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 investigate the changing carbapenem resistance profiles of Klebsiella pneumoniae in China hospitals from 2020 to 2024. Methods Antimicrobial susceptibility testing was performed using disk diffusion method, E-test, or commercial automated testing instruments such as VITEK-2 Compact according to China Antimicrobial Resistance Surveillance System (CARSS) protocol. The susceptibility testing results were interpreted against the standards of the Clinical and Laboratory Standards Institute (CLSI). WHONET 5.6 software was used to analyze the prevalence and susceptibility data of carbapenem resistant K. pneumoniae (CRKP). Results From 2020 to 2024, a total of 393 406 strains of CRKP were isolated. Overall, CRKP strains showed consistently high resistance rates (≥86.4%) to cephalosporins and quinolones, and relatively low resistance rate to tigecycline (≤13.5%), but with an increasing trend over the five-year period. The overall prevalence of CRKP decreased from 10.9% in 2020 to 10.0% in 2024. The prevalence of CRKP varied with region. In 2024, Shanghai and Beijing reported the highest prevalence (24.1% and 26.5%, respectively), whereas the lowest prevalence was observed in Ningxia Hui Autonomous Region and Qinghai Province (0.8% and 0.9%). CRKP prevalence (29.0%, 34.0%, 30.9%, 33.8%, and 37.6% from 2020 to 2024) was significantly higher in the strains isolated from cerebrospinal fluid samples compared to other specimen types. CRKP prevalence (21.1%, 21.0%, 18.2%, 21.7%, and 18.6% from 2020 to 2024) in the strains isolated from intensive care units was the highest among different clinical settings. Among different hospitals, children’s hospitals were associated with the highest CRKP prevalence from 2020 to 2022 (13.6%, 13.1%, and 10.8%), while tertiary general hospitals showed the highest CRKP prevalence in 2023 and 2024 (11.7% and 10.9%). Among different age groups, neonates had the highest CRKP prevalence in 2020 and 2021 (15.0% and 13.4%), whereas elderly patients showed the highest prevalence from 2022 to 2024 (11.4%, 12.3%, and 11.3%). Conclusions The overall prevalence of CRKP decreased from 2020 to 2024 in China hospitals. However, the prevalence varied greatly with year, region, specimen type, clinical setting, hospital type, and age group, underscoring the need for ongoing surveillance of CRKP.

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 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 distribution and antimicrobial susceptibility of the bacterial strains isolated from outpatients in hospitals across China from 2020 to 2024. Methods According to China Antimicrobial Resistance Surveillance System (CARSS) technical protocol, bacterial isolates were identified using automated systems or manual methods. Antimicrobial susceptibility testing was conducted using disk diffusion method and automated systems. The susceptibility testing results were interpreted according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. WHONET 5.6 software was used to analyze the distribution of bacterial isolates and antimicrobial susceptibility testing results reported by all CARSS member hospitals in 2020-2024. Results Overall, 569 924 strains of bacteria were isolated from outpatients during the period from 2020 to 2024. Gram-positive bacteria accounted for 38.1%, and gram-negative bacteria accounted for 61.9%. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) from 2020 to 2024 was 25.1%, 24.0%, 23.9%, 23.8% and 23.3%, respectively. The corresponding prevalence of methicillin-resistant coagulase-negative Staphylococcus (MRCNS) was 66.1%, 68.0%, 65.6%, 63.3% and 62.7%, respectively. MRSA and MRCNS strains showed higher resistance rates to most antimicrobial agents than methicillin susceptible strains. Enterococcus faecalis showed lower resistance rates to most antimicrobial agents tested than Enterococcus faecium. Vancomycin-, teicoplanin- and linezolid-resistant strains were identified in both E. faecalis and E. faecium. From 2020 to 2024, the prevalence of penicillin-resistant Streptococcus pneumoniae strains isolated from non-cerebrospinal fluid specimens was 0.3%, 0.6%, 0.7%,1.0% and 0.8%, respectively. The prevalence of imipenem-resistant Pseudomonas aeruginosa was 10.5%, 10.1%, 9.4%,10.4% and 10.5%, respectively. The prevalence of imipenem-resistant Acinetobacter baumannii was 36.5%, 38.3%, 35.4%, 36.7% and 40.3%, respectively. The prevalence of ceftriaxone-resistant Escherichia coli was 47.3%, 44.5%, 44.0%, 44.7% and 44.1%, respectively. The prevalence of imipenem-resistant E. coli was 0.7%, 0.7%, 0.8%, 0.8% and 0.8%, respectively. The prevalence of ceftriaxone-resistant Klebsiella pneumoniae was 28.8%, 27.5%, 26.8%, 28.9% and 29.5%, respectively. The prevalence of imipenem-resistant K. pneumoniae was 6.0%, 6.3%, 6.1%, 6.7% and 6.9%, respectively. From 2020 to 2024, the prevalence of ampicillin-resistant Haemophilus influenzae was 44.5%, 60.7%, 68.5%, 69.3% and 79.5%, respectively. Conclusions Antimicrobial resistance of the bacterial strains isolated from outpatients is still serious, especially multidrug-resistant Gram-negative bacilli and methicillin-resistant Staphylococcus.

