Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2024. Methods Clinical isolates from 74 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems. Results were interpreted using the 2024 Clinical & Laboratory Standards Institute (CLSI) breakpoints. Results A total of 458 271 clinical isolates were collected in 2024, of which 28.3% were gram-positive and 71.7% were gram-negative. The prevalence of methicillin-resistant strains in Staphylococcus aureus, Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA, MRSE and MRCNS) were 28.4%, 76.5%, and 70.2%, respectively. No vancomycin-resistant strains were found. The resistance rates of Enterococcus faecalis and Enterococcus faecium to high-concentration gentamicin were 36.6% and 39.7%, respectively. A few vancomycin-resistant strains were identified in both E. faecalis and E. faecium. E. faecium showed higher resistance rates to most antimicrobials compared to E. faecalis. The prevalence of penicillin-nonsusceptible strains (PISP and PRSP) among non-meningitis Streptococcus pneumoniae isolated from children and adults was 0.1% and 1.0%, respectively. The resistance rate to carbapenems was lower than 15.0% for most Enterobacterales species except for Klebsiella, 21.3%, and 22.1% of which were resistant to imipenem and meropenem, respectively. Most Enterobacterales isolates were highly susceptible to tigecycline (≤3.1% resistant) and colistin (≤4.2% resistant). The resistance rates to imipenem and meropenem were 21.3% and 17.3% for Pseudomonas aeruginosa, respectively, 64.5% and 64.7% for Acinetobacter baumannii, respectively. Conclusions In 2024, the antimicrobial resistance of clinical bacterial isolates was still serious. Clinicians should rationally select antimicrobial agents based on the results of antimicrobial resistance surveillance to effectively control the development of bacterial resistance.

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.

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.

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.

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.

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.

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.

Objective To evaluate the efficacy and safety of amoxicillin-clavulanate (10:1) for injection in the treatment of community-acquired pneumonia (CAP) in adult patients. Methods Eligible patients were randomized to receive amoxicillin-clavulanate (10:1) 2.2 g or ampicillin-sulbactam (2:1) 3.0 g via intravenous infusion q12h or q8h for 7 to 14 days. The primary endpoint was to the clinical efficacy 7-14 days after discontinuation of treatment. The secondary endpoints included microbiological efficacy and safety. Results All enrolled patients (n=324) were included in the full analysis set (FAS), specifically 165 patients receiving amoxicillin sodium-clavulanate potassium (10:1) and 159 patients receiving ampicillin sodium-sulbactam sodium (2:1). The clinical cure rate was 78.8% (130/165) for amoxicillin-clavulanate (10:1) and 77.4% (123/159) for ampicillin-sulbactam 7-14 days after end of treatment (P > 0.05). The clinical cure rate was 87.5% (126/144) for amoxicillin-clavulanate (10:1) and 87.4% (111/127) for ampicillin-sulbactam (2:1) in per protocol set (P > 0.05). Therefore, amoxicillin-clavulanate (10:1) was non-inferior to ampicillin-sulbactam in the primary endpoint in the treatment of CAP in adult patients. The overall bacterial eradication rate was 94.4% (34/36) for amoxicillin-clavulanate (10:1) and 89.3% (25/28)for ampicillin-sulbactam (P > 0.05). The common study drug-related clinical adverse event were abnormalities of hepatic function in both the amoxicillin-clavulanate (10:1) group (4.8%, 8/165) and ampicillin-sulbactam group (3.1%, 5/159) (P > 0.05). Conclusions Amoxicillin-clavulanate (10:1) 2.2 g IV infusion q12h or q8h for 7-14 days was noninferior to ampicillin-sulbactam in terms of clinical and microbiological efficacy in the treatment of CAP in adult patients. The safety of the two dosing regimens was comparable.

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.

