As azole-resistant Aspergillus fumigatus emerges globally, healthcare facilities face mounting challenges in managing invasive aspergillosis. This review synthesizes worldwide azole resistance data to reveal profound regional variability, demonstrating that findings from other regions cannot be directly extrapolated to local settings. Consequently, hospital-level environmental surveillance is crucial for tailoring interventions to local epidemiology and detecting resistant strains in real-time. We outline practical approaches—encompassing sampling site prioritization, diagnostic workflows (culture-based and molecular), and PDCA-driven continuous improvement—so that even resource-limited facilities can manage resistant isolates more effectively. By linking real-time surveillance findings with clinical decisions, hospitals can tailor antifungal stewardship programs and swiftly adjust prophylaxis or treatment regimens. Our approach aims to enable accurate, ongoing evaluations of emerging resistance patterns, ensuring that institutions maintain efficient and adaptive programs. Ultimately, we advocate for sustained, collaborative efforts worldwide, where facilities adapt protocols to local conditions, share data through international networks, and contribute to a global knowledge base on resistance mechanisms. Through consistent application of these recommendations, healthcare systems can better preserve azole efficacy, safeguard immunocompromised populations, and refine infection control practices in the face of evolving challenges.

Integrating the automated collection of antimicrobial use metrics into national surveillance systems is vital for antimicrobial stewardship evaluation. The days of antibiotic spectrum coverage (DASC) serves as a quantitative metric for assessing de-escalation strategies. A major challenge is that DASC has not yet been integrated into the national surveillance system, partly owing to the omission of commonly used antibiotics in Japan in the initially developed antibiotic spectrum coverage (ASC) scores. This study aimed to establish ASC scores for antibiotics approved in Japan and generate data supporting their integration into the national surveillance system. Antibiotics approved in Japan that had not been assigned ASC scores in the prior study were identified. Their antimicrobial activity was assessed against 16 organism categories using the same methodology as the original study. We analyzed the correlation between the Access, Watch, Reserve (AWaRe) classification and ASC scores for antibiotics approved in Japan. The ASC scores had a range of 3-16, with a median of seven. The AWaRe classification was slightly correlated with ASC scores (Spearman's ρ = 0.234). Our findings highlight the significance of employing diverse antimicrobial use metrics for comprehensively evaluating antimicrobial stewardship. The results of this study will support stakeholders in implementing ASC scores into the national surveillance system.

Background: Non–AIDS-defining cancers (NADCs) in patients infected with HIV have recently attracted attention because of the improved survival of this patient population. To obtain accurate data, a longitudinal study is warranted for the nationwide surveillance of the current status and national trend of NADCs in patients infected with HIV in Japan. Setting: An annual nationwide surveillance of NADCs in patients infected with HIV-1 in Japan from 1999 to 2021. Methods: An annual questionnaire was sent to 378 HIV/AIDS referral hospitals across Japan to collect data (clusters of differentiation 4-positive lymphocytes, time of onset, outcomes, and antiretroviral therapy status) of patients diagnosed with any of the NADCs between 1999 and 2021. Results: The response and case-capture rates for the questionnaires in 2021 were 37.8% and 81.2%, respectively. The number of reported NADC cases subsequently increased since the beginning of this study. Evaluation of the case counts of NADCs demonstrated a high incidence of lung, colorectal, gastric, and liver cancers as the top 4 cancers. Pancreatic cancer (0.63), lung cancer (0.49), and leukemia (0.49) had the highest mortality rates among the NADCs. Trends of NADCs regarding transmission routes were maintained over the years in male individuals who have sex with male individuals compared with heterosexual male individuals and female individuals. Conclusions: We demonstrated an increasing trend in the incidence of NADCs over a period of 23 years in Japan. The current data highlighted the importance of raising awareness regarding cancer management for patients infected with HIV in Japan.

Hospital sink drains act as reservoirs for nosocomial infection-causing bacteria. Drainpipe thermal disinfection units (DTDUs) inhibit or reduce bacterial colonization by elevating drainpipe temperature. However, their effectiveness remains to be comprehensively evaluated. This study investigated the effectiveness of a DTDU, in addition to routine cleaning and disinfection, in preventing bacterial colonization of new metal drainpipes in a clinical setting. This non-blinded parallel group comparative study was conducted in the intensive care unit of Nagasaki University Hospital, Japan. DTDUs were installed in three and five new sink drains for cleaning oral care (OC) devices and staff handwashing (HW), respectively. Two new sink drains without DTDUs for OC and HW were used as controls. Sinks were used as usual, with daily cleaning with ethanol-wipes and weekly flushing of a drain cleaner containing sodium hypochlorite. Additionally, OC drainpipes were disinfected using foam-type sodium hypochlorite. Samples were collected from insides of drainpipes biweekly for bacterial identification, semi-quantitative culturing, and antibiotic susceptibility test. The effect of the DTDUs on drainpipe bioburden was assessed using Fisher's exact test. Each sink was sampled 14 times. Bioburden was significantly lower in DTDU-equipped drainpipes than in controls for both OC devices and HW (both P < 0.01). Pseudomonas aeruginosa was the most frequently isolated bacterium (46.3%); however, it was not detected in DTDU-equipped OC drainpipes. Carbapenemase-producing Enterobacterales were detected in control HW drainpipes but not in DTDU-equipped HW drainpipes. Thermal disinfection of drainpipes may suppress bacterial colonization, including strains resistant to regular cleaning and disinfection.

The optimal metric for outpatient antimicrobial stewardship has not been well defined. The number of antibiotic prescriptions per clinic visit does not account for the therapeutic duration. We found only moderate association between prescription-based metrics and days-supplied–based metrics. Outpatient antibiotic consumption metrics should incorporate the duration of therapy.