Abstract:Currently, aging is a major public health topic globally. Infectious diseases exhibit high incidence and mortality among the elderly, which seriously affect the quality of life of the elderly and cause a heavy economic burden. The changes of immune function in the elderly are complicated. Their immune response and clinical immune regulation methods after infection need further clarification. This expert consensus summarizes the immune characteristics of the elderly and the inherent connection with infections, the application of glucocorticoids, the use of related immune modulators, as well as diagnosis and treatment under specific conditions, providing high-quality recommendations for clinical practice.

Abstract:Objective To analyze the risk factors for postoperative intra-abdominal infection in gastric cancer patients, as well as construct and validate a nomogram prediction model. Methods 588 gastric cancer surgery patients who admitted to the Department of General Surgery of the First Affiliated Hospital of Soochow University from April 2021 to March 2024 were selected as the study subjects. Clinical data of patients were collected and randomly divided into the training set and the validation set according to the ratio of 3 ∶1. Clinical data between two groups of patients were compared. Patients were divided into the infection group and non-infection group according to whether they had intra-abdominal infection after surgery. Univariate and multivariate analyses were conducted, and a nomogram prediction model was constructed and validated based on the results of multivariate analysis. Results Among the 588 patients, 52 (8.84%) had postoperative intra-abdominal infection. A total of 65 strains of pathogens were detected from 52 peritoneal fluid specimens, out of which 47 (72.31%) were Gram-negative bacteria, 15 (23.07%) were Gram-positive bacteria, and 3 (4.62%) were fungi. Multivariate logistic regression analysis showed that the degree of eradication (microscopic residue), combined organ resection, hypertension, history of abdominal surgery, and duration of surgery were all independent risk factors for postoperative intra-abdominal infection in gastric cancer patients (all P<0.05). Based on multivariate analysis results, a nomogram prediction model for postoperative intra-abdominal infection in gastric cancer patients was constructed. The receiver operating characteristic (ROC) curve result showed that the areas under the ROC curve (AUCs) of the training set and validation set were 0.764 (95%CI: 0.677-0.852) and 0.712 (95%CI: 0.565-0.860), respectively, indicating that the model had good discriminability for postoperative intra-abdominal infection in gastric cancer patients. Hosmer-Lemeshow test showed a χ² value of 8.491 and a P value of 0.387, suggesting goodness fit of the model. The decision curve analysis (DCA) result showed that within the risk threshold ranges of the training set (0.05-0.4) and validation set (0.1-1.0), positive benefits may be obtained by using the model to intervene in patients with high risk of postoperative intra-abdominal infection. Clinical impact curve (CIC) analysis result showed that within the risk threshold ranges of the training set (0-0.4) and validation set (0-0.5), the number of infected cases predicted by the model was higher than the actual number, indicating good clinical practicality of the model. Conclusion Construction of a nomogram prediction model based on independent risk factors for postoperative intra-abdominal infection in gastric cancer can provide a quantitative and intuitive reference for the early clinical assessment of postoperative intra-abdominal infection in gastric cancer.

Abstract:Objective To explore the effect of hypoxia-inducible factor-1α (HIF-1α) inhibitor LW6 on ferroptosis in septic cardiomyopathy rats. Methods Rat septic cardiomyopathy model was prepared using cecal ligation and puncture (CLP) method. Thirty-six specific pathogen-free (SPF) 6-8 weeks male SD rats were randomly divided into the sham-operated group, CLP group, CLP+solvent group, LW6 group, ferrostatin-1 (Fer-1) group, and LW6+Fer-1 group. The degree of myocardial damage in each group was evaluated through hematoxylin-eosin staining and detection of lactate dehydrogenase and creatine kinase content in cardiac tissue. Myocardial mitochondrial damage was observed by transmission electron microscopy. Ferroptosis level was determined by detecting iron ion concentration, reduced glutathione, malondialdehyde, and reactive oxygen species. Protein expression levels of HIF-1α, solute carrier family 7 member 11 (SLC7A11), and glutathione peroxidase 4 (GPX4) in cardiac tissue were detected by Western blotting. Results Compared with the CLP group and the CLP+solvent group, the LW6 group could ameliorate myocardial damage, alleviate mitochondrial damage, inhibit ferroptosis-related indicators (all P<0.05), reduce HIF-1α protein expression levels (P<0.05), and enhance SLC7A11 and GPX4 protein expression levels (both P<0.05). Conclusion LW6 decreases HIF-1α expression and ferroptosis levels through the SLC7A11/GPX4 pathway, and ameliorates sepsis-induced cardiomyopathy.