Objective To characterize the changing species distribution and antibiotic resistance profiles of respiratory isolates in hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021. Methods Commercial automated antimicrobial susceptibility testing systems and disk diffusion method were used to test the susceptibility of respiratory bacterial isolates to antimicrobial agents following the standardized technical protocol established by the CHINET program. Results A total of 589 746 respiratory isolates were collected from 2015 to 2021. Overall, 82.6% of the isolates were Gram-negative bacteria and 17.4% were Gram-positive bacteria. The bacterial isolates from outpatients and inpatients accounted for (6.0 ± 0.9)% and (94.0 ± 0.1)%, respectively. The top microorganisms were Klebsiella spp., Acinetobacter spp., Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus spp., Stenotrophomonas maltophilia, Escherichia coli, and Streptococcus pneumoniae. Each microorganism was isolated from significantly more males than from females (P < 0.05). The overall prevalence of methicillin-resistant S. aureus (MRSA) was 39.9%. The prevalence of penicillin-resistant S. pneumoniae was 1.4%. The prevalence of extended-spectrum β-lactamase (ESBL)-producing E. coli and K. pneumoniae was 67.8% and 41.3%, respectively. The overall prevalence of carbapenem-resistant E. coli, K. pneumoniae, Enterobacter cloacae, Pseudomonas aeruginosa, and Acinetobacter baumannii was 3.7%, 20.8%, 9.4%, 29.8%, and 73.3%, respectively. The prevalence of β-lactamase was 96.1% in Moraxella catarrhalis and 60.0% in Haemophilus influenzae. The H. influenzae isolates from children (<18 years) showed significantly higher resistance rates to β-lactam antibiotics than the isolates from adults (P < 0.05). Conclusions Gram-negative bacteria are still predominant in respiratory isolates associated with serious antibiotic resistance. Antimicrobial resistance surveillance should be strengthened in clinical practice to support accurate etiological diagnosis and appropriate antimicrobial therapy based on antimicrobial susceptibility testing results.

Objective To investigate the changing profiles and prognostic value of serological biomarkers in patients with severe pneumonia caused by different pathogens. Methods A total of 164 patients diagnosed with severe pneumonia in Xishan People’s Hospital from July 2022 to April 2024 were enrolled. The patients were assigned to bacterial infection group (n=64), Mycoplasma infection group (n=47), or viral infection group (n=53). The patients were also stratified into survivor group (n=107) or death group (n=57) according to outcomes. F test, t-test and Chi-square test were used to analyze the demographic data, symptoms, vital signs, and serological biomarkers in different groups. Multivariate Cox proportional hazards model was constructed to predict the poor prognosis of severe pneumonia. Goodness-of-fit test was performed, and the receiver operating characteristic curve (ROC) was used to evaluate the performance of the model. The locally weighted regression (LOWESS) was used to analyze the correlation between platelet-to-lymphocyte ratio (PLR) and clinical pulmonary infection score (CPIS). The restricted cubic spline (RCS) model was constructed to analyze the dose-response relationship between PLR and the risk of adverse outcome of severe pneumonia. Results The clinical pulmonary infection score (CPIS), white blood cell count (WBC), platelet count (PLT), lymphocyte (LYM), neutrophil (NEU), PLR, neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), procalcitonin (PCT) and serum amyloid-like protein A (SAA) showed significant differences between the patients caused by bacterial infection, Mycoplasma infection or viral infection (P < 0.05). The CPIS score, WBC, LYM, PLR, NLR, CRP and SAA were significantly different between survivors and deaths (P < 0.05). Multivariate Cox proportional hazards model analysis showed that CPIS score, NLR, CRP, SAA and PLR were risk factors for poor prognosis in patients with severe pneumonia (P < 0.05). The model incorporating PLR for poor prognosis had better Hosmer-Lemeshow goodness of fit, larger AUC value and better diagnostic efficiency for patients with severe pneumonia. The LOWESS analysis showed nonlinear relationship between PLR and CPIS score to some extent. RCS model analysis showed that there was a nonlinear dose-response relationship between PLR and the risk of poor outcome in patients with severe pneumonia (P _{for nonlinear} = 0.048 < 0.05). Conclusions PLR is significantly different between patients with severe pneumonia caused by different pathogens. PLR-containing biomarker panel can improve the diagnostic performance of severe pneumonia.

