Background  The number of foreign tourists visiting Japan has increased to about 30 million people per year. 1.5% of them were injured or became sick during their travelin Japan and had to undergo medical treatment. Among the foreign tourists, 27% were not covered by travel health insurance.Case  A 40-year-old man from Southeast Asia who was visiting his relative in Japan experienced sudden hemiparesis and was diagnosed with cerebral infarction. During the initial treatment, it was found that the patient did not have health insurance and the relatives could not afford to pay the treatment costs. No other source of financial support was available to him During our consultations with the patient and his relatives about the medical treatment including medical expenses, he continued to be treated as an outpatient and it was aimed at an early return to his home country.Discussion  Foreigners, who are not covered under travel health insurance, could fall ill or sustain an injury during their stay in Japan. Appropriate medical care should be provided regardless of their ability to pay. However, a situation that could lead them to incur huge medical expenses from availing medical care should be avoided. For medical consultations of non-insured foreigners, it is better to consult the available systems and pay attention about feasible medical expenses. There is a need for a long-term vision of medical care to make a smooth transition from medical treatment in Japan to treatment in their home country.Conclusion  Although medical institutions can offer only a limited response, it is necessary to accumulate case examples from across the nation and prepare specific countermeasures and counselors.

Early detection of third-generation cephalosporin-resistant bacteria in blood culture tests influences the choice of antimicrobial agents. We report on our hospital’s system for early reporting of third-generation cephalosporin-resistant bacteria and its utility. The hospital operates a 24-h simple cefpodoxime (CPDX) testing system, where the content of a sample container with a positive blood culture result is smeared on a CA Sheep Blood Agar/VCM Chocolate EX II fractionation medium, and an antibiotic susceptibility test (AST) disk (Sensi-Disk CPDX) is placed at the center of the medium and incubated. The presence or absence of third-generation cephalosporin-resistant bacteria is estimated from the diameter of the growth inhibition zone. The physician in charge of AST makes comments on the chart based on the simple CPDX test results. The sensitivity of the simple CPDX test for detecting third-generation cephalosporin-resistant bacteria, based on AST results, was 95.5%. Among patients with failed antimicrobial therapy, the rate of switching antimicrobials before the AST results were known was 57.9% in cases where there were comments made by the physicians in charge of AST, compared with 42.9% in cases without comments. These results suggest that the simple CPDX test enables early and accurate detection of third-generation cephalosporin-resistant bacteria, facilitating early switching of antimicrobial agents through collaboration with physicians in charge of AST.