Abstract:Objective To analyze the clinical characteristics, laboratory test, imaging examination, and treatment outcome of invasive Klebsiella pneumoniae liver abscess syndrome (IKPLAS) in the elderly, and improve clinicians’ understanding on this disease. Methods Clinical data of 7 elderly patients who were diagnosed with IKPLAS in a hospital from January 2020 to February 2024 were analyzed retrospectively. Results Among the 7 elderly patients with IKPLAS, there were 3 males and 4 females, ranging in age from 60 to 78 years old. All 7 patients were with community-acquired infection. The main clinical symptoms were fever (n=7), chills (n=6), upper abdominal pain (n=4), fatigue and poor appetite (n=3), cough and expectoration (n=5), vomiting (n=3), vision decrease (n=2), and disturbance of consciousness (n=1). All 7 patients had pathogenic evidence of Klebsiella pneumoniae (KP), including 4 cases with KP isolated from liver puncture pus, 3 from blood culture, and 1 from both liver puncture pus and intraocular pus. Among the 7 patients, there were 5, 2, 1, 3,1,1 cases combined with pulmonary abscess, endophthalmitis, brain abscess, bloodstream infection, urinary system infection, and pelvic infection, respectively. Conclusion Elderly patients with IKPLAS have a variety of underlying diseases and diverse clinical symptoms, showing no specificity. Once IKPLAS was suspected, timely testing for pathogen and screening for other metastatic infection sites outside the liver should be performed. Timely drainage of liver abscess and selection of appropriate antimicrobial agents for treatment based on antimicrobial susceptibility testing result can improve patients’ survival rate.

Abstract:Objective To analyze the clinical characteristics and treatment schemes of patients with severe Japanese spotted fever (JSF), and provide a basis for the diagnosis and treatment of severe JSF. Methods Data of JSF patients who admitted to Yichang Central People’s Hospital from April 2022 to September 2024 were collected, and severe patients were selected for analysis. Epidemiological and clinical characteristics, as well as treatment schemes were investigated. Results A total of 19 JSF patients were admitted, including 10 mild cases and 9 severe cases. All 9 severe cases (100%) had a history of outdoor activities. All patients presented with multiple organ dysfunction besides symptoms such as fever, rash, fatigue, poor appetite, and scab. Laboratory examination results were as follows: white blood cell count and neutrophil percentage elevated in 5 (55.6%) and 9 (100%) cases, respectively; lymphocyte percentage and platelets decreased in 9 (100%) and 8 cases (88.9%), respectively; C-reactive protein increases significantly in 9 cases (100%); alanine aminotransferase and aspartate aminotransferase increased in 9 cases (100%) and 8 cases (88.9%), respectively; total protein, albumin, and albumin/globulin ratio decreased in 6 cases (66.7%) and 9 cases (100%), respectively; blood sodium and blood calcium decreased in 3 (33.3%) and 9 cases (100%), respectively; urea elevated in 8 cases (88.9%); creatinine, lactic dehydrogenase and α-hydroxybutyrate, and creatine kinase isoenzyme elevated in 6 (66.7%), 9 (100%), and 4 cases (44.4%), respectively. In terms of treatment, all patients were treated with doxycycline combined with other antimicrobial agents. Six patients (66.7%) received tracheal intubation for ventilator-assisted ventilation; 8 patients (88.9%) received infusion of blood products such as platelets and plasma; 9 patients (100%) received infusion of albumin and support treatment such as liver and stomach protection, water and electrolyte balance maintenance, et al; 6 patients (66.7%) were finally cured. Conclusion Severe JSF not only causes typical symptoms such as fever, rash, and scab, but also leads to multiple organ dysfunction. Timely application of doxycycline supportive treatment for various organs can help patients get through the critical period and receive effective treatment.

