Abstract:Enterobacterales are important pathogens responsible for healthcare-associated infections and can cause various severe infectious diseases. Since their first report, extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) have become widely prevalent worldwide. These strains often exhibit multidrug resistance, significantly increase the risk of treatment failure and patient mortality. In China, the prevention and control of ESBL-E faces numerous challenges, including high prevalence rates, significant regional distribution disparities, uneven laboratory detection capabilities, and variations in antimicrobial stewardship and prescribing practices. To address these issues, Professors Zhuo Chao, Xu Yingchun and Yu Yunsong initiated the development of the Expert consensus on clinical management strategies for infections caused by extended-spectrum β-lactamase-producing Ente-robacterales (2025), in collaboration with multidisciplinary experts. This consensus systematically reviews the global and domestic epidemiological characteristics of ESBL-E, clinical laboratory detection techniques, treatment principles and key therapeutic agents, as well as infection prevention and control measures. Furthermore, it elaborates on the microbiological features and stratified treatment strategies for infections of different sources (including bloodstream, intracranial, respiratory system, thoracic mediastinal, intra-abdominal, and urinary tract infections) and special populations (such as neutropenic patients with fever, emergency patients, and pediatric patients). The consensus aims to enhance the detection capacity of clinical laboratories for ESBL-E, standardize diagnosis and treatment strategies in healthcare settings, and provide scientific guidance to curb the spread of ESBL-E in China, thereby reducing associated morbidity and mortality.

Abstract:Objective To explore the effect of Mycobacterium tuberculosis infection on the primary cilia of monocytse-macrophages and its potential mechanisms of promoting osteoclast differentiation. Methods Bone marrow-derived mononuclear cells (BMMCs) isolated from patients in control group and spinal tuberculosis group (TB group) were performed in vitro culture, and then cultured with Mycobacterium tuberculosis, infection model (Rv group) was constructed. Changes in cilia were observed by fluorescence staining and scanning electron microscopy technique, a mouse spinal TB model was constructed for validating. Results Compared with the control group, the expression of primary cili markers in the lesion of bone tissue of patients in TB group decreased significantly; After co-culturing with Mycobacterium tuberculosis, the ratio (48.56%±7.77% vs 9.58%±5.59%) and length (4.050［3.289, 4.666］ μm vs 0［0, 0.676］ μm) of primary cilia of monocytes-macrophages in the Rv group decreased significantly; The infiltration of osteoclasts in the bone marrow cavity of spinal TB mice was obvious, and the proportion and length of primary cilia decreased significantly. Conclusion Intracellular infection of Mycobacterium tuberculosis can induce degradation of primary cilia in monocytes-macrophages, promote osteoclast differentiation, and exacerbate vertebral bone resorption.

Abstract:Objective To identify the potential pathological mechanisms of tuberculous spondylitis (TS). Methods Spinal specimens were collected from 13 TS patients and 13 controls who received treatment at a hospital from March 2021 to March 2023. Specimens were randomly selected from 3 TS patients and 3 controls to perform high-throughput lncRNAs and mRNAs sequencing with Illumina NovaSeq 6000. Differentially expressed lncRNAs (DELncRs) and mRNAs (DEmRs) in TS specimens were identified and analyzed through differential expression, and enrichment analysis was performed. The top 20 DEmRs with high connectivity were identified through protein-protein interaction (PPI) network. Regulatory network of DElncRs and DEmRs was built. Finally, gene expression of the remaining specimens was analyzed using qRT-PCR detection. Results A total of 1 243 DEmRs and 262 DElncRs were identified. Enrichment analysis revealed that muscle contraction, muscle system processes, muscle structural development, PI3K Akt signaling pathway, calcium signaling pathway, and cAMP signaling pathway were activated in TS, while responses to cytokines, cytokine-mediated signaling pathways, regulation of immune system processes, cytokine-cytokine receptor interactions, human T-cell leukemia virus type 1 infection, and phagosomes were inhibited in TS. Three sub-networks were identified in PPI, among which MYL1, TTN, LOC102723407, HLA-A, interleukin (IL)-6, and IL-1β had the highest connectivity and were identified as key DEmRs. MYL1, TTN, and IL-6 were regulated by DElncRs. qRT-PCR validated the differential expression of key DEmRs in TS. Conclusion DEmRs are regulated by lncRNAs and participate in the pathological process of TS, and the immune responses are inhibited in diseases condition. This study reveals key molecules and signaling pathways in TS, providing new insights into the pathological mechanisms of TS, and suggest scientific basis for developing new therapeutic targets.

