20 May 2026, Volume 26 Issue 3

  

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Original Article
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  Trajectory classification and predictive factors of treatment adherence in chronic hepatitis B patients: A latent variable growth mixture model approach

  CHEN Yunxia, SONG Tingting, MIAO Peipei, XUE Hong, YANG Jianmei

  2026, 26(3): 215-222. https://doi.org/10.16718/j.1009-7708.2026.03.001

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  Objective To examine the trajectory classes of treatment adherence in chronic hepatitis B (CHB) patients and the relevant predictive factors. Methods Patients with CHB were prospectively enrolled from our hospital between June 2022 and October 2023 (n=430) by convenience sampling. Overall, 30 patients dropped out during the study period, and 400 patients were finally included in this analysis. Treatment adherence was evaluated using the CHB Treatment Adherence Scale at T₀ (before treatment), T₁, T₂, T₃, and T₄ (1, 3, 6, 12 months after treatment), respectively. The trajectory classes of treatment adherence was analyzed via latent growth mixture model (LGMM). Patient-related data were collected to identify independent predictive factors for different trajectory classes by univariate and multivariate logistic regression analyses. Results The treatment adherence trajectories of 400 CHB patients were divided into four classes: high-stable, moderate-increasing, moderate-decreasing, and low-persistent. Economic income, bad habits, educational background, number of comorbidities, adverse reactions to CHB treatment, disease uncertainty, negative emotions, quality of life, family care, and social support were independent predictive factors for CHB treatment adherence trajectories (all P < 0.05). Conclusions The developmental trajectory of treatment adherence in CHB patients can be classified into four heterogeneous types. The trajectory classification is significantly influenced by multidimensional factors such as sociodemographic, clinical, and psychosocial factors. Healthcare providers can develop individualized interventions tailored to the characteristics of patients in different trajectory classes to enhance their treatment adherence.
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  Utility of amoxicillin-clavulanic acid (10∶1) dosing regimens in Chinese subjects based on pharmacokinetic/pharmacodynamic analysis

  TANG Xingyu, ZHAN Huizhong, ZHANG Jing, YU Jicheng, WU Xiaojie, FAN Yaxin, WANG Yu, WU Hailan, GUO Beining, YANG Yang, GUO Yan, HU Fupin, HUANG Quanhua, CHEN Ning, CHEN Yuancheng, CAO Guoying

  2026, 26(3): 223-231. https://doi.org/10.16718/j.1009-7708.2026.03.002

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  Objective To investigate the pharmacokinetic (PK) characteristics of amoxicillin-clavulanic acid (10∶; 1) (AMX-CLA) after single or multiple doses via intravenous injection (IV) in healthy subjects, and conduct pharmacokinetic/pharmacodynamic (PK/PD) analysis to evaluate the utility of different dosing regimens. Methods A single-center, randomized, open-label, phase I clinical trial was conducted in healthy Chinese subjects. A single dose (0.55 g, 1.1 g, and 2.2 g, self-cross over, three-cycle) or multiple doses (2.2 g q12h) of AMX-CLA were administered by IV infusion. Blood and urine samples were collected to measure the concentrations of AMX and CLA. The PK parameters were calculated and PK/PD analysis was conducted using Monte Carlo simulation. Results After a single dose of 0.55 g, 1.1 g or 2.2 g AMX-CLA, the peak plasma concentration of AMX (C_max) was (27.9 ±; 3.97),(50.8 ±; 6.50) and (101 ±; 14.1) mg/L, respectively in the 12 healthy subjects. The C_max of CLA was (3.19 ±; 0.477), (5.78 ±; 0.594) and (9.82 ±; 1.52) mg/L, respectively. A total of 12 subjects received multiple doses of AMX-CLA 2.2 g q12h IV for 8 consecutive days to reach steady state. The accumulation factors R_Cmax and R_AUC were 1.00 ±; 0.09 and 0.93 ±; 0.10 for AMX, 1.06 ±; 0.20 and 1.00 ±; 0.17 for CLA, respectively. Monte Carlo simulation revealed that when PK/PD (%T > MIC) target of AMX-CLA was 40%, AMX-CLA 2.2 g q12h, 0.5 h infusion provided ≥; 90% probability of target attainment (PTA) for the target pathogens for which the minimum inhibitory concentration (MIC) of AMX was ≤; 1 mg/L. AMX-CLA 1.1 g q8h, 0.5 h infusion achieved the cumulative fraction of response (CFR) of 85.40%, 98.65%, 97.85%-99.85%, and 99.35% respectively for penicillin-sensitive Streptococcus pneumoniae (PSSP), methicillin-sensitive Staphylococcus aureus, Haemophilus influenzae, and Moraxella catarrhalis. AMX-CLA 2.2 g q12h, 0.5 h infusion provided CFR of 77.40%, 26.85%, 32.15%, and 17.30% for PSSP, penicillin-intermediate S. pneumoniae (PISP), extension-spectrum β-lactamase-negative Klebsiella pneumoniae and Escherichia coli, respectively. AMX-CLA 2.2 g q8h, 0.5 h infusion could increase CFR to 96.55%, 83.30%, 75.20% and 46.25%, respectively. All of the above dosing regimens could achieve CRF up to 100% against Streptococcus pyogenes. Conclusions Single and multiple doses of AMX-CLA have good safety and tolerability within the dose range of 0.55-2.2 g IV in healthy Chinese subjects. AMX-CLA 2.2 g q12h or 1.1 g q8h dosing regimen is recommended for respiratory tract infections such as community-acquired pneumonia (CAP) caused by PSSP, methicillin-sensitive S. aureus, H. influenzae and M. catarrhalis. AMX-CLA 2.2 g q8h regimen is suitable for CAP caused by PISP, extended-spectrum β-lactamase-negative K. pneumoniae and E. coli. AMX-CLA 1.1 g q12h is adequate for CAP caused by S. pyogenes.;
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  Latent tuberculosis infection in individuals aged 0-18 years: a retrospective study from a tertiary hospital, 2020-2024

