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 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 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 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 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 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 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 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 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 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 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 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 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.

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 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 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 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 elucidate the clinical manifestations, diagnostic criteria, therapeutic strategies, and pathogenesis of Good's syndrome complicated with Pneumocystis pneumonia so as to improve clinicians' awareness of this rare yet clinically significant disease, and minimize the chance of missed diagnosis or misdiagnosis. Methods The diagnosis and treatment of a patient diagnosed with Good's syndrome complicated with Pneumocystis jirovecii pneumonia (PJP) in Taihe Hospital were reviewed and summarized. The cases of Good's syndrome complicated with PJP reported in Wanfang, China National Knowledge Infrastructure (CNKI), and PubMed database were identified from 1970 to 2024. The relevant clinical data were analyzed retrospectively. Results A 39-year-old female patient was diagnosed with Good's syndrome complicated with PJP in Taihe Hospital. At early stage of treatment, she failed to respond to trimethoprim-sulfamethoxazole monotherapy. The patient experienced disease recurrence. Subsequently, the treatment regimen was adjusted to include gamma globulin therapy. The patient's symptoms were effectively controlled after treatment. A total of 9 cases were identified with Good's syndrome complicated with PJP. These patients included six males and three females. The age of patients ranged from 39 to 74 years old. Type AB thymoma was the most common thymoma subtype. All patients received treatment with intravenous gamma globulin. Conclusions IVIG constitutes a cornerstone in the treatment armamentarium for Good's syndrome complicated with PJP. Prophylactic use of immunoglobulin may be a proactive measure to avert the development of complex infections.

Objective To evaluate the bioequivalence of locally produced lefamulin acetate tablets and imported lefamulin acetate tablets in healthy subjects. Methods A total of 38 healthy subjects were divided into two groups using an open, random, two-cycle, two-sequence, crossover design. Subjects in both groups took 0.6 g test preparation and reference preparation orally on day 1 and day 8 in sequence, with a washout period of at least 1 week. The concentration of lefamulin in plasma was determined by liquid chromatography-tandem mass spectrometry. The main pharmacokinetic parameters were calculated by using Phoenix WinNonlin 8.4 software. Results The mean values of main pharmacokinetic parameters C_max, AUC_0-t, and AUC_0-inf of the test preparation of lefamulin were 1 481 μg/L, 8 100 μg·h/L, and 8 346 μg·h/L, respectively. The mean values of the corresponding parameters of the reference preparation were 1 518 μg/L, 8 271 μg·h/L, and 8 520 μg·h/L, respectively. The 90% confidence interval of geometric mean ratio between test and reference preparation of lefamulin for the main pharmacokinetics parameters C_max, AUC_0-t and AUC_0-inf all fell in the range of 80.0% to 125.0%. Conclusions The test preparation and the reference preparation of lefamulin acetate tablets are bioequivalent in healthy Chinese adult subjects.

Objective To evaluate the utility of tuberculosis antibody (TB-Ab), adenosine deaminase (ADA), and carbohydrate antigen 125 (CA125) alone or in combination for differentiating tuberculous from non-tuberculous pleural effusion. Methods This retrospective study included 75 patients initially diagnosed with tuberculous pleural effusion (observation group) and 75 patients hospitalized with non-tuberculous pleural effusion (control group) between January 2020 and June 2024. Receiver operating characteristic (ROC) curve analysis was used to compare the diagnostic performance of TB-Ab, ADA, CA125 alone or in combination for diagnosing tuberculous pleurisy. Results The patients with tuberculous pleural effusion showed significantly higher TB-Ab positive rate than the patients with non-tuberculous pleural effusion (control group) (60.00% vs 9.33%, P < 0.001). Tuberculous pleural effusion was associated with significantly higher levels of ADA [(43.44 ± 15.51) U/L] and CA125 [(175.57 ± 64.66) U/mL] compared to the control group [(27.81 ± 3.42) U/L] and (122.35 ± 41.22) U/mL, respectively (P < 0.001). Taking 34 U/L as cutoff value, ADA showed good diagnostic performance with an AUC of 0.856, sensitivity of 98.67%, and specificity of 78.67%. Taking 180 U/mL as cutoff value, CA125 demonstrated high sensitivity (89.94%) but low specificity (52.33%) with an AUC of 0.739. CA125 alone was not so specific for detecting tuberculous pleurisy. TB-Ab had an AUC of 0.753 in detecting tuberculous pleurisy, with a sensitivity of 90.67% and specificity of 61.22%. These three markers in combination significantly improved diagnostic performance, with an AUC of 0.926, sensitivity of 90.67%, and specificity of 86.67%. Conclusions TB-Ab, ADA, and CA125 in combination performed better than these biomarkers alone in diagnosing tuberculous pleurisy.