Abstract:Objective To investigate the incidence and adverse prognosis of late onset sepsis (LOS) in neonates in neonatal intensive care unit (NICU). Methods A retrospective study was conducted to collect and analyze the perinatal condition, underlying diseases, invasive procedures, and adverse prognosis of neonates in NICU of a regional maternal and child healthcare hospital from 2019 to 2023. According to whether LOS occurred during hospitalization, neonates were divided into LOS group and non-LOS group. The LOS group was divided into 5 subgroups based on whether invasive procedures were performed: LOS plus umbilical vein catheter (UVC) group, LOS plus peripherally inserted central catheter (PICC) group, LOS plus sequential catheter group, LOS plus tracheal intubation group, and LOS plus lumbar puncture group, the relationship between LOS and adverse prognosis was analyzed. Results Among 2 945 neonates in NICU, 354 (12.02%) developed LOS. Comparison between LOS groups and non-LOS group were as follows: in term of perinatal condition of neonates, there were statistically significant difference in weight, gestational age, and whether they were twins between the two groups (all P<0.001); in term of underlying diseases, there were statistically significant differences in the number of cases of maternal gestational hypertension, neonatal asphyxia, neonatal congenital heart disease, neonatal ventricular dilation, neonatal pneumonia, neonatal hyperthyrotropinemia, and neonatal anemia, as well as five invasive procedures between the two groups (all P<0.05). Compared with the non-LOS group, the incidences of retinopathy of prematurity (ROP), neonatal necrotizing enterocolitis (NNEC), bronchopulmonary dysplasia (BPD), and neonatal respiratory distress syndrome (NRDS) in LOS group were all higher (all P<0.001). Regression analysis showed that compared with the non-LOS groups, the risk of ROP increased in the LOS group and its subgroups, with the LOS plus sequential catheter group having a 2.27-fold higher risk of ROP than non-LOS group; the risk of NNEC increased in the LOS group and its subgroups, with the LOS plus UVC group having an 8.29-fold higher risk of NNEC than the non-LOS group. Except for the LOS plus UVC group, the risk of BPD increased in the LOS group and other subgroups, with the LOS plus PICC group and LOS plus sequential catheter group having 4.68- and 4.64-fold higher risk of BPD than the non-LOS group, respectively; the risk of NRDS in the LOS plus PICC group was 6.84-fold higher than the non-LOS group (all P<0.05). The top three pathogens causing LOS were coagulase negative Staphylococcus, Klebsiella pneumoniae, and Escherichia coli. Conclusion LOS can significantly increase the risks of ROP, NNEC, BPD, and NRDS. LOS plus invasive procedures can further increase the risk of adverse prognosis.

Abstract:Objective To investigate the contamination status of cloth mouse pads in dental clinics, and provide theoretical basis for standardizing environmental surface disinfection and scientific intervention in dental clinics. Methods The contamination status of cloth mouse pads in 5 dental clinics were investigated by adenosine triphosphate (ATP) fluorescence detection method, visual observation method, and bacterial culture method. Disinfection efficacy of ultraviolet disinfection method and wiping disinfection using two types of disinfectant wipes on cloth mouse pads and photovoltaic glass mouse pads was compared. Intervention measures (using photovoltaic glass mouse pads, regular cleaning and disinfecting) were taken, and contamination status of cloth mouse pads in different departments before and after intervention was compared. Results The baseline investigation found that the conta-mination status of mouse pads varied in different dental clinics. The qualified rate of bacterial culture of mouse pads in department of endodontics was the lowest (20.00%), followed by the department of periodontology (30.00%). There was statistically significant difference in ATP detection values between two types of disinfectant wipes before and after wiping and disinfecting photovoltaic glass mouse pads (both P<0.001). After using photovoltaic glass mouse pads, the contamination of mouse pads in 5 dental clinics was alleviated, and the qualified rate of ATP detection increased (＞80%), compared with qualified rate of ATP detection before intervention, differences were all statistically significant (all P<0.001). Conclusion The contamination of the cloth mouse pads in dental clinics is serious, and the conventional cloth mouse pad is difficult to be cleaned and disinfected. It is suggested that medical institutions use the mouse pad which is convenient for cleaning and disinfection, and specify the disinfection method and frequency to control the contamination of the mouse pads.

