20 May 2025, Volume 25 Issue 3

  

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Original Article
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  Clinical characteristics of scrub typhus in 159 patients from 2019 to 2023

  MA Hua, WANG Shui, ZHANG Qiu, LI Zhiping, PENG Yinzhi, XIAO Shuiling, LIU Bo

  2025, 25(3): 241-247. https://doi.org/10.16718/j.1009-7708.2025.03.001

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  Objective To analyze the epidemiological and clinical characteristics of scrub typhus in Liuyang People's Hospital Hunan Province for better diagnosis, treatment, prevention and control of scrub typhus. Methods A retrospective study was conducted on 159 confirmed cases of scrub typhus. The demographic data of patients, clinical manifestations of scrub typhus, laboratory tests, and chest CT findings, complications, treatment, and outcomes were analyzed. Results The 159 patients with scrub typhus included 142 males and 17 females. The average age of patients was (53.8 ± 11.9) (18-82 ) years old. The peak incidence of scrub typhus was in the period from July to September (87.42%). The common clinical manifestations included fever (97.48%), headache (41.51%), and fatigue (23.90%). The most common signs were eschar (92.45%) on the lower limbs (25.16%), scrotum (15.72%), and buttocks (11.32%). Laboratory test results upon admission showed decreased platelet count (64.15%), elevated creatinine (38.36%), elevated AST (90.57%), ALT (80.50%), and LDH (90.57%). Pulmonary imaging study revealed pulmonary inflammation (22.64%), pleural effusion (13.21%), and pericardial effusion (6.29%). The common complications included liver impairment (69.81%) and decreased platelet count (50.94%), as well as other complications such as renal dysfunction, myocardial injury, sepsis, respiratory failure, and disseminated intravascular coagulation (DIC). Doxycycline-based therapies resulted in cure rate of 98.11% (156/159). Three patients died due to severe complications. Conclusions The peak incidence of scrub typhus was in the period from July to September in Hunan Province. Eschar is a key feature for clinical diagnosis. Scrub typhus can affect multiple organ systems, leading to various systemic complications. The cure rate is high with doxycycline treatment, but some patients may die from severe complications due to delayed medical treatment.
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  Clinical characteristics of Pneumocystis carinii pneumonia complicated with acute respiratory failure in 123 immunocompromised patients

  LIN Xiuhua, LIN Jiaping, SHI Yixian, ZHANG Siting, LIN Xin, CHEN Lei, LI Hui, XIE Baosong

  2025, 25(3): 248-253. https://doi.org/10.16718/j.1009-7708.2025.03.002

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  Objective To investigate the risk factors for acute respiratory failure in immunocompromised patients with Pneumocystis jirovecii pneumonia (PJP). Methods Clinical data of 123 immunocompromised patients complicated with PJP hospitalized at Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2021 to December 2023 were retrospectively collected and analyzed. SPSS 22.0 statistical software package was used to perform multivariate binary logistic regression analysis to identify risk factors for acute respiratory failure in PJP patients. Results Among the 123 PJP patients, 77 were HIV-positive, and 46 were HIV-negative. HIV-negative PJP patients were more likely to have comorbidities such as hypertension (P < 0.001), diabetes mellitus (P < 0.001), coronary heart disease (P = 0.034), chronic kidney disease (P < 0.001), chronic liver disease (P = 0.019), chronic lung disease (P = 0.011), and malignant tumor (P < 0.001). They were also more prone to respiratory failure (P < 0.001) and ICU admission (P < 0.001). The HIV-positive patients had significantly lower CD4⁺ T lymphocyte counts and albumin levels (P < 0.001). Forty patients developed acute respiratory failure, and six patients died. Multivariate analysis showed that high neutrophil-to-lymphocyte ratio (NLR) (P = 0.031), non-HIV infection (P = 0.002), and concomitant infections with other pathogens (P < 0.001) were independent risk factors for incidence of respiratory failure. ROC curve analysis revealed that the area under the curve (AUC) was 0.686 (0.584, 0.789) for non-HIV infection, 0.731 (0.637, 0.826) for concomitant infections with other pathogens, 0.648 (0.546, 0.750) for NLR. The predicted probability was 0.845 (0.778, 0.912). Conclusions Non-HIV infection, high NLR, and concomitant infections with other pathogens are independent risk factors for incidence of respiratory failure in PJP patients. The panel combining these factors provides a higher predictive value for respiratory failure. Timely assessment of patient condition and early treatment are vital for better outcomes.
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  The risk factors for voriconazole-induced adverse reactions in patients with acquired immunodeficiency syndrome complicated with fungal infection

