Objective To investigate the susceptibility and resistance of clinical isolates collected from hospitals in several regions of China. Methods These clinical strains were collected from 51 hospitals. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. Results were analyzed according to CLSI 2021 breakpoints. Results A total of 301 917 clinical isolates were collected from January to December 2021, of which gram negative organisms and gram positive cocci accounted for 71.4% and 28.6% respectively. Methicillin-resistant strains in S. aureus (MRSA), S. epidermidis and other Staphylococcus species (except S. pseudintermedius and S. schleiferi) accounted for 30.0%, 80.7% and 77.7% respectively. MR strains showed much higher resistance rates to most of other antimicrobial agents than MS strains. However, 92.4% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole, while 90.7% of MRSE strains were susceptible to rifampin. No staphylococcal strains were found resistant to vancomycin. E. faecalis strains demonstrated much lower resistance rates to most of the drugs tested than E. faecium. A few strains of both Enterococcus species were resistant to vancomycin. The prevalence of PSSP was 97.8% in the non-meningitis S. pneumoniae isolates from children and 95.1% in the non-meningitis S. pneumoniae isolates from adults. The Enterobacterales strains were still highly susceptible to carbapenems. Overall, less than 13% of these strains were resistant to carbapenems. K. pneumoniae isolates showed increasing resistance rates to imipenem and meropenem, from 3.0% and 2.9% in 2005 to 25.0% and 26.3% in 2018. However, the resistance rates of Klebsiella pneumoniae to imipenem and meropenem decreased since 2019. About 65.6% and 66.5% of Acinetobacter spp. were resistant to imipenem and meropenem, respectively. Overall, 23.0% and 18.9% of the Pseudomonas aeruginosa isolates were resistant to imipenem and meropenem, respectively. Conclusions Bacterial resistance to commonly used antibiotics is still on the rise. However, the prevalence of carbapenem-resistant K. pneumoniae and P. aeruginosa is decreasing in recent years. It is suggested that strengthening the monitoring of bacterial resistance and multidisciplinary teamwork are effective in controlling the spread of drug-resistant bacteria.

碳青霉烯类耐药革兰阴性菌（CRGNB）的广泛播散是一个全球性的公共卫生问题。CRGNB临床分离株通常呈现广泛耐药或全耐药,对其感染的抗菌治疗方案有限、死亡率高。由感染病临床诊疗、临床微生物、临床药理、医院感染控制及指南方法学等多学科专家组成的指南制定小组,根据现有科学证据制定了本临床实践指南,以解答有关CRGNB检测、抗菌治疗及感染预防控制的系列临床优先问题。本指南聚焦于碳青霉烯类耐药肠杆菌目细菌、碳青霉烯类耐药鲍曼不动杆菌和碳青霉烯类耐药铜绿假单胞菌,从当前临床实践的角度提出16个临床问题,采用人群、干预、对照及预后（population, intervention, comparator, outcomes,PICO）格式转换为研究问题,全面收集和综合分析相关研究证据。采用推荐的分级、评估、制定与评价（grading of recommendations, assessment, development and evaluation, GRADE）方法评估相应干预措施的证据体质量、效益及风险,从而制定推荐意见或建议。随机对照临床试验及系统评价获得的结果被优先用于治疗相关临床问题的推荐证据。在缺乏随机对照临床试验的情况下,观察性研究、非对照研究和专家意见被考虑作为补充证据。推荐意见分为强推荐或弱推荐（有条件推荐）。结合中国的临床实践经验,本指南同时提出实施建议,便于指南推荐意见的临床实施。本指南对耐药菌感染诊疗相关的临床医师等多学科专业人员具有参考价值。

