Infection and Drug Resistance最新文献

Purpose: It is well known that bacteria often acquire drug resistance genes through acquiring exogenous resistant plasmids. The tmexCD1-toprJ1-positive plasmid confers tigecycline resistance to bacterial strains.

Methods: Three sequence type (ST) 17 Klebsiella pneumoniae strains were isolated from two patients within 5 days. Experimental and comparative genomic analyses were performed to investigate potential transmission routes and antimicrobial resistance phenotype disparities.

Results: Strain HD9931 was tigecycline-sensitive, whereas HD9932 and HD10868 were tigecycline-resistant because of the presence of a tmexCD1-toprJ1-positive plasmid. HD10868 exhibited enhanced fitness and greater tigecycline resistance than HD9932 did. Comparative analysis revealed mutations in the AcrAB-TolC efflux pump and lamb in HD9932 and HD10868.

Conclusion: Our study highlights the complexity of resistance gene transfer and underscores the need for continued vigilance and research in this field.

Objective: This study aimed to analyze the distribution characteristics and changes in antimicrobial resistance of pathogens in the Pediatric Intensive Care Unit (PICU) of Beijing Children's Hospital from 2014 to 2023 to guide the rational use of antibiotics and provide a scientific basis for hospital infection prevention and control, as well as public health policy formulation.

Methods: A retrospective cohort design was used to systematically analyze the clinical data and antibiotic sensitivity results of 4,468 children aged 0-17 years who were admitted to the PICU of Beijing Children's Hospital between 2014 and 2023.

Results: 6,079 strains of pathogenic bacteria were cultured and isolated. There were 4,276 strains of Gram-negative bacteria, including Acinetobacter baumannii (20.0%), Pseudomonas aeruginosa (15.2%), and Klebsiella pneumoniae (12.9%); There were 1,803 Gram-positive bacteria, including Staphylococcus aureus (11.3%) and coagulase-negative Staphylococci (CoNS) (7.9%). Between 2014 and 2023, the number of detected Gram-negative and Gram-positive bacteria showed a fluctuating upward trend. A. baumannii showed a resistance rate of over 70% to most antibiotics, P. aeruginosa exhibited a relatively high resistance rate to carbapenems, and Escherichia coli demonstrated a high resistance rate to third-generation cephalosporins, but a low resistance rate to carbapenems. Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococci (MRCNS) were highly resistant to most antibiotics but remained highly sensitive to linezolid and vancomycin. Carbapenem-resistance (CR) and difficult-to-treat resistance (DTR) phenotypes of K. pneumoniae showed a marked upward trend. In contrast, E. coli, P. aeruginosa, and A. baumannii exhibited fluctuating or relatively stable resistance to extended-spectrum cephalosporins (ECR) and fluoroquinolones (FQR).

Conclusion: This study revealed the distribution and antibiotic resistance trends of pathogens in the PICU of Beijing Children's Hospital, providing important evidence for empirical anti-infective treatment in clinical practice.

Infectious complications still remain a major challenge in the treatment of children with hematological malignancies. Invasive mold infections such as invasive aspergillosis or mucormycosis have a significant and negative impact on overall outcome in pediatric cancer patients. Although severe prolonged neutropenia is the major risk factor for invasive mold infection, other factors such as steroid exposure and acute or chronic graft-versus-host disease have to be considered in increasing the risk for infection. As clinical signs and symptoms are unspecific, diagnosis of invasive mold infection is mainly based on imaging and microbiological evaluation. Non-culture based tests using biomarkers such as galactomannan are more sensitive than culture-based tests, and there is major development of molecular techniques including next generation sequencing and analysis of cell-free DNA in order to improve both specificity and sensitivity. Antifungal strategies can be divided in prophylaxis (indicated for patients with a natural incidence of fungal infection ≥10%), empirical (eg, prolonged neutopenic fever despite broad-spectrum antibiotics) and pre-emptive therapy and treatment of established infection. Although there are exciting potent novel-class antifungal agents in the pipeline, pediatric approval of antifungal compounds significantly lags that for adult patients. To this end, despite major improvements over the last three decades, invasive mold infection is still a major challenge for pediatric patients with hematological malignancies.