Objective To investigate the clinical characteristics and prognostic factors of Staphylococcus aureus bloodstream infections in adult patients for improving clinical treatment and identifying potential interventions. Methods Clinical data of inpatients diagnosed with S. aureus bloodstream infection confirmed by blood culture in a hospital from January 2016 to December 2023 were retrospectively reviewed. The data included patient age, gender, history of hospital admission, department of admission, underlying diseases, primary infection, quick Pitt bacteremia score (qPitt), invasive treatment, empirical anti-infective treatment, and treatment outcomes. Patients were assigned to case group or control group according to whether they died in hospital in order to identify the prognostic factors of patient outcomes. Binary logistic regression analysis was used to identify independent prognostic factors. Results A total of 233 cases of S. aureus bacteremia were identified. Multivariate logistic regression analysis showed that age ≥ 70 years old (OR = 4.725, 95% CI: 1.228-18.173, P = 0.024), diabetes mellitus (OR = 8.161, 95% CI: 1.954-34.086, P = 0.004), Charlson comorbidity index (CCI) ≥ 5 (OR = 7.672, 95% CI: 1.901-30.963, P = 0.004), hospital infection (OR= 7.853, 95% CI: 1.588-38.832, P = 0.012), and qPitt ≥ 2 (OR = 23.189, 95% CI: 4.461-120.552, P < 0.001) were independent prognostic factors for poor outcome of patients with S. aureus bacteremia, while catheter-associated infection (OR = 0.051, 95% CI: 0.005-0.579, P = 0.016) was negatively correlated with mortality. Conclusions Advanced age, diabetes mellitus, high CCI, hospital infection, and high qPitt were independent prognostic factors for poor outcomes of patients with S. aureus bacteremia. The patients should be well managed by timely removal of eradicable lesions to improve patient outcomes.

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.

Objective To summarize the changing prevalence of carbapenem resistance in Enterobacterales based on the data of CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021 for improving antimicrobial treatment in clinical practice. Methods Antimicrobial susceptibility testing was performed using a commercial automated susceptibility testing system according to the unified CHINET protocol. The results were interpreted according to the breakpoints of the Clinical & Laboratory Standards Institute (CLSI) M100 31st ed in 2021. Results Over the seven-year period (2015-2021), the overall prevalence of carbapenem-resistant Enterobacterales (CRE) was 9.43% (62 342/661 235). The prevalence of CRE strains in Klebsiella pneumoniae, Citrobacter freundii, and Enterobacter cloacae was 22.38%, 9.73%, and 8.47%, respectively. The prevalence of CRE strains in Escherichia coli was 1.99%. A few CRE strains were also identified in Salmonella and Shigella. The CRE strains were mainly isolated from respiratory specimens (44.23 ± 2.80)%, followed by blood (20.88 ± 3.40)% and urine (18.40 ± 3.45)%. Intensive care units (ICUs) were the major source of the CRE strains (27.43 ± 5.20)%. CRE strains were resistant to all the β-lactam antibiotics tested and most non-β-lactam antimicrobial agents. The CRE strains were relatively susceptible to tigecycline and polymyxins with low resistance rates. Conclusions The prevalence of CRE strains was increasing from 2015 to 2021. CRE strains were highly resistant to most of the antibacterial drugs used in clinical practice. Clinicians should prescribe antimicrobial agents rationally. Hospitals should strengthen antibiotic stewardship in key clinical settings such as ICUs, and take effective infection control measures to curb CRE outbreak and epidemic in hospitals.

