Abstract:To summarize the progress in the management of antimicrobial use in Chinese children, explore special requirements for top-level design, multidisciplinary collaboration and antimicrobial management, assess the difficulties in the establishment of an evaluation system and consider corresponding strategies, and provide reference to further improve the management of antimicrobial use in Chinese children and the effectiveness of curbing bacterial resistance.

Abstract:Objective To understand the distribution and changing trend of multidrug-resistant organisms (MDROs) from clinical specimens in traditional Chinese medicine hospitals, provide scientific basis for rational clinical antimicrobial use. Methods In vitro antimicrobial susceptibility testing data of frequently clinically isolated bacteria from traditional Chinese medicine hospitals nationwide from 2018 to 2021 were collected. In vitro antimicrobial susceptibility testing methods included disk diffusion method, automated apparatus method, and E-test method. Antimicrobial susceptibility testing results were interpreted according to the American Clinical and Laboratory Standards Institute (CLSI) standards. According to the technical program of China Antimicrobial Resistance Surveillance System (CARSS), the distribution of bacterial species as well as the detection and changing trend of MDROs were analyzed with WHONET 5.6 software. Results Among clinical isolates from 2018 to 2021, Gram-positive and Gram-negative bacteria accounted for 26.4%-27.4% and 72.6%-73.6%, respectively, with a stable trend. Among Gram-positive bacteria, isolation rates of methicillin-resistant Staphylococcus aureus (MRSA) increased from 28.5% to 30.2%, however, methicillin-resistant coagulase negative Staphylococcus (MRCNS), vancomycin-resistant Enterococcus faecium and penicillin-resistant Streptococcus pneumoniae (PRSP) all showed decreasing trends, from 76.1%, 2.7% and 3.1% in 2018 to 72.4%, 1.5% and 1.8%, respectively. Among Gram-negative bacteria, isolation rates of carbapenem-resistant Escherichia coli and carbapenem-resistant Klebsiella pneumoniae gradually increased from 1.6% and 10.4% to 1.9% and 13.3%, respectively. However, isolation rates of carbapenem-resistant Pseudomonas aeruginosa and carbapenem-resistant Acinetobacter baumannii showed downward trends, decreasing from 22.4% and 49.5% to 21.9% and 48.2%, respectively. In addition, detection of MDROs varied significantly in different regions. Isolation rates of MRSA were highest in Anhui, Jiangsu, and Guangdong Provinces, but lowest in Yunnan, Heilongjiang, and Jilin Provinces. Meanwhile, isolation rates of carbapenem-resistant Klebsiella pneumoniae were highest in Anhui Province, Shanghai City, and Henan Province, but lowest in Ningxia, Qinghai and Jilin Provinces. Conclusion The isolation rates of MRSA, carbapenem-resistant Klebsiella pneumoniae, and carbapenem-resistant Escherichia coli show increasing trends, while isolation rates of other clinically isolated MDROs present downward trends or remain unchanged. There are temporal and regional differences in the isolation rate of MDROs. Management of rational use of antimicrobial agents as well as healthcare-associated infection prevention and control should continue to be strengthened, bacterial antimicrobial resistance monitoring should be conducted well.