  WU Lili, LI Qiaoxi, WANG Yan

  2025, 25(3): 254-258. https://doi.org/10.16718/j.1009-7708.2025.03.003

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  Objective To explore the risk factors for voriconazole-induced adverse reactions in patients with acquired immunodeficiency syndrome (AIDS) for screening the high-risk populations and safe use of voriconazole. Methods Retrospective analysis was performed on patients who received voriconazole from January 2020 to December 2023. Demographic details, medical history, laboratory tests, concomitant medications, and adverse reactions of patients were collected from the hospital information system (HIS). The potential risk factors for the adverse reactions induced by voriconazole were analyzed by univariate and logistic multivariate analysis. Receiver operating characteristic (ROC) curve was used to analyze the specificity and sensitivity of the risk factors as predictor. Results A total of 170 patients were included in this study. Adverse drug reaction was reported in 62 patients (36.5%). Central nervous system toxicity, hepatotoxicity, and visual impairment were the most common adverse reactions. Univariate analysis showed that the adverse reactions of voriconazole were significantly associated with C-reactive protein, aspartic aminotransferase, aspartic aminotransferase/alanine aminotransferase, and CD4⁺T lymphocytes/CD8⁺T lymphocytes (CD4⁺/CD8⁺). Multivariate analysis indicated that CD4⁺/CD8⁺ was an independent risk factor for voriconazole-induced adverse reactions. ROC curve indicated that CD4⁺/CD8⁺ had a better predictive capability (AUC = 0.756). Conclusions CD4⁺/CD8⁺ should be monitored closely during voriconazole treatment for fungal infection in patients with AIDS. CD4⁺/CD8⁺ may be a good predictor for voriconazole-related psychiatric and visual abnormalities and hepatotoxicity.
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  Efficacy and safety of different preparations of amphotericin B in the treatment of AIDS complicated with talaromycosis

  XIAO Qiqi, YU Min, LUO Jianrong, CHEN Yonggang

  2025, 25(3): 259-264. https://doi.org/10.16718/j.1009-7708.2025.03.004

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  Objective To compare the anti fungal efficacy and safety of amphotericin B cholesteryl sulfate complex (amphotericin B colloidal dispersion, ABCD) and amphotericin B for injection (amphotericin B deoxycholate, AmB-D) in the treatment of AIDS complicated with talaromycosis (TSM). Methods A total of 80 patients who were diagnosed with AIDS and complicated with TSM from December 2021 to January 2024 in Department of Infection, Kunming Third People's Hospital were included in the study. The patients were randomized to receive ABCD (n=40) via intravenous infusion or AmB-D (control, n=40) via IV infusion protected from light. The overall treatment efficacy rate, CD4⁺ T lymphocyte count, routine blood tests, liver and kidney function tests, K⁺ concentration, and the incidence of adverse drug reactions (ADR) during study were compared between the two treatment groups. Results The overall efficacy rate was 87.5% (35/40) in ABCD group and 80.0% (32/40) in the control (AmB-D) group (P > 0.05). WBC, hemoglobin, and platelet count were significantly higher after treatment compared with pretreatment levels (P < 0.05) in both groups. The CD4⁺ T lymphocyte count was higher after treatment compared with pretreatment levels in both groups. And the CD4⁺ T lymphocyte count in ABCD group was significantly higher than that in the control group (P < 0.05). The levels of total bilirubin, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, and serum creatinine increased after treatment in both groups. Blood urea nitrogen and serum creatinine increased significantly in control group compared with ABCD group (P < 0.05). After treatment, serum K⁺ concentration decreased significantly in control group compared with the pretreatment level and compared with ABCD group (P < 0.05). The incidence of adverse events in ABCD group was significantly lower than that in the control group. The time to renal injury was delayed significantly (P < 0.05). Conclusions In the treatment of AIDS complicated with TSM, the efficacy of ABCD was comparable to AmB-D. The incidence of hepatic impairment did not show significant difference between ABCD and AmB-D. However, ABCD is associated with less renal impairment, lower incidence of adverse events, and better safety, which is valuable for clinical use.
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  The correlation between the test panel of serum CCL3, sPDPN, FABP5 and the severity of lung injury and clinical outcomes in children with severe pneumonia