Abstract:Objective To explore the effectiveness of risk assessment in the prevention and control of central line associated-bloodstream infection(CLABSI), identify high-risk departments and processes, and develop targeted measures to reduce the risk. Methods Healthcare-associated infection control risk assessment form designed by American Association for Professionals in Infection Control and Epidemiology (APIC) was applied to assess the risk factors for CLABSI in 13 intensive care units (ICUs) in a hospital. Each risk indicator was identified, analyzed, and evaluated from three dimensions: the likelihood of risk occurrence, severity of consequences, and integrity of the current management system. Results The risk assessment results found that the general ICU and respiratory ICU had extremely high risk, cardiac surgery ICU and organ transplant ICU had high risk. Through one-year continuous intervention, the incidence of CLABSI decreased significantly, the awareness rate of CLABSI prevention and control measures and the implementation rate of partial measures increased significantly (all P<0.05). Conclusion The application of risk assessment can screen high-risk departments, focus efforts on the intervention, and enhance the effectiveness of CLABSI risk prevention and control.

Abstract:Objective To investigate the application of the "integration of four dimensions (mainline teaching-online course-medical case-mind map) " teaching mode in the undergraduate compulsory teaching course "Healthcare-associated Infection Control", and provide reference for further improving the design of undergraduate compulsory course on infection control. Methods A questionnaire survey on undergraduate students’ satisfaction for compulsory course "Healthcare-associated Infection Control" was conducted using KANO model. A total of 4 dimensions and 21 quality indicators were set up. KANO attribute classification, satisfaction degree, and importance coefficients etc. were analyzed, and curriculum design was optimized. Results The overall questionnaire reliability Cronbach’s ɑ coefficient was 0.915, and the validity analysis Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy value was 0.867. Among the 21 quality indicators, 12 were charismatic attributes, which accounted for the largest proportion (57.14%) of the total indicators. Most quality indicators received high student satisfaction ratings. The indicators with the highest satisfaction coefficients were "playing teaching videos in class" (4.73), along with "integrating typical healthcare-associated infection cases into the curriculum for relevant teaching" "maintaining a relaxed and pleasant teaching atmosphere", and "humorous and witty teaching style of the teacher" (all scoring 4.71). Four important but currently with low satisfaction indicators were "combining course content with utilitarian exam preparation" "adopting a completely offline teaching format" "adopting relatively strict assessment methods", and "reflecting differentiation based on difficulty coefficient in final assessment". Conclusion This course has achieved certain efficacy in undergraduate compulsory education, but there is still room for improvement in the setting of curriculum assessment methods. In the future, the course system should be integrated, the assessment mode of combining theory and practice should be optimized, and course improvement and innovation should be promoted.

