Objective To investigate the clinical features,etiological features and prognosis of patients with hematologic diseases complicated with candidemia for improving clinical diagnosis and treatment.Methods A retrospective analysis was conducted for 107 hematological patients complicated with candidemia who were treated in the First Affiliated Hospital of Zhengzhou University,Henan Cancer Hospital,Henan Provincial People's Hospital,or Zhengzhou People's Hospital from June 2022 to May 2024.The clinical data and pathogenic bacteria were analyzed by univariate and multivariate analyses.Results The Candida pathogen of the 107 cases of candidemia were mostly Candida tropicalis(73.8％),followed by Candida parapsilosis,Candida glabrata,and Candida albicans.Antifungal susceptibility testing showed that 43.9％,47.7％,and 48.6％of the Candida strains were resistant voriconazole,fluconazole and itraconazole,respectively.Logistic regression analysis found that disease not in remission(OR=7.795,95％CI:2.274-26.723),septic shock(OR=10.376,95％CI:1.129-95.388),multiple organ dysfunction syndrome(MODS)(OR=9.107,95％CI:1.789-46.361),and inappropriate antifungal treatment(OR=3.422,95％CI:1.153-10.153)were risk factors for 30-day mortality in hematological patients with candidemia.Conclusions Candidemia in patients with hematological diseases is associated with high mortality rate,the major pathogen of which is Candida tropicalis.The Candida isolates showed high resistance rates to azoles.Disease not in remission,septic shock,MODS,and inappropriate antifungal treatment are the risk factors for mortality.

Objective To analyze the clinical distribution and antimicrobial susceptibility of Ralstonia mannitolilytica strains isolated from clinical specimens at a tertiary hospital in Shanghai.The results could inform better clinical treatment of R.mannitolilytica.Methods A total of 47 R.mannitolilytica isolated from January 2022 to August 2024 were collected.The clinical data of patients from whom these strains were isolated were reviewed and analyzed.Results The 47 strains of R.mannitolilytica were mainly isolated from hematology department(85.1％,40/47)and intensive care unit(4.3％,2/47).In the 47 patients with R.mannitolilytica isolate,83.0％had hematological disease and 85.1％stayed in hospital for at least 28 days.Overall,63.8％of the 47 patients used antibiotics for at least 3 weeks and 76.6％of the patients used at least three types of antibiotics during hospital stay.All of the 47 R.mannitolilytica strains were resistant to aztreonam,while 84.6％,83.3％,70.4％,and 69.6％of the strains were resistant to meropenem,ticarcillin-clavulanate acid,ceftazidime,and piperacillin-tazobactam,respectively,58.7％,55.8％,52.2％,and 42.2％of the strains were resistant to amikacin,tobramycin,cefepime,and imipenem,respectively.In contrast,88.1％,83.3％,82.9％,67.4％and 60.5％of the strains were susceptible to minocycline,doxycycline,cotrimoxazole,ciprofloxacin,and levofloxacin,respectively.Conclusions Most of the R.mannitolilytica strains were multi-drug resistant.The bacteria is more prevalent in patients with hematological disorders and long-term treatment with multiple broad-spectrum antimicrobial agents.

Objective To evaluate the efficacy and safety of amoxicillin-clavulanate(10∶1)for injection in the treatment of community-acquired pneumonia(CAP)in adult patients.Methods Eligible patients were randomized to receive amoxicillin-clavulanate(10∶1)2.2 g or ampicillin-sulbactam(2∶1)3.0 g via intravenous infusion q12h or q8h for 7 to 14 days.The primary endpoint was to the clinical efficacy 7-14 days after discontinuation of treatment.The secondary endpoints included microbiological efficacy and safety.Results All enrolled patients(n=324)were included in the full analysis set(FAS),specifically 165 patients receiving amoxicillin sodium-clavulanate potassium(10∶1)and 159 patients receiving ampicillin sodium-sulbactam sodium(2∶1).The clinical cure rate was 78.8％(130/165)for amoxicillin-clavulanate(10∶1)and 77.4％(123/159)for ampicillin-sulbactam 7-14 days after end of treatment(P＞0.05).The clinical cure rate was 87.5％(126/144)for amoxicillin-clavulanate(10∶1)and 87.4％(111/127)for ampicillin-sulbactam(2∶1)in per protocol set(P＞0.05).Therefore,amoxicillin-clavulanate(10∶1)was non-inferior to ampicillin-sulbactam in the primary endpoint in the treatment of CAP in adult patients.The overall bacterial eradication rate was 94.4％(34/36)for amoxicillin-clavulanate(10∶1)and 89.3％(25/28)for ampicillin-sulbactam(P＞0.05).The common study drug-related clinical adverse event were abnormalities of hepatic function in both the amoxicillin-clavulanate(10∶1)group(4.8％,8/165)and ampicillin-sulbactam group(3.1％,5/159)(P＞0.05).Conclusions Amoxicillin-clavulanate(10∶1)2.2 g Ⅳ infusion q12h or q8h for 7-14 days was noninferior to ampicillin-sulbactam in terms of clinical and microbiological efficacy in the treatment of CAP in adult patients.The safety of the two dosing regimens was comparable.

