Details of a Researcher - Uno, Shunsuke

Papers - Uno, Shunsuke

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Adverse effects of long-term drain placement and the importance of direct aspiration: A retrospective cohort study.

Jun Okui, Hideaki Obara, Shunsuke Uno, Yasunori Sato, Gaku Shimane, Masashi Takeuchi, Hirofumi Kawakubo, Minoru Kitago, Koji Okabayashi, Yuko Kitagawa

The Journal of hospital infection 131 156 - 163 2022.11

ISSN 0195-6701

BACKGROUND: Long-term placement of prophylactic drains can result in retrograde infections. AIM: We aimed to investigate the association between the timing of drain removal and clinical outcomes. METHODS: This retrospective, single-center cohort study evaluated 110 patients who underwent elective gastrointestinal or hepatopancreatobiliary surgery and developed subsequent organ/space surgical site infection (SSI) between 2016 and 2020. We evaluated the difference between the culture-positive species of prophylactic drains and direct aspiration, whether the prophylactic drains functioned effectively at the time of SSI diagnosis, and whether the empirical antibiotics administered before drainage were able to treat all the detected bacteria. Finally, clinical outcomes were compared between early (i.e. cases wherein the prophylactic drain had already been removed or replaced at the time of SSI diagnosis) and late (removal after diagnosis) drain removal. FINDINGS: The prophylactic drains functioned effectively in only 27 (25%) patients at the time of SSI diagnosis. Due to the results of direct aspiration cultures, 43% of patients required antibiotic escalation. The median time to drain removal or first replacement was seven postoperative days. The early removal group included 43 patients (39%). Compared with early removal, late removal resulted in a higher frequency of vancomycin use (7.0% versus 22.4%; P = 0.037). CONCLUSIONS: Prolonged prophylactic drain placement is associated with complicated infections requiring vancomycin, therefore, the drains should be removed as soon as possible. Additionally, obtaining the cultures of direct aspiration should be actively considered, as escalation of antimicrobial therapy is often performed based on culture results.

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In vitro effects of diazabicyclooctane β-lactamase inhibitors relebactam and nacubactam against three subspecies of Mycobacterium abscessus complex.

Kana Misawa, Tomoyasu Nishimura, Shoko Kashimura, Yuki Enoki, Kazuaki Taguchi, Shunsuke Uno, Yoshifumi Uwamino, Kazuaki Matsumoto, Naoki Hasegawa

International journal of antimicrobial agents (International Journal of Antimicrobial Agents) 60 ( 5-6 ) 106669 - 106669 2022.11

ISSN 09248579

BACKGROUND: Mycobacterium abscessus complex (MABC) pulmonary disease is notoriously difficult to treat due to intrinsic resistance to many common antibiotics. MABC is β-lactam-resistant as it produces class A β-lactamases, such as blaMab, which are inhibited by diazabicyclooctane (DBO) β-lactamase inhibitors. OBJECTIVES: To investigate the microbiological effects of the combination of β-lactam and DBO β-lactamase inhibitors (relebactam and nacubactam) against MABC and determine if the effects are associated with the MABC subspecies and colony morphotypes. METHODS: We evaluated the antimicrobial susceptibility of three type strains and 20 clinical isolates of MABC to the combination of seven β-lactams with relebactam or nacubactam by broth microdilution checkerboard assays. For these strains, we assessed blaMab expression levels by quantitative real-time polymerase chain reaction and the genotypic diversity by 18-locus variable number tandem repeat assay. RESULTS: Relebactam and nacubactam lowered the minimum inhibitory concentrations of β-lactams, especially imipenem, meropenem, tebipenem, against MABC. There was no difference in efficacy of combination treatment between three subspecies, but rough morphotypes tended to be less susceptible than smooth morphotypes. There were no differences in blaMab expression levels and genotypic diversity between the morphotypes. CONCLUSIONS: The combination of β-lactam with relebactam or nacubactam improved the efficacy of β-lactams against all MABC subspecies, but higher concentrations of β-lactams are needed for rough morphotypes.

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Impact of rifampicin on the pharmacokinetics of clarithromycin and 14-hydroxy clarithromycin in patients with multidrug combination therapy for pulmonary Mycobacterium avium complex infection.

