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

Objective To evaluate the 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 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 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 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 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 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 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 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.

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 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 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 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 mortality and risk factors of HIV-infected patients complicated with progressive multifocal leukoencephalopathy (PML) to inform the outcomes of these patients. Methods The clinical data of people living with HIV related PML who were treated at Chongqing Public Health Medical Treatment Center from January 1, 2019 to December 31, 2023 were retrospectively analyzed. Kaplan-Meier method was used for survival analysis. Log-rank test was performed. Cox regression model was used for multivariate analysis. Results A total of 42 people living with HIV related PML were enrolled, including 34 males (81.0 %). The median age was 44.5 (36.3, 51.0) years. PML was confirmed in 76.2% (32/42) of patients, and possible PML was diagnosed in 23.8% (10/42) of patients. The median time to diagnosis was 32.5 (14.8, 58.3) days. The median CD4⁺ T cell count was 69.0 (39.8, 112.0) cells/μL. The median HIV viral load was 5.05 (2.62, 5.77) log₁₀ copies/mL. The overall mortality rate was 54.8% (23/42) for patients with HIV related PML. CD4⁺ T cell count ≤50 cells/μL and initial modified Rankin scale (mRS) score ≥4 points were independent risk factors for the overall mortality of people living with HIV related PML (P < 0.05). Conclusions People living with HIV related PML have a high mortality rate. Low CD4⁺ T cell count and high initial mRS score were independent risk factors for the mortality of patients with HIV related PML. Currently, no definitive and effective drug treatment is available for PML. Early detection, diagnosis and initiation of antiretroviral therapy may improve the outcomes of patients.

Objective To investigate the effect of long non-coding RNA non-coding RNA-activated by DNA damage (LncRNA NORAD) on macrophage apoptosis induced by Mycobacterium tuberculosis infection via sponging microRNA-20a-5p (miR-20a-5p). Methods Healthy subjects (n=50) who came for health checkup, patients with active tuberculosis (n=50) and individuals with asymptomatic M. tuberculosis infection (n=50) were enrolled from Hebei Chest Hospital from March 2022 to April 2023. Venous blood samples were collected to prepare serum samples. The expression levels of LncRNA NORAD, miR-20a-5p, and inflammatory factors in the serum were measured. Human monocyte line THP-1 was induced to differentiate into macrophages and assigned into Control group, Model group, transfection of NORAD empty vector group (sh-NC group), transfection of sh-NORAD vector group (sh-NORAD group), co-transfection of sh-NORAD and miR-20a-5p inhibitor empty vector group (sh-NORAD+miR-20a-5p inhibitor NC group), co-transfection of sh-NORAD and miR-20a-5p inhibitor vector group (sh-NORAD+miR-20a-5p inhibitor group), transfection of miR-20a-5p empty vector group (miR-NC group), and transfection of miR-20a-5p vector group (miR-20a-5p mimics group). The expression levels of LncRNA NORAD and miR-20a-5p (qRT PCR method), cell proliferation ability (CCK-8 kit method), cell apoptosis (flow cytometry method), inflammatory factor levels (ELISA method), and protein expression levels of BCL2-Associated X (Bax), B-cell lymphoma-2 (Bcl-2), and cleaved caspase 3 in cells were detected. The targeted relationship between LncRNA NORAD and miR-20a-5p was validated. Results Compared with healthy subjects, the patients with active tuberculosis and asymptomatic M. tuberculosis infection had significantly higher serum levels of inflammatory factors and expression of LncRNA NORAD, and significantly lower miR-20a-5p. Compared with Control group, Model group had significantly higher LncRNA NORAD level, cell proliferation ability, Bcl-2 protein expression, and inflammatory factor levels, but significantly lower miR-20a-5p level, apoptosis rate, and Bax and cleaved caspase 3 protein expression (P < 0.05). Compared with the sh-NC group, the sh-NORAD group had significantly lower LncRNA NORAD level, Bcl-2 protein expression, inflammatory factor levels, and cell proliferation ability, but significantly higher miR-20a-5p level, apoptosis rate, and Bax and cleaved caspase 3 protein expression (P < 0.05). Compared with the sh-NORAD+miR-20a-5p inhibitor NC group, the sh-NORAD+miR-20a-5p inhibitor group had significantly higher inflammatory factor levels, Bcl-2 protein expression, and cell proliferation ability, but significantly lower miR-20a-5p level, apoptosis rate, and Bax and cleaved caspase 3 protein expression (P < 0.05). Compared with the miR-NC group, the miR-20a-5p mimics group had significantly increased inflammatory cytokines and proliferation ability, and significantly reduced apoptosis rate (P < 0.05). The targeted relationship between LncRNA NORAD and miR-20a-5p was further confirmed through experiments. Conclusions LncRNA NORAD is overexpressed in macrophages induced by M. tuberculosis. Silencing the expression of LncRNA NORAD can target the downregulation of miR-20a-5p expression, thereby inhibiting the inflammatory response of macrophages induced by M. tuberculosis and promoting cell apoptosis.

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 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 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 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 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.