Objective To investigate the clinical features,imaging features,diagnosis and treatment of empyema caused by Streptococcus constellatus for improving early diagnosis and treatment and reduce mortality rate.Methods The clinical data of 11 patients with empyema caused by S.constellatus who were treated in Fuding Hospital of Fujian Province from February 2021 to August 2024 were retrospectively analyzed.Results All the 11 patients were male,51 to 78 years old.Underlying disease was reported in 9 patients.The main clinical manifestations were chest tightness and dyspnea.Fever may not be present.The white blood cell count,neutrophil ratio,C-reactive protein,procalcitonin,fibrinogen and D-dimer were significantly increased in 11 patients.Chest imaging showed unilateral encapsulated effusion,more common on the right side(9/11),and sometimes accompanied by pneumothorax(2/10).The lung lobes of the same side of empyema were mostly accompanied by exudation and consolidation,and cavities were common(6/10)in the consolidation lesions.White blood cells,multinucleated cells,lactate dehydrogenase(LDH)and adenosine deaminase(ADA)were significantly increased in pleural effusion of 11 patients.The positive rate of pleural effusion culture in aerobic bottle(10/11)and anaerobic bottle(6/7)was higher than that in blood plate culture(1/7).All the 11 patients were treated with antibiotics combined with thoracentesis and drainage.Ten patients improved after treatment.One patient died of septic shock in a short time.Conclusions Drainage of pleural effusion and pleural fluid culture should be performed as soon as possible for middle-aged and elderly male patients with underlying diseases,acute or subacute onset of chest distress,dyspnea,associated with significantly increased blood inflammatory markers,and chest imaging suggesting pleural effusion.Pleural fluid can be injected into the blood culture bottle to improve the detection of S.constellatus.At the same time,antimicrobial therapy should be prescribed reasonably according to the results of antimicrobial susceptibility test.

Objective To summarize the changing prevalence of carbapenem resistance in Enterobacterales based on the data of CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021 for improving antimicrobial treatment in clinical practice.Methods Antimicrobial susceptibility testing was performed using a commercial automated susceptibility testing system according to the unified CHINET protocol.The results were interpreted according to the breakpoints of the Clinical & Laboratory Standards Institute(CLSI)M100 31st ed in 2021.Results Over the seven-year period(2015-2021),the overall prevalence of carbapenem-resistant Enterobacterales(CRE)was 9.43％(62 342/661 235).The prevalence of CRE strains in Klebsiella pneumoniae,Citrobacter freundii,and Enterobacter cloacae was 22.38％,9.73％,and 8.47％,respectively.The prevalence of CRE strains in Escherichia coli was 1.99％.A few CRE strains were also identified in Salmonella and Shigella.The CRE strains were mainly isolated from respiratory specimens(44.23±2.80)％,followed by blood(20.88±3.40)％and urine(18.40±3.45)％.Intensive care units(ICUs)were the major source of the CRE strains(27.43±5.20)％.CRE strains were resistant to all the β-lactam antibiotics tested and most non-β-lactam antimicrobial agents.The CRE strains were relatively susceptible to tigecycline and polymyxins with low resistance rates.Conclusions The prevalence of CRE strains was increasing from 2015 to 2021.CRE strains were highly resistant to most of the antibacterial drugs used in clinical practice.Clinicians should prescribe antimicrobial agents rationally.Hospitals should strengthen antibiotic stewardship in key clinical settings such as ICUs,and take effective infection control measures to curb CRE outbreak and epidemic in hospitals.