Objective To investigate the clinical features, imaging features, diagnosis and treatment of empyema caused by Streptococcus constellatus for improving early diagnosis and treatment and reduce mortality rate. Methods The clinical data of 11 patients with empyema caused by S. constellatus who were treated in Fuding Hospital of Fujian Province from February 2021 to August 2024 were retrospectively analyzed. Results All the 11 patients were male, 51 to 78 years old. Underlying disease was reported in 9 patients. The main clinical manifestations were chest tightness and dyspnea. Fever may not be present. The white blood cell count, neutrophil ratio, C-reactive protein, procalcitonin, fibrinogen and D-dimer were significantly increased in 11 patients. Chest imaging showed unilateral encapsulated effusion, more common on the right side (9/11), and sometimes accompanied by pneumothorax (2/10). The lung lobes of the same side of empyema were mostly accompanied by exudation and consolidation, and cavities were common (6/10) in the consolidation lesions. White blood cells, multinucleated cells, lactate dehydrogenase (LDH) and adenosine deaminase (ADA) were significantly increased in pleural effusion of 11 patients. The positive rate of pleural effusion culture in aerobic bottle (10/11) and anaerobic bottle (6/7) was higher than that in blood plate culture (1/7). All the 11 patients were treated with antibiotics combined with thoracentesis and drainage. Ten patients improved after treatment. One patient died of septic shock in a short time. Conclusions Drainage of pleural effusion and pleural fluid culture should be performed as soon as possible for middle-aged and elderly male patients with underlying diseases, acute or subacute onset of chest distress, dyspnea, associated with significantly increased blood inflammatory markers, and chest imaging suggesting pleural effusion. Pleural fluid can be injected into the blood culture bottle to improve the detection of S. constellatus. At the same time, antimicrobial therapy should be prescribed reasonably according to the results of antimicrobial susceptibility test.

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.

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.

Objective To analyze the clinical distribution and antimicrobial susceptibility of Ralstonia mannitolilytica strains isolated from clinical specimens at a tertiary hospital in Shanghai. The results could inform better clinical treatment of R. mannitolilytica. Methods A total of 47 R. mannitolilytica isolated from January 2022 to August 2024 were collected. The clinical data of patients from whom these strains were isolated were reviewed and analyzed. Results The 47 strains of R. mannitolilytica were mainly isolated from hematology department (85.1%, 40/47) and intensive care unit (4.3%, 2/47). In the 47 patients with R. mannitolilytica isolate, 83.0% had hematological disease and 85.1% stayed in hospital for at least 28 days. Overall, 63.8% of the 47 patients used antibiotics for at least 3 weeks and 76.6% of the patients used at least three types of antibiotics during hospital stay. All of the 47 R. mannitolilytica strains were resistant to aztreonam, while 84.6%, 83.3%, 70.4%, and 69.6% of the strains were resistant to meropenem, ticarcillin-clavulanate acid, ceftazidime, and piperacillin-tazobactam, respectively, 58.7%, 55.8%, 52.2%, and 42.2% of the strains were resistant to amikacin, tobramycin, cefepime, and imipenem, respectively. In contrast, 88.1%, 83.3%, 82.9%, 67.4% and 60.5% of the strains were susceptible to minocycline, doxycycline, cotrimoxazole, ciprofloxacin, and levofloxacin, respectively. Conclusions Most of the R. mannitolilytica strains were multi-drug resistant. The bacteria is more prevalent in patients with hematological disorders and long-term treatment with multiple broad-spectrum antimicrobial agents.

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.

Objective To explore the factors influencing the blood concentration of voriconazole in elderly hospitalized patients and inform the probability of attaining the target concentration in clinical practice. Methods Patients aged ≥65 years who were hospitalized in the First Affiliated Hospital of Anhui Medical University from January 2022 to December 2023 and underwent voriconazole blood concentration monitoring were enrolled. Their voriconazole blood concentrations and clinical data were collected. The patients were grouped according to the target effective concentration 0.5-5.0 mg/L of voriconazole recommended by the Chinese Pharmacological Society guidelines. Multivariate logistic regression analysis was used to determine the factors affecting the rate of achieving the target concentration. Results The 202 enrolled patients included 139 males and 63 females. A total of 244 voriconazole blood concentrations were available. The median age of the patients was 74 (range: 65-95) years. Voriconazole blood concentration ranged from 0.08 to 13.38 mg/L. The average concentration was (4.10 ± 2.45) mg/L. The target effective blood concentration of voriconazole was achieved in 65.35% (132/202) of the patients. Logistic regression results showed that the dosage regimen, body weight, and hypoproteinemia (albumin < 25 g/L) were the main factors affecting voriconazole blood concentration. Conclusions The dosing regimen, body weight, and hypoproteinemia are the main influencing factors of voriconazole blood concentration. Relevant factors should be fully considered in clinical medication to ensure the safety and effectiveness of voriconazole.