  ZHANG Yiwen, HUANG Minmin, CHU Yiming, HUANG Yeqiu

  2025, 25(3): 265-271. https://doi.org/10.16718/j.1009-7708.2025.03.005

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  Objective To explore the correlation between the test panel of serum CC chemokine ligand 3 (CCL3), soluble podoplanin (sPDPN), fatty acid-binding protein 5 (FABP5) and the severity of lung injury and clinical outcomes in children with severe pneumonia. Methods A total of 168 children with severe pneumonia who visited our hospital from January 2022 to January 2023 were included in this study as severe group. The patients were assigned to good outcome group (137 cases) or poor outcome group (31 cases) based on their prognosis. Additional 80 children with mild or moderate pneumonia were treated as non-severe group. In addition, 80 children who underwent health checkup were included as control group. Baseline data such as body mass index and duration of disease were observed and recorded for all children. Enzyme linked immunosorbent assay (ELISA) was applied to detect the expression levels of C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), CCL3, sPDPN, and FABP5 in the serum of all children. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Lung Injury Prediction (LIPS) score were rated to evaluate the degree of lung injury. Multivariate logistic regression was used to analyze the impact of various factors on the poor outcome of children with severe pneumonia. Spearman correlation was applied to analyze the correlation between the expression levels of CCL3, sPDPN, FABP5 and poor outcome, the severity of lung injury, APACHE II score, and LIPS score in children with severe pneumoniae. Receiver operating characteristic (ROC) curve was applied to analyze the diagnostic value of CCL3, sPDPN, and FABP5 expression levels for poor outcome in children with severe pneumonia. Z-test was used to compare the differences in area under the curve (AUC). Results The baseline data such as duration of disease, body mass index, age, and sex did not show significant differences among the control group, non-severe group, and severe group (P > 0.05). The levels of serum CRP, PCT, IL-6, TNF-α, CCL3, sPDPN increased, while the level of FABP5 decreased gradually from the control group to non-severe group, and severe group (P < 0.05). The patients with poor outcomes showed higher serum levels of CRP, PCT, IL-6, TNF-α, CCL3, sPDPN, APACHE II score, and LIPS score but lower FABP5 level compared to the patients with good outcomes (P < 0.05). TNF-α, CCL3, sPDPN, APACHE II, and LIPS scores were independent risk factors for poor outcomes in children with severe pneumonia, while FABP5 level was independent protective factor for poor outcomes in children with severe pneumonia (P < 0.05). The levels of CCL3 and sPDPN were positively correlated with APACHE II score and LIPS score, while FABP5 was negatively correlated with APACHE II score and LIPS score (P < 0.05). The AUC of CCL3, sPDPN, and FABP5 alone was 0.802, 0.864, and 0.859 respectively for predicting poor prognosis in children with severe pneumonia. The test panel of CCL3 + sPDPN + FABP5 was superior to CCL3, sPDPN, or FABP5 alone (Z _{combination - CCL3}=3.842, Z _{combination - sPDPN} = 2.585, Z _{combination - FABP5} = 2.957, P < 0.05). Conclusions The serum levels of CCL3 and sPDPN are positively correlated with the severity of lung injury, while FABP5 is negatively correlated with the severity of lung injury in children with severe pneumonia. The test panel of CCL3 + sPDPN + FABP5 is valuable for predicting poor outcomes in children with severe pneumonia.
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  Liver abscesses caused by Streptococcus: report of 21 cases