Objective To evaluate the safety and efficacy of amphotericin B colloidal dispersion (ABCD) in the salvage treatment of invasive fungal disease (IFD). Methods A total of 106 patients who received ABCD salvage therapy from April to August 2021 after failure of previous antifungal therapy were reviewed and analyzed retrospectively. The demographic and clinical data and ABCD-related adverse reactions were summarized with descriptive statistics. Results Transfusion reactions were the most common ABCD-related adverse events in the 106 patients, including chills (60.4%), fever (54.7%) and fear of cold (11.3%). Most of the adverse reactions were grade 1 or 2. The efficacy rate of ABCD treatment was 85.8% (91/106, 95% CI: 77.7%-91.9%) in all of the patients, and 92.6% (25/27, 95% CI: 75.7%-99.1%) in the patients with proven/probable IFD, including mucormycosis (n=9), invasive pulmonary aspergillosis (n=5), cryptococcal meningitis (n=5), talaromycosis (n=3), pulmonary moniliasis (n=2), and one of three patients with candidemia. ABCD salvage treatment succeeded in all of the seven patients with proven/probable IFD who received prior polyene antifungal therapies. All patients with proven/probable IFD were alive within 6 weeks after ABCD treatment. Conclusions ABCD is safe and well-tolerated in the treatment of IFD with low renal toxicity. ABCD salvage treatment is also effective in patients who are intolerant of or failed to prior antifungal therapy.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023. Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems. Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints. Results A total of 445 199 clinical isolates were collected in 2023, of which 29.0% were gram-positive and 71.0% 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) was 29.6%, 81.9% and 78.5%, respectively. Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA, MSSE and MSCNS). Overall, 92.9% of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4% of MRSE strains were susceptible to rifampicin. No vancomycin-resistant strains were found. Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium. A few vancomycin-resistant strains were identified in both E. faecalis and E. faecium. The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1% in the isolates from children and and 95.9% in the isolates from adults. The resistance rate to carbapenems was lower than 15.0% for most Enterobacterales species except for Klebsiella, 22.5% and 23.6% of which were resistant to imipenem and meropenem, respectively . Most Enterobacterales isolates were highly susceptible to tigecycline, colistin and polymyxin B, with resistance rates ranging from 0.6% to 10.0%. The resistance rate to imipenem and meropenem was 21.9% and 17.4% for Pseudomonas aeruginosa, respectively, and 67.5% and 68.1% for Acinetobacter baumannii, respectively. Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates. However, the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K. pneumoniae, P. aeruginosa, and A. baumannii showed a slightly decreasing trend. This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

Objective To investigate the susceptibility and resistance pattern of clinical isolates in hospitals across China. Methods These clinical strains were collected from 52 hospitals. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. Results were analyzed according to CLSI 2020 breakpoints. Results A total of 251 135 clinical isolates were collected from January to December 2020, of which gram negative organisms and gram positive cocci accounted for 71.9% and 28.1%, respectively. Methicillin-resistant strains in S. aureus (MRSA), S epidermidis and other Staphylococcus spp. (except S. pseudintermedius and S. schleiferi) accounted for 31.0%, 81.7%, and 77.5%, respectively. The resistance rates of MR strains to most of other antimicrobial agents were much higher than those of MS strains. However, 93.6% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole, while 89.9% of MRCNS strains were susceptible to rifampin. No staphylococcal strains were found resistant to vancomycin. E. faecalis strains showed much lower resistance rates to most of the drugs tested than E. faecium. A few strains of both species were resistant to vancomycin. Among the S. pneumoniae strains isolated from children and adults, the prevalence of PSSP (96.7% and 95.5%, respectively) strains were higher than those isolated in 2019. The prevalence of PISP and PRSP were lower than those isolated in 2019. The strains of Enterobacteriaceae were still highly susceptible to carbapenems, Overall, less than 12% of these strains (except Klebsiella) were resistant to carbapenems. The percentage of K. pneumoniae strains resistant to imipenem and meropenem increased from 3.0% to 25.0% and from 2.9% to 26.3%, respectively from 2005 to 2018. However, the prevalence of imipenem- and meropenem-resistant Klebsiella strains decreased in 2019 and 2020. About 68.1% and 69.0% of Acinetobacter spp. strains were resistant to imipenem and meropenem, respectively. The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 23.2% and 19.3%, respectively. Conclusions The prevalence of carbapenem-resistant K. pneumoniae and P. aeruginosa decreased even though bacterial resistance to commonly used antibiotics is still on the rise. It is necessary to strengthen the surveillance of bacterial resistance and the measures for control of infectious diseases.