  ZHANG Qi, WU Jing

  2026, 26(3): 232-237. https://doi.org/10.16718/j.1009-7708.2026.03.003

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  Objective To investigate the prevalence and features of latent tuberculosis infection (LTBI) among individuals aged 0-18 years using purified protein derivative (PPD) test and chest X-ray screening data from a tertiary hospital during the period from 2020 to 2024. Methods A retrospective analysis was conducted in 71 443 participants undergoing health checkup. LTBI and relevant radiographic findings were evaluated in terms of years, age groups, and sex. The correlation between LTBI and chest radiographic findings was further investigated. Results The overall prevalence of LTBI was 8.1%, varying from year to year. The peak prevalence was 12.5% in 2021, and declined to 2.3% in 2024. No significant sex difference was found in overall or age-stratified analyses. LTBI prevalence increased with age (0-6 years: 5.7%; 7-12 years: 7.1%; 13-15 years: 11.3%; 16-18 years: 9.3%; χ²=131.796, P < 0.001). Concurrent LTBI and relevant radiographic abnormalities was associated with higher risk of active tuberculosis. Conclusions These findings highlight persistent LTBI burden in this 0-18 year-old population. The prevalence of LTBI varied with time and age but not sex. The link between LTBI and chest radiographic findings supports PPD testing for LTBI screening and assessment of the risk for active TB.
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  Utility of interferon-gamma release assay in screening tuberculosis infection among hospitalized patients in a general hospital

