoses, or prescriptions, the percentages of patients with a combination of tests, diagnoses, and prescriptions were calculated by the influenza season year (SY), demographics, and type of health insurance plan. The percentage of patients diagnosed to those who underwent tests and the percentage of patients who obtained prescriptions to those diagnosed (prescriptions/diagnoses) were calculated according to the medical facility characteristics.</div></div><div><h3>Results</h3><div>The database included 199,964,548 target patients; ≥90 % received either the test alone or test + diagnosis + prescription in SY 2014 and later. The two patterns were predominant at approximately ≥90 % by age in both sexes. Most patients visited medical facilities without beds, where the percentage of prescriptions/diagnoses was 88.1 %.</div></div><div><h3>Conclusions</h3><div>We showed that most patients diagnosed with influenza underwent diagnostic testing and were prescribed antiviral drugs using comprehensive Japanese health insurance claims data. This finding was consistent with our previous study.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 5","pages":"Article 102692"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780346","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":"Isolated brain abscess caused by Aspergillus tubingensis in a patient with alcoholic liver cirrhosis","authors":"Takumi Inaba ,&nbsp;Kensuke Minami ,&nbsp;Haruhiko Ishioka ,&nbsp;Kazumasa Sekiguchi ,&nbsp;Akira Watanabe ,&nbsp;Shuji Hatakeyama","doi":"10.1016/j.jiac.2025.102691","DOIUrl":"10.1016/j.jiac.2025.102691","url":null,"abstract":"<div><div>A 67-year-old Japanese man with alcoholic liver cirrhosis without any other known immunosuppressive conditions presented with a solitary brain abscess caused by <em>Aspergillus tubingensis</em>. <em>A. tubingensis</em>, a cryptic species within the <em>Aspergillus</em> section <em>Nigri</em>, has been reported to exhibit resistance to voriconazole. This case highlights the necessity for considering central nervous system aspergillosis as a differential diagnosis, even in patients without significant immunosuppression. Moreover, molecular identification and antifungal susceptibility testing are crucial for accurate diagnosis and effective management of such infections, as cryptic species within the <em>Aspergillus</em> genus may exhibit varying degrees of resistance to established treatments.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 5","pages":"Article 102691"},"PeriodicalIF":1.9,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of incidence and risk factors of COVID-19-associated candidemia using diagnosis procedure combination data","authors":"Waki Imoto ,&nbsp;Yasutaka Ihara ,&nbsp;Tsubasa Bito ,&nbsp;Ryota Kawai ,&nbsp;Hiroki Namikawa ,&nbsp;Wataru Shibata ,&nbsp;Yukihiro Kaneko ,&nbsp;Ayumi Shintani ,&nbsp;Hiroshi Kakeya","doi":"10.1016/j.jiac.2025.102689","DOIUrl":"10.1016/j.jiac.2025.102689","url":null,"abstract":"<div><h3>Background</h3><div>Candidemia is an important coronavirus disease 2019 (COVID-19)-associated invasive fungal infection. Patients with COVID-19 may be susceptible to candidemia; however, evidence regarding its incidence, risk factors, and involvement in mortality is insufficient.</div></div><div><h3>Objectives</h3><div>To explore the incidence of and potential risk factors for candidemia in patients with severe or critical COVID-19 and evaluate the relationship between candidemia and mortality in patients with severe or critical COVID-19.</div></div><div><h3>Methods</h3><div>The incidence of candidemia in patients with severe and critical COVID-19 was evaluated using administrative claims data from acute care hospitals in Japan. Multivariable regression models were used to explore potential risk factors for candidemia and their contribution to mortality in patients with severe and critical COVID-19.</div></div><div><h3>Results</h3><div>Candidemia occurred in 0.3–1.1 % of patients with severe or critical COVID-19. Renal impairment, use of steroid, blood transfusion, and use of central venous catheter were potential risk factors for candidemia in patients with severe to critical COVID-19.</div></div><div><h3>Conclusions</h3><div>Candidemia in patients with COVID-19 was an independent risk factor for mortality. Candidemia in patients with severe to critical COVID-19 is a grave complication and may increase mortality.