Objective To investigate the pathogen distribution and antifungal susceptibility of the strains isolated from invasive fungal bloodstream infections, and conduct epidemiological analysis of Candida tropicalis for improving clinical antifungal treatment. Methods Fungal isolates from blood were collected at the clinical laboratories. Microbial identification and antifungal susceptibility testing were conducted by matrix assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF) and VITEK2 AST-YS08 kit, respectively. Genotyping of C. tropicalis were conducted using multilocus sequence typing (MLST) system to explore the molecular epidemiology. The MLST clonal clusters (CCs) were analyzed by goeBURST software. Results A total of 47 fungal strains isolated from 46 patients were collected from August 2022 to January 2025. The patients are mainly in intensive care units (65.22%), including 36.96% in internal medicine intensive care unit, 19.57% in cardiac and vascular surgery intensive care unit, and 8.70% in neurological intensive care unit. The top three strains are C. albicans (n=15), C. tropicalis (n=13) and C. parapsilosis complex (n=11). Antifungal susceptibility testing showed that fluconazole-non-susceptible rate was 22.22% in C. parapsilosis and 76.92% in C. tropicalis. However, echinocandin drugs showed low minimum inhibitory concentration (MIC) against most fungal isolates. The concatenated sequences of the 13 strains of C. tropicalis were classified into 9 diploid sequence types (DSTs), 3 of which were newly identified DSTs. Phylogenetic analysis found clonal aggregation between azole-resistant C. tropicalis isolates. The strains resistant to both fluconazole and voriconazole are classified into the same clone cluster. Conclusions Candida are still the most common pathogens causing fungal bloodstream infections. C. albicans showed low resistance to azole drugs. C. parapsilosis showed certain degree of azole-non-susceptibility. Significantly, C. tropicalis strains were highly resistant to azoles. Azole drugs are apparently not suitable for first-line treatment of C. tropicalis candidemia. The clonal aggregation phenomenon of azole-resistant isolates calls for more epidemiological researches on C. tropicalis in future clinical practice.

Objective To review the clinical characteristics of Slackia exigua infections for improving the diagnosis and treatment. Methods We reviewed the clinical characteristics of a case of pulmonary abscess caused by Slackia exigua. The infection cases caused by Slackia exigua were searched and retrieved from PubMed, CNKI, and Wanfang databases, for the articles published during the period from January 1, 2011 to December 31, 2023. Results Among the 15 cases of Slackia exigua infection, 84.6% (11/13) had underlying diseases. Hypertension was the most common underlying disease, reported in 54.5% (6/11) of patients. Fever was present in 73.3% (11/15) of patients. Oral diseases and abscess caused by Slackia exigua were found in 63.6% (7/11) and 60.0% (9/15) of patients, respectively. Mixed infection was identified in 33.3% (5/15) of patients. The bacterium was susceptible to penicillin, ampicillin-sulbactam, ceftriaxone, levofloxacin and clindamycin, but mostly (2/3) resistant to metronidazole. Conclusions Slackia exigua infection often originates from oral aspiration and can cause abscess. Beta-lactam antibiotics are preferred for treatment of Slackia exigua infections. More data are required to confirm whether metronidazole is effective.

