Objective Although extended-spectrum β-lactamase (ESBL)-producing bacteria are a global threat, as they may cause respiratory infection, the factors associated with the isolation of these bacteria from sputum remain unclear. We therefore explored the factors related to ESBL-producing Klebsiella pneumoniae and Escherichia coli isolated from sputum samples. Patients and Methods This study included consecutive patients admitted to our department from 2010 to 2021 with K. pneumoniae or E. coli isolated from their sputum. The patients were categorized into ESBLproducing and non-ESBL-producing groups, and the factors associated with ESBL-producing bacteria isolation were assessed using a binomial logistic regression analysis. ResultsWe included 82 patients, and ESBL-producing pathogens were isolated from 23 (28%). The usage rates of cephem [odds ratio (OR) 4.000, 95% confidence interval (CI) 1.402-11.409, p=0.010], quinolone (OR 2.961, 95% CI 1.097-7.996, p=0.032), and macrolide (OR 4.273, p=0.006) in the past year were significantly higher in the ESBL-producing group than in the non-ESBL-producing group. The multivariate analysis revealed that the applications of cephem (adjusted OR: 4.130, 95% CI: 1.233-13.830, p=0.021) and macrolide (adjusted OR: 6.365, 95% CI: 1.922-21.077, p=0.002) was independently associated with the isolation of ESBL-producing bacteria. Conclusions A history of cephem and macrolide use can be considered a risk factor for ESBL-producing bacteria isolation from sputum samples. Physicians need to consider these risk factors when determining antibiotics for the treatment of patients with respiratory infections.
We herein report the first case of c-ros oncogene 1 (ROS1)-rearranged advanced non-small-cell lung cancer (NSCLC) in which lung injury was induced by crizotinib and entrectinib. Crizotinib was administered as first-line chemotherapy in a woman in her early 70s with stage IV NSCLC showing ROS1 rearrangement. This resulted in the development of drug-induced organizing pneumonia, which was alleviated by discontinuing drug administration and giving corticosteroids. Following second-line chemotherapy with entrectinib, a similar lung injury was noted. In cases of crizotinib-induced lung injury, physicians must be alert for druginduced lung injury in subsequent treatment with entrectinib.
convenient and common than cutaneous vesicostomy; however, cutaneous vesicostomy has the advantages of being associated with less pain, discomfort, and bacteriuria. 5 Importantly, both these techniques require the management of a catheter to void urine, which might be problematic in a patient with cognitive decline.The differential diagnosis of peri-urethral infection associated with diabetes consists of abscess, NSTI including Fournier's gangrene, cellulitis, candidiasis, and folliculitis. 2 Although NSTI is uncommon, its prognosis is extremely poor, and thus it is important to recognize this condition. 6 Fournier's gangrene is characterized by severe pain, skin necrosis, foul-smelling pus, subcutaneous emphysema, obstructive arterial endarteritis, and a mixed infection with aerobic and anaerobic bacteria. 7 Swelling, pain, and erythema are reported to be characteristic of NSTI; 2,8 however, painless NSTI would occur owing to diabetic neuropathy. 7 Therefore, careful observation is essential.Elderly patients with diabetes are at a high risk of geriatric syndrome, 9 and the mild cognitive impairment associated with diabetes can lead to a decrease in instrumental activities of daily living, 10 implying that complex medical self-care, including selfcatheterization, may be difficult for some individuals. Given that an increasing number of elderly patients now live alone, we clinicians should monitor our patients carefully so as not to miss either cognitive impairment or minimal signs of infection.
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