Objective To explore the effect of bedaquiline on QT interval when comnined with clofazimine and fluoroquinolones in patients with multidrug-resistant tuberculosis (MDR-TB) for safe drug use and monitoring of drug adverse reactions. Methods Ninety-one eligible patients were enrolled in Chengdu Public Health Clinical Medical Center from March 2018 to March 2020 according to the inclusion and exclusion criteria. All the patients received bedaquiline-containing treatment regimen. The electrocardiograph (ECG) was recorded at baseline, and at end of 2, 4, 8, 12, 16, 20, 24, and 36 weeks after initiation of treatment, and compared between the patients receiving clofazimine co-treatment (n=55) and those not receiving clofazimine (n=36). Results Bedaquiline combined with clofazimine resulted in significantly higher incidence (54.5%, 30/55) of QTcF prolongation ≥ 60 ms from baseline than the regimen not containing clofazimine (33.3%, 12/36) (P < 0.05). The incidence of QT prolongation was 45.9% when bedaquiline combined with one drug causing QT prolongation, which was not significantly different from the incidence of 52.4% (P > 0.05) when bedaquiline combined with two drugs causing QT prolongation. Conclusions Bedaquiline combined with clofazimine led to significantly higher incidence of QTcF prolongation ≥ 60 ms from baseline than the regimen not containing clofazimine in patients with MDR-TB. The patients should be monitored closely for cardiac symptoms and ECG abnormalities during combination treatment with bedaquiline and clofazimine.

Objective To investigate the clinical manifestations, diagnosis and treatment of catheter-related bloodstream infection caused by Tsukamurella species, and improve clinicians' awareness of this disease. Methods Data were retrospectively collected from a patient who was diagnosed with catheter-related bloodstream infection caused by Tsukamurella species. The databases of PubMed, CNKI, Wanfang and VIP were searched, using the term “Tsukamurella”, to identify the reported cases of catheter-related bloodstream infection caused by Tsukamurella species. The relevant data were extracted for further analysis. Results Our case was a 37-year-old male with underlying diseases including short bowel syndrome, hypersplenism, and intra-abdominal desmoid tumor, who had a long-term indwelling peripherally inserted central catheter. He presented with fever, and was diagnosed with catheter-related bloodstream infection caused by Tsukamurella species based on cultures of peripheral blood sample and catheter tip. He eventually recovered after antimicrobial treatment with cefoperazone-sulbactam followed by imipenem-cilastatin. We identified 56 cases in the literature search, of which most patients were immunocompromised. Chemotaxonomic and/or molecular methods were utilized for pathogen identification in most cases. Intravascular catheters were removed for treatment in most of the patients. Overall, one patient died, 54 patients survived, and the outcome of one patient was unknown. It was unclear whether the only death was attributable to Tsukamurella species infection. Conclusions Tsukamurella species are opportunistic pathogens, which are rarely seen in clinical practice. The identification of these bacteria relies on mass spectrometry and gene sequencing. In addition to appropriate antibiotic treatment, removal of intravascular catheters is essential to infection control.

Objective To evaluate the efficacy and safety of eravacycline in the treatment of complicated intra-abdominal infection (cIAI) in Chinese adult patients. Methods In this multicenter, randomized, double-blind phase III study, cIAI patients were randomly assigned to receive either eravacycline (1.0 mg/kg, q12h) or ertapenem (1 g, q24h) by intravenous infusion for 5 to 14 days. The primary and secondary efficacy endpoints included the clinical efficacy and microbiological efficacy in different populations, including modified intention-to-treat (MITT) population, clinically evaluable (CE) population, and microbiologically evaluable (ME) population, at different time points after treatment. Clinical cure rates at specific visits were summarized and compared between treatment groups in different populations. The microbial eradication rate was calculated for the patients with baseline pathogens. The incidence of adverse events (AE) and drug-related treatment emergent adverse event (TEAE) was analyzed by treatment group. Results A total of 144 patients with cIAI who received at least one dose of the study drug were included in the MITT population. The clinical cure rate was 77.8% (56/72) in eravacycline-treated patients and 90.3% (65/72) in ertapenem-treated patients at 25-31 days after the first dose (TOC visit). When the patients who received insufficient treatment (< 72 hours) were excluded, the clinical cure rate was 83.6% (56/67) in eravacycline group and 90.3% (65/72) in ertapenem. For CE and ME patients, the clinical cure rate at TOC visit was 91.1% (51/56) and 83.3% (25/30) in eravacycline group, 95.3% (61/64) and 90.9% (30/33) in ertapenem group. Eravacycline treatment achieved microbiological eradication rate of 91.3% (21/23) against Escherichia coli at TOC visit in micro-MITT population while ertapenem treatment resulted in a microbiological eradication rate of 96.2% (25/26). The microbiological efficacy of eravacycline and ertapenem against Klebsiella pneumoniae was 4/5 and 3/3, respectively. The incidence of TEAE was similar in eravacycline and ertapenem groups (75.0% vs.70.8%), most of which were mild or moderate. The AEs associated with eravacycline were mainly infusion site phlebitis (9.7%, 7/72) and infusion site pain (8.3%, 6/72). Conclusions Similar to ertapenem, eravacycline has good clinical and microbiological efficacy in treating cIAI. It is also safe and well-tolerated in the patients.