Objective This study aimed to examine the risk factors and prognostic factors of brucellar spondylitis for early prevention and treatment of the disease, and improving the outcomes of patients. Methods A retrospective case-control study was conducted on the patients with brucellosis who were hospitalized in the Third Hospital of Hebei Medical University from June 2020 to June 2022. Patients were assigned to brucellosis without spondylitis group or brucellar spondylitis group according to the presence of spondylitis. The patients in brucellar spondylitis group were followed for 1 year. Then they were stratified into a subgroup of good or poor prognosis according to clinical outcomes. The dataset for the demographic and clinical variables of patients were analyzed using SPSS 26.0 software. Results A total of 300 patients with brucellosis were enrolled, including 113 cases of brucellosis without spondylitis and 187 cases of brucellar spondylitis. Multivariate analysis showed that age, time from onset to diagnosis, low back pain, and erythrocyte sedimentation rate were independent risk factors for brucellar spondylitis (P < 0.05). Of the 154 cases of brucellar spondylitis with known outcomes, 121 cases showed good prognosis and 33 cases had poor prognosis. COX regression analysis showed that the time from onset to diagnosis, diabetes mellitus, paravertebral abscess, and neurological impairment were independent risk factors for poor prognosis in patients with brucellar spondylitis (P < 0.05). Conclusions Old age, prolonged time from onset to diagnosis, low back pain, and increased erythrocyte sedimentation rate are independent risk factors for spondylitis in patients with brucellosis. Prolonged time from onset to diagnosis, diabetes mellitus, paravertebral abscess, and neurological impairment are independent risk factors for poor prognosis of brucellar spondylitis.

Objective To explore the clinical manifestations, diagnosis, treatment, and prognosis of patients with cutaneous nocardiosis. Methods Two patients with cutaneous nocardiosis admitted to Department of Dermatology of Jiangsu Province Hospital during the period from 2023 to 2024 were reported. Gene sequencing confirmed Nocardia infection. They were treated with trimethoprim-sulfamethoxazole. The clinical characteristics, treatment process, and disease progression were analyzed. CNKI and Wanfang Databases were searched using the Chinese search terms "cutaneous" and "Nocardia" for the reports from January 1, 2004, to September 25, 2024, yielding 281 articles. PubMed was searched for the reports in English using "cutaneous" and "Nocardia" as search terms, yielding 282 articles. A total of 52 reports in Chinese and 109 in English were included in this review. The detailed data of 180 patients with primary cutaneous nocardiosis were analyzed and summarized to systematically elaborate on cutaneous nocardiosis. Results The cutaneous nocardiosis was caused by Nocardia brasiliensis in one patient, and caused by Nocardia farcinica in the other patient. Both patients were cured after treatment with trimethoprim-sulfamethoxazole. Overall, 60.00% of the 180 cases of cutaneous nocardiosis reported in the literature were in males. The average age of patients was 52.7 ± 19.8 years. Most of the patients were middle-aged and elderly individuals. Nocardia species were identified in 149 cases, of which 69 (69/149, 46.31%) were caused by Nocardia brasiliensis. The site of infection was mainly on the limbs, including 65 cases (36.11%) on the upper limbs and 53 cases (29.44%) on the lower limbs. Most patients (72.22%) were treated with trimethoprim-sulfamethoxazole alone or in combination with other antibacterial drugs. The prognosis was good for patients with primary cutaneous nocardiosis, which was cured in most cases. Conclusions The rashes are diverse and nonspecific for cutaneous nocardiosis. The gold standard for diagnosis is the isolation of Nocardia from clinical samples. Relevant cases are rarely reported. Sulfonamide antimicrobials are currently the first-choice treatment.

Objective To explore the clinical features, diagnosis, and treatment of Mycobacterium senegalense infection. Methods We reported a case of postoperative wound infection caused by M. senegalense in a patient who underwent spinal intradural tumor surgery at Beijing Tsinghua Changgung Hospital. CNKI, Wanfang, VIP, and PubMed databases were searched from inception to April 1, 2024 using keywords Mycobacterium senegalense both in Chinese and English to identify relevant reports. Thirteen eligible articles were retrieved, including 1 in Chinese and 12 in English. The clinical data of the 13 cases of M. senegalense infection were reviewed and analyzed. Results A case of postoperative wound infection caused by M. senegalense was reported in a patient who underwent spinal intradural tumor surgery. The patient was a 53-year-old male. He was previously healthy. The patient was initially treated for schwannoma by resection of an intraspinal space-occupying lesion at another hospital. Two weeks after the operation, the skin surrounding the surgical incision became redness, swelling, and pain. The patient did not have fever. M. senegalense was identified from pus culture. The patient was treated with doxycycline, moxifloxacin, and clarithromycin combination therapy, as well as wound disinfection and dressing changes. The infected wound subsequently healed. Among the 13 patients with M. senegalense infection, 30.8% (4/13) were males and 69.2% (9/13) were females. The average age of patients was (51.6 ± 17.7) years. The reported cases included skin and soft tissue infection (7 cases), bloodstream infection (2 cases), artificial joint infection (2 cases), and one case each of osteomyelitis and prosthetic infection. About half (46.2%, 6/13) of the patients were immunosuppressed. Most (76.9%, 10/13) of the patients were infected after surgery and trauma. Antimicrobial susceptibility test showed that all of the M. senegalense isolates were susceptible to amikacin, ciprofloxacin, clarithromycin and doxycycline. Conclusions M. senegalense infection is rarely reported. It primarily occurs following surgical procedures or trauma. Appropriate and adequate antibiotic combination therapy based on antimicrobial susceptibility testing generally results in favorable outcomes.