Abstract:Objective To investigate the distribution and antimicrobial resistance of pathogenic bacteria isolated from infected patients in department of oncology, and provide scientific basis for rational selection of antimicrobial agents in clinical practice. Methods Antimicrobial resistance data of 102 570 bacterial strains from department of on- cology reported by China Antimicrobial Resistance Surveillance System (CARSS) from October 2020 to September 2021 were analyzed with WHONET 5.6. Results The main sources of specimens of patients from department of oncology were sputum (38.3%), urine (18.5%), and blood (12.2%). Among clinically isolated bacteria, the top 3 Gram-positive bacteria were Staphylococcus aureus (35.9%), Enterococcus faecalis (13.6%), and Enterococcus faecium (10.6%). Isolation rate of methicillin-resistant Staphylococcus aureus (MRSA) was 25.0%. Resistance rates of Enterococcus faecalis and Enterococcus faecium to vancomycin were 0.1% and 0.8%, respectively. The top 3 Gram-negative bacteria were Escherichia coli (30.6%), Klebsiella pneumoniae (21.7%), and Pseudomonas aeruginosa (12.0%). Resistance rate of Escherichia coli to third-generation cephalosporins cefotaxime and ceftria-xone exceeded 50%, resistance rate to carbapenems was about 1%. Resistance rate of Klebsiella pneumoniae to carba-penems was about 3%. The isolation rate of carbapenem-resistant Pseudomonas aeruginosa was about 6%. Conclusion Gram-negative bacteria are the major clinically isolated bacteria from tumor patients, resistance rate of which is not high. Rational use of antimicrobial agents should be strengthened in clinical practice, and monitoring on bacterial resistance should be conducted well.

Abstract:Objective To understand the distribution and antimicrobial resistance of bacteria isolated from patients in department of hematology in China, and provide scientific basis for rational clinical antimicrobial use in patients with infection from department of hematology. Methods According to the technical program from China Antimicrobial Resistance Surveillance System (CARSS), distribution and antimicrobial resistance of clinically isolated bacteria from patients in department of hematology in 2021 were analyzed by WHONET 5.6 software. Results A total of 74 300 non-repetitive clinically isolated strains were collected from patients from department of hematology in CARSS hospitals, including 53 970 (72.6%) Gram-negative bacteria and 20 330 (27.4%) Gram-positive bacteria. Escherichia coli was the most frequently isolated bacteria (n=16 051, 21.6%), followed by Klebsiella pneumoniae (11 214, 15.1%), Pseudomonas aeruginosa (6 071, 8.2%), Staphylococcus aureus (4 768, 6.4%) and Enterococcus faecium (3 600, 4.8%). The most common specimen source was blood (24.6%), followed by sputum (24.0%) and urine (16.6%). The resistance rates of Escherichia coli to imipenem and meropenem were 4.4% and 4.3%, respectively, and those of Klebsiella pneumoniae to imipenem and meropenem were 10.8% and 11.5%, respectively. Resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 16.7% and 12.8%, respectively. Resistance rates of Acinetobacter baumannii to most tested antimicrobial agents were 14.3%-27.0%, except polymyxin B, minocycline and tigecycline, which were less than 10%. The resistance rate of Haemophilus influenzae to ampicillin was 64.5%. Among Staphylococcus aureus and coagulase negative Staphylococcus, isolation rates of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase negative Staphylococcus (MRCNS) were 28.8% and 82.1%, respectively. No Staphylococcus aureus strains were found to be resistant to vancomycin and linezolid. The resistance rates of Enterococcus faecium and Enterococcus faecalis to vancomycin were 3.2% and 0.2%, respectively, and that of Streptococcus pneumoniae to penicillin was 1.6%. No Streptococcus strains were found to be resistant to vancomycin and linezolid. Conclusion Gram-negative bacteria are the major bacteria isolated from department of hematology. Carbapenem-resistant Klebsiella pneumoniae, linezolid-resistant Staphylococcus and linezolid-resistant Enterococcus should be paid more attention. Monitoring of antimicrobial resistance of pathogenic bacteria should be strengthened, and antimicrobial agents should be used rationally.