Objective To know the changing distribution and antimicrobial resistance profiles of Acinetobacter spp. isolated from 51 hospitals across China from 2015 to 2021. Methods According to the CHINET antimicrobial resistance surveillance program, antimicrobial susceptibility testing for isolates was conducted by Kirby-Bauer method and automatic microbiological analysis systems. The susceptibilities of the isolates to antimicrobial agents tested were interpreted according to CLSI 2021 breakpoints. The data were analyzed by WHONET 5.6 software. Results During the period from 2015 to 2021, a total of 143 393 clinical isolates of Acinetobacter were collected, among which Acinetobacter baumannii was the most common species, accounting for 89.6% of all Acinetobacter strains. Overall, 73.0% of the Acinetobacter strains were from respiratory tract. The majority of the Acinetobacter strains were from inpatients (94.0%), of which isolates from ICUs accounted for 35.5%. Acinetobacter strains showed high resistance rates to antimicrobial agents such as β-lactams, aminoglycosides and fluoroquinolones except for minocycline, tigecycline and polymyxin B. The antimicrobial resistance pattern of Acinetobacter strains varied with different levels of hospitals and different departments. During the period from 2015 to 2021, the resistance rate of A. baumannii to cefoperazone-sulbactam and piperacillin-tazobactam had increased, while the resistance rate to minocycline and tigecycline showed a downward trend. The prevalence of carbapenem-resistant A. baumannii was high, reaching 75.2% in tertiary hospitals. Conclusions Acinetobacter spp. is an important pathogen of nosocomial infections, which showed high resistance rates to commonly used antimicrobial agents in clinical practice. Polymyxin B, tigecycline and minocycline are appropriate for treatment of multidrug-resistant Acinetobacter infections.

多黏菌素类抗生素是目前临床用于治疗难治性革兰阴性菌感染的重要药物,在国内临床应用也呈增多趋势,但对该类药物的认识尚有不足。日前美国临床药学院(ACCP)、欧洲临床微生物和感染病学会(ESCMID)、美国感染病学会(IDSA)、国际抗感染药学会(ISAP)、重症医学会(SCCM)和感染病药师学会(SIDP)等6家国际权威学会联合发布多黏菌素类合理应用共识指南[Pharmacotherapy,2019,39(1):10-39.DOI:10.1002/phar.2209],其中基于近年来新的循证依据,对品种和剂型的选择、给药剂量及其调整、药动学/药效学治疗靶值等作了推荐。现将其中要点作成编译,以供读者参考。

Objective To investigate the changing antimicrobial susceptibility profiles of Pseudomonas aeruginosa to various antibiotics in hospitals across China from 2015 to 2021. Methods The P. aeruginosa strains were isolated from 52 hospitals across China. Antimicrobial susceptibility testing was carried out by Kirby-Bauer method and automated systems according to the unified protocol of CHINET program. The results were interpreted according to the Clinical & Laboratory Standards Institute (CLSI) breakpoints. The data were analyzed with WHONET 5.6 software. Results A total of 129 701 strains of P. aeruginosa were collected from 2015 to 2021, accounting for 8.6% of all clinical isolates. The proportion of P. aeruginosa among non-fermentative gram-negative bacilli was only secondary to the proportion of Acinetobacter spp. Majority (91.4% ± 1.0%) of the P. aeruginosa strains were isolated from inpatients and (66.4 ± 2.8)% of the strains were isolated from respiratory tract secretions. P. aeruginosa strains showed decreasing resistance rates to the antimicrobial agents tested during the 7-year period. More than 90% of the P. aeruginosa strains were resistant to amikacin, polymyxins, and ceftazidime-avibactam. About 1.0%-19.8% of the P. aeruginosa strains from outpatient and emergency departments, 0.6%-40.5% of the strains from ICU inpatients, 0.8%-28.8% of the strains from the inpatients in internal medicine wards, and 1.2%-23.3% of the strains from the inpatients in surgery wards were resistant to the antimicrobial agents tested. About 0.8%- 18.8% of the P. aeruginosa strains isolated from children, 1.2%-26.1% of the strains from adult patients, and 1.0%- 28.5% of the strains from the elderly patients were resistant to the antimicrobial agents tested. Overall, 2.5%-24.2%, 0.7%-27.6%, and 0.6%-20.3% of the P. aeruginosa strains isolated from secondary hospitals, tertiary hospitals, and children's hospitals respectively were resistant to the antimicrobial agents tested. The prevalence of carbapenem-resistant P. aeruginosa was 27.1% (35 153/129 701). Conclusions P. aeruginosa is one of the most common clinical isolates of non-fermentative gram-negative bacilli. P. aeruginosa isolates showed downward resistance rates to the antimicrobial agents tested during the 7-year period. Antimicrobial resistance surveillance is an effective way for controlling the emergence and development of antimicrobial resistance. The antimicrobial resistance profile of P. aeruginosa strains varied with specimen type, clinical setting, and patient age. We should strengthen antimicrobial resistance surveillance and improve rational antibiotic use to prevent and control the spread of antibiotic-resistant P. aeruginosa.

