Objective:To investigate the clinical characteristics and prognosis of Klebsiella pneumoniae liver abscess with extrahepatic invasive infection.Methods:We collected and analyzed clinical data from patients diagnosed with invasive Klebsiella pneumoniae liver abscess syndrome (IKPLAS) at China-Japan Friendship Hospital from March 2017 to March 2023. The analysis summarized the clinical characteristics and prognosis of these patients based on the clinical information, laboratory tests, and imaging findings.Results:The clinical characteristics included chills, fever, abdominal pain, nausea, and vomiting. Eight cases showed elevated total white blood cell counts, while 9 cases had increased neutrophil counts. Abdominal imaging typically showed low-density massesor patchy shadows in the liver. Nine cases were complicated by lung abscesses, 1 case by bilateral pyopneumothorax, 1 case by abdominal and splenic abscesses, 2 cases by endophthalmitis. Seven patients were initially treated with carbapenem antibiotics alone, and 4 received combination therapy. Nine patients improved and were discharged, while 1 patient′s condition worsened and died.Conclusions:The clinical manifestations of Klebsiella pneumoniae liver abscess with extrahepatic invasive infection are nonspecific, and the onset is insidious with rapid disease progression. Early imaging and microbiological examinations should be performed to confirm the diagnosis and screen all infection sites. Timely antimicrobial therapy and drainage are essential for improving the prognosis.

Objective:To investigate the clinical characteristics and prognosis of Klebsiella pneumoniae liver abscess with extrahepatic invasive infection.Methods:We collected and analyzed clinical data from patients diagnosed with invasive Klebsiella pneumoniae liver abscess syndrome (IKPLAS) at China-Japan Friendship Hospital from March 2017 to March 2023. The analysis summarized the clinical characteristics and prognosis of these patients based on the clinical information, laboratory tests, and imaging findings.Results:The clinical characteristics included chills, fever, abdominal pain, nausea, and vomiting. Eight cases showed elevated total white blood cell counts, while 9 cases had increased neutrophil counts. Abdominal imaging typically showed low-density massesor patchy shadows in the liver. Nine cases were complicated by lung abscesses, 1 case by bilateral pyopneumothorax, 1 case by abdominal and splenic abscesses, 2 cases by endophthalmitis. Seven patients were initially treated with carbapenem antibiotics alone, and 4 received combination therapy. Nine patients improved and were discharged, while 1 patient′s condition worsened and died.Conclusions:The clinical manifestations of Klebsiella pneumoniae liver abscess with extrahepatic invasive infection are nonspecific, and the onset is insidious with rapid disease progression. Early imaging and microbiological examinations should be performed to confirm the diagnosis and screen all infection sites. Timely antimicrobial therapy and drainage are essential for improving the prognosis.

Objective:To investigate the spectrum and antimicrobial resistance of major pathogens causing nosocomial infections in China during 2020-2021.Methods:A total of 1 311 non-duplicated nosocomial pathogens causing bloodstream infections (BSI, n=670), hospital-acquired pneumonia (HAP, n=394) and intra-abdominal infections (IAI, n=297) were collected from 10 teaching hospitals across China. The minimum inhibitory concentrations (MICs) of clinical common strains were determined using agar dilution or broth microdilution method. Interpretation of reults followed the CLSI M100-Ed33 criteria, with data analysis conducted using WHONET-5.6 software. The Chi-square test was used to compare rates. Results:The most prevalent pathogens causing BSI were Escherichia coli (21.2%, 142/670), Klebsiella pneumoniae (14.9%, 100/670) and Staphylococcus aureus (11.5%, 77/670); the most prevalent pathogens causing HAP were K. pneumoniae (27.7%, 109/394), Acinetobacter baumanii (22.1%, 87/394) and Pseudomonas aeruginosa (18.3%, 72/394). IN IAI, E. coli (24.3%, 60/247), Enterococcus faecium and K. pneumoniae (both 14.6%, 36/247) were dominated. All S. aureus strains were susceptible to tigecycline, linezolid, daptomycin and glycopeptides. Rates of methicillin-resistant S. aureus (MRSA) and coagulase-negative Staphylococcus (MRCNS) were 36.5% (42/115) and 74.5% (38/51), respectively. The rate of vancomycin-resistant E. faecium and E. faecalis was 3.3% (3/90) and 1.9% (1/53), respectively. The prevalence of extended-spectrum β-lactamase (ESBL) was 23.7% (58/245) in K. pneumonia and 60.5% (130/215) in E. coli.The rate of carbapenem-resistant K. pneumonia and E. coli was 29.8% (73/245) and 4.2% (9/215), respectively; the percentage of tigecycline-resistant K. pneumonia and E. coli was 1.6% (4/245) and 0, respectively; the rate of colistin-resistant K. pneumonia and E. coli was 1.6% (4/245) and 2.8% (6/215), respectively; the percentage of ceftazidime/avibactam-resistant K. pneumonia and E. coli was 2.0% (5/245) and 2.3% (5/215), respectively. The rate of carbapenem-resistant A. baumanii and P. aeruginosa was 76.7% (125/163) and 28.4% (33/116), respectively. A. baumanii showed low susceptibility to most antimicrobial agents except colistin (98.8%, 161/163) and tigecycline (89.6%, 146/163). Colistin, amikacin and ceftazidime/avibactam demonstrated high antibacterial activity against P. aeruginosa with susceptility rates of 99.1% (115/116), 94.0% (109/116) and 83.6% (97/116), respectively. Conclusions:The major pathogens of nosocomial infections were K. pneumonia, E. coli, A. baumanii, P. aeruginosa and S. aureus. Nosocomial Gram-negative pathogens exhibited high susceptibilities to tigecycline, colistin and ceftazidime/avibactam. Antimicrobial resistance in A. baumannii remains a significant challenge. The increasing prevalence of carbapenem-resistant Enterobacterales underscores the urgency of antibiotics rational applications and hospital infection controls.

Objective To observe CT findings of mycoplasma pneumoniae pneumonia(MPP)in children.Methods A total of 85 MPP children confirmed by mycoplasma pneumoniae nucleic acid test were retrospectively collected.Chest CT manifestations of MPP were analyzed,and artificial intelligence pneumonia CT image-assisted diagnostic analysis software was used to quantify lesion volume(LV),percentage of lesion LV in total lung volume(LV％)and CT value,and the correlations of quantitative CT parameters with clinical laboratory indicators were explored.Results The main CT manifestations of MPP in children included thickened bronchial wall(78/85,91.76％),tree bud sign(70/85,82.35％),large mass compaction(39/85,45.88％),bronchial occlusion(29/85,34.12％),air bronchial sign(25/85,29.41％),acinar nodules(23/85,27.06％),consolidation along the bronchus(21/85,24.71％),cotton ball sign(19/85,22.35％),tree fog sign(15/85,17.65％)and atelectasis(14/85,16.47％).The median LV of MPP was 50.73(26.38,85.90)cm3,the median LV％was 3.10％(1.60％,5.70％)and the median CT value was-422.61(-479.46,-343.76)HU.MPP LV was positively correlated with serum sialic acid,C reactive protein(CRP),D-dimer,fibrin degradation products(FDP)and fibrinogen(Fib)(rs=0.232-0.400),while LV％was positively correlated with serum sialic acid,D-dimer and FDP(rs=0.349-0.439).There was a positive correlation between CT value and CRP(rs=0.288).Conclusion CT findings of MPP in children had certain characteristics.Combining with laboratory examinations was conducive to clinical diagnosis,monitoring condition and evaluating therapeutic efficacy of MPP in children.

Objective To observe CT findings of mycoplasma pneumoniae pneumonia(MPP)in children.Methods A total of 85 MPP children confirmed by mycoplasma pneumoniae nucleic acid test were retrospectively collected.Chest CT manifestations of MPP were analyzed,and artificial intelligence pneumonia CT image-assisted diagnostic analysis software was used to quantify lesion volume(LV),percentage of lesion LV in total lung volume(LV％)and CT value,and the correlations of quantitative CT parameters with clinical laboratory indicators were explored.Results The main CT manifestations of MPP in children included thickened bronchial wall(78/85,91.76％),tree bud sign(70/85,82.35％),large mass compaction(39/85,45.88％),bronchial occlusion(29/85,34.12％),air bronchial sign(25/85,29.41％),acinar nodules(23/85,27.06％),consolidation along the bronchus(21/85,24.71％),cotton ball sign(19/85,22.35％),tree fog sign(15/85,17.65％)and atelectasis(14/85,16.47％).The median LV of MPP was 50.73(26.38,85.90)cm3,the median LV％was 3.10％(1.60％,5.70％)and the median CT value was-422.61(-479.46,-343.76)HU.MPP LV was positively correlated with serum sialic acid,C reactive protein(CRP),D-dimer,fibrin degradation products(FDP)and fibrinogen(Fib)(rs=0.232-0.400),while LV％was positively correlated with serum sialic acid,D-dimer and FDP(rs=0.349-0.439).There was a positive correlation between CT value and CRP(rs=0.288).Conclusion CT findings of MPP in children had certain characteristics.Combining with laboratory examinations was conducive to clinical diagnosis,monitoring condition and evaluating therapeutic efficacy of MPP in children.

In recent years, the carbapenem-resistant Klebsiella pneumoniae (CRKP) continues to significantly threaten public health. The limited therapeutic options are increasingly challenging for clinicians to reintroduce the polymyxin as last-resort drug, with the results that polymyxin resistance is not scarce in settings. The polymyxin resistance mechanism is diversified, mainly the modification of the lipopolysaccharide (LPS). In addition to phoPQ, pmrAB, crrAB and mgrB on chromosome, plasmid-carried mcr gene have been found to mediate the LPS modification. The mgrB gene variation plays an important role in polymyxin resistance. Above all, the aim of the current review is to discuss the mechanism of polymyxin resistance mechanism in Klebsiella pneumoniae provide insights for preventing this phenomenon.

Few studies have described the key features and prognostic roles of lung microbiota in patients with severe community-acquired pneumonia (SCAP). We prospectively enrolled consecutive SCAP patients admitted to ICU. Bronchoscopy was performed at bedside within 48 h of ICU admission, and 16S rRNA gene sequencing was applied to the collected bronchoalveolar lavage fluid. The primary outcome was clinical improvements defined as a decrease of 2 categories and above on a 7-category ordinal scale within 14 days following bronchoscopy. Sixty-seven patients were included. Multivariable permutational multivariate analysis of variance found that positive bacteria lab test results had the strongest independent association with lung microbiota (R² = 0.033; P = 0.018), followed by acute kidney injury (AKI; R² = 0.032; P = 0.011) and plasma MIP-1β level (R² = 0.027; P = 0.044). Random forest identified that the families Prevotellaceae, Moraxellaceae, and Staphylococcaceae were the biomarkers related to the positive bacteria lab test results. Multivariable Cox regression showed that the increase in α-diversity and the abundance of the families Prevotellaceae and Actinomycetaceae were associated with clinical improvements. The positive bacteria lab test results, AKI, and plasma MIP-1β level were associated with patients' lung microbiota composition on ICU admission. The families Prevotellaceae and Actinomycetaceae on admission predicted clinical improvements.
Acute Kidney Injury/complications* ; Bacteria/classification* ; Chemokine CCL4/blood* ; Community-Acquired Infections/microbiology* ; Humans ; Lung ; Microbiota/genetics* ; Pneumonia, Bacterial/diagnosis* ; Prognosis ; RNA, Ribosomal, 16S/genetics*

Objective:The clinical features, laboratory indices, and imaging data of patients with Pneumocystis jirovecii pneumonia (PJP) were described and analyzed, aiming to provide helpful information for the diagnosis and treatment of PJP. Methods:A retrospective study were conducted with data from 154 PJP patients who visited China-Japan Friendship Hospital from May 2017 to August 2020. Their clinical characteristics, laboratory and imaging data, and clinical outcomes were collected for analysis. The patients were further divided into the death group (51 cases) and the survival group(103 cases). The differences between the groups were compared by using t-test, nonparametric test, and chi-square test. Results:Of the 154 PJP patients, there were 89 males and 65 females, with a mean age of (53.7±14.8) years. Among them, 85.7% (132/154) were on immunosuppressive/glucocorticoids agents within the past month. Besides, 27.9% (43/154) and 33.1% (51/154) had kidney diseases and connective tissue diseases, respectively. The major clinical manifestations in these patients involved fever 82.9% (126/154), cough 59.7% (92/154), and dyspnea 52.6% (81/154). For the laboratory data, the lactate dehydrogenase (LDH) was 561.0 (434.3, 749.0) IU/L and the value increased in 91.3% (95/104) of the patients. The CD4+T-cell lymphocytes in 88.0% (95/108) and 57.4% (62/108) of patients were lower than 400/μl and 200/μl, respectively. Furthermore, (1, 3)-β-D glucan (BG) increased in 74.4% (67/90) of PJP patients (≥100.0 ng/L). For the imaging results, chest computed tomography (CT) showed diffuse ground-glass shadows/grid shadows in 90% (117/130) patients. Compared with the survival group, higher LDH [690.5 (528.8, 932.3) IU/L vs 502.5 (381.8, 657.0) IU/L, Z=-3.375, P=0.001], white blood cell count (WBC) [9.8 (5.8, 12.6) ×10 9/L vs 7.3 (5.0, 10.1) ×10 9/L, Z=-2.392, P=0.017], and age [(69.8±14.5) years vs (50.6±14.0) years, t=-3.756, P=0.001] were found in the death group. Lower lymphocyte ratio [5.3 (3.2, 9.3) % vs 9.6 (5.6, 17.2) %, Z=?3.262, P=0.001] and oxygen partial pressure (PaO 2) levels [(73.2±20.5) mmHg vs (64.8±17.7) mmHg (1 mmHg=0.133 kPa), t=2.345, P=0.021] were also observed in the death group. Furthermore, in the death group, the bacterial and fungal infection rate was higher than the rates in the survival group [55.1% (27/51) vs 21.5% (22/103), χ 2=15.372, P=0.001]. Conclusions:Long-term use of immunosuppressive agents or glucocorticoids predispose to PJP. CD4+T-lymphocytes, LDH, and BG might be used as important auxiliary examinations for PJP patients. Age, LDH, WBC, lymphocyte ratio, PaO 2 and possible combinations with bacterial or fungal infections are more closely related to the prognostic of PJP patients.

Biofilms ; Humans ; Multilocus Sequence Typing ; Serogroup ; Streptococcal Infections ; Streptococcus agalactiae/genetics* ; Virulence

Objective:To investigate the role and influencing factors of case design in PBL teaching.Methods:Thirty-two six-year-program undergraduates from the Department of Medicine of Peking University in batch 2014 and batch 2015 were selected as the subjects. PBL teaching was used in the practice class of experimental diagnostics. The feedback effects of four times PBL courses were analyzed by collecting questionnaires for teachers, students, and supervisors. The data obtained from the five-point questionnaire and the question-and-answer questionnaire were analyzed by one-way ANOVA and statistics respectively. Then the problems in case preparation process are discussed and the experience of case design is summarized. SPSS 13.0 was used in this study.Results:The 5-point questionnaire showed that the average score of anemia PBL course was the highest among students' self-evaluation and mutual evaluation of teachers and students (4.84 points, 4.79 points), with statistical significance compared with other courses ( P<0.05). The question-and-answer questionnaire survey showed that 93.75% of the students generally agreed with the teaching model of anemia cases; 78.13% and 59.38% of the students believed that it was difficult to set up cases of infection and coagulation, which affected the classroom effect; and 50% of the supervisors thinked that the students' level should be taken into account in case design and oral expression should be avoided. Conclusion:Case design is the key to PBL teaching. Summarizing the experience of case design can lay a good foundation for the establishment of PBL teaching database.