Abstract:Objective To understand the distribution and antimicrobial susceptibility of clinically isolated bacteria from department of rheumatology and immunology in China in 2021. Methods According to China Antimicrobial Resistance Surveillance System (CARSS) program, information of clinically isolated bacteria from department of rheumatology and immunology reported by all CARSS member hospitals in 2021 were statistically analyzed. Antimicrobial susceptibility testing results were interpreted according to the standards from Clinical and Laboratory Stan-dards Institute (CLSI). Results In 2021, 28 863 strains of non-repetitive bacteria were isolated from patients in the department rheumatology and immunology, with Gram-negative bacteria and Gram-positive bacteria accounting for 72.0% (n=20 784) and 28.0% (n=8 079), respectively. The top five detected bacterial strains were Escherichia coli (n=9 825, 34.0%), Klebsiella pneumoniae (n=3 222, 11.2%), Staphylococcus aureus (n=3 002, 10.4%), Pseudomonas aeruginosa (n=1 793, 6.2%) and Enterococcus faecalis (n=866, 3.0%). The specimens were mainly from urine (n=13 496, 46.8%), sputum (n=7 597, 26.3%), blood (n=2 402, 8.3%) and pus (n=1 243, 4.3%). Isolation rates of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coa-ulase negative Staphylococcus (MRCNS) were 22.8% and 67.2%, respectively. The resistance rate of MRCNS to linezolid was 0.1%, and no strains were found to be resistant to vancomycin and teicoplanin. Resistance rates of Enterococcus faecalis and Enterococcus faecium to vancomycin and linezolid were 0.2%-4.0%. Resistance rate of Streptococcus pneumoniae isolated from non-cerebrospinal fluid specimens to penicillin was 2.8%. Resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannii to impenem were 9.6% and 20.2%, respectively. Resis-tance rates of Escherichia coli to cefotaxime and imipenem were 41.0% and 0.9%, respectively. Resistance rates of Klebsiella pneumoniae to cefotaxime and imipenem were 18.2% and 4.5%, respectively. Resistance rate of Haemophilus influenzae to ampicillin was 69.4%. Conclusion Clinically isolated bacteria from patients in department of rheumatology and immunology mainly come from urine specimens, and antimicrobial resistance of bacteria still remains at a high level.

Abstract:Objective To understand the distribution and antimicrobial resistance of frequently isolated pathogenic bacteria from hospitalized patients in nephrology department in China. Methods All isolated pathogenic bacteria from hospitalized patients in nephrology department reported by member units of China Antimicrobial Resistance Surveillance System (CARSS) in 2021 and their antimicrobial resistance were analyzed. Results A total of 122 203 bacterial strains were isolated from hospitalized patients in nephrology department, mainly from urine, sputum and blood, accounting for 49.2%, 16.7% and 13.4%, respectively. 81 994 strains (67.1%) were Gram-negative bacteria and 40 209 strains (32.9%) were Gram-positive bacteria. The top 5 frequently isolated pathogens were Escherichia coli (39 914, 32.7%), Klebsiella pneumoniae (12 695, 10.4%), Staphylococcus aureus (11 977, 9.8%), Pseudomonas aeruginosa (6 583, 5.4%) and Enterococcus faecium (5 821, 4.8%). The detection rate of ceftria-xone-resistant Escherichia coli and Klebsiella pneumoniae were 47.2% (15 704/33 272) and 30.7% (3 091/10 070), respectively. The detection rates of carbapenem-resistant Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae were 1.0% (388/38 813), 8.2% (1 000/12 206) and 4.8% (135/2 813), respectively. The resistance rates of Acinetobacter baumannii to imipenem, meropenem, polymyxin and tigecycline were 27.6% (972/3 523), 29.6% (813/2 748), 1.3% (8/625) and 2.2% (38/1 730), respectively. The resistance rates of Pseudomonas aeruginosa to imipenem, meropenem and polymyxin were 10.1% (640/6 335), 8.4% (477/5 678) and 1.2% (11/955), respectively. The detection rates of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcs (MRCNS) were 23.3% (2 787/11 977) and 68.5% (7 290/10 644), respectively. No vancomycin-resistant Staphylococcus was detected. The resistance rates of Enterococcus faecium and Enterococcus faecalis to vancomycin were 1.1% (65/5 740) and 0.1% (7/4 738), respectively. Conclusion Gram-negative bacteria isolated from hospitalized patients in nephrology department are mainly Escherichia coli and Klebsiella pneumoniae, and Gram-positive bacteria are mainly Staphylococcus aureus. The resistance rates of Gram-ne-gative bacteria to carbapenems, piperacillin/tazobactam, cefoperazone/sulbactam, and ceftazidime/avibactam are low, and the resistance rates of Gram-positive bacteria to vancomycin, teicoplanin, and linezolid are low. Antimicrobial agents should be selected rationally according to antimicrobial susceptibility testing results and disease features of patients in nephrology department.