目的对诺卡菌培养阳性病例的临床特点进行分析,提高对该菌感染的认识。方法回顾性分析宁夏医科大学总医院2012年5月-2014年12月住院患者标本培养为诺卡菌阳性的11例患者的临床资料。结果11例诺卡菌培养阳性病中2例考虑污染所致,9例为不同部位感染的患者,其中6例为肺部感染,2例为皮肤软组织感染,1例为透析相关性腹膜炎;9例均合并基础疾病,其中4例因基础病使用糖皮质激素或免疫抑制剂。结论诺卡菌可引起全身各部位感染,以肺为常见。有基础疾病者易发生诺卡菌感染,尤其使用糖皮质激素及免疫抑制剂患者。

Objective Meta-analysis was used to investigate the diagnostic value of MxA protein for respiratory virus infection. Methods EMbase, PubMed, the Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), and Wanfang databases were searched from the inception of these databases up to January 2022 to retrieve relevant studies on MxA protein. According to the inclusion and exclusion criteria, two researchers selected the eligible references for quality evaluation based on QUADAS-2 standard. Revman 5.3 software was used to plot the risk of bias. Stata 15.0 software was used to perform data analysis. Results A total of 14 studies were included, for which the overall risk of bias was low. For diagnosis of respiratory virus infection, MxA alone showed sensitivity Q = 15.71, P = 0.02, I ² = 61.80%, specificity Q = 11.07, P = 0.09, I ² = 45.81%. Meta-analysis indicated that the pooled sensitivity was 0.91 (95% CI: 0.86, 0.94). Pooled specificity was 0.89 (95% CI: 0.83,0.93). Pooled positive likelihood ratio (PLR) was 8.20 (95% CI: 5.20,12.80). Pooled negative likelihood ratio (NLR) was 0.10 (95% CI: 0.07, 0.16). Pooled diagnostic odds ratio (DOR) was 79.00 (95% CI: 45.00, 141.00). The area under the summary receiver operating characteristic (SROC) curve was 0.96 (95% CI: 0.93, 0.97). The rapid diagnostic test FebriDx showed sensitivity Q = 75.87, P < 0.05, I ² = 92.09%, and specificity Q = 17.79, P < 0.05, I ² = 66.27%. Meta-analysis demonstrated that the pooled sensitivity was 0.91 (95% CI: 0.80, 0.97). Pooled specificity was 0.86 (95% CI: 0.80, 0. 91). Pooled PLR was 6.60 (95% CI: 4.40, 10.00). Pooled NLR was 0.10 (95% CI: 0.04, 0.25). Pooled DOR was 65.00 (95% CI: 19.00, 222.00). The area under the SROC curve was 0.92 (95% CI: 0.89, 0.94). Deeks’ funnel plot did not show significant difference in publication bias among the studies. Conclusions MxA protein has certain diagnostic value for respiratory virus infection.

