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 Enterobactera-les(ESBL-E)have become widely prevalent worldwide.These strains often exhibit multidrug resistance,signifi-cantly 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 la-boratory 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 consen-sus 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 elabo-rates 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 treat-ment strategies in healthcare settings,and provide scientific guidance to curb the spread of ESBL-E in China,there-by reducing associated morbidity and mortality.

Objective To explore the effect of Mycobacterium tuberculosis infection on the primary cilia of mono-cytse-macrophages and its potential mechanisms of promoting osteoclast differentiation.Methods Bone marrow-de-rived 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 tech-nique,a mouse spinal TB model was constructed for validating.Results Compared with the control group,the ex-pression 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 sig-nificantly;The infiltration of osteoclasts in the bone marrow cavity of spinal TB mice was obvious,and the propor-tion 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.

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 phago-somes 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.

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 hospi-tal 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,speci-men 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 re-spiratory 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 fim H(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 com-pound 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.

Objective To investigate the distribution characteristics of Klebsiella pneumoniae(KP),hyperviru-lent Klebsiella pneumoniae(hvKP),carbapenem-resistant Klebsiella pneumoniae(CRKP),and hypervirulent car-bapenem-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 in-fection(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 suscep-tibility 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,oqx AB,tet(A),blaTEM-1B,blaKPC-2,qnrS11,etc.All strains carried viru-lence genes fimH,iutA,ent A,entB,entC,entD,entE,and entF,with only one strain carrying rmp A 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 signifi-cant infection and pathogenic risks to patients,necessitating enhanced clinical vigilance and preparedness for poten-tial outbreaks.

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 Kap-lan-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 regi-men 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％;x2=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.Re-ceiving 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 educa-tion have certain clinical reference value for reducing the risk of death in HIV/AIDS patients.

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 speci-mens 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 ad-hesins and Bacillus cereus.After disinfection,only 2 out of 72 water specimens(2.78％)exceeded the bacterial lim-it.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 Lacto-baci-llus,Ralstonia,Acinetobacter,and Bradyrhizobium.PCoA analysis showed that there was a statistically sig-nificant 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.

Objective To systematically analyze the research status,hotspots,and trends in the field of health-care-associated infection(HAI)in 2020-2025 globally,with a focus on exploring the development strategy of sci-entific 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 epide-miology 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.

Objective To identify high-risk factors for healthcare-associated infection(HAI)in patients in inten-sive 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.

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 for-mulate 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 Sci-ence,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 summa-ries,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 evi-dence summary,and 1 systematic review.Ultimately,28 pieces of evidence covering 6 topics including manage-ment,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 rele-vant evidence rationally and prudently,so as to reduce the incidence of PICC-related infections.