Abstract:Objective To explore the distribution of healthcare-associated infection (HAI) and direct economic burden in neurosurgical patients based on disease diagnosis-related grouping (DRG), providing data support for infection prevention and control. Methods Clinical data of neurosurgical patients in a hospital from January to December 2023 were retrospectively investigated, the average length of hospital stay and average hospitalization expense of HAI and non-HAI groups of the subgroups of DRG were analyzed. Results A total of 102 cases of HAI occurred among 2 180 neurosurgical patients, with HAI incidence being 4.68%. The main infection sites were lower respiratory tract and organ space, accounting for 53.92% and 25.49% respectively. HAI patients distributed in 16 DRG subgroups, out of which AH19 subgroup (invasive ventilator support ≥96 hours or extracorporeal membrane oxygenation ［ECMO］ or total artificial heart transplantation) had the highest incidence (58.82%), followed by BC19 subgroup (intracranial vascular surgery accompanied with hemorrhage diagnosis) (17.65%) and BB2A subgroup (craniotomy other than trauma, with severe or general complications and comorbidities)(12.81%). There was no statistically significant difference in resource consumption between HAI group and control group of AH19 group (all P>0.05). HAI in BB2A group increased the average length of hospital stay and average hospitalization expense by 5.00 days and 34 600 Yuan, respectively. HAI in BC19 group increased the average length of hospital stay and ave-rage hospitalization expense by 8.50 days and 42 800 Yuan, respectively. Lower respiratory tract infection had a significant impact on resource consumption, while organ space infection only increased length of hospital stay of patients. Conclusion Analysis of incidence of HAI and resource consumption of major infection sites based on DRG can clarify the focus of infection prevention and control, formulate targeted intervention measures, control medical expense and improve the quality of medical services.

Abstract:Objective To explore the differences in clinical characteristics of sudden sensorineural hearing loss (SSNHL) between patients with coronavirus disease 2019 (COVID-19) and those without-COVID-19. Methods 31 SSNHL patients with COVID-19 who were hospitalized in a department during the COVID-19 epidemic period (from December 2022 to January 2023) were included as the study group, and 12 SSNHL patients without COVID-19 who received treatment during the non-COVID-19 epidemic period (from December 2021 to January 2022) were co-llected as the control group. Two groups of patients received standardized treatment, and their clinical characteristics and prognosis were compared. Clinical characteristics of SSNHL patients with COVID-19 during the COVID-19 epidemic period were analyzed. Results The time interval from patients developed COVID-19 to the onset of SSNHL in the study group was 3-30 days. The time interval from onset to consultation were 3 (1, 7) days and 5 (4, 6) days in the study group and the control group, respectively, with no significant difference (P>0.05). The average age of patients in the study group was (44.16±13.54) years, which was higher than that of the control group (35.23±9.24) years, and the difference was statistically significant (P<0.05). The hearing at damaged frequency of the study group improved by 6.5 (0.5, 24.5) dB after therapy, which was lower than that of the control group (36.0 ［27.0, 38.0］dB), with statistically significant difference (P<0.05). There was a negative correlation of the interval of consultation with the average improvement level of hearing at damaged frequency (r=-0.318, P=0.033). The longer the interval, the less the hearing improvement and the worse the therapeutic effect. Correlation analysis was further conducted on the time interval from development of COVID-19 to SSNHL onset and the time interval of consultation in patients in the study group, which showed no correlation (r=-0.337, P=0.059). There was no statistically significant difference in the types and degree of SSNHL between two groups of patients (both P>0.05). After standardized treatment, the rate of ineffective patients in the study group was 56.25%, which was higher than that in the control group (15.38%), and the difference was statistically significant (P<0.05). Conclusion After adjusting the COVID-19 prevention and control policies, there are more hospitalized COVID-19 patients with SSNHL, with a higher proportion in patients of older age, with poorer efficacy, and ineffective treatment. The earlier the treatment for SSNHL patients, the better the effect can achieve. COVID-19 may be a potential inducement and/or etiological factor of SSNHL, and further research is needed.

