Objectives To explore the occurrence and characterization of carbapenemase‐producing pathogens among carbapenem‐resistant Gram‐negative bacilli isolated from hospitalized patients with urinary tract infection in Indonesia. Methods This was a study promoted by the Japanese–Indonesian collaborative research program in the Japan Initiative for Global Research Network on Infectious Diseases. Bacterial pathogens were prospectively isolated from urine specimens of hospitalized urinary tract infection patients at Dr. Soetomo Hospital (Surabaya, Indonesia). All Gram‐negative bacteria resistant to third‐generation cephalosporin or carbapenem were included in this study. Carbapenemase genes were investigated for phenotype and genotype. Results In total, 1082 Gram‐negative bacilli were isolated, of which 116 strains were resistant to imipenem or meropenem (carbapenem‐resistant Gram‐negative bacilli), and 22 strains were carbapenemase‐producing Gram‐negative bacilli. Carbapenemase‐producing Gram‐negative bacilli consisted of Acinetobacter baumannii (n = 4), Pseudomonas aeruginosa (n = 4), Klebsiella pneumoniae (n = 5), Providencia rettgeri (n = 4) and five others. The carbapenemase‐producing Gram‐negative bacilli included NDM‐1 (n = 18, 81.8%, in Enterobacteriaceae and Acinetobacter spp.) and IMP‐7 (n = 4, 18.2%, all in P. aeruginosa). Among carbapenem‐resistant Gram‐negative bacilli, all four P. aeruginosa were sensitive to colistin, and all six Acinetobacter spp. were sensitive to minocycline, colistin and tigecycline. Of those patients harboring carbapenemase‐producing Gram‐negative bacilli, 12 (54.5%) were seriously ill at the time of admission, with longer hospital stays and three deaths (13.6% mortality rate). Conclusions Urinary tract infection‐causing carbapenem‐resistant Gram‐negative bacilli are widely disseminated in Indonesia. The NDM‐1 phenotype seems to be dominant, and it can be treated with colistin and tigecycline in most cases. Most patients harboring carbapenemase‐producing Gram‐negative bacilli are seriously ill, have a bad prognosis, with a longer hospital stay and a significant mortality rate.

Objective This study compared urinary tract infection (UTI) pathogens and antibiotic susceptibilities between Kobe, Japan and Taipei, Taiwan to investigate the regional resistance pattern of UTI-causative bacteria. Methods UTI-causative bacteria and antibiotic susceptibility for 4519 samples from Kobe University Hospital, Kobe and 25,131 samples from Shuang-Ho Hospital, Taipei from 2015 to 2017 were retrospectively analyzed to compare the differences between these hospitals. Results Escherichia coli was the most common pathogen in both areas (30.0% in Kobe, 41.2% in Taipei). The prevalence of cephalosporin and gentamicin-resistant E. coli tended to be higher in Taipei than in Kobe. Additionally, antibiotic susceptibilities of Klebsiella pneumonia and Pseudomonas aeruginosa tended to be higher in Kobe than in Taipei. The ratio of extended-spectrum β-lactamase-producing K. pneumoniae was significantly higher in Taipei than in Kobe (up to 40% vs. 14.8%), but this was not observed for E. coli. Conclusion Variations in the type of UTI-causative bacteria and antibiotic susceptibility between the two hospitals may be influenced by the use of different antibiotics. Further surveillance of resistance patterns is necessary for effective treatment.

Background: The best method of antimicrobial prophylaxis administration for surgical site infection (SSI) in transurethral holmium laser resection and enucleation of the prostate (HoLEP)/bipolar transurethral enucleation (TUEB) remains controversial. The purpose of this study is to compare one-day and two-day cefazolin in a randomized 2nd-phase study to help establish a protocol with a 95% confidence interval (CI) for SSI prevention. Methods: Patients undergoing HoLEP/TUEB for benign prostate hyperplasia without preoperative pyuria will be enrolled and randomized to receive prophylactic antibiotic administration for HoLEP/TUEB in two groups, 1-day cefazolin and 2-day cefazolin. The primary endpoint is the occurrence rate of postoperative urinary tract infection or urogenital infection within 30 days after HoLEP/TUEB with a statistical 95% CI in comparison between those groups. Secondary outcomes include the kind of infectious disease and evidence of diagnosis, day of diagnosis of infectious disease, performance of urine or blood culture, detection of bacteria, treatments, duration of treatments, AEs other than surgical site infection, and drug-induced AEs. Discussion: The results of this study will provide evidence for defining the optimal duration of cefazolin prophylactic antibiotic administration for SSI. Trial registration: This study was registered in the University Hospital Medical Information Network-Clinical Trial Registry (UMIN000027955) based on recommendations from the International Committee of Medical Journal Editors (ICMJE) on July 1st 2017.

Background: The best method of antimicrobial prophylaxis administration for surgical site infection (SSI) in transurethral holmium laser resection and enucleation of the prostate (HoLEP)/bipolar transurethral enucleation (TUEB) remains controversial. The purpose of this study is to compare one-day and two-day cefazolin in a randomized 2nd-phase study to help establish a protocol with a 95% confidence interval (CI) for SSI prevention. Methods: Patients undergoing HoLEP/TUEB for benign prostate hyperplasia without preoperative pyuria will be enrolled and randomized to receive prophylactic antibiotic administration for HoLEP/TUEB in two groups, 1-day (single dose) cefazolin and 2-day cefazolin. The primary endpoint is the occurrence rate of postoperative urinary tract infection or urogenital infection within 30 days after HoLEP/TUEB with a statistical 95% CI in comparison between those groups. Secondary outcomes include the kind of infectious disease and evidence of diagnosis, day of diagnosis of infectious disease, performance of urine or blood culture, detection of bacteria, treatments, duration of treatments, AEs other than surgical site infection, and drug-induced AEs. Discussion: The results of this study will provide evidence for defining the optimal duration of cefazolin prophylactic antibiotic administration for SSI. Trial registration: This study was registered in the University Hospital Medical Information Network-Clinical Trial Registry (UMIN000027955) based on recommendations from the International Committee of Medical Journal Editors (ICMJE) on July 1st 2017.