SARS-CoV-2 is a major global public health burden associated with significant morbidity, mortality, and complications, including respiratory, cardiovascular, neurological, and digestive disorders. COVID-19 may induce venous and arterial thromboembolic complications, including deep vein thrombosis, myocardial infarction and cerebral infarction. Simultaneous myocardial and cerebral infarction, termed cardio-cerebral infarction, is exceedingly rare. There is only limited case of concurrent cardio-cerebral infarction in patients with COVID-19. Although there is no standard treatment for the condition, antiplatelet and anticoagulation agents should be used. We emphasize the catastrophic coexistence of concurrent cardio-cerebral infarction in a patient co-infected with SARS-CoV-2 and influenza A. We described a 75-year-old woman was admitted for SARS-CoV-2 and influenza A coinfection. She received anti-viral agent treatment for the virus infection. The patient presented with right side limbs weakness and declined consciousness. The magnetic resonance imaging of brain revealed acute cerebral infarction over the left corona radiata and basal ganglion. Meanwhile, acute myocardial infarction was diagnosed using electrocardiogram and elevated cardiac enzymes. Percutaneous coronary intervention and dual-antiplatelet agents were applied for the arterial thrombosis. The patient survived and recovered with mild residual hemiparesis. In addition, this is the first reported case of concurrent cardio-cerebral infarction in patients with SARS-CoV-2 and influenza A coinfection. Coinfection with SARS-CoV-2 and influenza A is associated with more complications including thromboembolic complications. Management of concurrent cardio-cerebral infarction poses challenges, as timely intervention is critical to prevent disability or death, yet aggressive anticoagulation risks hemorrhagic complications. Optimal treatment strategies remain unclear, highlighting the need for further research. This case underscores the importance of vigilance in managing thrombotic complications in patients with SARS-CoV-2 and influenza coinfection. Despite the downgrading of the COVID-19 pandemic, clinicians must remain alert to complex presentations caused by coinfections with respiratory viruses.

Background and aims: The coexistence of chronic hepatitis B (CHB) and non-alcoholic fatty liver disease (NAFLD) is increasingly common, yet their combined impact on antiviral outcomes remains unclear. This study aimed to compare baseline histopathological features and longitudinal virological responses to entecavir (ETV) therapy in CHB patients with and without NAFLD.

Methods: From October 2014 to January 2022, 299 treatment-naïve CHB patients (130 with NAFLD, 169 without NAFLD) were enrolled in a real-world observational cohort at Tianjin Second People's Hospital. NAFLD diagnosis was confirmed by liver biopsy and (or) ultrasound examination following AASLD guidelines. Baseline characteristics (histopathology, metabolic profiles, HBV markers) and serial virological outcomes (HBV DNA seroconversion, HBsAg/HBeAg loss rate) were analyzed over 96 weeks of ETV therapy. Statistical comparisons utilized Mann-Whitney U and chi-square tests.

Results: At baseline, NAFLD-comorbid patients exhibited milder hepatic inflammation (G≥3: 6.9% vs 17.2%, P =0.022) and fibrosis (S≥3: 10.8% vs 17.2%, P =0.020) despite higher metabolic dysregulation (BMI: 24.8 vs 21.5 kg/m², TG: 1.05 vs 0.89 mmol/L, P <0.001). While early virological responses (4-48 weeks) were comparable, NAFLD patients showed significantly lower HBV DNA seroconversion rates at 96 weeks (82.7% vs 92.1%, P =0.038) and persistently reduced HBsAg levels (3.17±1.07 vs 3.57±0.67, P = 0.017).

Conclusion: Despite milder baseline histology, NAFLD comorbidity predicts suboptimal 96-week HBV DNA seroconversion and slower HBsAg decline during entecavir therapy, underscoring the need for intensified, integrated metabolic-antiviral management in this cohort.

Purpose: To analyze the pathogen distribution, epidemiological characteristics, and antimicrobial resistance patterns of bacterial conjunctivitis in a Shanghai secondary hospital from 2020 to 2024, providing evidence for clinical treatment optimization.

Patients and methods: Conjunctival swab specimens from patients clinically diagnosed with bacterial conjunctivitis were collected between January 2020 and December 2024. Bacterial identification and antimicrobial susceptibility testing were performed using the VITEK 2 Compact system and Kirby-Bauer disk diffusion method, respectively. Statistical analyses were conducted using WHONET 5.6 and SPSS 26.0.

Results: Among the 611 specimens, 58 bacterial isolates were identified (9.5% positivity rate). Gram-positive cocci predominated (70.7%, 41/58), primarily Staphylococcus epidermidis (21 strains) and Staphylococcus aureus (10 strains). Gram-negative bacilli accounted for 15.5% (9/58), including Pseudomonas aeruginosa and multidrug-resistant Acinetobacter baumannii. A significant seasonal variation was observed, with higher incidence in summer-autumn (72.4%) than in winter (12.1%, P=0.005). Cases in 2023-2024 nearly doubled those in 2020-2022 (65.5% vs 34.5%). The detection rate of S. aureus increased significantly annually (P=0.043). High resistance rates were observed among Gram-positive cocci to penicillin (89.5%), oxacillin (60.5%), and erythromycin (55.3%). All Gram-positive isolates remained susceptible to vancomycin, linezolid, and tigecycline. Gram-negative isolates exhibited 100% resistance to ampicillin, with A. baumannii demonstrating pandrug-resistance.

Conclusion: Gram-positive cocci, particularly Staphylococcus spp. were the predominant pathogens in bacterial conjunctivitis, with an increasing trend of S. aureus and multidrug-resistant A. baumannii. The significant seasonal pattern and high resistance to first-line antibiotics emphasize the necessity for culture-guided therapy and enhanced antimicrobial stewardship in ocular infections.

