OBJECTIVE To explore the serum growth hormone(GH)of the children with infectious pneumonia and analyze its association with blood biochemistry and body immunity.METHODS A total of 211 children with infec-tious pneumonia who were treated in Huaihe Hospital,Henan University from Jan.2023 to Jan.2024 were recrui-ted as the research subjects and were divided into the mild group with 156 cases and the severe group with 55 cases according to the severity of disease.The change of serum GH and the levels of blood biochemical indexes and im-munity indexes were observed and compared between the two groups.Multivariate logistic regression analysis was performed for the influencing factors,receiver operating characteristic(ROC)curves were drawn to analyze the predictive efficiencies.Linear regression analysis was performed to observe the relationship between the infectious pneumonia and the blood biochemistry and body immunity.RESULTS The GH level of the severe group was(18.34±4.33)μg/L,higher than(10.16±2.84)μg/L of the mild group(t=15.853,P＜0.001).There were sig-nificant differences in the blood biochemistry indexes,cellular and humoral immunity indexes between the severe group and the mild group(P＜0.05).The difference values of changes of C-reactive protein(CRP),CD4+and immunoglobulin(Ig)G were the most(t=16.023,87.639,111.957,all P＜0.001).ROC curve analysis showed that the area under the curve(AUC)of CD23+was the highest,with the sensitivity 100.00％,the specificity 98.88％.The result of the linear regression analysis showed that the GH was only positively correlated with the cellular immunity index CD23+(P＜0.05).CONCLUSION The GH level of the children with infectious pneumonia is reduced;the chang of GH level is closely associated with the blood biochemical indexes CRP and the body im-munity of the children.

OBJECTIVE To observe the causal association between colorectal cancer and sepsis by means of bidirec-tional two-sample Mendelian randomization(MR).METHODS The Genome Wide Association Study(GWAS)datasets for colorectal cancer and sepsis were retrieved from the GWAS databases between its establishment and Feb.1,2024.MR was carried out for the colorectal cancer and sepsis interacting as exposure and outcome factors.The single nucleotide polymorhpism(SNPs)that were significantly associated with the exposure factors were screened out by setting P as less than 5.0× 10-8,r2 less than 0.001,the genetic distance 10,000 kb.The SNPs that were remarkably associated with the exposure factors were extracted from the GWAS datasets of the outcome variables,the instrumental variable were finally obtained,the inverse variance weighting(IVW)was taken as the main approach for the causal inference.The level pleiotropy was tested by using MR Egger method and MR-PRESSO,the heterogeneity was tested by IVW method and MR-Egger method,the sensitivity was analyzed by leave-one-out method,and the robustness of the result was tested.RESULTS A total of 30 SNPs were screed out by setting the colorectal cancer as exposure factor and the sepsis as outcome variable(F＞10);there was causal as-sociation between the colorectal cancer and the sepsis(OR=28.955,95％CI:1.215 to 690.052,P=0.037).Totally 14 SNPs were screened out by setting the sepsis as exposure factor and the colorectal cancer as treatment variable(F＞10),and there was no causal association between the colorectal cancer and the sepsis(OR=0.999,95％CI:0.997 to 1.002,P=0.674).There was no level pleiotropy in the instrumental variables during the two times of MR analysis;there was no heterogeneity in the instrumental variables,and the result of the MR analysis was robust.CONCLUSION There is causal association between the colorectal cancer and the increases of risk of sepsis.But there is no causal association between the sepsis and the increase of risk of colorectal cancer.

OBJECTIVE To understand the changing trends of use of antibiotics and etiological submission rates in medical institutions of Wuhan and find out the key points of management.METHODS The survey data of Wuhan were collected from the cross-sectional survey databases for nosocomial infections in China of 2016,2018,2020 and 2022,and the data were retrospectively analyzed.RESULTS From 2016 to 2022,a total of 141 284 hospital-ized patients from 117 medical institutions were enrolled in the survey,and the utilization rate of antibiotics was 32.36％;the utilization rate of antibiotics was 32.87％in 2016,31.74％in 2018,28.75％in 2020,34.56％in 2022,showing an upward trend(x2=13.941,P＜0.001).The utilization rates of antibiotics were relatively high in respiratory medicine department and comprehensive ICU,which showed upward trends(x2=16.377,P＜0.001;x2=5.581,P=0.018);the utilization rate of antibiotics showed a downward trend in non-neonates pediatrics de-partment(x2=11.886,P＜0.001).The rates of prophylactic use of antibiotics for type Ⅰ incision surgery were 31.54％,23.53％,28.44％and 13.24％,respectively,showing downward trends(x2=230.333,P＜0.001).The etiological submission rates were 59.98％,55.77％,65.69％and 59.16％,respectively,which were basically same(P=0.072);the etiological submission rates of the medical institutions with less than 300 beds and 300 to 599 beds showed upward trends,while the etiological submission rates of the medical institutions with 600 to 899 beds and no less than 900 beds showed downward trends(x2=42.019,P＜0.001;x2=4.599,P=0.032).The etiological submission rate was 44.87％in 2018 before the treatment with antibiotics,47.80％in 2020,44.45％in 2022,which were basically same(P=0.431);the etiological submission rate of the medical institutions with no less than 900 beds showed a downward trend(x2=14.464,P＜0.001).CONCLUSIONS The use of antibiotics of the hospi-talized patients is generally normalized in the medical institutions of Wuhan,the utilization rate shows an upward trend,the etiological submission rate is basically same,and the rate of prophylactic use of antibiotics for type Ⅰincision surgery shows a downward trend.It is necessary to attach great importance to the etiological submission of large scale metical institutions before the treatment with antibiotics and the use of antibiotic of some key departments.