Abstract:Objective To analyze the molecular epidemiological characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP) in a hospital in Hainan Province, explore the differences in the distribution of resistance genes and virulence factors between hypervirulent CRKP (hv-CRKP) and non-hv-CRKP, analyze the clinical significance, and provide basis for optimizing treatment and prevention strategies. Methods CRKP strains isolated from a hospital in Hainan Province from July 2023 to June 2024 were collected retrospectively. Their resistance phenotypes were detected by antimicrobial susceptibility testing. Carbapenemase genes (KPC-2, NDM-1, IPM) and virulence factors (rmpA/rmpA2, iucA, iroB, etc.) were detected by polymerase chain reaction (PCR). Department source, specimen distribution, and resistance-virulence characteristics were analyzed. Results A total of 76 strains of CRKP were isolated, with an overall isolation rate of 7.7% (76/985). The strains were mainly distributed in the intensive care unit (ICU) (28.9%) and neurosurgery ICU (23.6%), with the highest proportion of strains isolated from respiratory tract specimens (60.5%). The resistance genes were mainly KPC-2 (72.4%) and NDM-1 (21.1%), and the virulence factors mrkD (type Ⅲ pili, 85.5%) and fimH (type Ⅰ pili, 84.2%) were commonly presented. Among 76 strains of CRKP, 39 strains (51.3%) met the criteria for hv-CRKP and all carried KPC-2 gene (100%). The detection rates of resistance genes and virulence factors rmpA2 (97.4%), iucA (100%), and iroB (89.7%) were all higher than those of non-hv-CRKP strains (KPC-2, 43.2%; rmpA2, 0; iucA, 8.1%; iroB, 13.5%). The main characteristics of hv-CRKP was the combination of KPC-2 resistance gene and rmpA2+iucA+iutA+iroB virulence factors (64.1%). Antimicrobial resistance phenotype of hv-CRKP was different from non-hv-CRKP. hv-CRKP presented higher susceptibility rates to aminoglycosides and compound sulfamethoxazole than non-hv-CRKP. Conclusion The proportion of hv-CRKP and non-hv-CRKP strains in this hospital is comparable. hv-CRKP is characterized by carrying the KPC-2 resistance gene in combination with rmpA2+iucA+iutA+iroB virulence factors, and the proportion of strains carrying multiple virulence factors is higher than that of non-hv-CRKP. Both are generally resistant to β-lactams and quinolones. hv-CRKP has lower resistance rates to aminoglycosides and compound sulfamethoxazole than non-hv-CRKP. Its advantage of aminoglycoside susceptibility provides a new treatment option. It is recommended to guide differential medication through molecular typing and strengthen infection control measures in ICU to curb the spread of antimicrobial-resistant bacteria.

Abstract:Objective To investigate the distribution characteristics of Klebsiella pneumoniae (KP), hypervirulent Klebsiella pneumoniae (hvKP), carbapenem-resistant Klebsiella pneumoniae (CRKP), and hypervirulent carbapenem-resistant Klebsiella pneumoniae (hv-CRKP/CR-hvKP) in the environment of general intensive care unit (ICU) at medical institutions, and provide reference for environment assessment as well as healthcare-associated infection (HAI) prevention and control in ICU. Methods A total of 3 336 environmental specimens were collected from general ICUs of medical institutions in Shanghai in 2019 and 2023. After strain isolation, antimicrobial susceptibility testing and whole genome sequencing were conducted. Results The detection rate of KP was 1.59% (n=53), among which hvKP, CRKP, and hv-CRKP/CR-hvKP accounted for 37.74% (20/53), 52.83% (28/53), and 24.53% (13/53) of the total detected strains, respectively. The main types of hvKP were ST11-KL64 and ST11-KL25, CRKP were ST15-KL19 and ST11-KL25, hv-CRKP/CR-hvKP were ST11-KL25 and ST11-KL64. The main carried resistance genes included fosA, oqxAB, tet(A), bla_TEM-1B, bla_KPC-2, qnrS11, etc. All strains carried virulence genes fimH, iutA, entA, entB, entC, entD, entE, and entF, with only one strain carrying rmpA gene. Conclusion KP contamination is widespread in general ICU environment of medical institutions, predominantly ST11 and ST15, presenting a polymorphic distribution. CRKP and hvKP account for a relatively high proportion, and multidrug resistance is serious. Co-evolution of drug resistance and virulence presents in KP, and poses significant infection and pathogenic risks to patients, necessitating enhanced clinical vigilance and preparedness for potential outbreaks.

