Infection and Drug Resistance最新文献

Introduction: Klebsiella pneumoniae (KP), a Gram-negative bacterium of the Enterobacteriaceae family, is a major opportunistic pathogen responsible for severe infections, particularly urinary tract infections (UTIs). The increasing incidence of KP infections poses a significant challenge to global healthcare systems.

Methods: In this study, we isolated KP strains from UTI patients and performed antimicrobial susceptibility testing, whole-genome sequencing (WGS), and comprehensive genomic analyses to delineate their molecular characteristics.

Results: Multilocus sequence typing (MLST) identified 41 sequence types (STs), with ST11 being the most prevalent. Phylogenetic analysis revealed that most local strains clustered closely with the globally disseminated KP clonal group 258 (CG258), suggesting a potential origin from this epidemic lineage. All isolates carried virulence and antibiotic resistance genes, with ST11 strains exhibiting the highest resistance gene burden, classifying them as multidrug-resistant (MDR). We further characterized the plasmid pNDM-MAR and identified biosynthetic gene clusters (BGCs) for redox-cofactors, azole-containing RiPPs, terpene precursors, NRP-metallophores, type I polyketide synthases (T1PKS), RiPP-like compounds, and non-ribosomal peptide synthetase-independent siderophores (NI-siderophores).

Discussion: These findings underscore the convergence of hypervirulence and multidrug resistance in KP, highlighting the need for continuous genomic surveillance to inform infection control strategies and antimicrobial stewardship.

Background: Type 2 diabetes mellitus (T2DM) patients infected with coronavirus disease 2019 (COVID-19) are at a higher risk of experiencing poorer prognoses and increased mortality. Glucocorticoids are recommended for the treatment of COVID-19, especially in patients with severe disease. However, the efficacy and safety of glucocorticoids in COVID-19 patients with T2DM remain a subject of debate.

Methods: We conducted a multicenter, retrospective cohort study of hospitalized patients with T2DM and confirmed COVID-19 admitted between November 1, 2022 and January 31, 2023. Data on clinical manifestations, treatment strategies, and clinical outcomes were systematically collected and rigorously evaluated.

Results: A total of 624 COVID-19 patients with T2DM were enrolled, comprising 259 patients with severe disease and 365 with non-severe disease. Compared with the non-severe group, the severe group demonstrated significantly elevated levels of inflammatory markers and more extensive multi-organ dysfunction. Multivariate logistic regression identified advanced age, male sex, cerebrovascular disease history, and poor fasting glucose control as independent predictors of progression to severe illness. Among patients with severe disease, glucocorticoid therapy was significantly associated with reduced in-hospital mortality and a shorter median length of stay; this association remained robust after adjustment for baseline glycemic status. Six-month post-discharge follow-up revealed no significant between-group differences in the incidence of long COVID-19 or interstitial pneumonia; however, among patients in non-severe group, those who received glucocorticoids exhibited a higher incidence of long COVID-19.

Conclusion: Glucose control is of particular importance for COVID-19 patients with T2DM. In mild or moderate cases, systemic use of glucocorticoid therapy should be strictly evaluated. In severe or critical cases, cautious, appropriate use of glucocorticoids may be associated with improved short-term prognosis and reduced mortality.

Osimertinib, a third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), is the standard treatment for EGFR-mutated advanced non-small cell lung cancer (NSCLC). We report a rare case of multidrug-resistant (MDR) Enterobacter cloacae pneumonia complicated by invasive pulmonary aspergillosis (IPA) in a 75-year-old male with lung adenocarcinoma who had been receiving osimertinib for 8 months. Prompt susceptibility-guided therapy with polymyxin B plus tigecycline (for MDR bacteria) and voriconazole (for aspergillosis) achieved complete resolution, highlighting the importance of rapid microbiological diagnosis and targeted antimicrobials in this vulnerable population.

Purpose: To analyze the changing distribution and drug resistance of pathogenic bacteria in patients with bloodstream infections (BSIs), thereby providing reference for hospital anti-infection treatment.

Methods: The clinical data, distribution of pathogenic bacteria and antimicrobial susceptibility profiles of patients with positive blood cultures at the First Affiliated Hospital of Xi'an Jiaotong University from January 1, 2015 to December 31, 2024 were collected retrospectively. WHONET 5.6 software was used for data analysis. The χ² test and Fisher exact test were used for statistical analysis.