OBJECTIVE To evaluate the effect of antimicrobial stewardship scientific(AMS)of antimicrobial agents on special antibiotics so as to provide evidence-based bases for reasonable use of antibiotics.METHODS A retro-spective survey was conducted for the status of use of special antibiotics in Zhongnan Hospital,Wuhan University.The utilization rate of intravenous infusion of antibiotics,antimicrobials use density(AUD)of special grade antibi-otics,defined daily doses(DDDs),etiological submission rate of microorganisms before use of antibiotics and drug resistance rates of major gram-negative bacteria to special grade antibiotics were observed and compared be-fore and after the AMS was carried out.RESULTS There were no significant differences in gender,severity of dis-ease and spectrum of infectious diseases before and after the AMS was carried out.The utilization rate of intrave-nous infusion of antibiotics was(55.64±1.63)％among the hospitalized patients after the AMS was carried out,the AUD of special grade antibiotics was 2.08±0.57,and the DDDs was 2406.53±292.16,showing generally downward trends(P＜0.05).The drug resistance rates of Acinetobacter baumannii strains to cefepime and imi-penem were 89.15％and 90.21％,respectively,showing upward trends(P＜0.05).CONCLUSION The AUD and DDDs of the special grade antibiotics can be remarkably reduced through powerful means such as carrying out AMS,setting up AMS task group for special grade antibiotics,developing guidance documents for scientific use of special antibiotics,taking full advantage of reasonable drug administration surveillance system,implementing closed-loop management of the special antibiotics,and completing early warning mechanisms for bacterial drug re-sistance as well as information construction to boost management.

OBJECTIVE To explore the effect of fluconazole on proteomics of Trichosporon asahii so as to reveal the responding process of T.asahii to fluconazole stress and the resistance mechanisms to azoles on the protein level.METHODS T.asahii AS 2.2174 was chosen as the research subject,the minimum inhibitory concentration(MIC)of fluconazole was determined by broth microdilution assay.The protein abundance of T.asahii was detec-ted by means of tandem mass tag(TMT)technique combined with liquid chromatography-tandem mass spectrom-etry(LC-MS/MS)before and after the treatment with fluconazole(1× MIC).The differentially expressed pro-teins(DEPs)were identified based on the screening standards of fold change ≥1.20 or ≤0.83 and P＜0.05.Gene ontlogy(GO)and Kyoto encyclopedia of genes and genomes(KEGG)enrichment analysis were performed for the DEPs so as to understand the biological property of the DEPs and the major biological pathways that the DEPs in-volved in.Finally,the targeted validation was carried out for the targeted differentially expressed proteins by using multiple reaction monitoring(MRM).RESULTS The MIC of fluconazole to T.asahii AS 2.2174 was 8 μg/ml.Totally 196 DEPs were identified,including 93 upregulated DEPs and 103 downregulated DEPs.The function en-richment analysis showed that the DEPs mainly participated in synthesis and metabolism of sterols,drug metabo-lism,stress response,energy metabolism and intertranslation.The targeted DEPs showed the consistent expres-sion trends in MRM target validation and TMT-LC-MS/MS.CONCLUSIONS The protein abundance of T.asahii has remarkable change under the fluconazole stress.The bioinformatics analysis reveals the complicated molecular mechanisms of T.asahii in response to the fluconazole stress,which may offer valuable ideas for understanding the drug resistance to azoles and developing new drug targets.