Objective To investigate the clinical characteristics,antimicrobial susceptibility of pathogens,and laboratory test results of patients with Vibrio vulnificus infection.Methods The clinical and etiological data,as well as laboratory tests were reviewed retrospectively for 14 patients with V.vulnificus infection,who were admitted to the 909th Hospital from May 2022 to November 2023.Results Overall,9 of the 14 patients(64.3％)had a history of exposure to seafood or seawater.Six patients(42.9％)had underlying diseases,such as hepatitis,coronary heart disease and diabetes mellitus.Eleven patients(78.6％)had a good outcome,while 3 patients(21.4％)had a poor outcome.A total of 18 strains of V.vulnificus were isolated,including 11(61.1％)strains from wound pus,and 7 strains(38.9％)from blood.V.vulnificus isolates were susceptible to ampicillin-sulbactam,piperacillin-tazobactam,imipenem,meropenem,tetracycline,ciprofloxacin,levofloxacin,trimethoprim-sulfamethoxazole,and chloramphenicol,but only 50.0％,55.6％,and 61.1％of the strains were susceptible to cefazolin,ampicillin,and amikacin,respectively.White blood cell count,neutrophil,C-reactive protein,prothrombin time,fibrinogen,activated partial thromboplastin time,D-Dimer,urea nitrogen,creatinine,uric acid,glutamic-pyruvic transaminase,glutamic oxaloacetic transaminase,lactate dehydrogenase,alkaline phosphatase,creatine kinase,creatine kinase isoenzyme MB,hypersensitive troponin I,myoglobin,procalcitonin,and N-terminal pro-brain natriuretic peptide were significantly increased in patients with V.vulnificus infection.Conclusions Wound pus and blood samples collected simultaneously for microbial culture can improve the detection of V.vulnificus.Early debridement and antibiotic combination therapy are vital for improving patient survival rate.

Objective To investigate the changing profiles and prognostic value of serological biomarkers in patients with severe pneumonia caused by different pathogens.Methods A total of 164 patients diagnosed with severe pneumonia in Xishan People's Hospital from July 2022 to April 2024 were enrolled.The patients were assigned to bacterial infection group(n=64),Mycoplasma infection group(n=47),or viral infection group(n=53).The patients were also stratified into survivor group(n=107)or death group(n=57)according to outcomes.F test,t-test and Chi-square test were used to analyze the demographic data,symptoms,vital signs,and serological biomarkers in different groups.Multivariate Cox proportional hazards model was constructed to predict the poor prognosis of severe pneumonia.Goodness-of-fit test was performed,and the receiver operating characteristic curve(ROC)was used to evaluate the performance of the model.The locally weighted regression(LOWESS)was used to analyze the correlation between platelet-to-lymphocyte ratio(PLR)and clinical pulmonary infection score(CPIS).The restricted cubic spline(RCS)model was constructed to analyze the dose-response relationship between PLR and the risk of adverse outcome of severe pneumonia.Results The clinical pulmonary infection score(CPIS),white blood cell count(WBC),platelet count(PLT),lymphocyte(LYM),neutrophil(NEU),PLR,neutrophil-lymphocyte ratio(NLR),C-reactive protein(CRP),procalcitonin(PCT)and serum amyloid-like protein A(SAA)showed significant differences between the patients caused by bacterial infection,Mycoplasma infection or viral infection(P＜0.05).The CPIS score,WBC,LYM,PLR,NLR,CRP and SAA were significantly different between survivors and deaths(P＜0.05).Multivariate Cox proportional hazards model analysis showed that CPIS score,NLR,CRP,SAA and PLR were risk factors for poor prognosis in patients with severe pneumonia(P＜0.05).The model incorporating PLR for poor prognosis had better Hosmer-Lemeshow goodness of fit,larger AUC value and better diagnostic efficiency for patients with severe pneumonia.The LOWESS analysis showed nonlinear relationship between PLR and CPIS score to some extent.RCS model analysis showed that there was a nonlinear dose-response relationship between PLR and the risk of poor outcome in patients with severe pneumonia(P for nonlinear=0.048＜0.05).Conclusions PLR is significantly different between patients with severe pneumonia caused by different pathogens.PLR-containing biomarker panel can improve the diagnostic performance of severe pneumonia.

Objective To investigate the clinical characteristics and prognostic factors of Staphylococcus aureus bloodstream infections in adult patients for improving clinical treatment and identifying potential interventions.Methods Clinical data of inpatients diagnosed with S.aureus bloodstream infection confirmed by blood culture in a hospital from January 2016 to December 2023 were retrospectively reviewed.The data included patient age,gender,history of hospital admission,department of admission,underlying diseases,primary infection,quick Pitt bacteremia score(qPitt),invasive treatment,empirical anti-infective treatment,and treatment outcomes.Patients were assigned to case group or control group according to whether they died in hospital in order to identify the prognostic factors of patient outcomes.Binary logistic regression analysis was used to identify independent prognostic factors.Results A total of 233 cases of S.aureus bacteremia were identified.Multivariate logistic regression analysis showed that age ≥ 70 years old(OR=4.725,95％CI:1.228-18.173,P=0.024),diabetes mellitus(OR=8.161,95％CI:1.954-34.086,P=0.004),Charlson comorbidity index(CCI)≥ 5(OR=7.672,95％CI:1.901-30.963,P=0.004),hospital infection(OR=7.853,95％CI:1.588-38.832,P=0.012),and qPitt ≥ 2(OR=23.189,95％CI:4.461-120.552,P＜0.001)were independent prognostic factors for poor outcome of patients with S.aureus bacteremia,while catheter-associated infection(OR=0.051,95％CI:0.005-0.579,P=0.016)was negatively correlated with mortality.Conclusions Advanced age,diabetes mellitus,high CCI,hospital infection,and high qPitt were independent prognostic factors for poor outcomes of patients with S.aureus bacteremia.The patients should be well managed by timely removal of eradicable lesions to improve patient outcomes.