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 investigate the clinical features, risk factors and prognosis of Streptococcus mitis bloodstream infection in children with acute myeloid leukemia (AML). Methods A retrospective analysis was conducted on the clinical data of 82 children with AML complicated with bloodstream infection, who were admitted to Department of Hematology and Oncology of Hunan Children’s Hospital from December 2018 to July 2024. The patients were assigned to case group (S. mitis bloodstream infection, n = 32) or control group ( bloodstream infection due to other pathogens, n = 50) based on pathogens. The clinical characteristics of patients were compared betwen groups and the risk factors for S. mitis bloodstream infection were analyzed by logistic regression. Results Logistic regression analysis showed that FLAG regimen (fludarabine, cytarabine, idarubicin and granulocyte colony stimulating factor) was an independent risk factor for S. mitis bloodstream infection in AML patients (OR = 6.631, 95% CI: 2.075 - 21.195). All the children in case group presented with high fever as the initial symptom, accompanied by symptoms such as cough (37.5%, 12/32), oral ulcers (25.0%, 8/32), red and swollen gums (9.4%, 3/32), and perianal skin ulcers (3.1%, 1/32). The median (P₂₅, P₇₅) duration of fever was 5.0 (3.5, 10.5) days. Overall, 61.9% (13/21) of bronchopneumonia cases progressed to severe pneumonia. Antimicrobial susceptibility testing showed that all of the 31 S. mitis strains were susceptible to vancomycin and linezolid, while 96.8%, 90.3%, 74.2%, 67.7%, 51.6%, and 29.0% of the strains were susceptible to meropenem, ceftriaxone, clindamycin, levofloxacin, penicillin, erythromycin, respectively. The 30-day overall mortality rate was 6.2% (2/32). Conclusions The FLAG regimen for AML significantly increases the risk for S. mitis bloodstream infection in children with AML. Such infections are characterized by persistent fever and are prone to complications such as severe pneumonia. S. mitis is highly resistant to penicillin. It is recommended to preferentially use highly active beta-lactam antibiotics, such as ceftriaxone, to effectively reduce the risk of infection and improve treatment outcomes.

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 analyze the types and characteristics of drug-resistant gene mutations in rifampicin-resistant tuberculosis (RR-TB) by whole-genome sequencing (WGS) and compared with the performance of the Xpert MTB/XDR assay. Methods Sixty-nine RR-TB strains isolated from Yunnan Provincial Hospital of Infectious Diseases and characterized by WGS and Xpert MTB/XDR testing between September 2020 and September 2023 were selected for analysis of drug resistance gene mutations. Results Among the 69 RR-TB strains, the resistance mutation rates for isoniazid, ethambutol, pyrazinamide, streptomycin, and fluoroquinolones were 65.2%, 52.2%, 21.7%, 47.8%, and 33.3%, respectively. Among the 45 isoniazid-resistant strains, mutations in katG gene were the most common (86.7%, 39/45). Among the 36 ethambutol-resistant strains, mutations in embB gene were predominant (91.7%, 33/36). All 15 pyrazinamide-resistant strains harbored mutations in pncA gene. Among the 33 streptomycin-resistant strains, mutations in rpsL gene were the most prevalent (72.7%, 24/33). All of the 23 fluoroquinolone-resistant strains exhibited mutations in gyrA gene. No amikacin resistance gene mutations were detected. The predominant mutation types were katG S315T, embB codon 306 mutations, pncA mutations, rpsL K43R, and gyrA mutations at codons 90, 91, or 94. Taking WGS as the reference standard, Xpert MTB/XDR testing demonstrated good sensitivity for detecting isoniazid resistance and favorable sensitivity and specificity for detecting fluoroquinolone resistance. Conclusions RR-TB strains showed relatively high rate of fluoroquinolone resistance. Xpert MTB/XDR testing has demonstrated good sensitivity and specificity for detecting fluoroquinolone resistance. It is appropriate for rapid diagnosis.

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.