Results: A total of 9372 bacterial strains were isolated from blood cultures. Gram-negative bacterial predominated (66.8%), markedly surpassing Gram-positive bacterial (33.2%). The top five pathogens were Escherichia coli (30.1%), Klebsiella pneumoniae (15.8%), Enterococcus faecium (6.9%), coagulase-negative Staphylococci (6.3%) and Staphylococcus aureus (6.1%). The detection rate of methicillin-resistant Staphylococcus aureus ranged from 25.8% to 38.4%, and it remained susceptible to vancomycin, linezolid, and teicoplanin. The detection rate of methicillin-resistant coagulase-negative Staphylococci peaked at 77.7% to 82.4%. Enterococcus faecium showed resistance to ampicillin exceeding 75%, with resistance rates to vancomycin and linezolid increasing from 0% to 5.8% and 1.2%, respectively. Escherichia coli demonstrated high susceptibility to Carbapenems, with imipenem resistance remaining low (1.6-2.2%). The resistance rates of Klebsiella pneumoniae to imipenem rose from 3.2% to 25.6%.The resistance rate of carbapenem-resistant Pseudomonas aeruginosa decreased from 36.4% in 2015-2016 to 16.5% in 2023-2024. However, the resistance rate of carbapenem-resistant Acinetobacter baumannii significantly increased from 47.2% to 75.7% during the same period.

Conclusion: The pathogenic bacteria in blood cultures isolates at this hospital are predominantly Gram-negative, with Escherichia coli and Klebsiella pneumoniae being the most common pathogens. The increasing trends of carbapenem-resistant Klebsiella pneumoniae, Acinetobacter baumannii and methicillin-resistant coagulase-negative Staphylococci underscore the urgent need for enhanced surveillance of pathogen distribution and antimicrobial resistance in bloodstream infections to guide rational antimicrobial use.

Introduction: Brucella infections can affect various systems in the body, such as the osteoarticular and genitourinary systems; however, cases involving the thyroid gland are rare. This case report describes the clinical management of a thyroid abscess associated with brucellosis in a farmer.

Case presentation: A 67-year-old male farmer presented to Shanxi Bethune Hospital on 17 March 2024 with a chief complaint of "intermittent fever with fatigue for over 3 months and neck swelling and pain for 2 months". Upon admission, his serum Brucella tube agglutination test titre was 1:200, Rose Bengal plate agglutination test was positive, and blood culture was negative for Brucella. Neck computed tomography revealed a low-density nodular shadow in the right thyroid lobe measuring approximately 4.79×4.45 cm. Coffee-coloured pus was aspirated during thyroid puncture. Pathogenic metagenomic next-generation sequencing and pus culture confirmed Brucella infection as the cause of the thyroid abscess. During treatment, the patient developed hemophagocytic syndrome. The patient's condition was controlled with aggressive anti-infective therapy and glucocorticoid treatment. However, because of symptom recurrence, the patient ultimately underwent surgical intervention, comprising partial thyroidectomy, abscess incision and drainage, and thyroid injection, following which he recovered fully.

Conclusion: This article reports an extremely rare case of brucellosis leading to a thyroid abscess. Physicians should consider the possibility of brucellosis when encountering patients with thyroid abscesses and be vigilant of other potential complications.

Objective: This study aimed to analyze drug resistance patterns and inpatient medication utilization among drug-resistant tuberculosis (DR-TB) patients in Fuyang City (2021-2023), and to identify factors associated with unsuccessful treatment outcomes in multidrug-resistant tuberculosis (MDR-TB) patients, to inform outcome-based local prevention and control strategies.

Methods: A retrospective analysis was conducted on patients who underwent drug susceptibility testing (DST) for Mycobacterium tuberculosis at the Second People's Hospital of Fuyang City from January 2021 to December 2023. Patients with resistance to any first-line anti-tuberculosis drug were included. Chi-square tests were used to compare drug resistance and medication utilization between initial and retreatment cases. Binary logistic regression identified factors associated with MDR-TB treatment outcomes. A p-value < 0.05 was considered statistically significant.

Results: Among 181 DR-TB patients, 120 were initial treatment and 61 retreatment cases. MDR-TB accounted for the highest proportion (40.88%, 74/181). Ethambutol showed the highest resistance prevalence (69.61%), followed by isoniazid (64.64%), rifampicin (51.38%), and streptomycin (33.70%). First-line drugs were used significantly more frequently in initial treatment than retreatment patients (p < 0.05). Annual increases were observed in the use of cycloserine, bedaquiline, linezolid, and clofazimine (p < 0.05). The treatment success rate among MDR-TB patients was 55.41%. Multivariate logistic regression identified retreatment as an independent risk factor for unfavorable outcomes (OR = 4.524, 95% CI: 1.174-17.435, p = 0.028), while a bedaquiline-containing regimen was a protective factor (OR = 0.155, 95% CI: 0.033-0.721, p = 0.017). Among the 31 patients receiving bedaquiline-containing regimens, 19 received long-course and 12 short-course treatment.

Conclusion: DR-TB remains a significant burden in Fuyang City, with high first-line drug resistance rates, a high proportion of MDR-TB exhibiting complex resistance profiles, and suboptimal treatment success. Bedaquiline-containing regimens are protective against poor outcomes.

Background: Given the rising incidence, acute onset of Pneumocystis jirovecii pneumonia (PJP) in HIV-negative patients, and the limitations of existing diagnostic methods (poor sensitivity, low accessibility, and difficulty distinguishing infection from colonization), this study aims to develop and validate a diagnostic prediction model for PJP in this population.