Abstract:Objective To understand the species distribution and antimicrobial resistance characteristics of pathogenic bacteria isolated from patients in department of neurology in China, and provide a basis for the prevention and control of healthcare-associated infection as well as the rational use of antimicrobial agents in clinical. Methods Bacterial resistance monitoring data of patients in department of neurology in member units of China Antimicrobial Resistance Surveillance System in 2021 were selected, and analyzed with WHONET 5.6 software. Results In 2021, a total of 127 506 strains of bacteria were isolated from patients in department of neurology. Gram-positive bacteria and Gram-negative bacteria accounted for 21.6% (n=27 526) and 78.4% (n=99 980), respectively. The major specimens were sputum (n=67 782, 53.2%), urine(n=37 789, 29.6%)and blood (n=10 599, 8.3%). Isolation rates of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase negative Staphylococcus (MRCNS) were 31.9% and 66.4%, respectively. No Staphylococcus strains were found to be resistant to vancomycin and teicoplanin. Resistance rates of Enterococcus faecalis and Enterococcus faecium to vancomycin were 0.4% and 1.7%, respectively. Among Enterobacterales, resistance rates of Klebsiella pneumoniae to imipenem and meropenem were 9.8% and 11.4%, which were higher than those of Escherichia coli (1.2% and 1.3%, respectively). Acinetobacter baumannii had a high resistance rate to carbapenems, with resistance rates to imipenem and meropenem being 52.0% and 54.4%, respectively. Conclusion Bacteria isolated from patients in department of neurology are mainly Gram-negative bacteria, mostly from lower respiratory tract specimens. Antimicrobial resistance of the frequently clinically isolated bacteria is severe. Cntinuous monitoring on bacterial resistance should be carried out to promote the rational use of antimicrobial agents.

Abstract:Objective To understand the distribution and antimicrobial resistance of bacteria isolated from patients in department of urology in China in 2021. Methods According to the technical program of China Antimicrobial Resistance Surveillance System (CARSS), data and antimicrobial susceptibility testing results of bacteria isolated from patients in department of urology reported by all CARSS member units in 2021were analyzed with WHONET 5.6 software. Results A total of 232 603 strains of bacteria were isolated from urological patients, 166 483 (71.6%) were Gram-negative bacteria and 66 120 (28.4%) were Gram-positive bacteria. The top 5 specimens were urine, blood, wound secretion, sputum, and abdominal peritoneal effusion. The top 5 isolated Gram-negative bacteria were Escherichia coli(57.5%), Klebsiella pneumoniae(10.8%), Pseudomonas aeruginosa(5.8%), Proteus mirabilis(5.3%), and Enterobacter cloacae(3.4%). The top 5 isolated Gram-positive bacteria were Enterococcus faecalis(36.2%), Enterococcus faecium(14.9%), Staphylococcus epidermidis(10.5%), Streptococcus lactis(9.5%), and Staphylococcus aureus(7.3%). Vancomycin-, teicoplanin-, and linezolid-resistant Staphylococcus aureus was not found. The resistance rates of methicillin-resistant Staphylococcus aureus to gentamicin, rifampicin, levofloxacin, cotrimoxazole, clindamycin, and erythromycin were all higher than those of methicillin-sensitive Staphylococcus aureus. The resistance rates of Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis to imipenem(1.1%-5.3%), meropenem(0.7%-5.9%), and ertapenem (0.7%-4.4%) were relatively low, and the resistance rates to ceftriaxone ranged from 36.5% to 54.5%. Resistance rates of Enterobacterales to tegacyclin, polymyxin B, and ceftazidime/avibactam were relatively low. Resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannii to imipenem, meropenem, polymyxin B, tegacyclin, ceftazidime/avibactam, and enzyme inhibitor agents were relatively low. Conclusion The major specimen from department of urology is urine, the main isolated pathogenic bacteria are Escherichia coli and Klebsiella pneumoniae, and antimicrobial resistance rate of Enterobacterales is different. Surveillance on the antimicrobial resistance of bacteria isolated from urine specimens can provide reference for the rational use of antimicrobial agents in urinary tract infection.