  XIE Ping, JIANG Jinli, WANG Yingying, CHEN Caiping

  2026, 26(3): 238-244. https://doi.org/10.16718/j.1009-7708.2026.03.004

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  Objective To evaluate the utility of interferon-gamma release assay (IGRA) in screening tuberculosis (TB) infection among hospitalized patients in a general hospital for improving stratified TB management. Methods A total of 6 279 patients who were admitted to Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between January 2023 and December 2024 and underwent peripheral blood IGRA testing were enrolled. The patients were assigned to one of the following groups: active tuberculosis (ATB, n=315), latent tuberculosis infection (LTBI, n=823), or non-tuberculosis infection (NTI, n=4 785) according to the final clinical diagnosis. The demographic characteristics and clinical setting of patients were compared between groups. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of IGRA for diagnosing ATB were calculated. Results The overall positive rate of IGRA was 22.97% (1 442/6 279), but 85.40% (269/315) in the ATB group. The proportion of male patients in the IGRA-positive group was significantly higher than that in the IGRA-negative group (64.91% vs 54.37%, P < 0.001). IGRA showed relatively high positive rate in Department of Endocrinology (43.24%), Department of Infectious Diseases (35.08%), and Department of Cardiology (32.31%). The positive rate was significantly different among departments (P < 0.001). Taking final clinical diagnosis as the gold standard, IGRA had a sensitivity of 85.40%, specificity of 80.33%, PPV of 18.65%, and NPV of 99.05% for detecting ATB. Only 22.82% of the patients at high risk of LTBI received TB preventive therapy (TPT). Most close contacts of TB patients (65.85%) received TPT, but the coverage rate was low among dialysis patients and immunosuppressant users. Conclusions IGRA can be used as an efficient screening tool for TB infection in general hospitals. It is appropriate to use this tool to strengthen active screening in high-risk populations such as males and diabetic patients, and promote TPT for the individuals at high risk of LTBI such as dialysis patients and immunosuppressant users to reduce the risk of TB transmission.
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  Clinical analysis of 12 cases of primary parotid tuberculosis

  SI Ying, XIAO Ke, HUANG Yongmao

  2026, 26(3): 245-248. https://doi.org/10.16718/j.1009-7708.2026.03.005

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  Objective To investigate the clinical features, imaging features, diagnosis, treatment and prognosis of primary parotid tuberculosis and avoid misdiagnosis. Methods A retrospective analysis was conducted on the clinical data of 12 patients diagnosed with primary parotid tuberculosis in the Affiliated Hospital of Southwest Medical University from October 2018 to January 2024. Results A total of 12 patients were included, including 7 males and 5 femals, aged 8 to 65 years. Underlying diseases were reported in 5 patients. The main clinical manifestations included palpable masses in one parotid gland, in some cases accompanied by pain and swollen lymph nodes in the affected side of the neck. The patients received imaging examinations, mainly ultrasound and CT scan. All patients underwent parotid gland lesion resection surgery. The postoperative histopathology is mainly characterized by granulomatous changes or caseous necrosis. All patients received regular anti-tuberculosis treatment after the operation. Eleven patients were cured and one patient was improved followed by recurrence. Conclusions Primary parotid tuberculosis is more common in young and middle-aged people. The clinical manifestations are atypical and the imaging signs lack specificity. Pathogen detection and pathological biopsy are the main diagnostic methods. After a confirmed diagnosis, regular anti-tuberculosis treatment should be carried out. Most patients had a good outcome.
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  Bloodstream infection caused by Penicillium chrysogenum: a case report and literature review

  NIU Dun, TIAN Nani

  2026, 26(3): 249-254. https://doi.org/10.16718/j.1009-7708.2026.03.006

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  Objective To analyze the clinical features of infections caused by Penicillium chrysogenum for improving clinical treatment. Methods We report a patient infected with P. chrysogenum. We identified 17 cases of P. chrysogenum infection based on literature review from PubMed, Embase, Web of Science and CNKI, Wanfang, VIP, SinoMed (in Chinese) databases since database establishment until July 31, 2025. The 18 cases (including this report) were retrospectively analyzed. Results Overall, 88.89% of the 18 patients were reported from Western countries. The mean age of patients was (37.64 ± 18.09) years. Most of the patients (72.59%) were male. Most patients (72.22%) had risk factors. The infection involved all systems of the body. Fever was the most common symptom. In vitro antimicrobial susceptibility testing results were available in 6 cases. The breakpoints for interpretation of susceptibility testing results were mentioned in 2 cases but without susceptibility testing results. Susceptibility or resistance was clearly stated in 4 cases. The pathogen was susceptible to polyenes in 4 cases. The pathogen was resistant to fluconazole in 2 cases, and susceptible to fluconazole in another 2 cases. The pathogen was susceptible to other azoles. Most patients were treated with amphotericin B. Patients died in 6 cases. The disease was improved in the remaining 12 cases. Conclusions P. chrysogenum is an opportunistic pathogen, which is more common in patients with underlying diseases and trauma. There are also infections in the patients without underlying diseases. P. chrysogenum infection is rarely reported, but it is associated with high mortality rate.
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  Necrotizing fasciitis caused by Helcococcus kunzii: a case report and literature review

  BAI Ting, HE Qingqing, ZHU Lin, TIAN Nani, LI Xiao, LIN Ruijuan, GAO Ya, YANG Rui

