Characteristics of preventive intervention acceptance for international travel among clients aged 60 years and older from a Japanese multicenter pretravel consultation registry

OBJECTIVES

Pretravel consultation (PTC) is important for older adults owing to health problems associated with overseas travel. Although older adults in Japan, their PTC characteristics are less known. This study aimed to investigate the epidemiology of clients aged ≥ 60 years based on data from the Japan Pre-travel Consultation Registry (J-PRECOR).

METHODS

Clients aged ≥ 60 years who visited J-PRECOR cooperative hospitals from February 1, 2018, to May 31, 2022, were included. The primary endpoint was a comparison of prescriptions for vaccines for hepatitis A, tetanus toxoid, and malaria prophylaxis in travelers to high-risk malaria countries in yellow fever vaccination (YFV)-available facilities with and without YFV.

RESULTS

In total, 1000 clients (median age: 67 years) were included. Although 523 clients were immunized with YFV, only 38.6% of the 961 unimmunized clients were vaccinated with the tetanus toxoid-containing vaccine. Malaria chemoprophylaxis was prescribed to 25.7% of clients traveling for ≤55 days. At YFV-capable institutes, 557 clients traveling to yellow fever risk countries took PTC, 474 of whom received YFV and 83 were unvaccinated. Lower age (odds rate 0.85 per 1 year; 95% CI 0.80-0.90) and lower hepatitis A vaccination rate (0.29; 95% CI 0.14-0.63) were significantly associated with YFV.

CONCLUSIONS

Preventive interventions other than YFV should be offered to older adults.

Characteristics and potential quality indicators for evaluating pre-travel consultations in Japan hospitals: the Japan Pretravel consultation registry (J-PRECOR)

Background

Awareness of pre-travel consultations (PTCs) and prevention methods for overseas travel-related diseases, and the understanding of PTCs among Japanese travelers and medical professionals remains low in Japan. A multicenter registry was established to examine PTCs in Japan. This study assessed the PTC implementation rate and examined the indicators of PTCs that can be used as criteria for evaluating quality.

Methods

Clients who presented for their PTCs at 17 facilities and were registered between February 1, 2018, and May 31, 2020, were included. Medical information was extracted retrospectively via a web-based system. Correlations between vaccination risk categories and advice/intervention proportions by the facility were evaluated using Spearman’s ordered phase relations (α = 0.05).

Results

Of the 9700 eligible clients (median age, 32 years; 880 [9.1%] aged < 16 years and 549 [5.7%] aged ≥65 years), the most common travel duration was ≥181 days (35.8%); higher among younger clients. The most common reason for travel was business (40.5%); the US (1118 [11.5%]) and Asia (4008 [41.3%]) were the most common destinations and continents, respectively. The vaccine number (median three per person) increased after the PTCs except for the tetanus toxoid. Only 60.8% of the clients recommended for malaria prophylaxis received anti-malarial agents. The gross national income; the incidence of human rabies, typhoid fever, falciparum malaria; and dengue risk category were associated with the percentage of hepatitis-A vaccines; explaining rabies post-exposure prophylaxis, typhoid-fever vaccinations, malaria-prophylaxis prescriptions; and mosquito repellants, respectively.

Conclusions

Although the characteristics of the travelers differed, the quality of the PTCs should be improved to address, for example, the lower rate of acceptance of malaria prophylaxis in Japan.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40794-021-00160-4.

Comparison between IMP carbapenemase-producing Enterobacteriaceae and non-carbapenemase-producing Enterobacteriaceae: a multicentre prospective study of the clinical and molecular epidemiology of carbapenem-resistant Enterobacteriaceae

BACKGROUND

Carbapenem-resistant Enterobacteriaceae (CRE) are classified as carbapenemase-producing Enterobacteriaceae (CPE) and non-CPE; the majority of CPE in Japan produce IMP carbapenemase.