Objective To analyze the clinical characteristics, antibiotic resistance profile, virulence genes, and molecular typing of Staphylococcus aureus strains isolated from skin and soft tissue infections in children for better understanding the molecular epidemiological characteristics of S. aureus in Children’s Hospital of Shanghai Jiao Tong University. Methods A total of 90 strains of S. aureus were isolated from children with skin and soft tissue infection in 2020. Broth microdilution method was used to test the susceptibility of the S. aureus isolates to antimicrobial agents. Fifteen virulence genes of S. aureus were detected by PCR. Multilocus sequence typing (MLST), staphylococcal protein A (SPA) and staphylococcal cassette chromosome mec (SCCmec) typing were carried out to characterize the strains. Results Among 90 strains of S. aureus, 44 were methicillin-resistant (MRSA). All the MRSA strains (100%) were resistant to penicillin. No staphylococcal isolate was resistant to rifampicin, linezolid, vancomycin, minocycline, or tigecycline. The adhesion toxin genes icaA and clfA and hematoxin gene hla were the most prevalent virulence genes (100%) in the S. aureus strains isolated from skin and soft tissue infections in children, followed by enterotoxin genes sei (66.7%) and pvl (58.9%). ST15-t437-SCCmec IV, ST22-t437-SCCmec IV, ST22-t437-SCCmec V, and ST22-t309-SCCmec V were the most prevalent types of MRSA isolates (9.1%). Both ST22-t309 (15.2%) and ST59-t309 (15.2%) were the most prevalent strains of MSSA isolates. Conclusions The prevalence of virulence genes and antibiotic resistance rates of MRSA strains were generally higher than those of MSSA strains. ST22-t309, ST22-t437, and ST59-t304 were the most prevalent types of S. aureus strains.

Objective To investigate the resistance profile of clinical Streptococcus isolates collected from hospitals in several major regions of China during the period from 2015 to 2021. Methods These clinical strains were collected from 51 hospitals. Antimicrobial susceptibility testing was carried out according to a unified protocol of CHINET using Kirby-Bauer method, E-test or automated commercial systems. Results were analyzed according to CLSI M100 2022 breakpoints. Results A total of 89 684 Streptococcus strains were collected from 2015 to 2021, including 35 254 strains (39.3%) of Streptococcus pneumoniae, 42 563 strains (47.6%) of β-hemolytic Streptococcus, and 11 767 strains (13.1%) of Streptococcus viridans. Group A, B, and unclassified Streptococcus accounted for 39.8%, 52.8% and 7.4%, respectively, among the 42 563 strains of β-hemolytic Streptococcus. The prevalence of penicillin-susceptible S. pneumoniae (PSSP), penicillin-intermediate S. pneumoniae (PISP), and penicillin-resistant S. pneumoniae (PRSP) was 86.2%-97.7%, 1.7%-6.5%, and 0.6%-7.3%, respectively, among the 25 552 S. pneumoniae strains isolated from non-cerebrospinal fluid (CSF) specimens in pediatric patients. The prevalence of PSSP, PISP, and PRSP was 92.0%-95.1%, 3.8%-5.3%, and 1.4%-2.7%, respectively, in the 7 997 strains of S. pneumoniae isolated from non-CSF specimens in adult patients. The prevalence of PRSP was 81.2% in the strains isolated from CSF specimens. Regardless of whether S. pneumoniae strains were isolated from CSF or non-CSF specimens, the strains isolated from both pediatric and adult patients were highly resistant to erythromycin and clindamycin, higher than 90% of the strains resistant in nearly all hospitals. β-hemolytic Streptococcus was sensitive to penicillin and ceftriaxone, and no resistant strains were found. The resistance rate of α-hemolytic Streptococcus to penicillin was 5.7% to 8.5%. About 46.3% to 55.0% of group B β-hemolytic Streptococcus isolates were resistant to levofloxacin, while other Streptococcus strains were still highly sensitive to levofloxacin. No strains resistant to linezolid or vancomycin were found in Streptococcus isolates. Conclusions Penicillin remains the first choice for non-central nervous system infections caused by Streptococcus. Streptococcus isolates are still highly resistant to erythromycin and clindamycin.

Objective To investigate the antimicrobial resistance profiles of the clinical strains isolated from tertiary hospitals across several regions of China. Methods These clinical strains were collected from 36 tertiary hospitals. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems. Results were analyzed according to CLSI breakpoints. Results A total of 249 758 clinical isolates were collected from January to December 2019, of which gram negative organisms and gram positive cocci accounted for 71.0% and 29.0%, respectively. Methicillin-resistant strains accounted for 31.4% in S. aureus (MRSA), 82.4% in S. epidermidis and 78.3% in other Staphylococcus species (except S. pseudintermedius and S. schleiferi). The MR strains showed much higher resistance rates to most of the antimicrobial agents tested than MS strains. However, 92.6% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole, while 89.0% of MRCNS strains were susceptible to rifampin. No staphylococcal strains were found resistant to vancomycin. E. faecalis strains demonstrated much lower resistance rates to most of the drugs tested than E. faecium. A few strains of both species were resistant to vancomycin. The prevalence of PSSP was 95.2% in the S. pneumoniae strains isolated from children and 95.3% in the isolates from adults, which were higher than the prevalence in 2018, while the prevalence of PISP and PRSP was lower than that in 2018. The strains of Enterobacteriaceae were still highly susceptible to carbapenems. Overall, less than 10% of these strains were resistant to carbapenems, except K. pneumoniae isolates, 27.6% of which were resistant to carbapenems. The results of 15-year surveillance from 2005 to 2019 showed a remarkable increase of imipenem resistance from 3.0% to 25.3% and meropenem resistance from 2.9% to 26.8% in K. pneumoniae isolates. About 73.6% and 75.1% of Acinetobacter spp. strains were resistant to imipenem and meropenem, respectively. The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 27.5% and 23.5%, respectively. Conclusions Bacterial resistance to commonly used antibiotics is still on the rise, especially for carbapenem-resistant gram-negative bacilli. It is necessary to strengthen the collaboration among different departments to combat the bacterial resistance.