  2026, 26(3): 255-259. https://doi.org/10.16718/j.1009-7708.2026.03.007

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  Objective To investigate the microbiological characteristics of Helcococcus kunzii and and the clinical features of infections caused by this pathogen, aiming to enhance clinical awareness of this rare pathogen. Methods The clinical data of a patient with necrotizing fasciitis caused by H. kunzii are presented. The literature reports on H. kunzii infections were searched in PubMed, Embase, CNKI, Wanfang, VIP, and SinoMed databases from inception to August 30, 2025 using search term Helcococcus kunzii. The characteristics of the patients with H. kunzii infection were reviewed. Results The patient was a 40-year-old male who visited the hospital due to redness, swelling, heat, pain, and abscess formation in the left foot for 3 days. He had a history of diabetes mellitus. Digital radiography showed swelling and gas accumulation in the soft tissue around the 5th metatarsal bone of the left foot, for which infection was considered. After admission, he underwent lesion incision, debridement, expansion, exploration and bone cement placement for left diabetic foot. He was diagnosed with necrotizing fasciitis after the surgery. During the operation, a wound swab was taken for culture, which showed H. kunzii. He improved after surgical and anti-infection treatment with ceftazidime. A total of 27 cases were reviewed from the literature, including this case. There were 20 males and 7 females. The age of these patients ranged from 17 to 88 years. The primary type of infection was skin and soft tissue infection (63.0%, 17/27). The treatment outcome was recovery or improvement in 22 patients, unknown in 4 cases, and persistent in one patient. Conclusions H. kunzii infection is rarely reported. The possibility of H. kunzii infection should be considered for the patients with underlying diseases such as diabetes mellitus. Beta-lactam antibiotics with potent activity against Gram-positive cocci are recommended as the first choice for empirical treatment.
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  Distribution and antimicrobial resistance of 50 strains of Candida auris in a hospital

  LIANG Sumei, ZHANG Rong, QIU Guixia, LIN Hui, SHAN Jinglan, LI Chang'an, YE Dan, MAO Pu

  2026, 26(3): 260-263. https://doi.org/10.16718/j.1009-7708.2026.03.008

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  Objective To analyze the clinical characteristics of patients with Candida auris infection in a hospital for improving diagnosis and treatment. Methods The patients with specimens positive for C. auris from January 2023 to December 2024 were identified at the First Affiliated Hospital of Guangzhou Medical University. The clinical data, site of infection, and results of antimicrobial susceptibility testing were analyzed retrospectively. Results Overall, 40 patients were identified with C. auris infection, mainly in Intensive Care Unit (ICU) (23/40, 57.5%) and respiratory medicine department (13/40, 32.5%). A total of 50 strains of C. auris were isolated, primarily from lower respiratory tract (26/50, 52.0%) and urine (13/50, 26.0%). All of the C. auris strains were susceptible to caspofungin, micafungin and amphotericin B, but only 16.0% of the strains were susceptible to fluconazole. Conclusions The C. auris strains in this hospital showed low resistance rate. C. auris strains are usually isolated from patients in ICU, who had severe underlying conditions and received multiple invasive procedures. Some patients were colonized with C. auris prior to admission. It is essential to enhance infection control measures in the hospital and prevent inter-facility transmission of this pathogen.
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  Antimicrobial resistance profiles of bacteria isolated from pleural effusion specimens: surveillance report from China Antimicrobial Resistance Surveillance System, 2020-2024