Abstract:Objective To understand the current status and influencing factors of microbial contamination of dental unit waterlines (DUWLs) of secondary and lower medical institutions in Wuhan, and provide scientific basis for formulating prevention and control measures. Methods A stratified convenience sampling method was adopted to conduct questionnaire survey on 248 dental medical institutions in 15 districts of Wuhan City, DUWLs from 44 medical institutions were sampled and detected according to hospital levels. Results Among disinfection and maintenance management measures for source water and waterlines, the highest implementation rate was the installation rate of anti-suction dental handpiece (73.39%, 182/248), but only 16.48% (30/182) of institutions regularly conducted the detection on anti-suction function; The lowest was the daily disinfection rate of water storage tanks (17.53%, 17/97). A total of 132 water specimens were collected from 44 medical institutions, with a qualified rate of microbial detection of 56.06%. The qualified rates for secondary, primary, and unclassified medical institutions were 77.78%, 50.00%, and 50.72%, respectively, with statistically significant differences (P<0.05). The qualified rates of microbial detection for source water, handpiece water, and three-way syringe water were 59.09%, 50.00%, and 59.09%, respectively, with no statistically significant difference (P>0.05). Univariate analysis results showed that medical institutions that regularly conducted chemical disinfection on DUWLs, understood DUWLs waterline cleaning and disinfection standards, regularly performed microbial monitoring on diagnosis and treatment water, qualified source water, and flushed waterlines for 3 minutes before and after daily consultations had a higher qualified rate of microbial detection in DUWLs diagnosis and treatment water, and the differences were all statistically significant (all P<0.05). Conclusion The contamination status of DUWLs in secondary and lower medical institutions in Wuhan is relatively serious. It is recommended to focus on strengthening the training of relevant regulations, installing inlet filters, regularly detecting the anti-suction function of dental handpieces, implementing chemical disinfection and microbial monitoring on waterlines, standardizing the implementation of flushing before and after diagnosis and treatment, and strengthening the disinfection and use management of independent water storage tanks to control contamination.

Abstract:Objective To evaluate the impact of COVID-19 prevention and control measures on the disease burden of upper respiratory infections (URIs) in China. Methods Age-standardized incidence rate, mortality rate, and di-sability-adjusted life-year rate in Global Burden of Disease (GBD) 2021 database were used to describe the disease burden and compared before and after the outbreak of COVID-19. The disease burden in 2022-2024 was predicted by the autoregressive integrated moving average model in R 4.4.0 software. Results The disease burden of URIs in China showed a fluctuating downward trend from 1990 to 2021. Age-standardized incidence rate, mortality rate, and disability-adjusted life-year rate showed a downward trend from 2018 to 2019. The age-standardized incidence rate decreased from 137 869.97/100 000 (95%UI: 121 058.04/100 000-158 137.76/100 000) in 2019 to 137 060.04/ 100 000 (95%UI: 120 167.04/100 000-156 888.93/100 000) in 2020. The age-standardized mortality rate were 0.15/100 000 (95%UI: 0.09/100 000-0.40/100 000) and 0.15/100 000 (95%UI: 0.09/100 000-0.38/100 000), respectively. The age-standardized disability-adjusted life-year rate decreased from 51.76/100 000 (95%UI: 32.16/100 000-77.43/100 000) to 51.44/100 000 (95%UI: 32.19/100 000-76.90/100 000). In 2021, the above-mentioned indicators were higher than those in 2020, but still lower than those in 2019. The autoregressive integrated moving average model predicted that over the next three years, the age-standardized incidence rate and disability-adjusted life-year rate might show an upward trend, and the age-standardized mortality rate was likely to decline. Conclusion The disease burden of URIs in China shows a downward trend, and declines significantly after the outbreak of COVID-19. After COVID-19 being categorized as a class B infectious disease managed with class B measures, the age-standardized incidence rate increases, which reflects the effectiveness of the COVID-19 prevention and control measures on reducing the disease burden of URIs.