We present the two adult cases of influenza diagnosed by multiplex polymerase chain reaction (PCR) in the 2024-2025 season, which was a major season of influenza in Japan. Although rapid antigen tests (RATs) were negative in these two cases, these patients were effectively treated by anti-influenza agents after influenza was definitively diagnosed by multiplex PCR. Relative low sensitivity and specificity might be shown in influenza diagnosis at bedside by RATs, therefore, these data suggest that multiplex PCR could be useful in influenza diagnosis and management during the influenza-endemic season.

Background: H. pylori infection is a worldwide health issue, fueling rising demand for medical counseling. LLMs have the potential to serve in medical counseling. However, their performance remains unclear.

Objective: This study aimed to evaluate the effectiveness of LLMs in providing H. pylori related medical counseling in a Chinese context.

Methods: 20 H. pylori-related questions were collected, covering four domains: definition and symptoms, diagnosis, treatment, and prevention. Each question was asked thrice in Chinese to each LLM. We assessed the responses across five dimensions (accuracy, relevance, completeness, clarity, and reliability).

Results: 1. In the first batch of tests, the overall performance distribution was 33.3% good, 66.1% medium, and 0.6% poor, respectively. No significant differences were observed among the three LLMs (p=0.158). Good performance was observed with 47.8% in accuracy, 53.9% in relevance, 68.3% in completeness, 36.7% in clarity, and 36.1% in reliability. No significant differences were observed in accuracy, relevance, completeness, or clarity. Reliability differed significantly (p<0.001), with Ernie Bot achieving the best performance. 2. The second test batch yielded performance rates of 70.6% good, 29.4% medium, and 0% poor, with a significant difference among the three LLMs (p=0.018). Doubao attained the best performance, surpassing other models in relevance and clarity. 3. The newly assessed AI batch showed markedly superior overall performance to the counterpart evaluated more than a year prior.

Conclusion: This study is the first to evaluate the effectiveness of various LLMs in H. pylori-related medical counseling in a real-world setting. The study showed that while LLMs generally performed acceptably in terms of accuracy, relevance, and completeness, their clarity and reliability were less satisfactory. Ernie Bot, developed by Chinese company, outperformed ChatGPT in certain aspects of medical counseling in Chinese. With the guidance of professionals, LLMs can serve as potential aids for medical counseling.

Background: Carbapenem-resistant organisms (CROs) are a growing threat in intensive care units (ICUs) worldwide due to the limited treatment options and high risk of morbidity and mortality. While previous studies have assessed the clinical implications of CROs, few have systematically quantified their economic burden.

Aim: This study aimed to evaluate the economic burden attributable to CROs compared with carbapenem-susceptible organisms (CSOs) among critically ill patients in China.

Methods: We conducted a retrospective cohort study including 7,232 ICU patients from two tertiary hospitals in Western China (2019-2024). Patients were assigned to either the CRO group or the CSO group and matched using a 1:1 propensity score matching (PSM) approach. ICU length of stay (LOS), hospital LOS, and total hospitalization cost were compared between the two groups, followed by generalized linear models (GLMs) to assess the independent impact of CRO status. Institutional-level opportunity costs were estimated based on excess ICU occupancy.

Results: Among the 7,232 patients, 379 (5.24%) developed CRO, with carbapenem-resistant Acinetobacter baumannii (CRAB) being the predominant pathogen. PSM produced 379 pairs of CRO and CSO patients. The CRO group had significantly longer ICU LOS (median 11.0 vs 5.0 days, P<0.001), longer hospital LOS (median 24.0 vs 13.0 days, P<0.001), and higher total hospitalization costs (median CNY 99,549 vs CNY 50,279, P<0.001) than the CSO group. GLMs showed that CRO independently predicted longer ICU LOS (OR: 2.37; 95% CI: 2.03-2.76), longer hospital LOS (OR: 1.97; 95% CI: 1.70-2.27), and higher total hospitalization costs (OR: 1.99; 95% CI: 1.78-2.23). An estimated 321 hospital admissions and 459 ICU admissions were lost over six years due to excess bed occupancy by CRO patients, resulting in a total institutional financial loss of approximately CNY 134,000 per year.

Conclusion: CROs are associated with substantially increased economic burden in ICU patients. These findings support the implementation of early screening, targeted prevention, and stewardship strategies to mitigate the impact of CROs.

Talaromyces marneffei (TM), a temperature-dependent dimorphic fungus and opportunistic pathogen, poses a significant threat to immunocompromised individuals, particularly in Southeast Asian regions such as China and India. This case report details an 8-month-old HIV negative Chinese infant with recurrent cough and fever, who was diagnosed with TM infection through blood culture and metagenomic next-generation sequencing (mNGS). Additionally, whole exome sequencing identified a point mutation (c.346+1G>T) in the child's CD40LG gene, primary immunodeficiency calized to chromosome position chrX:135736590, leading to X-linked Hyper IgM Syndrome (XHIGM). The patient was managed with intravenous immunoglobulin (IVIG) and a 12-day course of amphotericin B and itraconazole, which led to significant clinical improvement and discharge on a quarterly IVIG regimen. However, he required readmission for recurrent TM pneumonia at 9 and 40 months post-discharge. This case highlights the diagnostic challenge and management complexity of TM infection in the context of primary immunodeficiency.