Methods: A retrospective observational study was conducted on hospitalized patients with suspected PJP at Zhejiang Provincial People's Hospital from 2017 to 2022. Based on the inclusion and exclusion criteria, 115 HIV-negative patients were enrolled, including 37 with confirmed PJP and 78 with PJP ruled out. Clinical data including age, gender, comorbidities, laboratory indicators, and treatment history were collected. The LASSO method was used to screen predictive variables for constructing a model, which was internally validated via Bootstrap resampling and visualized as a nomogram.

Results: A 7-variable PJP diagnostic prediction model was constructed following LASSO variable screening. The model exhibited good performance in distinguishing whether HIV-negative patients were afflicted with PJP, with an area under the ROC curve (AUC) of 0.895 (95% CI: 0.834-0.956). The calibration curve revealed high consistency between predicted and actual probabilities, and decision curve analysis demonstrated its superior clinical net benefit over all-intervention and no-intervention strategies. Bootstrap internal validation yielded a stable AUC of 0.895 (95% CI: 0.831-0.947) with consistent calibration.

Conclusion: This study established a predictive model for Pneumocystis jirovecii pneumonia (PJP) in HIV-negative patients, and this effort is clinically meaningful. However, due to several limitations of the present study, it should be emphasized that the final nomogram only serves as a supplement to, rather than a replacement for, existing diagnostic approaches. The findings of this study warrant further validation in future multicenter or prospective investigations.

Background: Tuberculosis (TB) remains a significant public health burden among older adults, yet predictive tools for this population are limited. This study aimed to develop and validate machine learning models to predict TB risk among older adults in Eastern China.

Methods: A prospective cohort of 33,935 participants aged ≥60 years was followed for over 8 years. TB diagnosis was confirmed through linkage with the national TB surveillance system. LassoCox regression was used to identify key predictors of TB risk. Four machine learning models-CoxBoost, Generalized Boosted Models (GBM), LassoCox, and Random Survival Forests (RSF)-were developed and compared. Model performance was evaluated using time-dependent area under the receiver operating characteristic curve (AUC), Brier score, and concordance index.

Results: During follow-up, 387 participants developed TB, yielding an incidence rate of 134.5 per 100,000 person-years. The LassoCox model identified 14 predictors, including sex, alcohol consumption, dietary quality, body mass index, and C-reactive protein levels. Among the four models, the LassoCox model demonstrated the best discriminatory ability with an AUC of 0.717 (95% CI: 0.692-0.742), followed by GBM (AUC: 0.712, 95% CI: 0.687-0.737), CoxBoost (AUC: 0.708, 95% CI: 0.683-0.733), and RSF (AUC: 0.637, 95% CI: 0.611-0.663). The LassoCox model also demonstrated satisfactory calibration, with a Brier score of 0.338. Decision curve analysis confirmed clinical utility at threshold probabilities below 20%. Kaplan-Meier survival analysis showed significant differences between risk groups (log-rank P < 0.001), though survival curves revealed limited separation between low- and high-risk groups.

Conclusion: The LassoCox model demonstrated acceptable predictive performance for TB risk in older Chinese adults. These findings suggest that machine learning-based risk prediction tools could facilitate targeted TB screening by identifying high-risk individuals in aging populations, thereby enabling more efficient allocation of screening resources and earlier intervention. However, further model refinement and external validation in diverse populations are warranted before clinical implementation.

Background: Autoimmune pulmonary alveolar proteinosis (aPAP) is a rare lung disorder characterized by abnormal accumulation of surfactant in the alveoli, often leading to progressive respiratory failure. While whole lung lavage (WLL) remains the standard therapeutic intervention, its timing and safety in the context of active infection remain a critical clinical dilemma.

Case presentation: We present a fatal case of a 42-year-old Tibetan female with aPAP and progressive respiratory failure requiring V-V ECMO. Critically, serological tests were negative, but targeted next-generation sequencing (tNGS) of bronchoalveolar lavage fluid revealed a dominant mixed opportunistic infection (Cryptococcus neoformans: 3,877 reads; Enterococcus faecium: 118,062 reads). Despite this finding, the patient underwent emergent WLL and subsequently succumbed to the uncontrolled infection. To contextualize our findings, we conducted a systematic literature search in PubMed and Embase from their inception to November 21, 2025, which identified 27 relevant case reports and series. This review demonstrated that the majority of WLL procedures were performed after the active infection was controlled or had resolved following the initiation of antimicrobial therapy. The outcome was generally favorable, with clinical improvement reported in 23 cases (85.2%).

Conclusion: This fatal aPAP case suggests a staged management approach whereby WLL should be deferred until infection control is achieved. Early tNGS-guided pathogen identification appears crucial for directing antimicrobial therapy. This target-then-lavage strategy merits further validation but offers a prudent framework for managing these high-risk patients.