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 5","pages":"Article 102689"},"PeriodicalIF":1.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742899","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":"Comparison of urinary tract-related and catheter-related bloodstream infections in long-term and acute care wards: a retrospective cohort study1","authors":"Kohei Kumagai ,&nbsp;Ryo Inose ,&nbsp;Asako Kimura ,&nbsp;Yuichi Muraki","doi":"10.1016/j.jiac.2025.102690","DOIUrl":"10.1016/j.jiac.2025.102690","url":null,"abstract":"<div><h3>Background</h3><div>The characteristics of bloodstream infections in patients admitted to long-term care wards remain unclear. This study examined differences in nosocomial-onset urinary tract-related bloodstream infections (UTRBSIs) and catheter-related bloodstream infections (CRBSIs) between patients admitted to long-term and acute care wards.</div></div><div><h3>Methods</h3><div>This retrospective cohort study was conducted at a mixed-care hospital with long-term and acute care wards from April 2015 to March 2024. Patient backgrounds, causative pathogens, antibiotic resistance, and treatment patterns were compared between the two groups.</div></div><div><h3>Results</h3><div>Among the 252 patients, 108 (42.9%) were diagnosed with UTRBSIs and 87 (34.5%) with CRBSIs. In UTRBSIs, the long-term care group had significantly longer hospitalization (721 vs. 16 days, <em>P</em> &lt; 0.001), more frequent use of indwelling urinary catheters (76.7% vs. 28.6%, <em>P</em> &lt; 0.001), and higher isolation rates of extended-spectrum β-lactamase-producing <em>Enterobacterales</em> (41.1% vs. 8.6%, <em>P</em> &lt; 0.001). Piperacillin/tazobactam and meropenem were significantly more frequently used empirically in the long-term care group. In CRBSIs, the isolation rates of main causative pathogens, including methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) (9.5% vs. 6.7%, <em>P</em> = 0.707) and methicillin-resistant coagulase-negative <em>Staphylococcus</em> spp. (40.5% vs. 48.9%, <em>P</em> = 0.519), showed no significant differences between the two groups despite differences in patient backgrounds. Anti-MRSA agents were rarely used empirically in both groups (19.0% vs. 15.6%, <em>P</em> = 0.779).</div></div><div><h3>Conclusions</h3><div>Patients admitted to long-term care wards may require empirical therapy for UTRBSIs targeting drug-resistant <em>Enterobacterales</em>, while for CRBSIs, empirical use of anti-MRSA agents may be considered, similar to patients admitted to acute care wards.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 5","pages":"Article 102690"},"PeriodicalIF":1.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperammonemia caused by urinary tract infection due to Corynebacterium urealyticum","authors":"Hiroaki Nishioka,&nbsp;Riko Kusu","doi":"10.1016/j.jiac.2025.102688","DOIUrl":"10.1016/j.jiac.2025.102688","url":null,"abstract":"<div><div>Hyperammonemia can cause disturbances in consciousness. Although it is commonly associated with advanced liver disease, there have also been reports of hyperammonemia induced by obstructive urinary tract infections due to urease-producing bacteria. In this report, we present the case of an 87-year-old man with acutely impaired consciousness due to hyperammonemia resulting from an obstructive urinary tract infection caused by <em>Corynebacterium urealyticum</em>. The patient was admitted with a 1-day history of fever and impaired consciousness. Gram staining of the urine revealed gram-positive bacilli and white blood cells, and the pH test result was alkaline. Computed tomography revealed a dilated bladder with a large amount of urine and contrast enhancement of the bladder wall. Plasma ammonia levels were elevated. Therefore, urinary catheterization and vancomycin administration were initiated. The following day, the plasma ammonia level normalized, and the patient's level of consciousness returned to normal. Urine culture revealed the growth of <em>C. urealyticum</em>. Accordingly, the patient was diagnosed with an obstructive urinary tract infection caused by <em>C. urealyticum</em>, which presumably caused hyperammonemia and acutely impaired consciousness.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 5","pages":"Article 102688"},"PeriodicalIF":1.