Objective To review the characteristics of Rhizopus microsporus infection for better awareness of the disease. Methods One case of pneumonia caused by R. microsporus was reported in a 66-year-old male patient. Similar reports on infections caused by R. microsporus were retrieved in PubMed and CNKI databases since 2013. The characteristics of patients with R. microsporus infection were reviewed. Results This case involves a 66-year-old male patient presenting with a 10-day history of cough, sputum production, and hemoptysis. The patient had a previous history of diabetes mellitus. Pulmonary CT scan revealed an irregular soft tissue density mass in the right lower lobe and pneumonia. The clinical presentation and laboratory findings were consistent with pulmonary mucormycosis caused by R. microsporus. R. microsporus was isolated from bronchoalveolar lavage fluid culture. The patient was treated with intravenous liposomal amphotericin B followed by oral posaconazole for antifungal therapy, and achieved a favorable prognosis. A total of 24 cases (18 males, 5 females, 1 unknown) of R. microsporus infection were reviewed (including this one). The specific site of infection included pulmonary infection (n=10), ocular infection (n=1), skin tuberculosis (n=1), splenic abscess (n=1), oral mucositis (n=1), gouty arthritis (n=1), esophageal ulceration (n=1), abdominal infection (n=1), and others (n=7). The clinical symptoms varied with the organs involved. Majority of the patients (n=11) were cured by surgery combined with antimicrobial therapy. Overall, 13 patients died. Conclusions Clinicians should be aware of the possibility of R. microsporus infection in case of pulmonary infection, especially those with diabetes mellitus.

Objective To compare and analyze the clinical characteristics and outcomes of community-acquired pneumonia (CAP) caused by methicillin-sensitive Staphylococcus aureus (MSSA) and CAP caused by Streptococcus pneumoniae. Methods A prospective observational study was conducted on 870 patients with CAP diagnosis who were hospitalized during the period from February 2019 to January 2023. The patients were assigned to MSSA or S. pneumoniae group according to the primary pathogen of CAP. The clinical characteristics and outcomes of patients were compared between groups. Results Overall, 51 patients with MSSA CAP and 819 patients with S. pneumoniae CAP were included in this study. Fever was reported in 62.75% (32/51) of patients with MSSA-CAP and 79.49% (651/819) of patients with S. pneumoniae CAP. Compared to S. pneumoniae, MSSA was associated with longer hospital stay (OR = 2.016, P = 0.016), longer ICU stay (OR = 1.829, P = 0.004), more ICU admission (OR = 3.024, P < 0.001), more mechanical ventilation (OR = 2.243, P = 0.002), higher mortality within 30 days of admission (OR = 2.623, P < 0.001), and higher mortality within 1 year after onset (OR = 2.779, P = 0.033). Conclusions The clinical symptoms of patients with MSSA CAP are relatively mild, but the outcome is worse than the patients with S. pneumoniae CAP.