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 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 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 investigate the correlation between serum levels of miR-15a-5p, miR-155-5p, miR-146a-5p and the severity and prognosis of severe pneumonia. Methods Sixty-five patients with severe pneumonia admitted to Linyi Central Hospital during the period from July 2022 to July 2024 were selected as the study group. Another 40 patients with non-severe pneumonia were assigned to the control group. Spearman method was used to analyze the correlation between serum miR-15a-5p, miR-155-5p, miR-146a-5p levels and clinical pulmonary infection score (CPIS) in patients with severe pneumonia. Logistic analyses were carried out to identify the factors affecting the prognosis of patients with severe pneumonia. Receiver operating characteristic (ROC) curve was applied to analyze the value of serum miR-15a-5p, miR-155-5p, and miR-146a-5p levels for predicting the prognosis of patients with severe pneumonia. Results Compared with patients with non-severe pneumonia, the patients with severe pneumonia had significantly higher miR-15a-5p, miR-155-5p levels and CPIS, and significantly lower miR-146a-5p level (P < 0.05). Serum miR-15a-5p and miR-155-5p levels in patients with severe pneumonia were positively correlated with CPIS (r = 0.320, 0.416, P < 0.05), while serum miR-146a-5p level was negatively correlated with CPIS (r = –0.386, P < 0.05). Compared with surviving patients, the patients who died from severe pneumonia had significantly higher serum levels of miR-15a-5p and miR-155-5p, and significantly lower miR-146a-5p level (P < 0.05). Serum levels of miR-15a-5p and miR-155-5p were risk factors for the poor outcomes of patients with severe pneumonia, while serum miR-146a-5p level was a protective factor for the prognosis of patients with severe pneumonia (OR=1.989, 3.816, 0.481, P < 0.05). The area under the ROC curve of serum miR-15a-5p, miR-155-5p, miR-146a-5p, and their combination in predicting the prognosis of severe pneumonia patients was 0.788 (95% CI: 0.672-0.905), 0.805(95% CI: 0.690-0.919), 0.817 (95% CI: 0.717-0.918), and 0.923 (95% CI: 0.861-0.985), respectively. The corresponding sensitivity of prediction was 73.33%, 76.67%, 73.33%, and 93.33%, respectively. The specificity of prediction was 82.86%, 85.71%, 80.00%, and 77.14%, respectively. The combination of miR-15a-5p, miR-155-5p, miR-146a-5p had significantly higher value for predicting the prognosis of severe pneumonia patients than the three biomarkers alone (Z_{combination - miR-15a-5p} = 2.296, P = 0.022; Z_{combination - miR-155-5p} =2.147, P = 0.032; Z_{combination - miR-146a-5p} = 2.234, P = 0.026). Conclusions The increased serum levels of miR-15a-5p and miR-155-5p, and the decreased miR-146a-5p level are associated with disease severity and poor outcomes of patients with severe pneumonia. The combination of the three biomarkers is more useful for predicting the prognosis of patients with severe pneumonia.

Objective To explore the role of heparanase-mediated endothelial glycocalyx degradation in the pathophysiology of acute lung injury (ALI) in septic mice and evaluate the protective effects of heparanase inhibitors on ALI. Methods A septic mouse model was established using cecal ligation and puncture (CLP). The specific heparanase inhibitor PG545 was applied for intervention. Lung tissue pathological changes were assessed by HE staining. Transmission electron microscopy was used to observe the structural changes of the pulmonary microvascular endothelial glycocalyx. Western blot was performed to detect the expression of heparanase and related signaling pathway molecules. Wheat germ agglutinin (WGA) staining was utilized to examine the glycocalyx structure on the cell surface. High-performance liquid chromatography-mass spectrometry (HPLC-MS) was employed to detect heparan sulfate degradation products. ELISA was used to measure the levels of inflammatory cytokines and endothelial function-related markers. Results In CLP mice, heparanase expression in lung tissue was significantly upregulated, leading to severe damage to the endothelial glycocalyx structure, increased alveolar-capillary membrane permeability, and exacerbated inflammatory responses. PG545 intervention effectively inhibited heparanase activity, reduced endothelial glycocalyx injury, decreased inflammatory reactions, and improved lung tissue pathological damage. Mechanistic studies revealed that heparanase promotes the release of inflammatory cytokines by activating the NF-κB pathway and disrupts endothelial barrier function by inducing endothelial cytoskeletal remodeling. Conclusions Heparanase-mediated endothelial glycocalyx degradation is a key pathological mechanism in sepsis-induced acute lung injury. The heparanase inhibitor PG545 exerts significant protective effects on sepsis-associated acute lung injury by preserving the integrity of the endothelial glycocalyx, reducing the increase of lung vascular permeability, and attenuating inflammatory responses, thus providing a new potential target for clinical treatment of sepsis-related acute lung injury.