  China Antimicrobial Resistance Surveillance System

  2026, 26(3): 264-271. https://doi.org/10.16718/j.1009-7708.2026.03.009

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  Objective To understand the changing distribution and antimicrobial resistance profiles of bacterial strains isolated from pleural effusion specimens in China. Methods Antimicrobial susceptibility testing was performed in each member hospitals of China Antimicrobial Resistance Surveillance System (CARSS) using the unified protocol by automated systems, disk diffusion method, or E-test strip. The results were interpreted against the breakpoints released by the Clinical and Laboratory Standards Institute (CLSI) in 2024. Statistical analysis was conducted using WHONET 5.6 software. Results A total of 112 567 bacterial strains were isolated from pleural effusion specimens during the period from 2020 to 2024. Gram positive bacteria accounted for 62.7% and Gram negative bacteria accounted for 37.3%. The top three bacteria were coagulase-negative Staphylococcus, Streptococcus, and Enterococcus. The prevalence of MRSA ranged from 29.1% to 30.3% in the 5-year period. None of the staphylococcal strains was resistant vancomycin or teicoplanin. Enterococcus faecalis showed significantly lower resistance rates to all of the antibiotics tested except linezolid than Enterococcus faecalis. Streptococcus pneumoniae isolates were highly resistant to erythromycin and clindamycin. Group B β-hemolytic Streptococcus showed higher resistance rate to levofloxacin than Group A β-hemolytic Streptococcus. No vancomycin- or linezolid-resistant Streptococcus strains were found. The prevalence of carbapenem-resistant Escherichia coli and carbapenem-resistant Klebsiella pneumoniae was 2.5%-3.0% and 12.8%-16.9%, respectively in the 5-year period, while the prevalence of carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Pseudomonas aeruginosa was 45.1%-53.1% and 22.2%-24.8%, respectively. At least 17.5% of the Pseudomonas aeruginosa strains were resistant to carbapenems, while less than 10.3% of the strains were resistant to amikacin, gentamicin, or polymyxin B. At least 45.3% of the Acinetobacter baumannii strains were resistant to carbapenems, while at least 4.0% of the strains were resistant to polymyxin B. Burkholderia cepacia and Stenotrophomonas maltophilia showed low resistance rates to levofloxacin and trimethoprim-sulfamethoxazole. Conclusions The distribution and antimicrobial resistance profiles of the pathogenic bacteria isolated from pleural effusion specimens can inform the clinical antibiotic use. More attention should be paid to the pathogens such as methicillin-resistant Staphylococcus (particularly methicillin-resistant coagulase-negative Staphylococcus) and carbapenem-resistant Gram-negative bacteria (especially carbapenem-resistant Acinetobacter baumannii). Ongoing antimicrobial resistance surveillance is helpful for rational antibiotic use.
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  Antimicrobial resistance profiles of bacteria isolated from blood specimens: surveillance report from China Antimicrobial Resistance Surveillance System, 2020-2024

  China Antimicrobial Resistance Surveillance System

  2026, 26(3): 272-279. https://doi.org/10.16718/j.1009-7708.2026.03.010

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  Objective To analyze the changing distribution and antimicrobial resistance profiles of the bacterial strains isolated from blood samples in China during the period from 2020 to 2024. Methods Blood samples were collected from the patients in China Antimicrobial Resistance Surveillance System (CARSS) from 2020 to 2024. Antimicrobial susceptibility testing was performed for the strains in each participating hospital using the unified protocol. The changing distribution and antimicrobial resistance profiles of bacteria, as well a the prevalence of important drug-resistant bacteria were analyzed. Results A total of 2 036 052 strains of bacteria were isolated from blood samples during the 5-year period. Gram-negative bacteria accounted for 53.9% (1 097 336/2 036 052),while Gram-positive bacteria accounted for 46.1% (938 716/2 036 052). Overall, the top 5 bacteria were Escherichia coli (26.2%-27.8%), coagulase-negative Staphylococcus (26.5%-28.4%), Klebsiella pneumoniae (11.5%-12.0%), Staphylococcus aureus (6.7%-7.2%), and Enterococcus faecium (2.7%-3.1%). During the 5-year period, 1.1%-1.3% and 1.2%-1.4% (1.3% in 2024) of the E. coli isolates were resistant to imipenem and meropenem, respectively. The percentage of amikacin-resistant E. coli isolates increased from 1.6% to 3.8%. During the same period, about 8.9%-10.5% and 10.1%-12.1% of K. pneumoniae isolates were resistant to imipenem and meropenem, respectively. The prevalence of imipenem-resistant and meropenem-resistant Pseudomonas aeruginosa was 11.4%-13.6% and 8.8%-10.4%, respectively. During the same period, the percentage of ciprofloxacin-resistant P. aeruginosa decreased to 5.4%. The prevalence of imipenem-resistant and meropenem-resistant Acinetobacter baumannii was 44.7%-54.6% and 46.9%-56.5%, respectively. During the 5-year period, the prevalence of tigecycline-resistant A. baumannii increased from 2.4% to 2.5%. The proportion of MRSA in S. aureus decreased from 27.8% to 25.9%. None of the S. aureus strains were found resistant to vancomycin, linezolid, or teicoplanin. The proportion of MRCNS decreased from 76.5% to 73.8% in coagulase-negative Staphylococcus. The prevalence of linezolid-resistant CNS increased to 0.9% during the 5-year period. The prevalence of vancomycin-resistant E. faecium increased from 1.2% to 4.3%. The prevalence of linezolid-resistant E. faecalis (1.6%-2.7%) was higher than that of vancomycin-resistant E. faecalis (0.2%-0.4%). Conclusions Gram-negative bacteria, especially E. coli and K. pneumoniae, are the major bacterial isolates from blood samples during the period from 2020 to 2024. The prevalence of carbapenem-resistant A. baumannii and vancomycin-resistant E. faecium showed somewhat upward trend. It is necessary to strengthen antimicrobial resistance surveillance of the pathogens isolated from blood samples.
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  Antimicrobial resistance profiles of bacteria isolated from urine specimens: surveillance report from China Antimicrobial Resistance Surveillance System, 2020-2024