Objective To investigate the effect of linezolid on platelets in patients with acute myeloid leukemia (AML) and analyze the safety profile of linezolid by comparing the platelet count and bleeding risk of linezolid during bone marrow suppression in patients after chemotherapy for AML. Methods A retrospective study was conducted on patients who underwent chemotherapy for AML in a tertiary hospital from January 2020 to November 2024. The patients treated with linezolid and those not receiving linezolid were matched in a 1:2 ratio. The safety of linezolid during bone marrow suppression after chemotherapy for AML was analyzed in terms of platelet count <20×10⁹/L, <50×10⁹/L, minimum platelet count, total platelet transfusion volume, and clinical bleeding events. Results A total of 126 patients were enrolled, including 42 patients receiving linezolid and 84 patients not receiving linezolid. There was no significant difference between linezolid group and control group in the days for platelet count <20×10⁹/L and <50×10⁹/L. No life-threatening severe bleeding events were reported in either group. The time to platelet recovery and time to platelet count increase prolonged significantly in patients who received linezolid treatment for more than 7 days during bone marrow suppression. Albumin <35 g/L may prolong the time to platelet count increase. Conclusions This study suggests that short-term use of linezolid for not more than 7 days is safe during bone marrow suppression in patients after chemotherapy for AML. When linezolid is used for more than 7 days, the time required for platelet recovery and platelet count increase will be significantly prolonged. In cases of albumin <35 g/L, the time required for platelet count increase may be prolonged. These findings can inform clinical decision-making and help optimize infection management strategies for AML patients.

Objective To investigate the clinical features, etiological features and prognosis of patients with hematologic diseases complicated with candidemia for improving clinical diagnosis and treatment. Methods A retrospective analysis was conducted for 107 hematological patients complicated with candidemia who were treated in the First Affiliated Hospital of Zhengzhou University, Henan Cancer Hospital, Henan Provincial People's Hospital, or Zhengzhou People's Hospital from June 2022 to May 2024. The clinical data and pathogenic bacteria were analyzed by univariate and multivariate analyses. Results The Candida pathogen of the 107 cases of candidemia were mostly Candida tropicalis (73.8%), followed by Candida parapsilosis, Candida glabrata, and Candida albicans. Antifungal susceptibility testing showed that 43.9%, 47.7%, and 48.6% of the Candida strains were resistant voriconazole, fluconazole and itraconazole, respectively. Logistic regression analysis found that disease not in remission (OR=7.795, 95% CI: 2.274-26.723), septic shock (OR=10.376, 95% CI: 1.129-95.388), multiple organ dysfunction syndrome (MODS) (OR=9.107, 95% CI: 1.789-46.361), and inappropriate antifungal treatment (OR=3.422, 95% CI: 1.153-10.153) were risk factors for 30-day mortality in hematological patients with candidemia. Conclusions Candidemia in patients with hematological diseases is associated with high mortality rate, the major pathogen of which is Candida tropicalis. The Candida isolates showed high resistance rates to azoles. Disease not in remission, septic shock, MODS, and inappropriate antifungal treatment are the risk factors for mortality.

Objective To investigate the value of procalcitonin-to-albumin ratio (PAR) for predicting 28-day mortality risk in elderly patients with sepsis for optimizing the diagnosis and treatment strategies. Methods The clinical data of 112 elderly patients diagnosed with sepsis in the intensive care unit were retrospectively reviewed and analyzed. Patients were assigned to survivors group or deaths group based on 28-day outcomes. Clinical characteristics and the results of laboratory tests were collected, including procalcitonin (PCT), albumin, and C-reactive protein (CRP). The normally distributed data were compared between groups using t-test. Mann-Whitney U test was adopted for comparing non-normally distributed data. Cox proportional hazards regression model was used to analyze the effects of multiple variables on survival time. Receiver operating characteristic (ROC) curve analysis was performed to determine the sensitivity and specificity of various variables in predicting mortality risk. Results Mechanical ventilation, APACHE II scores, and length of hospital stay (all P < 0.05) were significantly different between survivors group and deaths group. Blood culture results showed that Gram-negative bacteria were predominant pathogen (75.9%), especially Escherichia coli (45.5%). Albumin level was significantly lower (P = 0.026), while PCT, CRP, and PAR levels were significantly higher (P <0.05) in the deaths group compared to those in the survivors group. Multivariate Cox regression analysis revealed that PAR was an independent predictor of 28-day mortality (HR = 3.72, 95% CI: 1.98-4.42, P < 0.001). ROC curve analysis showed that the area under the curve (AUC) of PAR was 0.852 in predicting mortality, with a sensitivity of 81.25% and specificity of 87.82%. Conclusions PAR outperformed PCT or albumin alone in predicting 28-day mortality risk in elderly patient with sepsis. For every 0.1 increase in PAR, the risk of mortality increased by 272%. Early monitoring of PAR can assist clinicians in rapidly identifying high-risk patients and optimizing treatment strategies.