OBJECTIVE To analyze the relationship between the postoperative intervertebral space infection and the expressions of β-catenin and glycogen synthase kinase-3β(GSK-3β)in the patients with lumbar disc herniation(LDH).METHODS A total of 201 patients with LDH who received surgical procedures in Harbin Orthopedics and Traumatology Hospital from Jan.2022 to May 2024 were enrolled in the study and were divided into the infection group and the no infection group according to the status of postoperative intervertebral space infection.The distri-bution and drug resistance of pathogens isolated from the patients of the infection group were detected.The rela-tive expression levels of peripheral blood Wnt,β-catenin and GSK-3β proteins were compared between the two groups.RESULTS Among the 201 patients who received surgical procedures,21 had postoperative intervertebral space infections,with the infection rate 10.45％.Totally 26 strains of pathogens were isolated from the 21 patients in the infection group,11(42.31％)of which were gram-negative bacteria,and 15(57.69％)were gram-positive bacteria.The operation duration of the infection group was(3.46±0.89)hour,longer than(3.09±0.73)hour of the no infection group(t=2.146,P=0.033).There were significant differences in the expressions of peripheral blood β-catenin and GSK-3β proteins between the infection group and the no infection group(P＜0.05).Receiver operating characteristic(ROC)curve analysis showed that the areas under the curves(AUCs)of the relative ex-pression levels of β-catenin and GSK-3β were 0.836 and 0.800,respectively;the sensitivities were 52.40％and 66.70％,respectively;the specificities were 90.56％and 93.89％,respectively;the cut-off point were 5.65 and 2.15,respectively.CONCLUSIONS The LDH patients are at high risk of postoperative intervertebral space infec-tion,the patients with the infection show the activation of Wnt/β-catenin signaling pathways and the rise of ex-pression levels of β-catenin and GSK-3β proteins.The levels of the indexes may facilitate the prediction of postop-erative intervertebral space infection in the LDH patients.

OBJECTIVE To explore the epidemiological characteristics of the children with acute respiratory tract in-fection and analyze the changes of peripheral blood prealbumin(PA),serum amyloid protein A(SAA)and pro-calcitonin(PCT)so as to provide bases for the clinical diagnosis.METHODS A total of 177 children with acute re-spiratory tract infection who were treated in Qingdao Haici Hospital Affiliated to Qingdao University from Nov.2021 to Nov.2023 were assigned as the infection group,meanwhile,195 healthy children who received physical examination were chosen as the healthy group.The distribution of pathogens isolated from the patients of the in-fection group was statistically analyzed.The levels of PA,SAA,CRP and PCT were compared between the two groups.The values of the indexes in diagnosis of the acute respiratory tract infection were analyzed.RESULTS The total positive rate of isolation of pathogens was 31.07％(55/177)among the children with acute respiratory tract infection,and Mycoplasma pneumoniae was the predominant species of pathogen.There was significant difference in the isolation rate of pathogens among the different age groups of children with acute respiratory tract infection(x2=8.270,P=0.041);the children of the preschool age group were dominant.There was significant difference in the isolation rate of pathogens from the children with acute respiratory tract infection among the different sea-sons(x2=9.557,P=0.023);the isolation rates were relatively high in spring and winter.There were significant differences in the levels of serum PA,SAA,CRP and PCT between the infection group and the healthy group(P＜0.05);the CRP level was(13.48±4.25)mg/L in the infection group,(7.85±2.51)mg/L in the healthy group,with the difference value maximum(t=15.724,P＜0.001).The area under the curve(AUC)value of the joint detection of the four indexes was higher than that of the single detection in diagnosis of the acute respiratory tract infection in the children(P＜0.05).CONCLUSIONS M.pneumoniae is dominant among the pathogens isolated from the children with acute respiratory tract infection,the preschool age children are in the majority.The infec-tion is prevalent in spring and winter.The children with the infection show the abnormal expressions of PA,SAA,CRP and PCT,and the joint detection of the four indexes has high value in diagnosis of the infection.