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 investigate the distribution and antimicrobial resistance profiles of the bacterial strains isolated from cerebrospinal fluid (CSF) in hospitals across China from 2020 to 2024. Methods The data on bacterial identification and antimicrobial susceptibility testing of the bacterial strains isolated from CSF specimens in about 2 000 member hospitals from 2020 to 2024 were collected and analyzed in accordance with the China Antimicrobial Resistance Surveillance System technical protocol. Results A total of 96 234 bacterial strains were isolated from 2020 to 2024, of which 71.7% were Gram positive and 28.3% were Gram negative. The top 6 organisms were coagulase-negative Staphylococcus, Acinetobacter spp., Enterococcus spp., Klebsiella spp., Escherichia coli, and Staphylococcus aureus. The prevalence of methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MRCNS) was stable at approximately 40% and 70%, respectively. The prevalence of vancomycin-resistant E. faecium increased from 3.2% in 2020 to 6.5% in 2024, while the prevalence of vancomycin-resistant E. faecalis was consistent at a low level of about 0.2%. The prevalence of penicillin-resistant S. pneumoniae increased from 71.2% to 76.9%. The prevalence of meropenem-resistant K. pneumoniae, A. baumannii and P. aeruginosa increased from 29.3%, 69.8%, and 24.3% to 39.1%, 74.6%, and 29.2%, respectively, while the prevalence of meropenem-resistant E. coli tended to be stable at approximately 4%. Conclusions Coagulase-negative Staphylococcus was predominant among the clinical isolates from CNS in China. Meropenem-resistant K. pneumoniae, A. baumannii, and P. aeruginosa are still highly prevalent. Ongoing bacterial resistance surveillance is essential for rational use of antibiotics in clinical practice and informing adequate control measures.

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

Objective To explore the clinical characteristics and predictive factors for plastic bronchitis (PB) in children with Mycoplasma pneumoniae pneumonia (MPP). Methods We retrospectively collected the clinical data from 91 MPP patients with PB (PB group) and 258 MPP patients without PB (non-PB group) who underwent bronchoscopy treatment at Department of Respiratory Medicine, Shanghai Children's Hospital between 2020 and 2023. Comparative analyses were performed on clinical manifestations, laboratory tests, imaging characteristics, and treatment regimens between the two groups to identify predictive factors for PB development in children with MPP. Results Univariate analysis showed that PB group had higher incidene rate of hypoxemia, decreased respiratory sounds, pleural effusion, ≥2/3 lobe consolidation, and atelectasis, and longer duration of fever, and higher levels of neutrophil count, C-reactive protein, alanine aminotransferase, creatine kinase MB, lactate dehydrogenase, ferritin, D-dimer, fibrinogen degradation products (FDP), interferon-γ (IFN-γ), interleukin-1β (IL-1β), tumor necrosis factor α, immunoglobulin A, and immunoglobulin M, and the higher levels of IFN-γ, IL-8, TNF-α and MP-DNA in bronchialveolar lavage fluid than the control group (P < 0.05). Multivariate logistic regression analysis showed that ≥2/3 lobe consolidation (OR=8.707,P<0.001), FDP (OR=1.216, P=0.001), and IFN-γ (OR=1.004,P=0.019) were independent risk factors for the occurrence of PB in children with MPP. ROC curve analysis demonstrated that serum FDP has certain predictive value for PB occurrence in MPP (AUC=0.73). When combined with chest CT findings of ≥2/3 lobar consolidation and serum IFN-γ levels, the predictive performance significantly improved (AUC=0.85), showing superior clinical predictive potential. Conclusions Early chest CT showing ≥2/3 lobar consolidation along with elevated serum FDP and IFN-γ levels serve as important predictive indicators for PB development in pediatric MPP patients. PB often results in stronger inflammatory response, immune disorders, and hypercoagulability.

Objective To screen out the independent risk factors for cefoperazone and sulbactam - related coagulation disorder and construct a nomogram prediction model. Methods The data of 694 patients who received cefoperazone and sulbactam (2:1) treatment in the Fifth Affiliated Hospital of Guangzhou Medical University from July 2017 to December 2023 were retrospectively collected. The patients were divided into a normal coagulation group and an abnormal coagulation group. Univariate analysis and multivariate Logistic regression analysis were performed to screen the independent risk factors. A nomogram model was constructed based on the independent risk factors. The predictive efficacy of the model was evaluated by the receiver operating characteristic (ROC) curve, calibration curve, and Hosmer-Lemeshow goodness-of-fit test. Results Among the 694 patients, 156 had abnormal coagulation, with an incidence of 22.48%. Univariate analysis showed that age, age groups, hypertension, diabetes mellitus, cerebrovascular diseases, renal function, liver function, diet type, nutrition score, serum albumin, and serum creatinine were significantly different between the two groups (P < 0.05). Multivariate logistic regression analysis indicated that renal function, liver function, nutritional score, and fasting were independent risk factors for cefoperazone and sulbactam-related coagulation disorder. A nomogram model was constructed based on these independent risk factors. Internal validation: The area under ROC curve (AUC) was 0.728 (95% CI: 0.685 - 0.771), and the χ² value of the Hosmer-Lemeshow goodness-of-fit test was 11.987 (P = 0.101), suggesting that the model had good discrimination and calibration. Conclusions Renal function, liver function, nutritional score, and fasting are independent risk factors for cefoperazone and sulbactam-related coagulation disorder. The nomogram model can directly predict the risk of medication, reminding clinicians of the risk.