Objective To report a case of fungal keratitis caused by plant pathogens, evidenced by laboratory testing. Methods Specimens were collected by corneal scraping from a 52-year-old male patient for pathogen culture. The patient was treated at Qionghai People’s Hospital for fungal keratitis. The isolates were identified and tested for antimicrobial susceptibility. PubMed, CNKI, Wanfang, and VIP database were searched using keywords Diaporthe or Diaporthe phaseolorum in English and Chinese from the establishment of the database to December 10, 2024. A retrospective literature review was conducted on the cases of human infection caused by Diaporthe. Results The specimens from corneal scraping were directly examined under a microscope. Septate fungal hyphae were observed. The isolate was identified as Diaporthe phaseolorum by targeted DNA sequencing. Antimicrobial susceptibility testing by microdilution method showed that the minimum inhibitory concentrations (MIC) of fluorocytosine, fluconazole, amphotericin B, voriconazole, itraconazole, posaconazole, micafungin, caspofungin, and anidulafungin against this strain were >64, 64, 0.5, 0.12, 2, 0.06, 0.03, <0.03, and 0.12 mg/L, respectively. Clinicians adjusted the antifungal treatment plan timely based on the antimicrobial susceptibility testing results. The patient's vision was restored. Literature review found that of the 12 reported cases of infection worldwide, 6 were localized skin or soft tissue infections, 3 were peritonitis, and the remaining 3 cases were keratitis. Overall, 9 patients were immunocompromised and 3 had normal immune function. Human infections caused by Diaporthe often occur in immunocompromised individuals. Invasive infections often lead to patient mortality. There are no established breakpoints for common antifungal agents against Diaporthe. The MICs against the strain were higher for flucytosine and fluconazole, but lower for azoles, echinocandins, and polyenes. Conclusions Fungal keratitis caused by D. phaseolorum is an emerging infection. The information in this case, including clinical symptoms, the morphology of D. phaseolorum under microscope after corneal scraping, the growth characteristics and antifungal susceptibility testing, targeted DNA sequencing, can inform the microbiology laboratory staff and clinicians of D. phaseolorum infections in the future.

Objective To establish a physiologically based pharmacokinetic (PBPK) model of vancomycin in Chinese adult patients with gram-positive bacterial infection for extrapolation to children to support the clinical use of vancomycin in pediatric patients. Methods A PBPK model was established based on vancomycin concentration data during therapeutic drug monitoring in prospective multicenter clinical studies in adults and pediatric patients with gram-positive bacterial infection. Simcyp^® software was used to establish a vancomycin PBPK model based on the concentration data from 18 organs of Chinese adults. Steady-state volume of distribution was predicted according to the Rogers and Rowland method. The tissue-plasma partition coefficient was predicted by the default value of the software. A vancomycin PBPK model was established for children aged 0-17 years by changing the physiological parameters of the population and extrapolating them to children. Clinical concentration data of vancomycin were used for internal and external validation. When the fold error of prediction was in the range of 05-2, the prediction effect of the model was considered to be good. Results In this study, 380 adult patients and 108 pediatric patients were included. A PBPK model was established for adult and pediatric patients, respectively. The external verification of the measured data of 23 children confirmed that following administration of vancomycin 40 mg·kg^-1·d^-1 every 6 hours, the measured and predicted mean values of steady-state peak concentration (C_max,ss) were 22.28 mg/L and 30.27 mg/L, respectively, with a fold error of 1.36. The measured and predicted mean values of steady-state trough concentration (C_min,ss) were 4.84 mg/L and 5.12 mg/L, respectively, with a fold error of 1.06. For the dosing regimen of vancomycin 60 mg·kg^-1·d^-1 every 6 hours, the measured and predicted mean values of C_max,ss were 28.60 mg/L and 45.56 mg/L, respectively, with a fold error of 1.59. The measured and predicted mean values of C_min,ss were 5.03 mg/L and 7.74 mg/L, respectively, with a fold error of 1.54. Conclusions The PBPK model of vancomycin established for adults in this study can be extrapolated to children, which is helpful for individualized treatment of vancomycin in children.