Osamu Iketani, Akari Komeya, Yuki Enoki, Kazuaki Taguchi, Shunsuke Uno, Yoshifumi Uwamino, Kazuaki Matsumoto, Junko Kizu, Naoki Hasegawa

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy (Journal of Infection and Chemotherapy) 28 ( 1 ) 61 - 66 2022.01

ISSN 1341321X

INTRODUCTION: Clarithromycin (CAM), ethambutol (EB), and rifampicin (RFP) combination therapy is used to treat pulmonary Mycobacterium avium complex (MAC) infection; however, serum CAM concentration decreases due to RFP-mediated induction of CYP3A activity. Therefore, we investigated the pharmacokinetics of CAM, 14-hydroxy clarithromycin (14-OH CAM), EB, and RFP in patients receiving this three-drug combination therapy. METHODS: CAM monotherapy was started, EB was added 2 weeks later, and RFP was added 2 weeks after that. Serum CAM, 14-OH CAM, EB, and RFP concentrations were measured before and at 2, 4, 6, and 12 or 24 h after administration on days 14, 28, and 42, and pharmacokinetic parameters were calculated. RESULTS: Median area under the curve (AUC) of CAM decreased by 92.1% from 0 to 12 h after concomitant administration of RFP compared with CAM monotherapy [1.7 (interquartile range [IQR], 1.4-1.8) μg·h/mL vs. 21.5 (IQR, 17.7-32.3) μg·h/mL, respectively]. In contrast, median AUC of 14-OH CAM was not significantly different between concomitant administration of RFP [9.1 (IQR, 7.9-10.9) μg·h/mL] and CAM monotherapy [8.2 (IQR, 6.3-9.3) μg·h/mL]. AUCs of CAM and 14-OH CAM did not change in CAM+EB combination therapy. CONCLUSIONS: When RFP is combined with CAM in the treatment of pulmonary MAC infection, the blood concentration of CAM significantly decreased and that of the active metabolite 14-OH CAM increased, but not significantly. Our results suggest that combination therapy with CAM and RFP needs to be reconsidered and may require dose modification in the treatment of pulmonary MAC infection.

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Digestive Decolonization of Colorectal Carriage of Vancomycin-resistant Enterococcus faecium in a Japanese Adult: A Case Report.

Shunsuke Uno, Yaoko Takano, Osamu Iketani, Tomohiro Abiko, Tomoru Miwa, Kosaku Nanki, Tomohiro Kurihara, Yuko Tamura, Miyuki Ara, Yoshifumi Uwamino, Masayoshi Shinjoh, Takehiko Mori, Naoki Hasegawa

Internal medicine (Tokyo, Japan) (Internal Medicine) 61 ( 2 ) 249 - 252 2022

Lead author, Accepted, ISSN 09182918

Patients with vancomycin-resistant Enterococcus (VRE) colonization should be managed in an isolation room with contact precautions. We herein report a patient whose colorectal carriage of VRE was successfully decolonized using concomitant bowel irrigation with polyethylene glycol, probiotics, and oral antimicrobials, linezolid and orally-administered daptomycin, for release from isolation and contact precautions. We therefore would like to suggest a potential strategy for managing patients with VRE colonization.

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CT screening for COVID-19 in asymptomatic patients before hospital admission.

Sho Uchida, Shunsuke Uno, Yoshifumi Uwamino, Masahiro Hashimoto, Shunsuke Matsumoto, Hideaki Obara, Masahiro Jinzaki, Yuko Kitagawa, Naoki Hasegawa

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy (Journal of Infection and Chemotherapy) 27 ( 2 ) 232 - 236 2021.02

Accepted, ISSN 1341321X

INTRODUCTION: In the novel coronavirus disease (COVID-19) pandemic era, it is essential to rule out COVID-19 effectively to prevent transmission in both communities and medical facilities. According to previous reports in high prevalence areas, CT screening may be useful in the diagnosis of COVID-19. However, the value of CT screening in low prevalence areas has scarcely been reported. METHODS: This report examines the diagnostic efficacy of CT screening before admission to a hospital in Tokyo. We conducted a retrospective analysis at Keio University Hospital from April 6, 2020, through May 29, 2020. We set up an outpatient screening clinic on April 6 for COVID-19, administering both PCR with nasopharyngeal swabs and chest CT for all patients scheduled for surgery under general anesthesia. RESULTS: A total of 292 asymptomatic patients were included in this study. There were three PCR-positive patients, and they all had negative CT findings, which revealed that both the sensitivity and positive predictive value of CT (PPV) were 0%. There were nine CT-positive patients; the specificity and the negative predictive value (NPV) were 96.9% and 98.9%, respectively. CONCLUSION: CT screening was not useful in low prevalence areas at this time in Tokyo, even with the inclusion of the most prevalent phase. Given that the utility of CT screening depends on disease prevalence, the criteria for performing CT screening based on the prevalence of COVID-19 should be established.