Objective To analyze the early clinical characteristics, pathogenic microorganisms, treatment measures at early stage, and prognosis of patients with necrotizing soft tissue infection (NSTI) for improving early diagnosis and treatment of the disease. Method A retrospective analysis was conducted on patients with NSTI who were admitted to hospital from January 2019 to February 2024. The essential information of patients, including cause of injury, laboratory test results, early antibiotic use, time from admission to diagnosis, time from admission to surgery, laboratory risk index score for necrotizing fasciitis (LRINEC), and clinical outcomes were recorded and analyzed. Results A total of 19 patients diagnosed with NSTI were identified, including 6 deaths (31.6%) and 11 amputations (57.9%). The causes of injury included injuries by marine organism in 8 cases, animal bites in 5 cases, injuries by foreign body in 4 cases, and car accidents in 2 cases. There were 5 cases (26.3%) of type I (mixed microbial infection), 6 cases (31.6%) of type II (single bacterial infection, excluding Vibrio species), 7 cases (36.8%) of type III (Vibrio infection alone), and 1 case (5.3%) without culture results. There were 4 cases with LRINEC scores below 6, 10 cases with scores between 6 and 8, and 5 cases with scores above 8. The false negative rate was 21.1% (4/19). Among the deceased patients, 3 were infected with Vibrio vulnificus and 2 were mixed infection with multiple microorganisms, 1 was infected with single bacterial strains. Three cases of open limb injury were treated with vacuum sealing drainage after debridement. The vacuum sealing drainage was removed after more than 48 hours. Fascial necrosis was not detected early. Two patients were cured by amputation, while one patient died from amputation. The time from admission to initial surgery was 21.4 (2-72) hours. The length of stay in the intensive care unit (ICU) was 1.4 (0-7) days. The total length of hospital stay was 20.5 (2-58) days. Conclusions The incidence and mortality rate of Vibrio vulnificus are high in coastal areas. Early diagnosis and treatment are the most important means to improve the prognosis of patients with NSTI. The use of vacuum sealing drainage may delay early diagnosis of NSTI after open injury surgery. There are still some false negatives in the LRINEC score for NSTI screening, and caution should be taken against this situation.

Objective To establish an age-stratified pathogen distribution profile of pediatric lower respiratory tract infections (LRTIs) in Yichun City during 2024-2025, supporting evidence-based antibiotic stewardship. Methods A total of 326 hospitalized pediatric patients with LRTIs were enrolled in Yichun People’s Hospital, including 196 infants (<3 years) and 130 children (3-13 years). Sputum samples were collected on admission for conducting conventional bacterial culture, nucleic acid assays for atypical pathogen and Mycobacterium tuberculosis, and multiplex PCR for respiratory viruses. Results The pathogen positive rate was 74.8%. The viral positive rate (53.7%) was higher than that of bacteria (35.0%). Haemophilus influenzae (12.6%), Moraxella catarrhalis (8.3%), and Streptococcus pneumoniae (7.4%) were the predominant species among the bacteria identified from conventional culture. Among atypical pathogens, M. pneumoniae had the highest positive rate (11.0%). Among viruses, human rhinovirus (16.0%), adenovirus (13.5%), and respiratory syncytial virus (12.6%) had the highest positive rates. Age-stratified analysis showed that bacterial positive rate (44.4%) and viral positive rate (63.8%) were higher in infant (<3 years) group, particularly for S. pneumoniae, K. pneumoniae and respiratory syncytial virus; while in the pediatric (3-13 years) group, atypical pathogens (such as M. pneumoniae, 22.3%) and influenza A virus (15.4%) were more prominent. The rate of pathogen co-detection reached 31.9%, primarily bacterial-viral mixed infections (24.8%). H. influenzae and respiratory syncytial virus/adenovirus mixed infections were the most common (2.1%) pattern. Conclusions The distribution of pathogens in pediatric LRTIs in Yichun City shows obvious regional characteristics, mainly consisting of H. influenzae, M. pneumoniae, and human rhinovirus. Virus-bacteria co-detection is relatively common. The distribution of pathogens in LRTIs was significantly different between infants and children.