Abstract:Objective To understand the risk and related influencing factors of death of patients with infection of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in Shaoyang City. Methods The survival status and death risk of HIV/AIDS patients in Shaoyang City from 1997 to 2024 were analyzed by Kaplan-Meier survival analysis and Cox proportional hazards regression model of retrospective cohort study method. Results A total of 5 805 patients were included in analysis, 1 941 died during the observation period, out of which 54.20% died from diseases irrelevant to AIDs, and the all-cause mortality was 9.01/100 person-year. The risk of death for males was 1.447 times of females. The comparison of death risk among patients with different ages of HIV infection diagnosis and educational levels showed statistically significant differences (all P<0.05). The death risk of patients with baseline CD4⁺T lymphocyte count in the 0-199 group was 1.497 times higher than that in the ≥500 group (P<0.001), and the mortality in this group was higher than those in other groups. Patients with lower last CD4⁺T lymphocyte counts had a higher risk of death(P＜0.001). The mortality of patients who did not receive antiviral treatment was 36.37/100 person-year, which was higher than 4.21/100 person-year of those who received treatment. The maximum ratio of death risk between the two was 6.578 (P<0.001). Compared with patients in the INSTI-containing regimen group, the death risks of patients in LPV/r-containing and NNRTI-containing regimen groups were 4.902 and 2.769, respectively (both P<0.001), and patients in the LPV/r-containing regimen group had a higher percentage of deaths due to cardiovascular and cerebrovascular diseases than those in the NNRTI regimen group (11.79% vs 7.26%; χ²=3.872, P=0.049). Conclusion HIV/AIDS patients in Shaoyang City face a high risk of death. Male, advanced age, low educational level, without receiving antiviral treatment, and low baseline/last CD4⁺T lymphocyte count are all important factors that contribute to the increase of death risk. Receiving INSTI-containing treatment regimen can significantly reduce mortality. Therefore, early detecting cases, timely optimizing antiviral treatment regimen, as well as strengthening patient management and compliance education have certain clinical reference value for reducing the risk of death in HIV/AIDS patients.

Abstract:Objective To explore the disinfection effect of periodic hypochlorous acid infusion on water supply pipelines. Methods Water specimens from 6 water outlets of central sterile supply department were collected at baseline for microbial culture. After introducing a slightly acidic hypochlorous acid water generator, water specimens were collected every 10 days. Continuous disinfection with hypochlorous acid was carried out on the 1st-3rd day, and discontinued on the 4th-10th day. Water specimens of 6 water outlets were collected on the 1st, 4th, 7th, and 10th day of each cycle, in total 3 cycles. Microbial culture and metagenomic next-generation sequencing (mNGS) analysis were conducted simultaneously on all water specimens from the outlets of the endoscope cleaning tank. Results Before disinfection of the pipeline, a total of 18 bottles of water specimens were collected. Bacterial count of water specimens from 10 bottles (55.56%) was between 10² and 10⁴ CFU/mL, mainly Sphingomonas adhesins and Bacillus cereus. After disinfection, only 2 out of 72 water specimens (2.78%) exceeded the bacterial limit. The mNGS results showed that three most dominant bacterial genera in the pre-disinfection water specimens were Sphingomonas, Methylobacterium, and Ralstonia, with stringent mapped reads number (SMRN) ranging from 10 000 to 100 000; while the most dominant bacterial genera in post-disinfection water specimens were Lactobaci-llus, Ralstonia, Acinetobacter, and Bradyrhizobium. PCoA analysis showed that there was a statistically significant difference in β-diversity of water specimens before and after disinfection (P<0.05). Conclusion Periodic hypochlorous acid infusion disinfection can effectively remove bacterial biofilms in water pipelines, but there is a risk of bacterial biofilm recovery during disinfection suspension. In the future, monitoring and management of medical water should be strengthened.