Abstract:Objective To analyze the trends and antimicrobial resistance of carbapenem-resistant Enterobacterales (CRE), and guide the rational use of antimicrobial agents in clinical practice. Methods WHONET 5.6 software was used to analyze the isolation rate, specimen source, ward distribution, and antimicrobial resistance of CRE in patients admitted to a hospital from January 2013 to December 2022. Results From 2013 to 2022, a total of 32 320 strains of pathogenic bacteria were detected from patient specimens collected at this hospital, among which 1 347 were CRE strains (4.17%). The top 3 detected CRE were carbapenem-resistant Klebsiella pneumoniae (CRKP), carbapenem-resistant Escherichia coli (CREC), and carbapenem-resistant Enterobacter cloacae (CRECL), accoun-ting for 78.10% (n=1 052), 7.94% (n=107), and 7.80% (n=105), respectively, the detection rates were 12.37% (1 052/8 504), 0.58% (107/18 407), and 5.36% (105/1 960), respectively. The detection rates of CRE, CRKP, CREC, and CRECL in 2022 were all higher than those in 2013 (all P < 0.05), and the detection rates in 2018 were higher than in 2017 (P < 0.05). The detection rates of CRE and CRKP showed an upward trend in other time periods, but the trend remained stable. The detection rate of CRECL started to decline since 2020, with a significant decrease in 2021 compared to 2020 (P < 0.05). While in other time periods, the CRECL detection rate has shown an upward trend with a stable pattern. The main source of specimens of CRKP and CRECL was respiratory tract, followed by urine and blood. The main source of CREC specimens was urine, followed by respiratory tract and blood. The main wards sources of CRE were cadre health care wards, intensive care unit, and department of neurosurgery. The resistance rates of CRKP, CREC, and CRECL to tigecycline were all 0. Comparison in the resistance rates of CRKP, CREC, and CRECL to aminoglycosides (amikacin, tobramycin, and gentamicin) showed that resistance rates of CRECL were the lowest (3.81%, 15.31%, 32.65%, respectively), followed by CREC (34.58%, 61.96%, 65.22%, respectively), and CRKP was the highest (84.22%, 87.06%, 88.16%, respectively). The resistance rates of CRECL to ciprofloxacin and levofloxacin (82.86%-89.80%) were lower than those of CRKP (97.72%-98.35%) and CREC (94.39%-97.83%). The resistance rates of CRKP, CREC, and CRECL to meropenem were 98.10%, 83.65%, and 82.52%, respectively. Conclusion The detection rate of CRE shows an increasing trend, and antimicrobial resistance is severe. Clinicians should choose antimicrobial agents rationally based on antimicrobial susceptibility test and take effective measures to reduce the infection rate of CRE.