Objective To analyze the current status and influencing factors of drug resistance among active pulmonary tuberculosis (TB) patients in Lanzhou city from 2015 to 2022 to inform better prevention and control of drug-resistant TB. Methods A retrospective case-control study was conducted using the data of 5 966 active TB patients in Lanzhou. Univariate and multivariate logistic regression analyses were performed to identify risk factors for drug resistance. A risk prediction nomogram model was constructed. The model performance was validated by the receiver operating characteristics (ROC) curves, calibration curves, and decision curve analysis. Results The overall drug resistance rate was 4.16% among active TB patients in Lanzhou. Multivariate analysis revealed that retreated patients (OR=2.903, 95% CI: 1.591-5.298), intercity migration (OR=12.424, 95% CI: 5.114-30.185), unemployment or temporary employment (OR=3.532, 95% CI: 1.199-10.404), non-use of fixed-dose combination (FDC) regimens (OR=2.532, 95% CI: 1.617-3.965), secondary TB (OR=2.035, 95% CI: 1.425-2.907), and referral-based patient origin (OR=3.409, 95% CI: 1.066-10.902) significantly increased drug resistance risk. Protective factors included Center for Disease Control and Prevention (CDC) management (OR=0.044, 95% CI: 0.026-0.075), intensive-phase supervision (OR=0.034, 95% CI: 0.011-0.104), contact tracing patient origin (OR=0.037, 95% CI: 0.010-0.147), absence of diabetes mellitus (OR=0.274, 95% CI: 0.152-0.493), no prior anti-TB treatment history (OR=0.033, 95% CI: 0.018-0.060), and non-comorbidity with other TB types (OR=0.093, 95% CI: 0.015-0.585). The nomogram demonstrated excellent predictive performance, with an area under the curve (AUC) of 0.977 (95% CI: 0.969-0.986). Calibration and decision curves confirmed the robust clinical utility of the nomogram model. Conclusions Drug-resistant active TB remains a critical challenge in Lanzhou, influenced by multidimensional factors. The constructed nomogram model provides a reliable tool for precise risk assessment and personalized intervention optimization, offering actionable insights for clinical practice and public health strategies.

Objective To investigate the clinical features, pathogenesis, diagnosis, treatment, and prognosis of patients with hepatitis B virus (HBV) reactivation secondary to BCR-ABL tyrosine kinase inhibitors (BCR-ABL-TKIs). Methods We reported two cases of dasatinib-induced HBV reactivation in leukaemia patients in the Second Affiliated Hospital of Bengbu Medical University. Relevant literature reports were identified from PubMed, Wanfang Data, VIP, and CNKI databases since 2000, using search terms “hepatitis B virus”, “reactivation”, “imatinib”, “dasatinib”, “nilotinib”, “flumatinib”, “olverembatinib”, “bosutinib”, “ponatinib”, “BCR-ABL”, “tyrosine kinases inhibitor” and “chronic myeloid leukemia”. We examined the clinical features of patients with HBV reactivation secondary to BCR-ABL-TKIs to further understand the pathogenesis, diagnosis, prevention,treatment and prognosis of such diseases. Results The data were collected from 28 patients with HBV reactivation secondary to BCR-ABL-TKIs, including 23 males and 5 females. The average age of patients was (51.6 ± 13.1) years. Among the 28 patients, 82.1% (23/28) were HBsAg carriers. The median time from initiation of BCR-ABL-TKIs to HBV reactivation was 7.0 (4.3, 12.0) months. The BCR-ABL-TKIs used were mostly first-generation imatinib (19 cases), followed by second-generation dasatinib (7 cases) and nilotinib (2 cases). Timely antiviral therapy resulted in favourable survival outcomes, with an overall survival rate of 82.1% (23/28). Conclusions The risk of HBV reactivation caused by BCR-ABL-TKIs is high. Clinicians should be vigilant about this potential complication during treatment. Preemptive measures and timely antiviral therapy in case of HBV reactivation can significantly improve patient outcomes.

Objective To diagnose leptospirosis by metagenomic next generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF). Methods A retrospective analysis was performed on the clinical manifestations, laboratory findings, treatment, and outcome of one patient diagnosed with leptospirosis by mNGS of BALF. Relevant cases were identified by searching CNKI, VIP, Wanfang, Chinese Medical Association Journal Database and PubMed databases using the keywords “leptospirosis” and “metagenomic next-generation sequencing”. The clinical characteristics of leptospirosis and diagnosis and treatment methods were reviewed. Results The patient was admitted with complaints of “intermittent fever for more than one week and elevated serum creatinine for two days.” After admission, Leptospira was detected from BALF by mNGS. The patient was treated with penicillin-based antibiotic therapy for one week. The patient was discharged after improvement. Literature review showed that most patients presented with nonspecific symptoms such as fever, cough, sputum production, and fatigue. In some cases, mNGS of BALF detects potential pathogen in addition to Leptospira, making it necessary to clarify whether these are merely colonizing organisms or true mixed infections. Penicillin remained the primary antibiotic treatment. Conclusions The onset of leptospirosis is commonly characterized by fever and respiratory symptoms. However, its non-specific clinical presentation makes diagnosis and treatment relatively difficult. Molecular detection techniques can be used to identify the pathogen early, thereby improving patient prognosis.