Abstract:Objective To systematically analyze the research status, hotspots, and trends in the field of healthcare-associated infection (HAI) in 2020-2025 globally, with a focus on exploring the development strategy of scientific and technological talents, and provide data support for talent cultivation, disciplinary layout, and evidence-based decision-making in this field. Methods Web of Science Core Collection was adopted as data source, and HAI-related literatures from January 2020 to January 2025 were retrieved. Bibliometric methods were employed with tools such as VOSviewer and Bibliometrix (R4.4.0) to conduct a cluster analysis on annual publication volume, countries/regions, authors, highly cited literatures, and keywords. The distribution characteristics, collaboration modes, and adaptability to research hotspots of scientific and technological talents in this field were also sorted out. Results A total of 9 566 literatures were included in the analysis. The annual publication volume peaked in 2021 and subsequently entered a high-level platform period with over 1 800 articles per year. China and the United States formed a dual-core research pattern, with Chinese scholars dominating the list of productive authors. Highly cited literatures were predominantly published in 2020-2021, mainly focusing on the clinical characteristics and HAI risks during the early stages of the COVID -19 pandemic. Research hotspots present a dual theme of "clinical epidemiology as well as management of prevention and control" and "antimicrobial resistance mechanisms of pathogens". However, the existing talent system shows deficiency in interdisciplinary adaptability and the depth of international collaboration. Conclusion Over the past five years, global research on HAI has entered a normalized stage, and Chinese scholars play vital role in the dual-core pattern of China and the United States. From the perspective of ta-lents, it is necessary to formulate a development strategy for scientific and technological talents around research hotspots, including improving transnational collaboration mechanisms, innovating interdisciplinary training models, and establishing a dynamic adaptability evaluation system, so as to provide action guidance and policy references for talent development in this field.

Abstract:Objective To identify high-risk factors for healthcare-associated infection (HAI) in patients in intensive care units (ICUs), and develop a quick response (QR) code-based APP prediction tool. Methods Information of inpatients in general ICUs of three hospitals in Guizhou Province from January to December 2024 were collected. Risk factors were analyzed with a logistic regression model. QR code-based APP was constructed and validated. Results A total of 1 782 patients in general ICUs of three hospitals in Guizhou Province in 2024 were included in the analysis, out of which 410 were HAI cases, and the incidence of HAI was 23.01%. Multivariate logistic regre-ssion analysis results of HAI in ICU inpatients showed that regional gross domestic product (GDP) ≥58 685 Yuan, performing pathogen culture during this hospitalization, history of diabetes mellitus, history of cancer, length of hospital stay ≥7 days before infection, and duration of persistent fever ＞5 days before infection were independent risk factors for HAI in ICU patients (all P<0.05). The discrimination of the model (area under the receiver operating characteristic curve ［AUC］ of 0.841), calibration (Brier score of 0.129), and clinical effectiveness (net benefit of 11.4% when the risk threshold was 5%-74%) all performed well. Conclusion The QR code-based APP prediction tool is of great significance for scientific research transformation and precise HAI control.

Abstract:Objective To systematically summarize the best evidence for the prevention of peripherally inserted central venous catheter (PICC)-associated infection, and provide evidence-based basis for healthcare workers to formulate management strategies for the prevention of PICC-associated infection. Methods According to the "6S" model of the evidence pyramid, relevant literatures on the prevention of PICC-related infection were systematically retrieved from top to bottom from UpToDate, websites of World Health Organization, Centers for Disease Control and Prevention, Infusion Nurses Society, Registered Nurses’ Association of Ontario, New South Wales Agency for Clinical Innovation, National Health Commission of the People’ Republic of China, Medlive, PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and SinoMed Database. The types of included literatures were clinical decision-making, guidelines, consensus, evidence summaries, and systematic reviews. The retrieval search window was from the establishment of the database to August 2024. Two researchers independently evaluated the quality of literatures and extracted evidence. Results A total of 19 papers were included in the analysis, including 2 clinical decisions, 9 guidelines, 6 expert consensuses, 1 evidence summary, and 1 systematic review. Ultimately, 28 pieces of evidence covering 6 topics including management, tools, catheterization, maintenance, infusion, and removal were formed. Conclusion This study summarizes the best evidence for preventing PICC-related infection, and recommends that clinical healthcare workers apply relevant evidence rationally and prudently, so as to reduce the incidence of PICC-related infections.