OBJECTIVE To explore the clinical characteristics and risk factors for refractory drug-resistant Pseudo-monas aeruginosa infection and evaluate the prognosis so as to provide theoretical bases for effective prevention and control of the refractory drug-resistant P.aeruginosa infection.METHODS A total of 95 patients who were di-agnosed with refractory drug-resistant P.aeruginosa infection and were treated in People's Hospital of Guangdong Province from Jan.2019 to Dec.2023 were assigned as the infection group.Meanwhile,95 patients who did not have drug-resistant P.aeruginosa infection,matched by the age and hospitalization period,were chosen as the non-infection group in a case-control(1∶1 ratio).The basic information and clinical data were collected from the two groups of patients.The characteristics and risk factors for the drug-resistant P.aeruginosa infection were ana-lyzed,and the prognosis of the patients was evaluated.RESULTS Among the clinical isolates of drug-resistant P.aeruginosa,78 were isolated from respiratory secretions;there were 59 patients from intensive care unit(ICU),13 patients from respiratory medicine department and 8 patients from geriatrics department.Fever,dyspnea,moist rales and cough were the major clinical manifestations.The proportions of patients with history of respirato-ry tract disease(P＜0.001),renal disease(P=0.008),nervous system disease(P=0.005),diabetes mellitus(P=0.017),hepatic disease(P=0.007),previous utilization rate of aminoglycosides(P=0.002)and previous u-tilization rate of no less than 3 types of antibiotics were higher in the infection group than in the non-infection group.Multivariate analysis showed that the history of respiratory tract disease(OR=2.813,95％CI:1.366 to 5.792,P=0.005),history of diabetes mellitus(OR=2.465,95％CI:1.129 to 5.382,P=0.024)and history of nervous system disease(OR=2.386,95％CI:1.151 to 4.944,P=0.019)were the risk factors for the drug-resist-ant P.aeruginosa infection.The mortality rate of the infection group was 30.53％,higher than 6.32％of the non-infection group(x2=18.527,P＜0.001).CONCLUSIONS The mortality rate of the patients with drug-resistant P.aeruginosa infection is high.The history of respiratory tract disease,history of diabetes mellitus and history of nervous system disease are the major risk factors for the infection.It is necessary for the hospital to strengthen the awareness of prevention of the drug-resistant P.aeruginosa infection so as to curb the hospital-associated infection.

To adapt to the immune environment and the stress of antimicrobial exposure,Klebsiella pneumoniae can evolve into resistance to multiple antimicrobial agents in the hosts.However,less attention has been paid to the genetic evolution in vivo from antimicrobial susceptibility to resistance.This paper reviews the adaptive evolu-tion of drug resistance and virulence of K.pneumoniae in patients in current clinical practice.The potential mecha-nisms of the evolution of resistance to carbapenems,ceftazidime-avibactam,tigecycline and colistin in human hosts were mainly summarized.

OBJECTIVE To explore the current status of surveillance data of nosocomial infections in a three-A hos-pital of Jiangsu Province and find out the problems in prevention and control of the nosocomial infection so as to provide scientific bases for formulating targeted prevention strategies.METHODS The related data of all infection cases from Changzhou First People's Hospital between 2014 and 2023 were exported from information real-time surveillance system and were analyzed by using Excel 2021 and R 4.3.2 software.RESULTS The average incidence rate of hospital-associated infection was 1.32％from 2014 to 2023,declining from 2.11％in 2014 to 0.97％in 2023,and it showed a downward trend(Z=-30.010,P＜0.001).The incidence rate of hospital-associated infec-tion was 19.86％in neurosurgery department(Z=-3.041,P=0.002),10.27％in hematology department(Z=5990,P＜0.001),8.85％in neurology department(Z=-1.437,P=0.151),7.00％in critical care medicine de-partment(Z=5.907,P＜0.001),6.28％in gastrointestinal surgery department(Z=-4.435,P＜0.001),thorac-ic surgery department(Z=1.696,P=0.090),4.52％in cardiothoracic surgery department(Z=13.218,P＜0.001),2.95％in oncology department(Z=9.064,P＜0.001).Among the patients with hospital-associated infec-tions,the patients with lower respiratory tract infection accounted for 46.71％(the highest),increasing from 34.94％to 51.67％(Z=12.532,P＜0.001),the patients with upper respiratory tract infection 10.37％(Z=-10.229,P＜0.001),the patients with urinary tract infection 6.92％(Z=1.489,P=0.137),the patients with urinary catheter-related infection 3.71％(Z=13.218,P=0.317).Totally 13,593 strains of pathogens were isola-ted,65.26％of which were gram-negative bacteria and did not show a significant changing trend,24.62％were gram-positive bacteria,and 10.12％were fungi;Klebsiella pneumoniae(15.76％)and Acinetobacter baumannii(15.34％)were the predominant species of the gram-negative bacteria;Staphylococcus aureus(8.37％)and Corynebacterium striatum(3.60％)were dominant among the gram-positive bacteria;Candida albicans(5.13％)and Candida tropicalis(0.96％)were the major species of the fungi.The percentage of central venous catheteriza-tion was the highest(27.04％)among the risk factors for the hospital-associated infection,increasing from 14.87％to 21.75％(Z=17.482,P＜0.001).CONCLUSIONS The control of hospital-associated infection has been made remarkable achievement.It is necessary to strengthen the construction of infection control team,push for-ward the whole process and delicacy management,normalize the use of antibiotics,reduce the unnecessary inva-sive procedures and shorten the duration of invasive operations so as to further improve the medical quality.