Objective To report the diagnosis and management of a case of tenosynovitis caused by Mycobacterium arupense, and summarize the clinical features by literature review in order to improve the understanding of the disease. Methods The diagnosis and treatment of a case of tenosynovitis caused by M. arupense were described. Similar case reports published during the period from January 2006 to January 2025 were retrieved from PubMed, CNKI, Wanfang and VIP databases using search terms “Mycobacterium arupense” and “tenosynovitis”. The reports were analyzed in terms of underlying disease, exposure history, pathological and etiological analyses, and therapeutic and prognostic characteristics. Results This case was successfully cured by lesion excision and carpal tunnel incision and decompression, dilatation, antimicrobial combinations of rifampicin + clarithromycin + ethambutol and amikacin + cefmetazole. A total of 15 relevant articles were reviewed, including 16 cases. Finally, 17 cases of M.arupense infection were analyzed, including the case in this report. Infections caused by M. arupense included 11 cases of tenosynovitis of the hand, and 6 cases of infections at other sites. Most of the patients with tenosynovitis had a history of foreign body stabbing and corticosteroid injection therapy. Most of the patients with M. arupense infection at other sites had underlying diseases. Pathologic findings were mainly granulomatous inflammation with or without multinucleated giant cells. The primary treatment approach was surgical treatment combined with rifabutin, ethambutol, clarithromycin, and other medications. Overall, 16 of the 17 patients were improved or cured, and 1 patient died due to liver failure. Conclusions Clinical infections caused by M. arupense are rarely reported. In patients with tenosynovitis who have a history of foreign body puncture wounds, negative routine pathogen tests, and a prolonged course of disease, the possibility of M. arupense infections should be considered. Targeted high-throughput sequencing can assist in early diagnosis.

Objective Analyze the plasma concentration of rifampicin in tuberculosis patients and explore the factors influencing the concentration for rational use of antimicrobial agents in clinical practice. Methods A retrospective study was conducted to collect clinical and laboratory data from patient and investigate the relevant factors affecting the plasma concentration of rifampicin. Results Overall, 40.8% of the 206 patients had rifampicin plasma concentrations below the lower limit of the reference range. Multiple linear regression analysis indicated that age and direct bilirubin (DBIL) levels were positively correlated with rifampicin plasma concentration (P < 0.05). Dosage of rifampicin, combined with human immunodeficiency virus (HIV) infection, and combined with kidney disease were significantly associated with rifampicin plasma concentrations (P < 0.05). Conclusions Low rifampicin plasma concentration was found in a high proportion of patients, underscoring the need to optimize dosing regimen based on therapeutic drug monitoring. The effects of age, dosage of rifampicin, DBIL levels, combined with HIV infection, and combined with kidney disease on rifampicin plasma concentration should be considered.

Objective To understand the efficacy of antiretroviral therapy (ART) initiated on the day of diagnosis in treatment-naive HIV/AIDS patients, and compare the virological suppression rate, treatment maintenance rate and maintenance rate of original ART regimen between different ART regimens. Methods Patients who initially treated with ART in Chongqing Public Health Medical Treatment Center from January 1, 2022 to December 31, 2022 were retrospectively identified. Their ART was initiated within 24 hours on the day of diagnosis. The patients were assigned to one of the following four group according to the ART regimen they received: three-drug combination (STR-3D), two-drug combination (STR-2D), or multi-drug combination (MTR1: 2NRTIs+NNRTIs, MTR2: 2NRTIs+LPV/r). Results A total of 163 treatment-naive HIV/AIDS patients were included in the study. Overall, 70.6% (115/163) of the patients were males, with a mean baseline age of (49.9±17.2) years and median CD4⁺ T lymphocytes count of 222.0 (136.0, 306.0) /μL. The median value of HIV RNA was 112 000 (46 700, 51 400) copies/mL. There were 105 (64.4%) patients in STR-3D group, 22 (13.5%) patients in STR-2D group, 34 (20.9%) patients in MTR1 group and 2 (1.2%) patients in MTR2 group. Only the first three ART regimens were statistically analyzed because the number of patient was too small in MTR2 group. The overall virologic suppression rate was 85.0% (113/133) at 24 weeks after ART-initiation in patients with viral load results, specifically 90.0% (81/90) in STR-3D group, 94.4% (17/18) in STR-2D group and 65.2% (15/23) in MTR1 group. Significant difference was found among the three groups (P = 0.011). The median increase of CD4⁺ T lymphocytes at 24 weeks was 106.5 (59.0, 185.3) cells/μL, of which the increase was 122.0 (64.0, 202.0) /μL in STR-3D group, 98.0 (49.5, 155.5)/μL in STR-2D group and 78.0 (8.0, 137.0) /μL in MTR1 group (P = 0.047). Among the patients with viral load results at 48 weeks of follow-up, the overall virological suppression rate was 97.7% (128/131), specifically 97.8% (88/90) in STR-3D group, 100% (13/13) in STR-2D group, and 96.2% (25/26) in MTR1 group (P = 0.664). At week 48, the median increase of CD4⁺ T lymphocytes was 144.5 (63.3, 234.8) /μL, specifically 148.5 (67.8, 241.0) /μL, 171.0 (63.5, 266.5) /μL, and 109.0 (46.0, 215.0) /μL in the three groups, respectively (P = 0.431). After 48 weeks of follow-up, the overall treatment maintenance rate was 91.4% (149/163). After excluding the 6 patients who died, the treatment maintenance rate was 98.0% (98/100) in STR-3D group, 90.9% (20/22) in STR-2D group, and 87.9% (29/33) in MTR1 group (P = 0.040). The overall maintenance rate of the original ART regimen within 48 weeks was 87.1% (142/163), and 94.3% (99/105), 77.3% (17/22), and 73.5% (25/34) in the three groups, respectively (P = 0.001). Conclusions The virological suppression rate, treatment maintenance rate and the maintenance rate of original ART regimen were high in treatment-naive HIV/AIDS patients who initiated ART on the same day of diagnosis. The early treatment effect of single-tablet ART was significantly better than that of multi-tablet ART. It is recommended to initiate single-tablet ART containing three drugs on the same day of diagnosis.