  China Antimicrobial Resistance Surveillance System

  2026, 26(3): 280-292. https://doi.org/10.16718/j.1009-7708.2026.03.011

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  Objective To determine the changing distribution and antimicrobial resistance of bacterial strains isolated from urine in China over 2020-2024. Methods According to China Antimicrobial Resistance Surveillance System (CARSS) technical protocol, antimicrobial susceptibility testing was carried out using Kirby-Bauer method or automated systems. WHONET 5.6 software was used to analyze the data of the bacterial isolates and antimicrobial susceptibility testing results reported by all CARSS member hospitals from 2020 to 2024. Results The top five species of urinary bacterial isolates from males were Escherichia coli (31.4%-32.6%), Enterococcus faecalis (10.4%-12.3%), Klebsiella pneumoniae (9.4%-9.8%), Enterococcus faecium (8.6%-10.0%) and Pseudomonas aeruginosa (4.6%-5.5%). The top five species of urinary bacterial isolates from females were E. coli (56.5%-57.3%), K. pneumoniae (8.8%-9.1%), E. faecium (7.3%-8.5%), E. faecalis (5.5%-6.0%) and Proteus mirabilis (3.5%-4.3%). The resistance rates of E. faecalis from both male and female patients to ampicillin and nitrofurantoin were less than 10%. >; 90% E. faecium strains were resistant to ampicillin and levofloxacin, while less than 4.3% were resistant to vancomycin. About 28.2%-60.8% of the E. coli strains isolated from males and 19.5%-47.7% of the E. coli strains isolated from females were resistant to the third generation cephalosporins, while the overall resistance rate of E. coli to cefoperazone-sulbactam, piperacillin-tazobactam and nitrofurantoin was less than 10%. About 40.5%-55.3% of the K. pneumoniae strains isolated from males and 25.5%-40.8% of the K. pneumoniae strains isolated from females were resistant to the third generation cephalosporins. Less than 11% of P. aeruginosa strains were resistant to cefoperazone-sulbactam and piperacillin-tazobactam, while about 13% were resistant to carbapenems. The resistance rates of A. baumannii isolates to cefoperazone-sulbactam and minocycline were less than 21% and 12%, respectively. About 28.9%-32.9% of the A. baumannii strains isolated from males and 24.9%-29.5% of the A. baumannii strains isolated from females were resistant to carbapenems. Conclusions The Enterobacterales strains isolated from urine showed sex difference in terms of species distribution and antimicrobial resistance. The antimicrobial resistance rates of some bacterial species to certain antibiotics varied over the period from 2020 to 2024. The antimicrobial resistance profiles of bacterial isolates from urine can inform rational use of antibiotics for urinary tract infections.
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  Antimicrobial resistance profiles of bacteria isolated from bronchoalveolar lavage fluid: surveillance report from China Antimicrobial Resistance Surveillance System, 2020-2024