Abstract:Objective To understand the current status of application, management, and maintenance of automated endoscope reprocessors (AERs) in China. Methods A questionnaire survey was conducted using convenience sampling method on the application, management, maintenance, and monitoring of AERs, as well as personnel training in digestive endoscopy centers of 292 medical institutions (MIs). Results A total of 316 questionnaires were distributed, and 292 were available, with an effective response rate of 92.41%. Among the 292 MIs, 198 (67.81%) were equipped with AERs, with equipment rates of 75.11% in tertiary MIs and 41.27% in secondary MIs. 88.38% of MIs performed manual cleaning before placing endoscopes into AERs, while 2.02% of MIs still didn’t perform this step, mainly in tertiary MIs. The most common problems in the application of AERs were the detachment or damage of connecting pipes (83.33%), followed by disinfectant leakage of AERs (43.94%), malfunction of control panel (43.94%), and failure or poor water flow of AER pipeline (42.93%). 92.42% of MIs regularly disinfected AERs, 72.73% of MIs regularly replaced AER air filters, and 80.30% of MIs regularly replaced AER water filters. 96.46% of MIs monitored the concentration of disinfectants before daily application of AERs, 87.88% of MIs regularly monitored the final rinse water of AERs, and 96.97% of MIs provided professio-nal training for new employees to use AERs for the first time. Conclusion The equipping rate of AERs at all levels of MIs in China still needs to be improved. Most MIs are able to monitor and maintain AERs well, but there are still many problems in the application process. Due to the large volume of endoscopic diagnosis and treatment as well as insufficient execution rate of manual cleaning in tertiary MIs, it is necessary to optimize workflow and strengthen training. Secondary MIs face challenges such as equipment shortages and low monitoring execution rates, requiring increased funding and regulatory efforts. It is recommended that manufacturers continuously optimize AER design, MIs establish standardized AER application protocol, and relevant departments improve AER application and ma-nagement standards, in order to improve the quality of endoscopic cleaning and disinfection and ensure patient safety during diagnosis and treatment.

Abstract:Objective To analyze the medical resource consumption of healthcare-associated infection (HAI) in patients in different groups of disease diagnosis-related grouping (DRG)based on the DRG payment model, provide reference for optimizing prevention and control of HAI as well as resource management. Methods Medical records and DRG-related indicators of discharged patients from a municipal hospital in Sichuan Province from January 1 to December 31, 2024 were analyzed retrospectively. Medical resource consumption of patients in HAI group and non-HAI group was compared. Differences in average length of hospital stay and average expense per hospitalization between two groups of patients were analyzed using stratified analysis. Results In 2024, HAI incidence of discharged patients in DRG management in this hospital was 1.57%. There were statistically significant differences in age, gender, admission and discharge ways between the HAI group and the non-HAI group (all P<0.05). The main HAI sites were lower respiratory tract, surgical site, urinary tract, and blood. The time consumption index (1.63 vs 0.85), average length of hospital stay (21.00 vs 5.00 days), expense consumption index (1.53 vs 0.92), ave-rage expense per hospitalization (44 700 vs 7 300), and multiple expense in HAI group were all higher than those in non-HAI group (all P<0.05). The consumption of medical resources for bloodstream infection was relatively higher. Patients with HAI were mostly concentrated in the groups related to acute leukemia with major complications or comorbidities (MCC), intracranial or craniotomy surgery with MCC, tracheotomy with mechanical ventilation for 96 hours, as well as gastric, esophageal, and duodenal surgery. The average length of hospital stay and average expense per hospitalization of patients in HAI group were both higher than those in the non-HAI group, differences were statistically significant (both P<0.05). Conclusion HAI significantly increase the consumption of medical resources. Based on DRG analysis, key disease groups for infection prevention and control can be further identified, and the consumption of medical resources can be more accurately and precisely evaluated, thereby optimizing the allocation of medical resources and improving hospital operational efficiency.