Objective To investigate the clinical characteristics and risk factors for death of candidemia for better prevention and reasonable diagnosis and treatment of candidiasis. Methods The clinical and microbiological data of patients diagnosed with candidemia in a hospital from January 2015 to December 2019 were retrospectively analyzed. The patients were assigned to survivor group and death group according to the outcome of the patients. Univariate analysis and binary logistic regression analysis were conducted to identify the risk factors for death. Results A total of 97 patients were diagnosed with candidemia in the 5-year period. Overall, 99 strains of Candida were isolated from blood, of which Candida albicans, Candida parapsilosis, Candida glabrata, and Candida tropicalis accounted for 32.3%, 25.3%, 22.2% and 20.2%, respectively. The candidemia cases were mainly found in the department of gastroenterology (26.3%), cardiovascular surgery (23.2%), and burn and skin surgery (17.2%). The 4 Candida species showed significantly different susceptibility rates to triazole drugs (P < 0.05). Non-albicans Candida strains demonstrated higher resistance rates than C. albicans. Thirty (30.9%) of the 97 patients died. Univariate analysis showed that ICU admission, different departments, indwelling urinary catheter, chest drainage tube, and cardiovascular implant, suffered from hypertension, (1,3)-β-D-glucan > 100 ng/L were associated with mortality (P < 0.05). Binary logistic analysis indicated that ICU admission (OR=4.942, 95% CI: 1.574-15.515, P = 0.006) and indwelling pleural drainage tube (OR=5.678, 95% CI: 1.427-22.598, P = 0.014) were independent risk factors for death in patients with candidemia. Conclusions Non-albicans Candida species are the main pathogens of candidemia. ICU admission and indwelling chest drainage tube are independent risk factors for the death of patients with candidemia.

Objective Eravacycline is a novel fully-synthetic fluorocycline. This review aims to aggregate real-world studies to understand the efficacy and safety of eravacycline in the real-world settings. Methods The real-world studies on eravacycline were screened out for systematic review and meta-analysis. The efficacy and safety data in each study were described separately and collectively to obtain the overall profiles in the real clinical practice. Results Five real-world studies were included, all of which were retrospective studies. A total of 265 patients with different types of infections were analyzed, including 80 patients (30.2%) with abdominal infections. The meta-analysis showed that the overall clinical cure rate was 69% (95% CI: 62%-75%) in 215 patients with severe illness. The clinical cure rate reached 94.0% in 50 outpatient subjects. Among all the 265 patients, 29 (10.9%) reported AEs. The most common AE was gastrointestinal reactions. Conclusions Different dosage regimens of eravacycline demonstrated favorable clinical effects in various scenarios, including severe infections caused by drug-resistant pathogens. Eravacycline was well tolerated, which is consistent with the results of global clinical trials.