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Identification of B.1.346 Lineage of SARS-CoV-2 in Japan: Genomic Evidence of Re-entry of Clade 20C.

Kodai Abe, Takako Shimura, Toshiki Takenouchi, Yuka W Iwasaki, Hirotsugu Ishizu, Yoshifumi Uwamino, Shunsuke Uno, Jun Gotoh, Natsuo Tachikawa, Yuriko Takeuchi, Junpei Katayama, Hiroyuki Nozaki, Susumu Fujii, Shikou Seki, Morio Nakamura, Kazuhiro Uda, Takahiko Misumi, Jun Ishihara, Kenichiro Yamada, Toshio Kanai, Shinji Murai, Kazuhiro Araki, Tamotsu Ebihara, Haruhiko Siomi, Naoki Hasegawa, Yuko Kitagawa, Masayuki Amagai, Makoto Suematsu, Kenjiro Kosaki

The Keio journal of medicine (Keio Journal of Medicine) 70 ( 2 ) 44 - 50 2021

ISSN 00229717

SARS-CoV-2 whole-genome sequencing of samples from COVID-19 patients is useful for informing infection control. Datasets of these genomes assembled from multiple hospitals can give critical clues to regional or national trends in infection. Herein, we report a lineage summary based on data collected from hospitals located in the Tokyo metropolitan area. We performed SARS-CoV-2 whole-genome sequencing of specimens from 198 patients with COVID-19 at 13 collaborating hospitals located in the Kanto region. Phylogenetic analysis and fingerprinting of the nucleotide substitutions were performed to differentiate and classify the viral lineages. More than 90% of the identified strains belonged to Clade 20B, which has been prevalent in European countries since March 2020. Only two lineages (B.1.1.284 and B.1.1.214) were found to be predominant in Japan. However, one sample from a COVID-19 patient admitted to a hospital in the Kanto region in November 2020 belonged to the B.1.346 lineage of Clade 20C, which has been prevalent in the western United States since November 2020. The patient had no history of overseas travel or any known contact with anyone who had travelled abroad. Consequently, the Clade 20C strain belonging to the B.1.346 lineage appeared likely to have been imported from the western United States to Japan across the strict quarantine barrier. B.1.1.284 and B.1.1.214 lineages were found to be predominant in the Kanto region, but a single case of the B.1.346 lineage of clade 20C, probably imported from the western United States, was also identified. These results illustrate that a decentralized network of hospitals offers significant advantages as a highly responsive system for monitoring regional molecular epidemiologic trends.

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Control of a Nosocomial Outbreak of COVID-19 in a University Hospital.

Sei Harada, Shunsuke Uno, Takayuki Ando, Miho Iida, Yaoko Takano, Yoshiki Ishibashi, Yoshifumi Uwamino, Tomoyasu Nishimura, Ayano Takeda, Sho Uchida, Aya Hirata, Mizuki Sata, Minako Matsumoto, Ayano Takeuchi, Hideaki Obara, Hirokazu Yokoyama, Koichi Fukunaga, Masayuki Amagai, Yuko Kitagawa, Toru Takebayashi, Naoki Hasegawa

Open forum infectious diseases 7 ( 12 ) ofaa512 2020.12

Lead author, Accepted

Background: Nosocomial spread of coronavirus disease 2019 (COVID-19) causes clusters of infection among high-risk individuals. Controlling this spread is critical to reducing COVID-19 morbidity and mortality. We describe an outbreak of COVID-19 in Keio University Hospital, Japan, and its control and propose effective control measures. Methods: When an outbreak was suspected, immediate isolation and thorough polymerase chain reaction (PCR) testing of patients and health care workers (HCWs) using an in-house system, together with extensive contact tracing and social distancing measures, were conducted. Nosocomial infections (NIs) were defined as having an onset or positive test after the fifth day of admission for patients and having high-risk contacts in our hospital for HCWs. We performed descriptive analyses for this outbreak. Results: Between March 24 and April 24, 2020, 27 of 562 tested patients were confirmed positive, of whom 5 (18.5%) were suspected as NIs. For HCWs, 52 of 697 tested positive, and 40 (76.9%) were considered NIs. Among transmissions, 95.5% were suspected of having occurred during the asymptomatic period. Large-scale isolation and testing at the first sign of outbreak terminated NIs. The number of secondary cases directly generated by a single primary case found before March 31 was 1.74, compared with 0 after April 1. Only 4 of 28 primary cases generated definite secondary infection; these were all asymptomatic. Conclusions: Viral shedding from asymptomatic cases played a major role in NIs. PCR screening of asymptomatic individuals helped clarify the pattern of spread. Immediate large-scale isolation, contact tracing, and social distancing measures were essential to containing outbreaks.

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Comorbidities associated with nontuberculous mycobacterial disease in Japanese adults: a claims-data analysis.

Shunsuke Uno, Takanori Asakura, Kozo Morimoto, Kimio Yoshimura, Yoshifumi Uwamino, Tomoyasu Nishimura, Yoshihiko Hoshino, Naoki Hasegawa

BMC pulmonary medicine 20 ( 1 ) 262 - 262 2020.10

Lead author, Accepted

BACKGROUND: Nontuberculous mycobacterial (NTM) lung disease is one of a growing number of chronic health problems that is difficult to cure in aging societies. While it is important to be vigilant about associated comorbidities in order to provide better patient care, data on the prevalence of comorbidities stratified by country or region are scarce. We aimed to elucidate the comorbidities associated with NTM disease based on Japanese health insurance claims data. METHODS: Cross-sectional analyses were performed using the claims data for 2014 provided by the Japan Medical Data Center Co., Ltd. Patients aged 20-75 years with ≥3 claims associated with NTM disease were identified and matched to 10 sex-and-age-matched controls that had never made a claim for NTM disease. Thirty-one comorbidities previously suspected to be associated with NTM disease were selected, and the prevalence of these comorbidities compared between cases and controls. RESULT: Overall, 419 NTM patients (134 males and 285 females) and 4190 non-NTM controls were identified from the JMDC database. Aspergillosis, asthma, chronic heart failure, diffuse panbronchiolitis, gastroesophageal reflux, interstitial pneumonia, lung cancer, cancer other than breast, lung, ovary, or prostate cancer, and rheumatoid arthritis were associated with NTM disease in both males and females. Chronic obstructive pulmonary disease was associated with NTM in males while chronic kidney disease, osteoporosis, and Sjögren syndrome were associated with NTM in females. CONCLUSION: NTM disease was associated with multiple comorbidities that should be considered when providing medical care to individuals with NTM disease.

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Acute onset olfactory/taste disorders are associated with a high viral burden in mild or asymptomatic SARS-CoV-2 infections.

Kensuke Nakagawara, Katsunori Masaki, Yoshifumi Uwamino, Hiroki Kabata, Sho Uchida, Shunsuke Uno, Takanori Asakura, Takeru Funakoshi, Sho Kanzaki, Makoto Ishii, Naoki Hasegawa, Koichi Fukunaga

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 99 19 - 22 2020.10

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Effect of refrigeration of blood samples in lithium-heparin tubes on QuantiFERON TB Gold Plus test result.

Yoshifumi Uwamino, Akiko Sakai, Tomoyasu Nishimura, Masayo Noguchi, Shunsuke Uno, Hiroshi Fujiwara, Masaaki Mori, Masatoshi Wakui, Mitsuru Murata, Naoki Hasegawa

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 26 ( 3 ) 312 - 314 2020.03

Accepted, ISSN 1341-321X

The QuantiFERON TB Gold Plus (QFT-Plus) test is a newly approved interferon-gamma releasing assay test for detecting latent tuberculosis. Although blood samples for QFT test can be refrigerated for 48 h in lithium-heparin tubes according to package inserts, no published data are available on the effects of sample refrigeration on the test results. We conducted a clinical study that aimed to elucidate whether sample refrigeration for 48 h affects QFT-Plus test results. We collected 2 blood samples each from 40 participants for QFT-Plus; one sample was refrigerated before incubation for QFT-Plus assay, while the other sample was incubated soon after collection and treated as control. After comparing QFT-Plus test results of refrigerated samples and control samples, the concordance rate and kappa coefficient between them were 95% and 0.90, respectively. Thus, blood samples for QFT-Plus test can be refrigerated for 48 h in lithium-heparin tubes without influencing the test results.

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Evaluation for optimal dosing of vancomycin in patients with different physical types.

Hashimoto M, Iketani O, Ichinose N, Enoki Y, Taguchi K, Uno S, Uwamino Y, Hasegawa N, Matsumoto K

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 25 ( 9 ) 735 - 737 2019.09

Accepted, ISSN 1341-321X

The sufficient dose to obtain an optimal trough concentration of vancomycin (VCM) in patients with non-standard physical types remains controversial. In this study, we examined the relationship between the dose and physical type in patients in whom an optimal trough concentration was obtained among VCM-treated patients. We retrospectively investigated the dose of VCM and physical type in patients treated with VCM between January 2012 and January 2017 at two medical institutions (n = 272). The physical type was classified using the body mass index (BMI). Patients with a BMI of <18.5 kg/m2 were assigned to the lean group, those with a BMI of 18.5-24.9 kg/m2 were assigned to the standard group, and those with a BMI of ≥25 kg/m2 were assigned to the obesity group. The mean doses of VCM per time (mg/kg) to achieve the target trough concentration of VCM, 15-20 μg/mL, were 19.8 ± 4.3, 16.5 ± 3.7, and 13.7 ± 2.7 mg/kg in the lean, standard, and obesity groups, respectively. The dose per time to achieve the target trough concentration decreased significantly in association with an increase of BMI. The upper limit of the recommended dose (15-20 mg/kg) or higher in lean patients, and the lower dose in obese patients than the recommended dose might be appropriate to achieve the target trough concentration when we calculated the dose per time based on actual body weight.

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A successful antimicrobial therapeutic strategy for the discitis caused by Aggregatibacter actinomycetemcomitans under unknown drug susceptibility: A case report

Shunsuke Uno, Yosuke Horiuchi, Takae Uchida, Akiko Yonaha, Takanori Miyata, Eiko Nagano, Takao Kodama, Naoki Hasegawa

Journal of Infection and Chemotherapy (Elsevier B.V.) 24 ( 10 ) 849 - 851 2018.10

Accepted, ISSN 1341321X

Aggregatibacter actinomycetemcomitans is well-known as the pathogen of gingivitis or periodontitis, and discitis or vertebral osteomyelitis cases caused by this organism have rarely been reported. Ampicillin or amoxicillin has been used in the previously reported discitis cases
however, no cases have been reported that is treated with levofloxacin. We report the first published case we chose levofloxacin to treat. We failed to perform the susceptibility testing because of the poor growth and fastidious nature of the organism, and the result of susceptibility of amoxicillin was unclear. Levofloxacin, which A. actinomycetemcomitans is usually susceptible to, can be an effective alternative oral antimicrobial agent in such cases.

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Stability of benzylpenicillin potassium and ampicillin in an elastomeric infusion pump

Nakamura T., Enoki Y., Uno S., Uwamino Y., Iketani O., Hasegawa N., Matsumoto K.

Journal of Infection and Chemotherapy (Journal of Infection and Chemotherapy) 24 ( 10 ) 856 - 859 2018.10

ISSN 1341321X

© 2018 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases Some infectious diseases, such as infective endocarditis, osteomyelitis, and abscesses, require treatment with long-term intravenous antimicrobial treatment. Therefore, the patient is required to stay in the hospital to receive therapy, which lowers their quality of life. Establishing an outpatient parenteral antimicrobial therapy (OPAT) by continuous infusion pump is desired in Japan to overcome these issues. However, the 24-h stability of antimicrobial agents dissolved in infusion solutions is unclear. Thus, we investigated the stability of antimicrobial agents in five different infusion solutions in a clinical setting. Benzylpenicillin potassium (PCG) and ampicillin (ABPC) were dissolved separately in five different infusion solutions and kept at 25 or 31.1 °C for 24 h. The residual ratios were determined by high-performance liquid chromatography (HPLC). Dissolved PCG in acetate ringer solution remained stable for 24 h at temperatures of 25 and 31.1 °C (101.7 ± 1.4% and 92.9 ± 1.3%, respectively). In addition, the PCG solution did not adsorb onto the elastomeric infusion pump after 24 h at 31.1 °C. PCG dissolved in acetate ringer solution was also stable for 10 days after being kept in an elastomeric infusion pump at 4 °C (99.7 ± 0.5%). ABPC was unstable in all of the tested infusion solutions and temperatures. Based on our results, PCG in acetate ringer solution can be used in OPAT with continuous infusion pumps.

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Respiratory infectious diseases in patients with diabetes

Uno S., Hasegawa N.

Journal of the Japan Diabetes Society (Journal of the Japan Diabetes Society) 61 ( 10 ) 668 - 670 2018

ISSN 0021437X

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Impact of chronic Pseudomonas aeruginosa infection on health-related quality of life in Mycobacterium avium complex lung disease

Hirofumi Kamata, Takanori Asakura, Shoji Suzuki, Ho Namkoong, Kazuma Yagi, Yohei Funatsu, Satoshi Okamori, Shunsuke Uno, Yoshifumi Uwamino, Hiroshi Fujiwara, Tomoyasu Nishimura, Makoto Ishii, Tomoko Betsuyaku, Naoki Hasegawa

BMC PULMONARY MEDICINE (BIOMED CENTRAL LTD) 17 ( 1 ) 198 2017.12

Accepted, ISSN 1471-2466

Background: In bronchiectasis patients, chronic Pseudomonas aeruginosa (PA) infection has been associated with worse health-related quality of life (HRQL), but little is known about Mycobacterium avium complex lung disease (MACLD) patients in this context. This study aimed to evaluate HRQL and investigate the impact of chronic PA infection in MACLD patients.
Methods: This cross-sectional study was conducted using the Registry of Prospective Cohort Study including MACLD patients. The 36-item Short-Form health survey (SF-36) and St. George's Respiratory Questionnaire (SGRQ) were administered to assess clinical outcomes. Clinical variables included treatment and sputum culture status, pulmonary function tests, cavitary lesions, and modified Reiff scores on high-resolution computed tomography.
Results: The study included 244 MACLD patients (median age, 68 years; 196 women), 19 of whom had chronic PA infection. Modified Reiff score was higher in patients with chronic infection than in those without (P = 0.028). Regarding SF-36 scores, physical functioning subscale scores were significantly lower in patients with chronic infection (P = 0.029). Additionally, SGRQ symptoms, impact, and total scores were significantly higher in patients with chronic infection. During analysis of covariance comparisons, SGRQ symptoms and impact scores were significantly higher for patients with chronic infection (P = 0.043 and 0.021, respectively).
Conclusions: MACLD patients with chronic PA infection exhibited significantly higher SGRQ scores, indicating impaired HRQL. Chronic PA infection was significantly associated with the severity of bronchiectasis.

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hsa-miR-346 is a potential serum biomarker of Mycobacterium avium complex pulmonary disease activity

Tomoyasu Nishimura, Eiko Tamizu, Shunsuke Uno, Yoshifumi Uwamino, Hiroshi Fujiwara, Kazumi Nishio, Yasushi Nakano, Hirofumi Shiono, Ho Namkoong, Yoshihiko Hoshino, Satoshi Iwata, Naoki Hasegawa

JOURNAL OF INFECTION AND CHEMOTHERAPY (ELSEVIER SCIENCE BV) 23 ( 10 ) 703 - 708 2017.10

Accepted, ISSN 1341-321X

MicroRNA (miRNA) has been recently recognized as a biomarker of various diseases; however, there are no known miRNAs associated with Mycobacterium avium complex (MAC) pulmonary disease. In addition, there are no known biomarkers to precisely reflect disease activity after the diagnosis of MAC pulmonary disease. Thus, we sought to identify a miRNA which is a candidate biomarker of MAC pulmonary disease activity. Serum hsa-miR-346 concentrations of 16 patients with M. avium pulmonary disease were significantly higher than those of 16 healthy controls (p = 0.047). The secretion of hsa-miR-346 increased in a multiplicity of infection-dependent manner in M. avium-infected macrophages. Serum hsa-miR-346 levels of 5 patients with bacterial conversion at the end of follow-up were significantly lower than those at the beginning of the follow-up (p = 0.043). In addition, the longitudinal change in serum hsa-miR-346 concentration correlated with bacterial load in 2 patients with M. avium pulmonary disease. Based on our results, it is supposed that MAC-infected macrophages in pulmonary lesions produce hsa-miR-346, which is then secreted into the bloodstream. The magnitude of this process could be quantitatively controlled by the bacterial load, suggesting that serum hsa-miR-346 is a potentially useful biomarker of MAC pulmonary disease activity. (C) 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