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739488","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 systematic review and meta-analysis on the efficacy of carbapenems versus metronidazole combination therapy in patients infected with Bacteroides spp.","authors":"Hideo Kato ,&nbsp;Jun Hirai ,&nbsp;Tomonori Takano ,&nbsp;Yu Arakawa ,&nbsp;Yuka Yamagishi ,&nbsp;Hiroyuki Kunishima ,&nbsp;Hiroshige Mikamo","doi":"10.1016/j.jiac.2025.102687","DOIUrl":"10.1016/j.jiac.2025.102687","url":null,"abstract":"<div><h3>Background</h3><div><em>Bacteroides</em> spp. are frequently detected in anaerobic infections, with a mortality rate of 50 % attributed to inadequate antimicrobial therapy. Recently, <em>Bacteroides</em> spp. have shown increased resistance to metronidazole (MNZ) and carbapenems. Therefore, identifying appropriate drugs for treating infections caused by <em>Bacteroides</em> spp. is necessary. Hence, this meta-analysis aimed to compare the clinical efficacy of combination therapy with MNZ versus carbapenems for the treatment of infections due to <em>Bacteroides</em> spp.</div></div><div><h3>Methods</h3><div>Scopus, EMBASE, PubMed, CINAHL, and Ichushi databases were searched for relevant articles that met the inclusion criteria through October 2024. Clinical efficacy was defined as the percentage of patients who achieved complete resolution or remarkable improvement in all signs and symptoms of the infection; therefore, no additional antibiotics or procedures were necessary, and the percentage of eradication of <em>Bacteroides</em> spp.</div></div><div><h3>Results</h3><div>Of the 482 citations identified for screening, five studies with a total of 306 patients were enrolled. All included studies were randomized clinical trials, two were open-label studies, and three were double-blind studies. All the included patients had intra-abdominal infections (IAIs). The combined therapy with MNZ was comparable with the carbapenem group in clinical efficacy in the treatment of infections due to <em>Bacteroides</em> spp. (risk rate 1.03, 95 % confidence interval 0.93–1.14).</div></div><div><h3>Conclusions</h3><div>Combined therapy with MNZ could be an effective treatment option for infections caused by <em>Bacteroides</em> spp., similar to carbapenems.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 5","pages":"Article 102687"},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725164","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":"Optimizing cytomegalovirus treatment through therapeutic drug monitoring in a ganciclovir-unresponsive lung transplant recipient","authors":"Keisuke Umemura ,&nbsp;Yoshiki Katada ,&nbsp;Yurie Katsube ,&nbsp;Daiki Hira ,&nbsp;Masahiro Tsuda ,&nbsp;Shunsaku Nakagawa ,&nbsp;Chiaki Shima ,&nbsp;Akira Matsumoto ,&nbsp;Akihiro Ohsumi ,&nbsp;Hiroshi Date ,&nbsp;Miki Nagao ,&nbsp;Tomohiro Terada","doi":"10.1016/j.jiac.2025.102686","DOIUrl":"10.1016/j.jiac.2025.102686","url":null,"abstract":"<div><div>Ganciclovir and valganciclovir are utilized in the treatment of cytomegalovirus infection and its reactivation following lung transplantation. However, treatment complexity arises due to the development of resistant viruses. Recently, therapeutic drug monitoring of ganciclovir has been studied to enhance dosing strategies for both ganciclovir and valganciclovir. We present a case of a lung transplant recipient who developed cytomegalovirus infection and diarrhea despite valganciclovir prophylaxis. Therapeutic drug monitoring confirmed that the area under the curve of ganciclovir was 67.0 μg h/mL, indicating adequate drug absorption. Although genotypic sequencing tests for antiviral resistance to cytomegalovirus were unavailable at our institution, our therapeutic drug monitoring findings raised suspicion of ganciclovir resistance in the cytomegalovirus. Therefore, the antiviral regimen was modified to foscarnet, leading to prompt cytomegalovirus clearance. Subsequently, foscarnet was replaced with letermovir for secondary prophylaxis. Throughout the treatment, tests for cytomegalovirus DNA and pp65 antigens consistently yielded negative results. This case underscores the value of therapeutic drug monitoring in suspecting potential ganciclovir resistance.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 4","pages":"Article 102686"},"PeriodicalIF":1.9,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715483","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}