目的了解国内不同地区14所医院临床分离菌对常用抗菌药物的耐药性。方法国内不同地区14所教学医院(12所综合性医院、2所儿童医院)临床分离菌采用K-B法按统一方案进行细菌药物敏感试验。按CLSI2009版判断结果。结果2009年1月—12月收集各医院临床分离菌共43670株,其中革兰阳性菌占29%,革兰阴性菌占71%。金葡菌和凝固酶阴性葡萄球菌中甲氧西林耐药株(MRSA和MRCNS)平均为52.7%和71.7%。葡萄球菌属中甲氧西林耐药株对β内酰胺类抗生素和其他测试药的耐药率显著高于甲氧西林敏感株,但仍有72%和65%MRSA对磷霉素敏感;89.0%、66.0%和66.7%的MRCNS对利福平、磷霉素和氨苄西林-舒巴坦敏感,未发现万古霉素、替考拉宁和利奈唑胺耐药株。肠球菌属中粪肠球菌对多数测试药物的耐药率低于屎肠球菌,两者中均有少数万古霉素耐药株,根据表型推测多数为VanA型耐药。本次监测首次出现少数耐利奈唑胺的粪肠球菌和屎肠球菌。非脑膜炎肺炎链球菌(SP)儿童株中PSSP较2008年减少,PISP和PRSP有所增多,在儿童株中首次出现少数喹诺酮类耐药株。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)中产ESBLs株分别平均为56.5%和41.4%。肠杆菌科细菌中产ESBLs株对药物的耐药率均比非产ESBLs株高。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,总耐药率<2%。铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为30.5%和25.2%,不动杆菌属(鲍曼不动杆菌占86.8%)对两者的耐药率分别为50.0%和52.4%。与2008年相比肺炎克雷伯菌和鲍曼不动杆菌中的泛耐药株数量显著增多。新出现了5株泛耐药大肠埃希菌和6株泛耐药肠杆菌属细菌。结论细菌耐药性仍呈增长趋势,尤其泛耐药革兰阴性杆菌增多,对临床构成严重威胁。合理选用抗菌药,及早检测泛耐药菌,加强感染控制措施是当务之急。

Objective To analyze the status quo, clinical characteristics and prognostic factors of opportunistic infections in human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) patients in Quanzhou for better prevention and treatment of opportunistic infections. Methods A total of 172 cases of HIV/AIDS patients with opportunistic infection treated in Quanzhou First Hospital Affiliated to Fujian Medical University from January 2017 to January 2022 were identified. Clinical data and opportunistic infection details of the patients were collected and reviewed. Multivariate Cox regression analysis was used to determine the independent prognostic factors for the prognosis of HIV/AIDS patients with opportunistic infection. Independent prognostic factors were introduced into R software to construct a Nomogram prediction model of prognosis based on the regression coefficients of each factor. A C-index was used to calibrate this model. The relationship between prognosis predicted by nomogram and actual outcome was illustrated by the calibration chart. The clinical performance of this nomogram model was verified by decision curve analysis (DCA). Results The opportunistic infection included bacterial pneumonia (54.65%), followed by oral leukoplakia (51.74%), Pneumocystis pneumonia (43.60%), herpes zoster (28.49%), tuberculosis (21.51%), infectious diarrhea (19.77%), central nervous system infection (12.79%), and cytomegalovirus infection (10.47%) in the 172 AIDS patients. The opportunistic infection was found in significantly more males than in females. Majority of the patients were 18-39 years of age. Age, number of infections, genotypic drug resistance, and CD4⁺ T lymphocyte level were factors predicting the prognosis of AIDS patients with opportunistic infection. Calibration curves and DCA showed that the Nomogram prediction model performed well in terms of predictive ability, clinical validity, and discriminative ability. Conclusions Age, number of infections, genotypic drug resistance, and CD4⁺ T lymphocyte level are the main factors predicting the prognosis of AIDS patients with opportunistic infection. The nomogram prediction model performs well in terms of predictive ability and clinical validity, which is useful for improving early detection, prevention and control.

Objective:To report one case of adverse reactions in central nervous system during ertapenem treatment and to remind clinicians of such toxicity when prescribing ertapenem.Methods:We described an 87 year-old woman with complicated urinary tract infection who received ertapenem treatment (1 g,qd).On the third day after treatment,the patient began to talk nonsense and have visual hallucination.She developed tonic-clonic seizures on day 5,associated with urinary incontinence.Her conscious status improved 2 days after discontinuation of ertapenem.We also reviewed another 19 cases of ertapenem-induced neurological adverse reactions.Results:The related CNS symptoms included various types of mental abnormalities,including hallucination,delirium,delusion,disorientation,dyscalculia,tremor,seizures,and altered mental status,which were not specific.In most of the reported cases,CNS symptoms occurred about 3-7 days after initiation of ertapenem treatment,and alleviated 2 days after withdrawal of the antibiotic.However,in patients with end-stage kidney disease,the symptoms could last up to two weeks.Conclusions:The risk factors for ertapenem-induced neurological adverse reactions include high dosage,co-administration with other antibiotics causing CNS symptoms,impaired renal function,advanced age,and underlying nervous system abnormalities.Advanced age,renal dysfunction,and factual overdosage of ertapenem were the risk factors in this case.