Abstract:Objective To investigate the carrying status of disinfectant resistance genes in clinically isolated carbapenem-resistant Klebsiella pneumoniae (CRKP) and the homology of strains that carried disinfectant resistance genes in Wuhan City, and provide theoretical basis for the effective prevention and control of CRKP transmission. Methods Non-repetitive CRKP strains isolated from hospitalized patients in three tertiary hospitals in Wuhan City from 2018 to 2019 were collected. Antimicrobial susceptibility were tested by minimum inhibitory concentration (MIC). Disinfectant resistance gene qacEΔ1 and cepA were detected by real-time polymerase chain reaction (RT-PCR). Homology of CRKP strains carrying both qacEΔ1 and cepA genes was analyzed by pulsed-field gel electrophoresis (PFGE). Results A total of 62 CRKP strains were collected, 77.42% were from intensive care unit (ICU), 40.32% were isolated from sputum specimens. All CRKP strains were multidrug-resistant, with resistance rates to ertapenem, amoxicillin/clavulanic acid, cefazolin, ceftazidime, and ceftriaxone being 100% and high resis-tance to other frequently used antimicrobial agents. The detection rate of disinfectant resistance genes was 95.16% (59/62), among which qacEΔ1 and cepA genes were 64.52% (40/62) and 91.94% (57/62), respectively, with 38 strains (61.29%) detected both qacEΔ1 and cepA genes. PFGE results showed that 38 CRKP strains can be divided into 11 types (from A to K), with type E being the major type, accounting for 42.11% (n=16). Conclusion Antimicrobial resistance of CRKP strains in Wuhan is severe. Strains carry disinfectant resistance genes widely. There is clonal transmission among different hospitals and departments. Epidemiological monitoring should be streng-thened, and disinfectant should be used rationally.

Abstract:Objective To explore the effect of Qiwei Baizhu Powder on the activities of intestinal β-D-glucosidase and β-D-glucuronidase in mice with antibiotic-associated diarrhea(AAD), and to explain the mechanism of Qiwei Baizhu Powder in treating AAD from the perspective of intestinal glycoside hydrolase. Methods AAD mice model was constructed using a mixed antibiotic solution and treated with gavage Qiwei Baizhu Powder decoction. Specimens of small intestine contents (SC), small intestine mucosa (SM), colon contents (CC), and colon mucosa (CM) from mice were collected after modeling and treatment respectively to detect intestinal glycoside hydrolase activity. Blood and liver specimens were taken to detect succinate dehydrogenase (SDH), lactate dehydrogenase (LDH), oxi-dative stress indicator malondialdehyde(MDA), inflammatory factor interleukin-17 (IL-17), and lipopolysaccharide (LPS). Results The activities of β-D-glucosidase and β-D-glucuronidase decreased significantly in SC, SM and CC in AAD mice (all P < 0.05), while increased significantly in CM (all P < 0.05). After treatment with Qiwei Baizhu Powder, glycoside hydrolase activity in each intestinal segment of mice in the treatment group was higher than that in the normal group and the natural recovery group. Compared to the natural recovery group, blood MDA, LDH, IL-17 and LPS decreased in the treatment group, while SDH increased. Conclusion Glycoside hydrolase activities in mice SC, SM, and CC decreases with antibiotics, while increases in CM. Qiwei Baizhu Powder can effectively regulate the activities of intestinal glycoside hydrolase, energy metabolism, oxidative stress, and inflammatory factors in AAD mice, restore their metabolic ability, improve the intestinal environment of mice, and treat diarrhea.

Abstract:Objective To compare the effectiveness, safety, and economy between vancomycin and linezolid in the treatment of suppurative spondylitis. Methods Medical records of 120 patients with suppurative spondylitis and treated with vancomycin or linezolid in the orthopedic department of a tertiary hospital from January 2019 to December 2022 were retrospectively analyzed. 71 patients were treated with vancomycin (vancomycin group) and 49 with linezolid (linezolid group). Data about inflammatory indicators, adverse reactions as well as treatment time and total cost of antimicrobial agents were collected, the effectiveness, safety, and economy of two groups of patients were compared. Results The white blood cell count (WBC), C-reactive protein (CRP), pain visual analogue scale (VAS), and Oswestry disability index (ODI) of patients in vancomycin and linezolid groups after treatment were all lower than before, with statistically significant differences (all P < 0.05). There were no statistically significant differences in the above indicators, treatment time and adverse reaction incidence of antimicrobial treatment between the two groups after treatment (all P>0.05). While the total cost of antimicrobial treatment in linezolid group was lower than that in vancomycin group, with a statistically significant difference (P < 0.05). Conclusion The effectiveness and safety of linezolid in the treatment of suppurative spondylitis are comparable to vancomycin, but the economy is superior to vancomycin.