Abstract:Objective To explore the value of analysis on the incidence of healthcare-associated infection (HAI) based on disease diagnosis-related grouping (DRG), case mix index (CMI), and relative weight (RW). Methods All discharged cases, DRG and HAI status in a tertiary first-class general hospital from January 1 to December 31, 2023 were analyzed retrospectively. Incidences of HAI in different departments were adjusted and compared by CMI. Incidences of HAI in different DRG groups were adjusted by RW. Results Among the 47 695 cases included in the analysis, 757 were HAI cases, including 225 DRG groups. The department of critical care medicine had the highest incidence of HAI (11.98%). After CMI adjustment, departments with higher incidence of HAI were mainly the department of respiratory and critical care medicine (3.96%), department of critical care medicine (3.04%), and department of neurology (2.85%), et al. DRG groups with the top five high incidence of HAI were AH11 (tracheotomy and with ventilator support ≥96 hours or extracorporeal membrane oxygenation ［ECMO］, accompanied by major complications and comorbidity ［MCC］, 50.00%), BC29 (ventricular shunt and revision surgery, 31.43%), BB21 (craniotomy other than trauma, accompanied by MCC, 27.56%), BB11 (craniotomy of brain trauma, accompanied by MCC, 26.32%), and GB1A (major surgery of esophagus, stomach, and duodenum, accompanied by major or moderate complications and comorbidity, 16.00%). After RW adjustment, the DRG groups with the top five high incidence of HAI were ES21 (respiratory system infection/inflammation, accompanied by MCC, 5.89%), BR21 (cerebral ischemic disease, accompanied by MCC, 5.17%), FR11 (heart failure, shock, accompanied by MCC, 4.80%), BC29 (4.57%) and AH11 (3.57%). Conclusion Analyzing the incidence of HAI based on CMI and RW can help to identify key departments and disease groups for infection prevention and control, and provide reference for precise prevention and control of HAI in the new era.

Abstract:Objective To investigate and analyze the epidemiological characteristics and the causes of a suspected outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) infection, and provide basis for healthcare-associated infection (HAI) prevention and control. Methods Information of 3 patients with CRAB positive culture from the respiratory intensive care unit (RICU) of a hospital in May 2024 was collected. Microbiological sampling was performed in patients’ ward environment, and the specimens were cultured and strains were identified. CRAB strains detected from the environment and patients were performed whole genome sequencing (WGS). Multiple departments jointly formulated and implemented comprehensive infection control measures, and the effectiveness were evaluated. Results CRAB was cultured from specimens of sputum and bedside office mice of 3 patients. WGS detection showed that ST2158 and ST1791 resistance genes were detected from both sputum and bedside office mice of 2 patients. After comprehensive assessment, 2 patients were confirmed with HAI and 1 patient was confirmed with colonization, ruling out an outbreak of HAI. A total of 24 environmental specimens were taken for environmental hygiene monitoring, with a CRAB detection rate of 58.33%. CRAB detected from bedside mice and patients’ sputum specimen had consistent CRAB drug susceptibility testing results. After implementing measures such as increasing the frequency of cleaning and disinfection of ward environment, strengthening the implementation of hand hygiene, and enhancing the supervision of department personnel as well as HAI prevention and control training, HAI was effectively controlled. Conclusion The possible transmission route of this suspected CRAB outbreak in RICU is the contamination of office mice, which caused healthcare workers carrying CRAB in their hands, leading to cross infection due to poor hand hygiene implementation of healthcare workers. Strengthening the cleaning and disinfection of environmental surface and the management of hand hygiene of healthcare workers are key measures to prevent CRAB HAI.

Abstract:Objective To investigate the causes for the continuous detection of Pseudomonas fluorescens (P. fluorescens) from bronchoalveolar lavage fluid (BALF) in pediatric department of a hospital, formulate intervention measures and evaluate its effectiveness, and provide basis for improving the whole process infection control of fiber bronchoscopy. Methods Epidemiological investigation was conducted on three children from whose BALF P. fluorescens were detected in May 3-6, 2024. The comprehensive methods were adopted, including case reviewing, on-site process tracking, environmental hygiene monitoring, laboratory testing on disinfectant sterilization effect, fiber bronchoscope structure maintenance and checking, etc. Risks were identified and targeted interventions were implemented. Results Among the 5 pediatric patients who underwent fiber bronchoscopy within 4 days, P. fluorescens was detected from BALF of 3 cases, with a detection rate of 60.0%. The children were 5-8 years old and were admitted to the hospital due to lobar pneumonia. They underwent fiber bronchoscopy from the day of admission to the second day, and bacterial strains were clinically determined to be contaminated strains. Environmental sampling showed that the detection rate of P. fluorescens at sampling points such as fiber bronchoscope and enzyme solution storage tank was 15.7% (8/51). After implementing intervention, no target bacteria were detected again, and the difference was statistically significant (P<0.05). From January 1 to May 2, 2024, 71 BALF from pediatric department were not detected P. fluorescens; From May 3 to 6, among 5 detected BALF, 3 were detected P. fluorescens; After intervention (May 16 to December 31), no specimen was detected P. fluorescens. Conclusion This event is a pseudo-outbreak caused by fiber bronchoscope damage as well as improper cleaning and disinfection procedures. Through collaborative investigation and timely intervention by multiple departments, the event was effectively controlled.