Abstract:Objective To explore the impact of "knowledge-attitude-practice" (KAP) training mode on head nurses’ core competency in healthcare-associated infection (HAI) prevention and control in a tertiary first-class general hospital. Methods Head nurses of 113 departments in a tertiary first-class general hospital were taken as the research objects. Guided by problems and demands, HAI training was conducted using the KAP training mode. The training was divided into two stages: a stage with problems of infection control and investigation of knowledge demands, as well as a stage with KAP training mode implementation. It included theoretical lectures, visits and lear-ning, and supervision on rectification. Scores of theory, supervision, and core competency of head nurses before training, 1 month and 6 months after training were compared by the analysis of variance. SPSS 26.0 statistical software was used for analysis. Results The top three infection control problems in this hospital were hand hygiene, prevention and control of infection with multidrug-resistant organisms, as well as HAI prevention and control in the wards. The top three training modules required urgently by the head nurses were occupational exposure and self-protection, principles of medical waste disposal, as well as prevention and control of HAI in the wards. Both scores of theory and supervision after training were higher than those before training, with statistically significant diffe-rences (both P<0.01). The core competencies of the head nurses were at a high level. After implementing KAP training mode, the scores of dimensions in critical thought and research, clinical nursing, leadership, and profe-ssional development, as well as the overall score of core competencies were all higher than before training. Diffe-rences were all statistically significant (all P<0.05). The overall scores of dimensions in legal and ethical practice, education and consultation, as well as interpersonal relationship were all higher than before training, but the diffe-rences were not statistically significant (all P>0.05). Conclusion KAP training mode can significantly improve the scores of theory, supervision, and core competencies of head nurses, and can be further promoted and applied in head nurses’ infection control training.

Abstract:Objective To explore the clinical and epidemiological characteristics of fosfomycin (FOS)-resistant hypervirulent carbapenem-resistant Klebsiella pneumoniae (hv-CRKP) strains, as well as potential molecular mechanisms of FOS resistance, and provide reference for clinical anti-infection treatment decision making. Methods Through antimicrobial susceptibility testing, non-repetitive hv-CRKP strains from a tertiary first-class hospital from January to December 2023 were screened and collected. The clinical characteristics and antimicrobial resistance were analyzed, and the molecular epidemiological characteristics of FOS non-susceptible hv-CRKP was studied by whole genome sequencing. Results A total of 73 hv-CRKP strains were included in the analysis, out of which 34 strains (46.6%) were resistant to FOS. The incidence of diabetes mellitus in patients in the FOS non-susceptible group was higher than that in the FOS susceptible group (P<0.05). There was no statistically significant difference among other clinical characteristics. Antimicrobial susceptibility results showed that, except for tigecycline, colistin, ceftazidime /avibactam, and FOS, the resistance rates of hv-CRKP to other common antimicrobial agents were all >90%. The detection of capsule serotypes and virulence genes showed that all hv-CRKP were Klebsiella pneumoniae carbapenemase (KPC)-producing ST11 strains, with the main serotypes being KL64 (47.9%) and KL25 (52.1%). There was no statistically significant difference in distribution of hv-CRKP capsule serotype between the FOS susceptible and FOS non-susceptible groups. Resistance gene detection results showed that the carbapenem-resistance gene bla_KPC as well as FOS resistance genes fosA and fosA6 were widely presented in hv-CRKP, with only one strain carrying the fosA3 gene detected in the FOS non-susceptible group. All 73 hv-CRKP strains carried the Leu359Gln mutation modification in murA, and some had mutations in the transport system-related gene glpT. No other FOS modification enzyme resistance genes were detected, such as fosA2, fosA5, fosA10, fosB, fosC, and fosX. Conclusion hv-CRKP has a high resistance rate to FOS. Modification mutations in murA and glpT, as well as the wide presence of FOS resistance genes fosA and fosA6 are the main mechanisms of FOS resistance in this study. It should be noted that fosA gene may be captured by strong promoters-containing high copy plasmids, leading to FOS resistance.