Abstract:Objective To analyze the impact of carbapenem-resistant Enterobacterales (CRE) colonization on gut microbes in patients in intensive care unit (ICU) based on 16S rRNA sequencing. Methods Fresh stool or anal swab specimens from ICU patients were collected and inoculated on MacConkey plates containing 2 μg/mL ertape-nem for incubation. Strains were identified by matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF MS). Antimicrobial susceptibility analysis was performed by disk diffusion method. 16S rDNA fragments of preliminarily screened CRE strains were amplified by polymerase chain reaction (PCR), and CRE strains were further determined using micro-broth dilution method. Finally, genomic DNA of fecal or anal swab specimens from CRE colonized and non-colonized patients was extracted for 16S rRNA sequencing analysis on the HiSeq platform. Results A total of 241 stool or anal swab specimens were collected from ICU patients, including 17 CRE-positive specimens. 726 OTUs were isolated by sequencing the V3-V4 region of the 16S amplicon, 631 in the non-colonized group and 480 in the colonized group, with a total of 385 OTUs in two groups. Most of these shared OTUs belonged to the Firmicutes, Proteobacteria, Bacteroidetes, Verrucomicrobia and Actinobacteria. At the class level, there was a significant difference in the relative abundance of γ-proteobacteria (W=193.000, P < 0.001, FDR=0.004) and Synergistia (W=37.500, P=0.001, FDR=0.018) before and after CRE colonization. At the genus level, Klebsiella pneumoniae (W=195.000, P < 0.001), Enterococcus saccharolyticus (W=153.000, P=0.038) and Campylobacter hominis (W=63.500, P=0.050) between the two groups had significant diffe-rences. No significant impact of intestinal CRE colonization on the KEGG functional pathway of gut microbiota in ICU patients was found. Conclusion CRE colonization can decrease the diversity of gut microbes in ICU patients. CRE colonization group showed significant differences in the abundance of Klebsiella pneumoniae, Enterococcus saccharolyticus and Campylobacter hominis compared to the non-colonization group.

Abstract:Objective To describe the current status of healthcare-associated infection (HAI) in medical institutions (MIs) in Guizhou Province. Methods A cross-sectional survey was conducted to investigate the prevalence rates of HAI in 186 MIs in Guizhou Province from July 15 to December 31, 2022. Results A total of 89 409 hospitalized patients were surveyed, with 1 066 cases of HAI. The prevalence rate of HAI was 1.19%, with Guiyang City having the highest HAI rate (1.38%) and Bijie City having the lowest (0.77%). Among HAI sites, the proportion of lower respiratory tract was the highest (38.96%), followed by urinary tract (14.42%) and skin soft tissue (8.00%). The department with the highest prevalence rate of HAI was general intensive care unit (11.39%), followed by department of hematology (6.68%) and department of neurosurgery (4.83%). The main pathogens of HAI was Gram-negative bacteria, accounting for 66.79%. The usage rate of antimicrobial agents was 36.06%. Among patients underwent class Ⅰ incision surgery, the prevalence rate of HAI was 3.30%, and the usage rate of antimicrobial agents was 20.87%. There were statistically significant differences in the usage rate of antimicrobial agents, the HAI prevalence rate of patients who underwent class Ⅰ incision surgery, and the preventive usage rate of antimicrobial agents in patients in MIs with different bed numbers(χ²=250.218, 16.454, 99.891, respectively all P < 0.01). Conclusion It is necessary to strengthen the management of infection prevention and control in hospitals in Guiyang and Bijie Cities, as well as target monitoring and infection control on surgical site infection of class Ⅰ incision surgery in general ICUs and large-scale MIs.