  LONG Qin, ZHAO Xiaoyu, CHEN Chang, HAO Min, QIN Xiaohua

  2025, 25(3): 272-278. https://doi.org/10.16718/j.1009-7708.2025.03.006

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  Objective To improve the diagnosis and treatment of Streptococcus liver abscesses by analyzing the clinical presentations, antibiotic susceptibility, and treatment strategies of patients. Methods A retrospective analysis was conducted on 21 patients diagnosed with liver abscess caused by Streptococcus from June 2012 to June 2022. The data included demographic information, clinical characteristics, laboratory tests, imaging findings, treatment strategies, and outcomes. Results The 21 patients were 29 to 77 years of age, and 81.0% were male. Clinical manifestations included fever, chills, fatigue, and abdominal pain. Some patients also had headache and altered consciousness, indicating possible concomitant brain abscess. Hematogenous dissemination and biliary tract origin were the most common routes of infection. The predominant pathogen was Streptococcus anginosus group (76.2%). Single pathogen infection was found in 12 cases and mixed infection in 9 cases. All isolates were sensitive to penicillin, cefotaxime, vancomycin, and levofloxacin, but 36.4% (4/11) of the isolates showed resistance to erythromycin and clindamycin. Four patients developed metastatic abscesses, and two experienced septic shock. The main treatment approach was a combination of antibiotics and percutaneous liver puncture drainage, resulting in improvement in 18 patients. Conclusions Liver abscesses caused by Streptococcus are usually non-specific in terms of symptoms. Streptococcus anginosus group is the primary pathogen. Antibiotics combined with percutaneous drainage is an effective treatment approach. It is crucial for clinicians to be aware of potential brain abscesses and the necessity of early intervention.
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  Distribution and resistance profiles of bacterial strains isolated from cerebrospinal fluid in hospitals across China: results from the CHINET Antimicrobial Resistance Surveillance Program, 2015-2021

  MA Juan, ZHANG Lixia, YANG Yang, HU Fupin, ZHU Demei, SHEN Han, ZHOU Wanqing, LIU Wenen, LI Yanming, XIE Yi, KANG Mei, GUO Dawen, ZHAO Jinying, HU Zhidong, LI Jin, WANG Shanmei, CHU Yafei, YU Yunsong, LIN Jie, XU Yingchun, ZHANG Xiaojiang, LI Jihong, SHAN Bin, DU Yan, JI Ping, Zhang Fengbo, ZHUO Chao, SU Danhong, WEI Lianhua, ZOU Fengmei, MA Xiaobo, ZHENG Yanping, XU Yuanhong, HUANG Ying, CHU Yunzhuo, TIAN Sufei, YU Hua, HUANG Xiangning, GUO Sufang, XU Xuesong, YAN Chao, HU Fangfang, JIN Yan, SHAO Chunhong, JIA Wei, LI Gang, WU Jinsong, LU Yuemei, DONG Fang, LÜ Zhiyong, ZHU Lei, MENG Jinhua, ZHOU Shuping, ZHOU Yan, WANG Chuanqing, FU Pan, HU Yunjian, AI Xiaoman, SUN Ziyong, CHEN Zhongju, ZHANG Hong, WANG Chun, NI Yuxing, SUN Jingyong, WEN Kaizhen, ZHANG Yirong, GUO Ruyi, ZHU Yan, DUAN Jinju, KANG Jianbang, HU Xuefei, WANG Shifu, CHEN Yunsheng, MENG Qing, ZHAO Yong, GONG Ping, WANG Ruizhong, FANG Hua, SHEN Jilu, LIU Jiangshan, GU Hongqin, FENG Jiao, XUE Shunhong, YU Bixia, HE Wen, JIANG Lin, LIAO Longfeng, YUE Chunlei, HUANG Wenhui