Objective This study aimed to explore the clinical and etiological characteristics of bloodstream infections in diabetic patients with different levels of glycosylated hemoglobin(HbA1c)for improving empirical diagnosis and treatment in clinical practice.Methods A retrospective study was conducted for diabetic patients with bloodstream infections who were admitted to Sichuan Mental Health Center from 2017 to 2023.Patients were assigned to one of the three groups based on HbA1c levels:low level(HbA1c＜7.0％),medium level(7.0％≤HbA1c＜9.0％),high level(HbA1c≥9.0％).The clinical data,pathogen distribution,and antimicrobial resistance were analyzed and compared between groups.Results A total of 426 diabetic patients with bloodstream infection were included.The proportion of community-acquired bloodstream infection,acidosis,and liver abscess in the high level HbA1c group were significantly higher than those in the medium and low level HbA1c groups.Overall,452 strains of nonduplicate pathogenic bacteria were isolated,the most common of which were Escherichia coli(47.1％),Klebsiella pneumoniae(23.0％),and Staphylococcus aureus(5.8％).The pathogens of bloodstream infections varied with different HbA1c levels.The proportion of K.pneumoniae in the high-level HbA1c group(30.7％)was significantly higher than that in the low-level HbA1c group(15.1％)and medium level HbA1c group(16.0％).More than 50％of E.coli isolates were resistant to piperacillin,cefazolin,and ampicillin,while lower than 10％of the isolates were resistant to cefoxitin and minocycline,and lower than 1％of the isolates were resistant to piperacillin-tazobactam,meropenem,imipenem,and amikacin.The E.coli strains isolated from hospital-acquired infections showed slightly higher resistance rates to penicillin,cephalosporins,aminoglycosides,and fluoroquinolones than the strains isolated from community-acquired infections.K.pneumoniae strains showed low resistance rates(＜30％)to the commonly used antibiotics.However,the strains isolated from hospital-acquired infections were significantly more resistant to cephalosporins,carbapenems,and aminoglycosides than the strains isolated from community-acquired infections.Conclusions E.coli,K.pneumoniae and S.aureus were the common pathogens of bloodstream infections in diabetic patients.Poor HbA1c control was associated with K.pneumoniae bloodstream infection,especially those originated from liver abscess.The antibiotic-resistant E.coli and K.pneumoniae strains were prevalent in hospital-acquired bloodstream infections in diabetic patients.Antimicrobial resistance surveillance should be strengthened for this patient population.

Objective This study aimed to examine the risk factors and prognostic factors of brucellar spondylitis for early prevention and treatment of the disease,and improving the outcomes of patients.Methods A retrospective case-control study was conducted on the patients with brucellosis who were hospitalized in the Third Hospital of Hebei Medical University from June 2020 to June 2022.Patients were assigned to brucellosis without spondylitis group or brucellar spondylitis group according to the presence of spondylitis.The patients in brucellar spondylitis group were followed for 1 year.Then they were stratified into a subgroup of good or poor prognosis according to clinical outcomes.The dataset for the demographic and clinical variables of patients were analyzed using SPSS 26.0 software.Results A total of 300 patients with brucellosis were enrolled,including 113 cases of brucellosis without spondylitis and 187 cases of brucellar spondylitis.Multivariate analysis showed that age,time from onset to diagnosis,low back pain,and erythrocyte sedimentation rate were independent risk factors for brucellar spondylitis(P＜0.05).Of the 154 cases of brucellar spondylitis with known outcomes,121 cases showed good prognosis and 33 cases had poor prognosis.COX regression analysis showed that the time from onset to diagnosis,diabetes mellitus,paravertebral abscess,and neurological impairment were independent risk factors for poor prognosis in patients with brucellar spondylitis(P＜0.05).Conclusions Old age,prolonged time from onset to diagnosis,low back pain,and increased erythrocyte sedimentation rate are independent risk factors for spondylitis in patients with brucellosis.Prolonged time from onset to diagnosis,diabetes mellitus,paravertebral abscess,and neurological impairment are independent risk factors for poor prognosis of brucellar spondylitis.