Abstract:Objective To investigate the distribution and antimicrobial resistance of pathogens of candidemia in a hospital, and explore the application efficacy of standardized intervention measures for healthcare-associated infection (HAI). Methods Patients who were hospitalized in a hospital in Huai'an City from January 2015 to December 2019 were select as the control group, and those from January 2020 to December 2022 were as the intervention group. Standardized HAI intervention measures were implemented. Clinical data of patients with candidemia were analyzed, including bacterial distribution, antimicrobial resistance, and HAI incidence. Results There were a total of 507 974 hospitalized patients in the control group and 392 616 in the intervention group. Over eight years, there were 181 cases of candidemia, 76 of which were HAI-associated candidemia. Among the 181 Candida strains, the proportions of Candida albicans, Candida glabrata, Candida dubliniensis, Candida tropicalis and Candida parapsilosis were 38.12%, 21.55%, 14.92%, 14.37% and 9.39%, respectively. Difference in the clinical distribution of HAI-associated Candida was statistically significant (P < 0.05). Candida tropicalis had high antimicrobial resistance (P < 0.05). In the control group, there were 117 cases of candidemia, with an incidence of 0.23 ‰; and 58 HAI cases, with a HAI incidence of 0.11 ‰. In the intervention group, there were 64 cases of candidemia, with an incidence of 0.11 ‰; and 18 HAI cases, with a HAI incidence of 0.05‰. The incidences of candidemia and HAI were both statistically significant between the two groups (both P < 0.05). The mortalities of candidemia and HAI-associated candidemia were 6.08% and 7.89%, respectively. Conclusion The clinical distribution of HAI-associated candidemia is sporadic, and antimicrobial resistance of strains is unspecific. The implementation of standardized HAI intervention measures can reduce HAI-associated candidemia.

Abstract:NF-κB (p50/p65)-regulated microRNA (miRNA) have been identified and partially characterized currently in Staphylococcus aureus (SA) infection, including miR-125b, miR-193b-5p, miR-128, miR-146a, miR155, bta-miR-223, and miR-30a. Experimental evidence reveals that upregulation of this pro-inflammatory miRNAs family coordinates the expression of pathogenic genes in SA infection, providing new possibilities for explaining the infection mechanism of SA infection, as well as the spread and severity of the disease. This article reviews NF-κB regu- lation of miRNA-mediated signaling pathways, as well as the therapeutic strategies targeting NF-κB and/or pro-inflammatory miRNA signaling involved in the current research fields, providing references for subsequent related research.

Abstract:The abuse of antimicrobial agents has led to a growing problem of bacterial antimicrobial resistance, and bacterial antimicrobial resistance has become a increasingly serious public health issue. This review introduces how different antimicrobial agents exert their antimicrobial effects and the mechanisms of producing bacterial antimicrobial resistance through changing cell membrane permeability, etc. In order to solve the problem of bacterial antimicrobial resistance, researchers have proposed a synergetic antimicrobial strategy by combining different antimicrobial agents, aiming to reduce the probability of bacterial resistance and improve antimicrobial efficacy through multi-target and multi-pathway action. This paper reviews the synergetic antimicrobial effects of the combined application of different antimicrobial agents from the perspective of synergistic antimicrobial mechanism. The synergetic effects of the combined application of antimicrobial peptides with traditional antimicrobial agents and their application in different fields are highlighted, aiming to further promote the innovation of antimicrobial application strategies such as antimicrobial peptides and inhibit the development of bacterial antimicrobial resistance.

Abstract: