Antimicrobial resistance (AMR) has emerged as a major global public health challenge, with traditional prevention and control methods exhibiting significant limitations in detection efficiency, data processing, and clinical decision-making. Leveraging its robust capabilities in data analysis and pattern recognition, artificial intelligence (AI) technology has been widely applied across multiple critical aspects of AMR containment. Current evidence demonstrates that AI technologies can significantly enhance the efficiency of resistancediagnosis, optimize personalized treatment strategies, and improve real-time monitoring of resistant pathogen transmission. Despite persistent challenges such as data heterogeneity, model interpretability, and ethical compliance in practical applications, AI holds immense promise in supporting precision infection management and addressing the growing crisis of antimicrobial resistance.This article systematically reviews the clinical applications of AI in AMR prevention and control, including resistance detection and prediction based on mass spectrometry and genomic data, the use of clinical decision support systems in anti-infective therapy, as well as the role of AI in epidemiological surveillance, pathogen tracking, early warning systems, and novel antimicrobial drug discovery aiming to provide reference for clinical practice.

Enterobacterales are important pathogens responsible for hospital-acquired 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 increasing the risk of treatment failure and patient mortality. In China, the prevention and control of ESBL-E face numerous challenges, including high prevalence rates, significant regional distribution disparities, uneven laboratory testing capabilities, and variations in antimicrobial stewardship and prescribing practices. To address these issues, Professors Zhuo Chao, Xu Yingchun and Yu Yunsong initiated the developmentof the Expert Consensus on Clinical Management Strategies for Infections Caused by Extended-Spectrum β-Lactamase-Producing Enterobacterales (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 different infection sources (including bloodstream infections, intracranial infections, respiratory and mediastinal infections, intra-abdominal infections, 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.

Objective: To classify the ABO blood group phenotypes of 5 cases from a family, and to explore the molecular mechanism for reduced B antigen expression in ABO blood group system. Methods: Serological identification of the ABO blood group was performed using microcolumn gel assay and saline tube method. The soluble antigens in saliva were detected by the agglutination inhibition assay. The full-length sequences and upstream promoter regions of ABO gene were sequenced for genotyping using PacBio SMRT sequencing technology. Results: The results of serological tests indicated the expression of B antigen decreased in 3 out of 5 blood samples. A mixed-field agglutination was observed with anti-B antibody. B antigen was not detected in all 5 saliva samples. The ABO genotype for all samples were ABO B.01/ABO O.01.02, and a novel mutation c. 28+5875C>T within the DNA-binding region of RUNX1 in +5.8-kb site were found in the B allele for 3 samples with reduced expression of B antigen. Conclusion: Results of serological and genetic analyses classify the 3 cases with reduced B antigen expression as B phenotype. The novel mutation c. 28+5875C>T of RUNX1 could be the key reason for reduced B antigen expression in 3 cases with B phenotype.

Objective To investigate the application effect of a refined early diet plan in patients with distal gastric cancer after laparoscopic radical surgery.Methods By convenience sampling method,46 patients with laparoscopic radical gastrectomy for distal gastric cancer admitted to a tertiary hospital in Zhejiang Province from July to December 2023 were selected as an experimental group,while 49 patients admitted from January to June 2023 as a control group.The experimental group was administered with the refined early diet plan,and the control group was administered with conventional methods.The intervention period was from the first day after surgery to discharge.The differences of the first postoperative defecation time,perioperative thirst and hunger score,postoperative hospitalization time,hospitalization cost,postoperative complications and the incidence of readmission 30 days after surgery were compared between the 2 groups.Results 42 patients in the experimental group and 49 patients in the control group completed the study.First postoperative exhaust time(t=4.922,P＜0.001),first postopera-tive defecation time(Z=-2.440,P=0.015),perioperative thirst score(Z=-8.024,P＜0.001),perioperative hunger score(Z=-8.192,P＜0.00 1),postoperative hospitalization time(Z=-7.622,P＜0.001)and hospitalization cost(Z=-4.522,P＜0.001)were lower than those of the control group,and the difference was statistically significant.There was no significant difference in complication rate and 30-day readmission rate between the experimental group and the control group(P＞0.05).Conclusion The refined early diet plan is safe and effective for early recovery of patients after laparoscopic radical gastrectomy for distal gastric cancer,promoting intestinal function recovery,shortening hospital stay,reducing hospital costs,and improving patients'subjective comfort.

The reliability and practicality of research findings in health economics are gradually becoming core issues of close concern for clinical and public health experts. As healthcare resources remain under increasing pressure, conducting efficient cost-effectiveness analyses and achieving rational resource allocation are becoming ever more critical. In recent years, medical laboratory health economics has transitioned from purely academic discussions to integration into clinical practice, becoming a key tool for improving the efficiency and quality of healthcare services. It has demonstrated remarkable results in optimizing patient management and medical decision-making processes. So we invited experts from the fields of medical laboratory science and health economics to share valuable experiences and unique insights on topics such as cost assessment methods, pricing strategies, quality regulation, and the role of medical laboratory health economics in enhancing clinical practice and patient benefits. These experts generally agree that, while research in medical laboratory health economics has shown significant advantages and effectively addressed urgent clinical needs in resource allocation and cost control, it still faces multiple challenges, including limitations in research methodology application, high operational costs, and insufficient standardization of management systems.

Objective:To explore the correlation between Chinese visceral adiposity index (CVAI) and metabolic associated fatty liver disease (MAFLD) so as to evaluate its predictive value for MAFLD.Methods:Six hundred and thirteen cases admitted to the Department of Gastroenterology, Zhongshan Hospital Affiliated to Dalian University from June 2022 to August 2023 were selected and divided into the MAFLD group ( n=312) and the non-MAFLD group ( n=301) according to the diagnostic criteria of MAFLD. The clinical data differences between the two groups were compared. The MAFLD group was divided into a mild MAFLD group ( n=243) and a moderate to severe MAFLD group ( n=69) according to the liver/spleen CT value. The differences in body fat indices such as CVAI, visceral fat index (VAI), and visceral fat area (VFA) were compared between subjects with different degrees of MAFLD. The Spearman test was used to analyze the correlation between CVAI, VAI, and various clinical indicators. The subjects were divided into groups (Q1-Q4) according to the quartile levels of CVAI and VAI, and the distribution of MAFLD conditions among the groups was compared. Logistic regression analysis was used to determine the occurrence risk of MAFLD at different CVAI and VAI levels. The receiver operating characteristic curve was drawn. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the predictive value of CVAI, VAI, VFA, waist circumference, and body mass index for MAFLD. The DeLong test was used to compare the differences in the AUC of each predictive index. Results:The prevalence of hypertension and type 2 diabetes mellitus, and the levels of systolic blood pressure, diastolic blood pressure, CVAI, VAI, VFA, subcutaneous fat area, waist circumference, body mass index, total cholesterol, triglycerides, low-density lipoprotein cholesterol, fasting blood glucose, fasting insulin, homeostasis model assessment of insulin resistance, high-sensitivity C-reactive protein, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transferase, and serum uric acid were higher in the MAFLD group than the non-MAFLD group ( P<0.05), while the level of high-density lipoprotein cholesterol was lower than the non-MAFLD group ( P<0.001). The levels of CVAI, VAI, VFA, waist circumference, and body mass index were higher in the mild and the moderate to severe MAFLD group than those in the non-MAFLD group ( P<0.001). The detection rate of MAFLD gradually increased( χ2=176.953, 133.659, P<0.001) with the increase of CVAI and VAI levels. Correlation analysis showed that CVAI was positively correlated with VFA ( r=0.755, P<0.001) and the homeostasis model assessment of insulin resistance ( r=0.579, P<0.001). Multivariate logistic regression analysis showed that after adjusting for various risk factors, the risk of MAFLD in the Q4 group of the CVAI subgroup was still 7.159 times that of the Q1 group (95% CI:3.126-16.392, P<0.001), and the risk of MAFLD in the Q4 group of the VAI subgroup was still 4.667 times that of the Q1 group (95% CI: 2.187-9.962, P<0.001). The receiver operating characteristic curve results showed that the AUC of CVAI for predicting MAFLD was similar to that of VFA (0.822 vs. 0.826), and higher than that of VAI (AUC 0.772), waist circumference (AUC 0.796), and body mass index (AUC 0.755). The optimal critical value of CVAI for predicting the risk of MAFLD was 125.50, with sensitivity and specificity at 70.5% and 79.1%, respectively. Conclusion:The patient's risk of MAFLD increases with the rise of CVAI level, and CVAI has a favorable predictive value for the occurrence of MAFLD.

Objective To investigate the distribution and antimicrobial resistance profiles of clinically isolated Haemophilus influenzae and Moraxella catarrhalis in hospitals across China from 2015 to 2021,and provide evidence for rational use of antimicrobial agents.Methods Data of H.influenzae and M.catarrhalis strains isolated from 2015 to 2021 in CHINET program were collected for analysis,and antimicrobial susceptibility testing was performed by disc diffusion method or automated systems according to the uniform protocol of CHINET.The results were interpreted according to the CLSI breakpoints in 2022.Beta-lactamases was detected by using nitrocefin disk.Results From 2015 to 2021,a total of 43 642 strains of Haemophilus species were isolated,accounting for 2.91％of the total clinical isolates and 4.07％of Gram-negative bacteria in CHINET program.Among the 40 437 strains of H.influenzae,66.89％were isolated from children and 33.11％were isolated from adults.More than 90％of the H.influenzae strains were isolated from respiratory tract specimens.The prevalence of β-lactamase was 53.79％in H.influenzae strains.The H.influenzae strains isolated from children showed higher resistance rate than the strains isolated from adults.Overall,779 strains of H.influenzae did not produce β-lactamase but were resistant to ampicillin(BLNAR).Beta-lactamase-producing strains showed significantly higher resistance rates to these antimicrobial agents than the β-lactamase-nonproducing strains.Of the 16 191 M.catarrhalis strains,80.06％were isolated from children and 19.94％isolated from adults.M.catarrhalis strains were mostly susceptible to both amoxicillin-clavulanic acid and cefuroxime,evidenced by resistance rate lower than 2.0％.Conclusions The emergence of antibiotic-resistant H.influenzae due to β-lactamase production poses a challenge for clinical anti-infective treatment.Therefore,it is very important to implement antibiotic resistance surveillance for H.influenzae and guide rational antibiotic use.All local clinical microbiology laboratories should actively improve antibiotic susceptibility testing and strengthen antibiotic resistance surveillance for H.influenzae.

Objective To understand the changing composition and antibiotic resistance of bacterial species in the clinical isolates from outpatient and emergency department(hereinafter referred to as outpatients)and inpatient children over time in various hospitals,and to provide laboratory evidence for rational antibiotic use.Methods The data on clinically isolated pathogenic bacteria and antimicrobial susceptibility of isolates from outpatients and inpatient children in the CHINET program from 2015 to 2021 were collected and analyzed.Results A total of 278 471 isolates were isolated from pediatric patients in the CHINET program from 2015 to 2021.About 17.1％of the strains were isolated from outpatients,primarily group A β-hemolytic Streptococcus,Escherichia coli,and Staphylococcus aureus.Most of the strains(82.9％)were isolated from inpatients,mainly SS.aureus,E.coli,and H.influenzae.The prevalence of methicillin-resistant S.aureus(MRSA)in outpatients(24.5％)was lower than that in inpatient children(31.5％).The MRSA isolates from outpatients showed lower resistance rates to the antibiotics tested than the strains isolated from inpatient children.The prevalence of vancomycin-resistant Enterococcus faecalis or E.faecium and penicillin-resistant S.pneumoniae was low in either outpatients or inpatient children.S.pneumoniae,β-hemolytic Streptococcus and S.viridans showed high resistance rates to erythromycin.The prevalence of erythromycin-resistant group A β-hemolytic Streptococcus was higher in outpatients than that in inpatient children.The prevalence of β-lactamase-producing H.influenzae showed an overall upward trend in children,but lower in outpatients(45.1％)than in inpatient children(59.4％).The prevalence of carbapenem-resistant Klebsiella pneumoniae(CRKpn),carbapenem-resistant Pseudomonas aeruginosa(CRPae)and carbapenem-resistant Acinetobacter baumannii(CRAba)was 14％,11.7％,47.8％in outpatients,but 24.2％,20.6％,and 52.8％in inpatient children,respectively.The prevalence of multidrug-resistant E.coli,K.pneumoniae,Proteus mirabilis,P.aeruginosa and A.baumannii strains was lower in outpatients than in inpatient children.The prevalence of fluoroquinolone-resistant E.coli,ESBLs-producing K.pneumoniae,ESBLs-producing P.mirabilis,carbapenem-resistant E.coli(CREco),CRKpn,and CRPae was lower in children in outpatients than in inpatient children,but the prevalence of CRAba in 2021 was higher than in inpatient children.Conclusions The distribution of clinical isolates from children is different between outpatients and inpatients.The prevalence of MRSA,ESBL,and CRO was higher in inpatient children than in outpatients.Antibiotics should be used rationally in clinical practice based on etiological diagnosis and antimicrobial susceptibility test results.Ongoing antimicrobial resistance surveillance and prevention and control of hospital infections are crucial to curbing bacterial resistance.

Objective To investigate the changing antibiotic resistance profiles of E.coli isolated from patients in the 52 hospitals participating in the CHINET program from 2015 to 2021.Methods Antimicrobial susceptibility was tested for clinical isolates of E.coli according to the unified protocol of CHINET program.WHONET 5.6 and SPSS 20.0 software were used for data analysis.Results Atotal of 289 760 nonduplicate clinical strains ofE.coli were isolated from 2015 to 2021,mainly from urine samples(44.7±3.2)％.The proportion of E.coli strains isolated from urine samples was higher in females than in males(59.0％vs 29.5％).The proportion of E.coli strains isolated from respiratory tract and cerebrospinal fluid samples was significantly higher in children than in adults(16.7％vs 7.8％,0.8％vs 0.1％,both P＜0.05).The isolates from internal medicine department accounted for the largest proportion(28.9±2.8)％with an increasing trend over years.Overall,the prevalence of ESBLs-producing E.coli and carbapenem resistant E.coli(CREco)was 55.9％and 1.8％,respectively during the 7-year period.The prevalence of ESBLs-producing E.coli was the highest in tertiary hospitals each year from 2015 to 2021 compared to secondary hospitals.The prevalence of CREco was higher in children's hospitals compared to secondary and tertiary hospitals each year from 2015 to 2021.The prevalence of ESBLs-producing E.coli in tertiary hospitals and children's hospitals and the prevalence of CREco in children's hospitals showed a decreasing trend over the 7-year period.The prevalence of CREco in secondary and tertiary hospitals increased slowly.Antibiotic resistance rates changed slowly from 2015 to 2021.Carbapenem drugs(imipenem,meropenem)were the most active drugs amongβ-lactams against E.coli(resistance rate≤2.1％).The resistance rates of E.coli to β-lactam/β-lactam inhibitor combinations(piperacillin-tazobactam,cefoperazone-sulbactam),aminoglycosides(amikacin),nitrofurantoin and fosfomycin(for urinary isolates only)were all less than 10％.The resistance rate of E.coli strains to antibiotics varied with the level of hospitals and the departments where the strains were isolated,especially for cefazolin and ciprofloxacin,to which the resistance rate of E.coli strains from children in non-ICU departments was significantly lower than that of the strains isolated from other departments(P＜0.05).The E.coli isolates from ICU showed higher resistance rate to most antimicrobial agents tested(excluding tigecycline)than the strains isolated from other departments.The E.coli strains isolated from tertiary hospitals showed higher resistance rates to the antimicrobial agents tested(excluding tigecycline,polymyxin B,cefepime and carbapenems)than the strains from secondary hospitals and children's hospitals.Conclusions E.coli is an important pathogen causing clinical infection.More than half of the clinical isolates produced ESBL.The prevalence of CREco is increasing in secondary and tertiary hospitals over the 7-year period even though the overall prevalence is still low.This is an issue of concern.