Objective To investigate the correlation between serum microtubule-associated protein 1 light chain 3B (LC3B), neuron-specific enolase (NSE), acetylcholinesterase (AChE) and DNA load of varicella zoster virus and the performance of the biomarkers combined for predicting the outcomes of varicella-zoster virus encephalitis. Methods The patients with varicella zoster encephalitis (n=100) admitted to Hengshui People’s Hospital from January 2022 to June 2024 were selected as the disease group, and assigned to one of the two groups according to the outcomes. Meanwhile, 93 healthy subjects were included as control group. The serum levels of LC3B, NSE and AChE were compared between the disease group and control group. Varicella zoster virus DNA load was detected in the disease group. The correlation between serum LC3B, NSE, AChE and varicella zoster virus DNA load was analyzed by Pearson correlation method. Receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of the biomarkers in improving the outcomes of patients. Results The gender, age, body mass index, smoking history and drinking history did not show significant difference between disease group and control group (P > 0.05). Serum LC3B, NSE and AChE levels were significantly higher in disease group than those in control group (P < 0.05). Serum LC3B, NSE, AChE levels and viral DNA load were lower in the patients with improved outcomes compared to those without improved outcomes (P < 0.05). Pearson correlation analysis showed that serum LC3B, NSE and AChE were positively correlated with viral DNA load (r=0.311, 0.268, 0.202, P = 0.002, 0.007, 0.044). ROC curve analysis showed that the area under the curve (AUC) of serum LC3B, NSE, AChE levels and viral DNA load was 0.798, 0.811, 0.773 and 0.839, respectively in predicting disease outcome. The corresponding sensitivity was 78.8%, 81.8%, 90.9% and 81.8%, and the specificity was 76.5%, 70.6%, 58.8% and 79.4%, respectively. The AUC of the biomarkers combined was 0.932, which was higher than that of any biomarker alone (Z=2.554, P=0.011; Z=2.823, P=0.005; Z=3.303, P=0.001; Z=2.820, P=0.005), and the sensitivity and specificity were 97.0% and 79.4%, respectively. Conclusions Serum LC3B, NSE and AChE were positively correlated with varicella zoster viral DNA load. All the four biomarkers had certain predictive value for the outcomes of patients. These biomarkers combined can achieve better performance in predicting the outcomes of patients, which may be useful for predicting improved outcomes of patients with varicella zoster encephalitis.

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

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

Objective To identify the risk factors for HIV infection among spouses/sexual partners of in-patients living with HIV (PLWH) in Chongqing, China. Methods A cross-sectional study design was used to conduct a questionnaire-based survey on spouses/sexual partners of hospitalized AIDS patients from August 2021 to March 2023. Participants were stratified into two groups based on HIV co-infection status. Between-group comparisons were conducted using SPSS 27.0. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for HIV infection in this population. Results Overall, 200 spouses/sexual partners of hospitalized AIDS patients completed the survey, including 70 HIV-positive and 130 HIV-negative individuals. The overall infection rate was 35.0%. The HIV-negative group demonstrated significantly higher rates of consistent condom use during sexual intercourse (P < 0.05) and shorter time from infection onset to HIV status disclosure to spouses/sexual partners (<1 year, P < 0.05) and index patients who had initiated antiretroviral therapy (ART, P < 0.05) compared to the HIV-positive group. Conversely, the HIV-positive group had a significantly higher proportion of male participants (P < 0.05). Univariate analysis identified condom use, time from infection onset to HIV status disclosure to spouses/sexual partners, ART status, lacking knowledge of mother-to-child HIV transmission prevention, and poor awareness of pre-exposure prophylaxis, as risk factors significantly associated with HIV infection among spouses/sexual partners (all P < 0.05). Multivariate logistic regression analysis further revealed that unprotected sexual intercourse (OR = 6.734, 95% CI: 2.028-22.371) was an independent risk factor for HIV transmission. In contrast, female sex (OR = 0.240, 95% CI: 0.122-0.473) and ART initiation by the index patient (OR = 0.365, 95% CI: 0.189-0.704) were protective factors against HIV infection. Conclusions Spouses/sexual partners of hospitalized PLWH in Chongqing demonstrated poor awareness of HIV knowledge. Male partners, inconsistent condom use, and absence of ART in index patients significantly elevate the risk of HIV transmission to their spouses/sexual partners.