Objective To analyze the clinical characteristics and risk factors associated with the development of severe pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA). Methods Seventy patients with MRSA-associated pneumonia who were hospitalized in the First Affiliated Hospital of Soochow University from June 2023 to August 2024 were enrolled. They were assigned to severe pneumonia (SP group, n=28) or non-severe pneumonia (nSP group, n=57) based on the diagnostic criteria for severe pneumonia. The clinical data, underlying conditions, and laboratory test results were analyzed retrospectively to identify the risk factors for severe pneumonia. Results There was no statistically significant difference between the SP group and the nSP group in patient gender, age, common underlying diseases, clinical manifestations, white blood cell count, lymphocytes, neutrophils, or platelet count (P > 0.05). Healthcare-associated MRSA (HA-MRSA) was the most common pathogen in both groups without significant difference between groups (P > 0.05). However, the age-adjusted Charlson Comorbidity Index score (aCCI score), C-reactive protein, and serum lactate levels were significantly higher in the SP group compared to the nSP group(P < 0.05). Multivariate logistic regression analysis indicated that aCCI score, C-reactive protein, and serum lactate levels were risk factors for predicting the deterioration of MRSA pneumonia. The three variables combined performed better in predictive efficacy (AUC = 0.893, P < 0.001, 95% CI: 0.815 to 0.972). Conclusions The clinical manifestations of MRSA pneumonia are nonspecific. An aCCI score greater than 7, along with elevated levels of C-reactive protein, and serum lactate at early stage indicates that MRSA pneumonia may progress to a severe form.

Objective To examine the changing prevalence and antimicrobial resistance profiles of Burkholderia cepacia in 52 hospitals across China from 2015 to 2021. Methods A total of 9 261 strains of B. cepacia were collected from 52 hospitals between January 1, 2015 and December 31, 2021. Antimicrobial susceptibility of the strains was tested using Kirby-Bauer method or automated antimicrobial susceptibility testing systems according to a unified protocol. The results were interpreted according to the breakpoints released in the Clinical & Laboratory Standards Institute (CLSI) guidelines (2023 edition). Results A total of 9 261 strains of B. cepacia were isolated from all age groups, especially elderly patients. The proportion was 11.1% (1 032 strains) in children, significantly lower than the proportion in adults. About half (46.5%, 4 310/9 261) of the strains were isolated from patients at least 60 years old and 42.3% (3 919/9 261) of the strains were isolated from young adults. Most isolates (71.1%) were isolated from sputum and respiratory secretions, followed by urine (10.7%) and blood samples (8.1%). B. cepacia isolates were highly susceptible to the five antimicrobial agents recommended in the CLSI M100 document (33rd edition, 2023). B. cepacia isolates showed relatively higher resistance rates to meropenem and levofloxacin. However, the resistance rates to ceftazidime, trimethoprim-sulfamethoxazole, and minocycline remained below 8.1%. The percentage of B. cepacia strains resistant to levofloxacin was the highest compared to other antibiotics in any of the three age groups (from 12.4% in the patients < 18 years old to 20.6% in the patients aged 60 years or older). Conclusions B. cepacia is one of the clinically important non-fermenting gram-negative bacteria. Accurate and timely reporting of antimicrobial susceptibility test results and ongoing antimicrobial resistance surveillance are helpful for rational prescription of antimicrobial agents and proper prevention and control of nosocomial infections.