Objective To assess the diagnostic utility of white blood cell (WBC) count, neutrophil percentage (N%), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), human neutrophil lipocalin (HNL), and heparin-binding protein (HBP) in differentiating bacterial infections from viral infections, and compare the diagnostic efficacy of these biomarkers. Methods Blood samples were collected from 100 patients with bacterial infections, 100 patients with viral infections, and 80 healthy individuals (healthy controls) who underwent health check-ups. Seven inflammatory biomarkers were tested. The diagnostic efficacy of each marker alone and in combinations was analyzed. The receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was calculated. Results The levels of WBC, CRP, PCT and HNL in the bacterial infection group were higher than those in the viral infection group. The levels of 7 inflammatory biomarkers in the bacterial infection group and viral infection group were higher than those in the control group. The levels of N%, IL-6 and HBP did not show significant difference between the bacterial infection group and viral infection group. ROC analysis showed that HNL was the best single biomarker in terms of diagnostic performance, evidenced by AUC of 0.871. The AUC of HNL+CRP +PCT was 0.882, which was better than other combination panels. Conclusions HNL has higher diagnostic utility than other inflammatory biomarkers tested in differentiating bacterial infections from viral infections. HNL+CRP+PCT is the best combination panel with higher diagnostic value than each marker alone. Combination panel test of inflammatory biomarkers is beneficial for successful clinical diagnosis and treatment of infectious diseases.

Objective To investigate the clinical characteristics, antimicrobial susceptibility of pathogens, and laboratory test results of patients with Vibrio vulnificus infection. Methods The clinical and etiological data, as well as laboratory tests were reviewed retrospectively for 14 patients with V. vulnificus infection, who were admitted to the 909^th Hospital from May 2022 to November 2023. Results Overall, 9 of the 14 patients (64.3%) had a history of exposure to seafood or seawater. Six patients (42.9%) had underlying diseases, such as hepatitis, coronary heart disease and diabetes mellitus. Eleven patients (78.6%) had a good outcome, while 3 patients (21.4%) had a poor outcome. A total of 18 strains of V. vulnificus were isolated, including 11 (61.1%) strains from wound pus, and 7 strains (38.9%) from blood. V. vulnificus isolates were susceptible to ampicillin-sulbactam, piperacillin-tazobactam, imipenem, meropenem, tetracycline, ciprofloxacin, levofloxacin, trimethoprim-sulfamethoxazole, and chloramphenicol, but only 50.0%, 55.6%, and 61.1% of the strains were susceptible to cefazolin, ampicillin, and amikacin, respectively. White blood cell count, neutrophil, C-reactive protein, prothrombin time, fibrinogen, activated partial thromboplastin time, D-Dimer, urea nitrogen, creatinine, uric acid, glutamic-pyruvic transaminase, glutamic oxaloacetic transaminase, lactate dehydrogenase, alkaline phosphatase, creatine kinase, creatine kinase isoenzyme MB, hypersensitive troponin I, myoglobin, procalcitonin, and N-terminal pro-brain natriuretic peptide were significantly increased in patients with V. vulnificus infection. Conclusions Wound pus and blood samples collected simultaneously for microbial culture can improve the detection of V. vulnificus. Early debridement and antibiotic combination therapy are vital for improving patient survival rate.