Abstract:Objective To investigate the clinical characteristics of inguinal abscess caused by Actinotignum schaalii (A. schaalii), and improve the clinical recognition and attention on skin and soft tissue infection caused by this bacterium. Methods Clinical data of a patient with inguinal abscess caused by A. schaalii were reviewed. Biological characteristics of the bacterium were observed, and antimicrobial susceptibility testing was conducted. PubMed database was retrieved using "Actinobaculum schaalii" and "Actinotignum schaalii" as keywords. Meanwhile, China National Knowledge Infrastructure, Wanfang, and VIP databases were retrieved using corresponding Chinese retrieval terms. Clinical data of skin or soft tissue infections caused by A. schaalii were summarized and analyzed. Results After literature retrieval and screening, 38 cases from 13 literatures were finally included, out of which 33 patients with A. schaalii infection were treated with antimicrobial agents and/or incision drainage, and the treatment effect was good. Conclusion A. schaalii is an opportunistic pathogen. There are few reports on skin or soft tissue infections caused by it. Currently, the identification of this bacterium relies on mass spectrometry technology or gene sequencing. Clinical attention should be paid to the detection of this bacterium, and appropriate antimicrobial agents should be selected for its treatment.

Abstract:This paper reports the clinical characteristics as well as diagnosis and treatment processes of a patient with mixed pulmonary infection of Rhizopus microspores and Aspergillus. The patient had history of type 2 diabetes mellitus, and was admitted to the hospital due to diabetes ketoacidosis complicated with pneumonia. Clinical manifestations included cough, expectoration, and fever. Imaging examination showed inflammatory lesions of bila-teral lungs (mainly in the right lung) associated with local consolidation. Bronchoalveolar lavage fluid (BALF) smears and galactomannan antigen test (GM test) were both negative. Nucleic acid sequences of Rhizopus microspores and Aspergillus were detected by metagenomic next-generation sequencing (mNGS) at the early stage, while complicated infection of Klebsiella pneumoniae and COVID-19 were also found. The final pathological diagnosis was pulmonary mucormycosis combined with invasive pulmonary aspergillosis. The patient achieved clinical curing through the combination of isaconazole antifungal treatment and lobectomy of the right middle-lower lobes.

Abstract:Shewanella putrefaciens (S. putrefaciens) is an opportunistic pathogen, which rarely causes pulmonary infection in clinic. This article reports a case with fever and expectoration as the primary clinical manifestations on the basis of diabetes. It was confirmed as S. putrefaciens infection by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Relevant literature from China and abroad was reviewed systematically. High-risk factors, clinical manifestations, diagnosis, and drug treatment of infection caused by this pathogen were summarized, so as to improve the understanding on this pathogen and provide reference for the formulation of anti-infection programs.

Abstract:Antimicrobial resistance (AMR) has become a global public health crisis, posing a serious threat to the achievement of sustainable development goals (SDGs) of the United Nations. This article explores the potential consequences and far-reaching impacts of AMR on the global health system, economic development, and social well-being from the perspective of SDGs. This article analyzes the current situation and challenges of AMR prevention and control globally and domestically, proposes comprehensive response suggestions, such as establishing a global collaborative governance mechanism for AMR, deepening the "One Health" practice framework, perfecting survei-llance as well as infection prevention and control system on AMR, accelerating the development of new vaccines, exploring AMR innovative response technologies, and strengthening AMR literacy education for all people. The research findings can provide reference globally, especially for developing countries to comprehensively respond to the threat of AMR and promote the SDGs process.

Abstract:The main function of hemoglobin is to transport oxygen and carbon dioxide, and the level of hemoglobin is closely related to the adverse outcomes of infected patients. Low hemoglobin level may indicate higher infection incidence, disease severity and mortality. As a simple, rapid, and economical clinical indicator, hemoglobin may become a biomarker for predicting adverse outcomes in infected patients. This paper reviews the relationship between hemoglobin levels and adverse outcomes as well as the predictive value in infected patients, with the aim of helping clinicians (especially those in outpatient departments and primary hospitals) to understand the clinical signi-ficance of monitoring hemoglobin levels, so as to accurately identify high-risk infected patients, optimize treatment and referral decisions.