  2025, 25(3): 279-289. https://doi.org/10.16718/j.1009-7708.2025.03.007

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  Objective To investigate the distribution and antimicrobial resistance profiles of common pathogens isolated from cerebrospinal fluid (CSF) in CHINET program from 2015 to 2021. Methods The bacterial strains isolated from CSF were identified in accordance with clinical microbiology practice standards. Antimicrobial susceptibility test was conducted using Kirby-Bauer method and automated systems per the unified CHINET protocol. Results A total of 14 014 bacterial strains were isolated from CSF samples from 2015 to 2021, including the strains isolated from inpatients (95.3%) and from outpatient and emergency care patients (4.7%). Overall, 19.6% of the isolates were from children and 80.4% were from adults. Gram-positive and Gram-negative bacteria accounted for 68.0% and 32.0%, respectively. Coagulase negative Staphylococcus accounted for 73.0% of the total Gram-positive bacterial isolates. The prevalence of MRSA was 38.2% in children and 45.6% in adults. The prevalence of MRCNS was 67.6% in adults and 69.5% in children. A small number of vancomycin-resistant Enterococcus faecium (2.2%) and linezolid-resistant Enterococcus faecalis (3.1%) were isolated from adult patients. The resistance rates of Escherichia coli and Klebsiella pneumoniae to ceftriaxone were 52.2% and 76.4% in children, 70.5% and 63.5% in adults. The prevalence of carbapenem-resistant E. coli and K. pneumoniae (CRKP) was 1.3% and 47.7% in children, 6.4% and 47.9% in adults. The prevalence of carbapenem-resistant Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPA) was 74.0% and 37.1% in children, 81.7% and 39.9% in adults. Conclusions The data derived from antimicrobial resistance surveillance are crucial for clinicians to make evidence-based decisions regarding antibiotic therapy. Attention should be paid to the Gram-negative bacteria, especially CRKP and CRAB in central nervous system (CNS) infections. Ongoing antimicrobial resistance surveillance is helpful for optimizing antibiotic use in CNS infections.
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  Changing antibiotic resistance profiles of the bacterial strains isolated from geriatric patients in hospitals across China: data from CHINET Antimicrobial Resistance Surveillance Program, 2015-2021

  AI Xiaoman, HU Yunjian, GE Chunyue, YANG Yang, HU Fupin, ZHU Demei, XU Yingchun, ZHANG Xiaojiang, LI Hui, JI Ping, XIE Yi, KANG Mei, WANG Chuanqing, FU Pan, XU Yuanhong, HUANG Ying, SUN Ziyong, CHEN Zhongju, NI Yuxing, SUN Jingyong, CHU Yunzhuo, TIAN Sufei, HU Zhidong, LI Jin, YU Yunsong, LIN Jie, SHAN Bin, DU Yan, GUO Sufang, WEI Lianhua, ZOU Fengmei, ZHANG Hong, WANG Chun, ZHUO Chao, SU Danhong, GUO Dawen, ZHAO Jinying, YU Hua, HUANG Xiangning, LIU Wen'en, LI Yanming, JIN Yan, SHAO Chunhong, XU Xuesong, YAN Chao, WANG Shanmei, CHU Yafei, ZHANG Lixia, MA Juan, ZHOU Shuping, ZHOU Yan, ZHU Lei, MENG Jinhua, DONG Fang, LÜ Zhiyong, HU Fangfang, SHEN Han, ZHOU Wanqing, JIA Wei, LI Gang, WU Jinsong, LU Yuemei, LI Jihong, DUAN Jinju, KANG Jianbang, MA Xiaobo, ZHENG Yanping, GUO Ruyi, ZHU Yan, CHEN Yunsheng, MENG Qing, WANG Shifu, HU Xuefei, SHEN Jilu, HUANG Wenhui, WANG Ruizhong, FANG Hua, YU Bixia, ZHAO Yong, GONG Ping, WENG Kaizhen, ZHANG Yirong, LIU Jiangshan, LIAO Longfeng, GU Hongqin, JIANG Lin, HE Wen, XUE Shunhong, FENG Jiao, YUE Chunlei