OBJECTIVES

We evaluated the clinico-epidemiological and microbiological information and effects of IMP-type carbapenemase production in CRE.

METHODS

Patients with isolations of CRE (MICs of meropenem ≥2 mg/L, imipenem ≥2 mg/L or cefmetazole ≥64 mg/L) from August 2016 to March 2018 were included. Microbiological analyses and WGS were conducted and clinical parameters were compared between groups. Independent predictors for the isolation of CPE from patients were identified by logistic regression. For comparing clinical outcomes, a stabilized inverse probability weighting method was used to conduct propensity score-adjusted analysis.

RESULTS

Ninety isolates (27 CPE and 63 non-CPE) were collected from 88 patients (25 CPE and 63 non-CPE). All CPE tested positive for IMP carbapenemase. Antibiotic resistance (and the presence of resistance genes) was more frequent in the CPE group than in the non-CPE group. Independent predictors for CPE isolation were residence in a nursing home or long-term care facility, longer prior length of hospital stay (LOS), use of a urinary catheter and/or nasogastric tube, dependent functional status and exposure to carbapenem. Although in-hospital and 30 day mortality rates were similar between the two groups, LOS after CRE isolation was longer in the CPE group.

CONCLUSIONS

IMP-CPE were associated with prolonged hospital stays and had different clinical and microbiological characteristics compared with non-CPE. Tailored approaches are necessary for the investigational and public health reporting, and clinical and infection prevention perspectives for IMP-CPE and non-CPE.

503. Comparison of IMP Carbapenemase-Producing Enterobacteriaceae (CPE) and Non-Carbapenemase-Producing Enterobacteriaceae: A Multicenter Prospective Study of Clinical and Molecular Epidemiology in Japan

Background

IMP CPE are the dominant CPE type in Japan. We aimed to compare its epidemiology to that of non-CPE (NCPE).

Methods

Patients with isolation of carbapenem-resistant Enterobacteriaceae (CRE) with meropenem MIC ≥2 mg/L or imipenem MIC ≥2 mg/L and cefmetazole MIC ≥64 mg/L were included from August 2016 to March 2018. Adjusted outcome analyses were conducted using a generalized estimating equation model with weighting based on the inverse probability of propensity scores (PS).

Results

Ninety isolates (27 CPE and 63 NCPE) were collected from 88 patients (53 male) in 7 hospitals. CPE included 10 E. cloacae (ENC), 6 K. pneumoniae (KP), 4 E. coli (EC), 3 C. freundii (CF), 2 K. oxytoca, and 1 each of E. aerogenes (EA) and S. marcescens (SM). NCPE included 34 EA, 15 ENC, 4 each of KP, SM, and 2 CF. All CPE were positive for IMP carbapenemase (11 IMP-11, 6 IMP-42, 4 IMP-6, and 3 each of IMP-10 and IMP-1). Most of CPE/NCPE were isolated from sputum (39%), intra-abdomen (21%), and urine (20%). Levofloxacin, gentamicin, and amikacin resistance were found in 6 (22%), 4 (15%), and 1 (4%) CPE, respectively, and 6 (10%), 6 (10%), and 0 NCPE, respectively. Eighteen (67%) blaIMP were transferable by conjugation. Cases of CPE involved older patients with more frequent use of devices and carbapenem exposure than those in cases of NCPE (table). The mortality was similar in the 2 groups. Length of hospital stay (LOS) after CPE/NCPE isolation was significantly higher in the CPE group after PS adjustment (P = 0.02).

Conclusion

CPE had distinct epidemiological characteristics, and CPE isolation was associated with a prolonged hospital stay. Defining the underlying resistance mechanism of CRE is important for appropriate management.

Disclosures

All authors: No reported disclosures.

Three-year prospective, observational study of central line-associated bloodstream infections in a 600-bed Japanese acute care hospital

BACKGROUND

Central line-associated bloodstream infection (CLABSI) is an important concern associated with central venous catheter (CVC) use. The objective of this study was to determine the influences of CVC access sites, CVC types, and presumed causative microorganisms on CLABSI occurrence in an acute care hospital.

METHODS

We conducted a prospective, observational study of CLABSI occurrence for 3 consecutive years in a 600-bed Japanese acute care hospital. Data collected included patient characteristics, CVC access sites, CVC types, and microorganisms isolated by blood culture.

RESULTS

For 1,650 CVCs used for 1,237 patients, 39 cases of infection were identified. Most infections had occurred within 1 month of CVC insertion. Maximal sterile barrier precautions had been used for most cases (97.3%). The average CLABSI occurrence days with internal jugular vein access were shorter than those with subclavian vein access and femoral vein access. CLABSI rates were 1.1 and 0.7 for single- and multilumen CVCs, respectively. CLABSI occurrence tended to be shorter when gram-positive cocci were isolated and tended to be longer when fungi (Candida spp) were isolated.

CONCLUSION

Most CLABSI cases had occurred within 1 month of CVC insertion. Longer CVC duration increased chance of fungal infection.

Effective "short" double-balloon enteroscope for diagnostic and therapeutic ERCP in patients with altered gastrointestinal anatomy: a large case series

BACKGROUND AND STUDY AIMS

Although endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients with altered gastrointestinal anatomy, a double-balloon enteroscope (DBE) permits examinations of a much longer segment of the small bowel than does a standard endoscope, and may be used to perform ERCP in such patients. Since only limited accessories are available for a conventional DBE, we performed ERCP with a "short" DBE, which has a 2.8-mm working channel and a 152-cm working length and for which conventional accessories are available, in patients with altered gastrointestinal anatomy, and evaluated this alternative technique.

PATIENTS AND METHODS

In 68 patients with a Roux-en-Y total gastrectomy (n = 36), Billroth II gastrectomy (n = 17), or pancreatoduodenectomy (n = 15), ERCP (103 procedures) was performed with a "short" DBE.

RESULTS

Deep insertion was successful in 100/103 procedures (97 %). Cholangiogram was successfully obtained in 98/100 procedures (98 %). Treatment was accomplished in all 98 procedures in which a cholangiogram was obtained (100 %). Therapeutic interventions including stone extraction (n = 47), nasobiliary drainage (n = 38), stent placement (n = 36), sphincterotomy (n = 31), choledochojejunostomy dilation (n = 29), tumor biopsy (n = 10), and naso-pancreatic duct drainage (n = 1) were performed successfully. Complications occurred in 5/103 procedures (5 %), all in patients with Roux-en-Y reconstruction.

CONCLUSIONS

Despite the relatively high rate of complications seen in patients with Roux-en-Y reconstruction, ERCP with a "short" DBE is effective in patients who have undergone bowel reconstruction.

Human neutrophil functions in obstructive jaundice

BACKGROUND/AIMS

The effect of obstructive jaundice on neutrophil function has not been extensively studied. Therefore, the present study aimed at evaluating the effect of obstructive jaundice on human neutrophils.

METHODOLOGY

Twelve patients with obstructive jaundice due to common bile duct obstruction underwent endoscopic biliary drainage. Neutrophil functions (chemotaxis and superoxide anion generation) were evaluated before and 7 days after drainage.

RESULTS

Neutrophil chemotaxis in response to FMLP (formyl-methionyl-leucyl-phenylalanine) or interleukin-8 was abnormally increased before drainage, and was normalized after drainage. Similarly, enhanced superoxide anion generation in response to FMLP or phorbol myristate acetate before drainage was alleviated after drainage.

CONCLUSIONS

The results suggest neutrophil overactivity in patients with obstructive jaundice. The ameliorating effect of biliary drainage on neutrophil overactivity might play a role in the prevention of postoperative complications.

A method for measuring specific IgE in sera by direct ELISA without interference by IgG competition or IgG autoantibodies to IgE

BACKGROUND

In measuring specific IgE levels in sera by direct ELISA, competition with coexisting IgG often impedes an exact IgE determination; additionally, IgG autoantibodies to IgE (IgG-IgE) in sera affect the assay. In this paper, we attempt to determine accurate specific IgE levels by selective removal of IgG with a protein G-immobilized gel (PG) and by acid treatment of the PG to compensate for the unintended removal of IgE, probably due to the PG binding IgG-IgE.

METHODS

IgG in sera was removed using PG at pH 7.0. Then, the PG was treated with citrate buffer at pH 3.0 for 5 min to liberate IgE from IgG-IgE complexes, after IgG-binding sites on the PG were saturated with bovine IgG, since PG came to bind IgE at acidic pHs. IgE levels were then measured by ELISA.

RESULTS

The PG treatment of sera removed the effect of inhibitory competition by coexisting IgG, especially at higher concentrations of sera, to improve specific IgE detection by direct ELISA. However, PG treatment alone sometimes reduced IgE levels (39% of sera tested), even though PG does not bind IgE at pH 7.0, which indicated the presence of IgG-IgE complexes. The reduction in IgE returned almost to their original levels in the sera by acid treatment of the PG. By combining the PG treatment with acid treatment, specific IgE measurement in sera was improved significantly (p < 0.01, Wilcoxon signed rank test).

CONCLUSION

Measurement of specific IgE in sera by direct ELISA was improved by using the PG and acid treatment technique.

Lipid peroxidation and antioxidants in rat liver during development

The concentration of lipid peroxidation was extensively high in rat fetuses and early newborns. However, it declined sharply thereafter. Superoxide dismutase (SOD) activity was approximately 10% of the adult level during 5 days postpartum. The enzyme activity began to increase after the 10th day to 60% of the adult level at the 20th day. Catalase activity was low in the fetal period, corresponding to approximately 20% of the adult level, but increased rapidly after birth reaching approximately 50% of the adult level at 5-7 days postpartum. Glutathione peroxidase (GSH-Px) activity was measured to amount to only 7% of the adult level in the fetal and early newborn period. The level of this activity was approximately 20% of the adult level at the 20th day. The difference in GSH-Px activity became wide between sexes after the first 30 days of life; the male adult level was 61% of the female adult level. The concentration of vitamin E was low in the fetus. It increased by a factor of 10 times within a few days after birth, and thereafter it decreased gradually. Fetal and early newborn livers have low enzymatic defense capabilities against possible deleterious effects of lipid peroxidation processes.

Blood and tissue levels of lipoperoxides in rats during development

The excessive accumulation of lipoperoxides has been accepted as being highly responsible for the development of retinopathy of prematurity and idiopathic respiratory distress syndrome of the newborn infant. We have studied development-related levels of lipoperoxides in blood and tissues such as the liver, lungs, kidneys and brain from birth to adult age using rats as the experimental animal. Lipoperoxide concentrations in blood and tissues were low in fetal and early newborn periods. The concentrations increased with age and peaked in the early newborn period and gradually decreased as the development progressed. In vitro lipoperoxide formation and accumulation in tissues exhibited a close correlation with in vivo lipoperoxide concentrations, except in the brain.

Prevention of penicillin-induced lysis of Staphylococcus aureus by cellular lipoteichoic acid

The lysis of Staphylococcus aureus FDA 209P induced by benzylpenicillin was completely inhibited by cellular lipoteichoic acid isolated from an homologous organism. The cells prevented from penicillin-induced lysis were in static state and did not lose viability. The lipoteichoic acid inhibited either extracellular autolysin activity in culture supernatant or autolysis of whole cells in exponential phase of S. aureus. These results indicate that the prevention of penicillin-induced lysis of S. aureus by the lipoteichoic acid was brought about by the inhibition of autolytic activity of the organism.