  China Antimicrobial Resistance Surveillance System

  2026, 26(3): 293-301. https://doi.org/10.16718/j.1009-7708.2026.03.012

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  Objective To investigate the distribution and antimicrobial resistance profiles of pathogenic bacteria isolated from bronchoalveolar lavage fluid (BALF) across China during the period from 2020 to 2024. Methods BALF specimens were collected from the patients in hospitals participating in China Antimicrobial Resistance Surveillance System from 2020 to 2024. Antimicrobial susceptibility testing was performed for the strains using the unified protocol. The susceptibility data were analyzed using WHONET 5.6 software. Results A total of 539 873 bacterial strains were isolated from BALF specimens from 2020 to 2024, including 456 246 (84.5%) strains of Gram-negative bacteria and 83 627 (15.5%) strains of Gram-positive bacteria. The top five bacteria were Klebsiella pneumoniae (19.6%), Pseudomonas aeruginosa (17.1%), Acinetobacter baumannii (15.7%), Staphylococcus aureus (8.0%), and Stenotrophomonas maltophilia (7.2%). From 2020 to 2024, the prevalence of MRSA was 35.1%, 36.5%, 35.8%, 36.2%, and 34.9%, respectively. None of S. aureus strains was resistant to vancomycin, teicoplanin, or linezolid. In the 5-year period, the prevalence of penicillin-resistant Streptococcus pneumoniae was 1.3%, 1.8%, 1.7% , 1.4% and 1.0%, respectively. In the same period, 9.7% to 13.3% of the S. pneumoniae strains were resistant to third-generation cephalosporins. However, the prevalence of levofloxacin-resistant S. pneumoniae strains decreased from 3.7% in 2020 to 3.3% in 2024. Haemophilus influenzae showed increasing resistance rates to some antimicrobial agents, particularly ampicillin from 61.8% to 80.0%. The percentage of H. influenzae strains non-susceptible to azithromycin also increased from 27.1% to 49.3%. Both Klebsiella pneumoniae and Escherichia coli were highly resistant (≥; 40.6% resistant) to cephalosporins (cefotaxime, cefuroxime, cefazolin). Both species were relatively susceptible to β-lactam/β-lactamase inhibitor combinations such as piperacillin-tazobactam and cefoperazone-sulbactam (≤; 32.9% resistant). The prevalence of carbapenem-resistant K. pneumoniae was significantly higher than the prevalence of carbapenem-resistant E. coli and E. cloacae. For non-fermenting bacteria, the prevalence of carbapenem-resistant Acinetobacter baumannii was significantly higher than the prevalence of carbapenem-resistant Pseudomonas aeruginosa. Conclusions The pathogenic bacteria isolated from BALF in CARSS are predominantly Gram-negative bacilli during the period from 2020 to 2024. The distribution of bacterial species varied slightly over years. The epidemiological and susceptibility data of the pathogenic bacteria isolated from BALF can inform the rational use of antimicrobial agents.
Case Report
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  Bloodstream infection caused by carbapenem-resistant Acinetobacter baumannii treated with sulbactam-durlobactam in combination with imipenem-cilastatin: a case report

  CUI Yuhui, HUANG Li'ou, QI Yue, ZHAO Yujiao, YIN Suokun, TANG Jianguo

  2026, 26(3): 302-306. https://doi.org/10.16718/j.1009-7708.2026.03.013

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  Severe necrotizing pneumonia caused by Fusobacterium necrophorum: a case report

  DONG Xiaorong, ZHENG Xiaojuan, MA Xiaoxuan, LIU Jie

  2026, 26(3): 307-310. https://doi.org/10.16718/j.1009-7708.2026.03.014

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  Community-acquired bloodstream infection complicated with acute myelitis caused by methicillin-resistant Staphylococcus aureus: a case report

  YU Jingjing, DING Tao, YUAN Yang, LI Nan, ZANG Jing, WANG Guangdong

  2026, 26(3): 311-314. https://doi.org/10.16718/j.1009-7708.2026.03.015

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Review
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  Research updates on sulbactam-durlobactam in the treatment of Acinetobacter baumannii infection

  LI Xueyuan, BAI Xuelian, FENG Sizhou

  2026, 26(3): 315-321. https://doi.org/10.16718/j.1009-7708.2026.03.016

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  Advances in clinical guidelines for chronic carriage and gallbladder colonization in patients with typhoid fever or paratyphoid A

  WEI Zhongqiu, LIU Yue, CHEN Xiang, ZENG Mei, XU Xuebin

  2026, 26(3): 322-326. https://doi.org/10.16718/j.1009-7708.2026.03.017

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