  2025, 25(3): 290-302. https://doi.org/10.16718/j.1009-7708.2025.03.008

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  Objective To investigate the antimicrobial resistance of clinical isolates from elderly patients (≥65 years) in major medical institutions across China. Methods Bacterial strains were isolated from elderly patients in 52 hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program during the period from 2015 to 2021. Antimicrobial susceptibility test was carried out by disk diffusion method and automated systems according to the same CHINET protocol. The data were interpreted in accordance with the breakpoints recommended by the Clinical and Laboratory Standards Institute (CLSI) in 2021. Results A total of 514 715 nonduplicate clinical isolates were collected from elderly patients in 52 hospitals from January 1, 2015 to December 31, 2021. The number of isolates accounted for 34.3% of the total number of clinical isolates from all patients. Overall, 21.8% of the 514 715 strains were gram-positive bacteria, and 78.2% were gram-negative bacteria. Majority (90.9%) of the strains were isolated from inpatients. About 42.9% of the strains were isolated from respiratory specimens, and 22.9% were isolated from urine. More than half (60.7%) of the strains were isolated from male patients, and 39.3% isolated from females. About 51.1% of the strains were isolated from patients aged 65-<75 years. The prevalence of methicillin-resistant strains (MRSA) was 38.8% in 32 190 strains of Staphylococcus aureus. No vancomycin- or linezolid-resistant strains were found. The resistance rate of E. faecalis to most antibiotics was significantly lower than that of Enterococcus faecium, but a few vancomycin-resistant strains (0.2%, 1.5%) and linezolid-resistant strains (3.4%, 0.3%) were found in E. faecalis and E. faecium. The prevalence of penicillin-susceptible S. pneumoniae (PSSP), penicillin-intermediate S. pneumoniae (PISP), and penicillin-resistant S. pneumoniae (PRSP) was 94.3%, 4.0%, and 1.7% in nonmeningitis S. pneumoniae isolates. The resistance rates of Klebsiella spp. (Klebsiella pneumoniae 93.2%) to imipenem and meropenem were 20.9% and 22.3%, respectively. Other Enterobacterales species were highly sensitive to carbapenem antibiotics. Only 1.7%-7.8% of other Enterobacterales strains were resistant to carbapenems. The resistance rates of Acinetobacter spp. (Acinetobacter baumannii 90.6%) to imipenem and meropenem were 68.4% and 70.6% respectively, while 28.5% and 24.3% of P. aeruginosa strains were resistant to imipenem and meropenem, respectively. Conclusions The number of clinical isolates from elderly patients is increasing year by year, especially in the 65-<75 age group. Respiratory tract isolates were more prevalent in male elderly patients, and urinary tract isolates were more prevalent in female elderly patients. Klebsiella isolates were increasingly resistant to multiple antimicrobial agents, especially carbapenems. Antimicrobial resistance surveillance is helpful for accurate empirical antimicrobial therapy in elderly patients.
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  Antimicrobial resistance surveillance in the bacterial strains isolated from pediatric intensive care units in China: results from 2020 to 2022