Abstract:Objective To study the intervention effect of nursing staff’s participation in antimicrobial stewardship (AMS) on the rational use of antimicrobial agents, and explore its role in constructing a scientific healthcare-associated infection (HAI) control management. Methods The data on perioperative prophylactic use of antimicrobial agents, surgical-related HAI control, and pathogen detection before therapeutic use of antimicrobial agents among hospitalized patients in a hospital from January 2016 to December 2024 were collected. Relevant evaluation indicators before and after nursing staff participating in AMS were compared. 2016-2018, 2019-2021, and 2022-2024 were stages before intervention, during intervention, and after intervention, respectively. Results After nursing staff participated in AMS, the use rate of prophylactic antimicrobial agents 0.5-1 hour before surgery and discontinuation rate of antimicrobial agents within 24 hours after class I incision surgery increased from 64.54% and 81.41% before intervention to 75.31% and 84.56% after intervention, respectively. Incidences of surgical-related HAI and surgical site infection in patients decreased from 3.11% and 0.96% before intervention to 1.37% and 0.17% after intervention, respectively. Pathogen detection rates before restricted- and special-grade antimicrobial agents treatment increased from 50.80% and 68.70% before intervention to 55.19% and 80.53% after intervention, respectively. Proportion of blood specimen from which coagulase-negative Staphylococcus was detected decreased from 29.30% before intervention to 21.26% after intervention. Proportion of respiratory specimen from which Haemophilus influenzae was detected increased from 2.00% to 3.98%. Differences were all statistically significant (all P<0.05). Conclusion As important members of the AMS team, nursing staff can effectively reduce irrational antimicrobial use, optimize medication timing and duration, and have a positive effect on ensuring patient safety through participating in the use and management of antimicrobial agents in hospitalized patients.

Abstract:This paper reports a case of fungal keratitis (FK) in a 62-year-old male patient who was infected with Colletotrichum fructicola (C. fructicola) after plant-related trauma. Pathogen from patient was not clearly identified by two examination during hospitalization in other hospitals two months ago. Patient was confirmed with C. fructicola keratitis through confocal microscopy, corneal scraping, culture, and gene sequencing. The treatment of voriconazole combined with amphotericin B was adopted to enhance antifungal therapy, and anterior chamber irrigation, drug (voriconazole) injection in anterior chamber and corneal stromal as well as corneal lesion removal were performed. The patient’s symptoms were then improved. For patients with plant-related trauma keratitis, it is important to be alert to the possibility of rare fungal infection.

Abstract:Antimicrobial resistance poses a serious threat to human health and is the main cause for the increase in infection-related mortality. Rational and timely use of antimicrobial agents is crucial for improving the prognosis of infected patients, however, overdose and inappropriate use of antimicrobial agents can accelerate the acquisition of drug resistance of pathogenic microorganisms, promote the emergence of new resistance mechanisms, and ultimately lead to the emergence of "superbugs". Therefore, early identification of antimicrobial resistance is of significant importance for the rapid diagnosis and precise treatment of infectious diseases. With the development of molecular dia-gnostic techniques, third-generation sequencing (TGS) technique offers innovative solutions for detecting microbial resistance due to its advantages in long read length, easy operation, and rapid detection, significantly promoting early diagnosis and real-time monitoring of antimicrobial resistance. This review systematically summarizes the research progress of TGS in microbial resistance detection, analyzes its advantages and limitations in rapid detection of resis-tance in viruses, bacteria, and fungi, thus provides new perspectives for the early diagnosis and treatment of pathogenic microbial infections.

Abstract:In the global public health field, healthcare-associated infection (HAI) has become one of the important factors affecting patient safety, decreasing medical quality, and increasing medical expense. This paper comprehensively analyzes relevant research in recent years, deeply explores the relationship between the use of different types of drugs and HAI, including antimicrobial agents, immunosuppressants, and proton pump inhibitors, aiming to systematically review the risk factors and pathogenicity of drug-related HAI in hospitalized patients both domestica-lly and internationally, so as to provide theoretical basis for the prevention and control of HAI.

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