Objective To assess the public's knowledge level regarding basic antibiotic-related concepts, their adherence to proper antibiotic usage, and their attitudes toward discontinuing skin testing of β-lactam (penicillin) allergy. The study aims to provide guidance for improving the current state of antibiotic usage and reducing the healthcare burden. Methods A questionnaire survey was conducted via online questionnaire "Wenjuanxing" among patients in the Department of Infectious Diseases at the First Affiliated Hospital of China Medical University, as well as their family members and the hospital's healthcare workers between May 1, 2023, and April 30, 2024. The study analyzed the public's knowledge level of antibiotics, their adherence to appropriate antibiotic usage, and the factors influencing the formulation of policies on discontinuing skin testing of β-lactams. Results A total of 533 valid questionnaires were collected from patients and their family members, and 194 valid questionnaires were collected from healthcare workers at the hospital. Overall, the public's knowledge level regarding antibiotics was low and moderate, which was significantly associated with gender (OR = 1.484, 95% CI: 1.023-2.154), different income level (OR = 2.548, 95% CI: 1.433-4.531; OR = 1.981, 95% CI: 1.063-3.694), and family medical background (OR = 0.130, 95% CI: 0.036-0.465). Approximately 22.33% of individuals had antibiotic misuse. Multiple medical visits (OR = 1.990, 95% CI: 1.284-3.082) and the habit of purchasing health supplements (OR = 1.786, 95% CI: 1.045-3.053) significantly affect the standardization of public antibiotic use behavior. Regarding the policy of discontinuing β-lactam skin tests, approximately 81.24% of the public showed low levels of acceptance, particularly among urban residents (OR = 1.951, 95% CI: 1.109-3.433), low-income groups (OR = 2.441, 95% CI: 1.300-4.585), and 45-69 years individuals (OR = 4.094, 95% CI: 2.384-7.032). Analysis of the questionnaires from the healthcare workers of our hospital revealed that although nearly all respondents (92.78%) had a high level of knowledge about antibiotics, only 35.57% could use them in a very standardized manner. For the policy of discontinuing β-lactam skin tests, only 32.47% held a positive attitude, while 67.53% expressed opposition. Conclusions Currently, more efforts are needed to improve public knowledge about antibiotics, adherence to appropriate usage behaviors, and acceptance of the policy to abolish skin tests for beta-lactam drugs. Females, high-income individuals, and those from families with a medical background demonstrate higher levels of awareness, but improper use of antibiotics remains prevalent, particularly among individuals who frequently seek medical care or have a habit of purchasing health supplements. As for the policy to cancel skin tests, acceptance is lower among 45-69-year-old people, low-income groups, and urban residents. Although healthcare workers possess higher levels of knowledge about antibiotics, there is still room for improvement in their practice adherence and acceptance of the policy.

Objective To analyze the research hotspots and trends of nosocomial infections during the period from 2020 to 2024, and provide references and suggestions for future research. Methods The literature related to nosocomial infection from CNKI and Web of Science (WOS) databases published during the period from 2020 to 2024 were searched. The authors, countries, and keywords were analyzed by network co-occurrence analysis using CiteSpace 6.2.R3. Results A total of 1 132 articles were identified from the WOS database and 1 793 articles identified in the CNKI database. The United States published a large number of articles and established the world’s largest cooperation network. The authors with a relatively high number of publications include Yin Ruijie, Mehta Yatin, Duszynska Wieslawa, Li Liuyi, Wu Anhua, and Liu Yunxi. Cluster analysis found 14 clusters (WOS database) and 19 clusters (CNKI database) in the keyword co-occurrence network. It mainly covers three major themes of nosocomial infection: epidemiological characteristics, influencing factors, and prevention and control strategies as well as management measures. The key words bursts include antibacterial activity, multidrug-resistant organisms, gram-negative bacteria, machine learning, disinfection supply center, etiology, Omicron variant, cerebral infarction, logistic regression analysis, and multidisciplinary collaboration. Conclusions Future research should continue to promote academic exchanges and cooperation among research teams, and actively keep track of the latest developments in international research. The issues of microbial resistance, individualized infection prevention strategies, and multidisciplinary collaborative studies are likely to be the focus of future research.