  LIU Jing, YAN Huiyuan, YAN Gangfeng, LU Guoping, FU Pan, WANG Chuanqing, JIN Danqun, TONG Wenjia, ZHANG Chenyu, CHEN Jianli, LIN Yi, LEI Jia, CHENG Yibing, ZHANG Qunqun, GAO Kaijie, CHEN Yuanyuan, XIAO Shufang, HE Juan, JIANG Li, XU Huimin, LI Yuxia, DING Hanghai, CHEN Hehe, ZHENG Yao, CHEN Qunying, WANG Ying, REN Hong, ZHANG Chenmei, CHEN Zhenjie, ZHOU Mingming, ZHANG Yucai, ZHOU Yiping, BAI Zhenjiang, HUANG Saihu, HUANG Lili, YANG Weiguo, MA Weike, MENG Qing, ZHU Pengwei, LI Yong, XU Yan, WANG Yi, DU Yanqiang, CAI Huijun, ZHU Bizhen, SHI Huixuan, HONG Shaoxian, HUANG Yukun, HUANG Meilian

  2025, 25(3): 303-311. https://doi.org/10.16718/j.1009-7708.2025.03.009

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  Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units (PICU) in China for better antimicrobial therapy. Methods Clinical isolates were collected from 17 institutions, including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1, 2020 to December 31, 2022. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute (CLSI) in 2020. Results A total of 10 688 isolates were collected, including gram-positive organisms (39.2%) and gram-negative organisms (60.8%). The top three organisms were S. aureus (13.6%, 1 453/10 688), A. baumannii (10.0%, 1 067/10 688), and coagulase-negative Staphylococcus (9.9%, 1 058/10 688). Multi-drug resistant organisms (MDROs) were very common in children. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant E. coli, carbapenem-resistant K. pneumoniae (CRKP), carbapenem-resistant A. baumannii (CRAB), and carbapenem-resistant P. aeruginosa (CRPA) was 41.1%, 19.4%, 8.8%, 30.9%, 67.4%, and 28.8%, respectively. Overall, more than 50% of Enterobacteriales isolates were resistant to cephalosporins, while nearly 25% of Enterobacteriales isolates were resistant to carbapenems. MDROs were highly resistant to commonly used antibiotics. More than 80% of CRE and CRAB strains were resistant to all beta-lactam antibiotics. CRE and CRAB showed low resistance rates to tigecycline and polymyxin. CRPA showed lower resistance rates to piperacillin, beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins. All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline. None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin, vancomycin, or linezolid. The prevalence of β-lactamase-negative ampicillin-resistant (BLNAR) strains was 43.3% in Haemophilus influenzae. Conclusions MDROs were prevalent in PICU. It is necessary to establish an effective multidisciplinary team (MDT) to control the antimicrobial resistance．
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  Distribution and antimicrobial resistance profiles of bacterial isolates in Xi'an No. 3 Hospital from 2019 to 2023