Objective To understand the clinical characteristics of renal abscess caused by Brucella infection. Methods Two cases of renal abscess caused by Brucella infection were reported, including the diagnosis, treatment of patients and review of relevant literature reports. The Chinese databases of CNKI, Wanfang, and VIP were searched with search terms "Brucella" and "renal abscess" in Chinese. The PubMed database was searched with search terms "brucella/brucellosis" and "renal abscess/renal infection" or "renal brucelloma" in English. The databases were searched from the establishment of the databases to December 2024. The clinical data of patients with renal abscess caused by Brucella infection were screened out and summarized. Results Two patients in the Affiliated Hospital of Southwest Medical University were mainly presented with fever. Abdominal CT showed space-occupying lesions in the kidneys. One patient had Brucella isolated from blood culture. The renal lesion improved after anti-infection treatment. The other patient underwent nephrectomy on the affected side. Brucella was isolated from the postoperative pus culture. A total of 10 patients were included in this review, including 8 males and 2 females, aged 36 to 68 years. Eight patients had relevant epidemiological history of brucellosis. The time from onset to admission ranged from 10 days to 3 months. The main clinical manifestations were fever in 9 cases, lumbar pain/back pain in 5 cases, and weight loss in 3 cases. Brucella was isolated from blood culture or (and) pus culture in 8 patients. Brucella antibody was positive in one patient. Brucella nucleic acid was positive in the pathological tissue of one patient. Four patients underwent surgical resection of the lesion/affected kidney. The postoperative anti-infection treatment ranged from 3 weeks to 2 months. All of the 4 patients were cured. Four patients were treated with anti-infection drugs only. The duration of treatment ranged from 6 weeks to 4 months. Two of the 4 patients were cured. One patient improved but had a recurrence of brucellosis 6 months later, and one was lost to follow-up and died 7 months later. Two patients received drainage combined with anti-infection treatment, one improved and one was cured. Conclusions Renal abscess caused by Brucella infection is rare and easily misdiagnosed or missed in diagnosis. Effective antibacterial drugs combined with appropriate surgical treatment can result in good outcomes for most patients.

Objective To evaluate the early efficacy and safety of the regimens containing delamanid and linezolid in the treatment of rifampicin resistant tuberculosis (RR-TB). Methods A total of 47 patients diagnosed with RR-TB at Public Health Clinical Center of Chengdu from August 2020 to December 2021 were enrolled, including 22 cases (46.8%) of multidrug-resistant tuberculosis (MDR-TB), 8 cases (17.0%) of RR-TB, and 17 cases (36.2%) of pre-extensively drug-resistant tuberculosis (pre-XDR-TB). All patients were treated with a regimen based on delamanid and linezolid. The efficacy and safety were evaluated at 24 weeks of treatment. Results Among the 47 patients, 46 (97.9%) completed 24 weeks of treatment and 1 (2.1%) was lost to follow-up. At 24 weeks, the sputum culture conversion rate was 100% in the 43 patients with positive baseline sputum culture. The median conversion time was 2 (2, 8) weeks. Imaging examination showed absorption in 46 patients (97.9%). Overall, 40 patients (85.1%) experienced varying degrees of adverse events (AEs) within 24 weeks. Eleven patients (23.4%) experienced AEs possibly related to delamanid, mainly including QTcF interval prolongation (12.8%), gastrointestinal reactions (8.5%), dizziness (2.1%), headache (2.1%), and allergy (2.1%). Six patients permanently discontinued delamanid due to AEs including gastrointestinal reactions (6.4%), prolonged QTcF interval (2.1%), severe dizziness (2.1%), and drug allergy (2.1%). Patients with low baseline CD4⁺ T lymphocyte counts (OR = 0.991, 95% CI: 0.984-0.999) were more likely to experience delamanid-related AEs. Thirty patients (63.8%) experienced AEs possibly related to linezolid, including myelosuppression (55.3%),peripheral neuropathy (6.4%),optic neuritis occurred (2.1%), and allergy(2.1%). Three patients (6.4%) discontinued linezolid permanently due to severe anemia, peripheral neuropathy, and allergy. Conclusions The treatment regimens containing delamanid and linezolid for RR-TB showed a high sputum culture conversion rate and good tolerance at 24 weeks. Attention should be paid to gastrointestinal reactions and cellular immunity during treatment.