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A case of diverticulitis with bacteremia caused by Raoultella ornithinolytica.

UNO Shunsuke, HASE Ryota, HASHIMOTO Kohei, TOGUCHI Akihiro, OTSUKA Yoshihito, HOSOKAWA Naoto.

日本臨床微生物学雑誌 2016 ( 26 ) 136 - 140 2016

Research paper (scientific journal), Joint Work, Accepted

Acute Pyelonephritis and Candidemia Due to Candida lusitaniae: A Case Report

UNO Shunsuke

Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases (The Japanese Association for Infectious Diseases) 2016 ( 90 ) 134 - 137 2016

Research paper (scientific journal), Joint Work, Accepted, ISSN 0387-5911

Although candiduria is becoming increasingly common among hospitalized patients, Candida lusitaniae is a rare pathogen that account for less than 1% of Candida species isolated from urine. Ascending pyelonephritis and candidemia due to Candida species are uncommon complications. We report herein on a case of acute pyelonephritis and candidemia due to C. lusitaniae. A 66-year-old man presented with a high fever during hospitalization at our hospital following septic shock due to ischial osteomyelitis treated with tazobactam/piperacillin for 29 days. We suspected acute pyelonephritis, and urinary Gram staining showed only yeasts and leucocytes. The next day, blood culture and urine culture tested positive and showed yeast-like fungi. We diagnosed acute pyelonephritis and candidemia due to Candida species and started treatment with fluconazole. C. lusitaniae was identified on the hospital day 34 and treated with fluconazole for 14 days. Candida albicans was the most prevalent species isolated from the urinary tract, however non-albicans Candida species have emerged and are now dominant because of the advent and increasing use of fluconazole. C. lusitaniae is a rare but important pathogen, that is generally susceptible to fluconazole and resistant to amphotericin B. It is necessary to choose an appropriately effective antifungal drug based on identification of the fungal species.

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An 80-year-old woman surgically treated for native valve infective endocarditis caused by Citrobacter koseri

TAKAHASHI Kazusa, UNO Shunsuke, SADA Ryuichi

Journal of the Formosan Medical Association (ELSEVIER TAIWAN) 2016 ( 2 ) 129 - 130 2016

Research paper (scientific journal), Joint Work, Accepted, ISSN 0929-6646

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Antimicrobial Stewardshipを意識した抗菌薬選択発熱・頭痛を主訴に受診した65歳男性

宇野俊介

日本化学療法学会雑誌 ((公社)日本化学療法学会) 63 ( 5 ) 494 - 498 2015.09

Lead author, Corresponding author, ISSN 1340-7007

Outpatient Parenteral Antimicrobial Therapy (OPAT) with Elastomeric Pumps in Collaboration with Home-visit Nursing Services in Japan: Experience of the First 10 Patients

HASE Ryota, UNO Shunsuke, MIYOSHI Kazuyasu, FUJITA Koji, SUZUKI Hiroyuki, SUZUKI Daisuke, MIKAWA Takahiro, MURANAKA Kiyoharu, HOSOKAWA Naoto

Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 2015 ( 89 ) 567 - 573 2015

Research paper (scientific journal), Joint Work, Accepted, ISSN 0387-5911

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本邦初の持続静注投与法を用いた外来静注抗菌薬療法(OPAT:Outpatient Parenteral Antimicrobial Therapy)に関する報告

HASE Ryota, HOSOKAWA Naoto, UNO Shunsuke, SUZUKI Daisuke, MIKAWA Takahiro, UWAMINO Yoshifumi, MURANAKA Kiyoharu.

感染症学雑誌 2014 ( 88 ) 269 - 274 2014

Research paper (scientific journal), Joint Work, Accepted

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