  GUO Xiaopu, SHU Fang, LIU Yanli, XU Qian, ZHAI Yajun, QU Bing, WANG Haifeng

  2025, 25(3): 312-319. https://doi.org/10.16718/j.1009-7708.2025.03.010

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  Objective To investigate the distribution and antimicrobial resistance profiles of clinical isolates in Xi'an No. 3 Hospital from 2019 to 2023. Methods Clinical isolates were collected from January 1, 2019 to December 31, 2023. Antimicrobial susceptibility testing was carried out according to a unified protocol of China Antimicrobial Resistance Surveillance Network using Kirby-Bauer method or automated systems. The data were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute (CLSI) in 2023. Results A total of 6 621 clinical isolates were collected from 2019 to 2023, including 1 569 (23.7%) strains of Gram-positive bacteria and 5 052 (76.3%) strains of Gram-negative bacteria. The prevalence of methicillin-resistant S. aureus, S. epidermidis and other Staphylococcus species (except S. pseudintermedius and S. schleiferi) was 39.0%, 62.3%, and 74.4%, respectively. Methicillin-resistant strains showed much higher resistance rates to most of other antimicrobial agents than methicillin-sensitive strains. No Staphylococcus strains were found resistant to vancomycin or linezolid. E. faecium strains demonstrated much higher resistance rates to most antimicrobial agents tested than E. faecalis. The prevalence of linezolid-resistant E. faecalis and vancomycin-resistant E. faecium was 0.9% and 0.4%, respectively. The prevalence of penicillin-nonsusceptible strains (PISP+PRSP) was 5.8% in nonmeningitis S. pneumoniae isolates. The prevalence of ESBL-producing E. coli, K. pneumoniae, and P. mirabilis in Enterobacterales was 48.5%, 37.8%, and 47.2%, respectively. Among Enterobacterales strains, K. pneumoniae had the highest resistance rate to imipenem (18.2%) and meropenem (17.9%). Other Enterobacterales were highly sensitive to carbapenems. The resistance rates of P. aeruginosa to imipenem and meropenem were 22.5% and 19.5%, respectively. The resistance rates of A. baumannii to imipenem and meropenem were 65.0% and 71.6%, respectively. Conclusions Antibiotic resistance is still serious in this hospital. Nearly half of the strains of E. coli, K. pneumoniae and P. mirabilis produced ESBLs. K. pneumoniae and A. baumannii showed high resistance rates to carbapenems. Antimicrobial resistance surveillance should be performed appropriately. Relevant departments need to strengthen cooperation to curb the spread of drug-resistant bacteria.
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  Distribution and antimicrobial resistance profiles of clinical isolates of Nocardia in Hebei Province

  REN Hongtao, SHI Dongyan, CHENG Kuo, ZHANG Xuerui, LIU Dandan, LEI Qiuxiang

  2025, 25(3): 320-325. https://doi.org/10.16718/j.1009-7708.2025.03.011

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  Objective The aim of this study was to investigate the microbiological characteristics and antimicrobial resistance of Nocardia isolates in Hebei Province during the 9-year period. Methods The medical records of all hospitalized patients from whom Nocardia was isolated from 2015 to 2023 were analyzed retrospectively. The isolates were identified to the species level by amplification and sequencing of 16S rRNA, secA1 and ropB genes of Nocardia. Antimicrobial susceptibility of Nocardia isolates were tested by microbroth dilution method. Results Of the 162 strains of Nocardia, 128 (79.0%) were isolated from respiratory tract specimens, followed by skin and soft tissue infection (25/162, 15.4%). Most of the patients with respiratory tract infection were elderly (> 65 years old). Most of the patients with skin and soft tissue infection were middle-aged and elderly (> 45 years old). Twelve species were identified among the 162 isolates. The most common species were N. cyriacigeorgica (36.4%, 59/162), N. farcinica (25.3%, 41/162), and N. otitidiscaviarum (9.9%, 16/162). The most common Nocardia species isolated from the respiratory tract was N. cyriacigeorgica, followed by N. farcinica. The most common species causing skin and soft tissue infection were N. cyriacigeorgica, N. farcinica and N. brasiliensis. All Nocardia strains were susceptible to linezolid, followed by 98.8% susceptible to amikacin and 98.1% susceptible to trimethoprim-sulfamethoxazole (TMP-SMZ). Conclusions Nocardia is mainly isolated from respiratory tract, skin and soft tissues. N. cyriacigeorgica and N. farcinica are the most prevalent species. TMP-SMZ is the first choice for treatment of nocardiosis. Combination therapy may be appropriate for moderate and severe infections according to the results of antimicrobial susceptibility testing.
Case Report
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  Acquired immunodeficiency syndrome complicated with Nocardia brain abscess misdiagnosed as recurrent toxoplasma encephalitis: a case report

  ZENG Qin, YANG Honghong, LIU Qian, YU Qing, HUANG Rui, LIU Min

  2025, 25(3): 326-329. https://doi.org/10.16718/j.1009-7708.2025.03.012

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