Objective:To report the nationwide surveillance results of pathogenic profiles and antimicrobial resistance patterns of Gram-positive bloodstream infections in China in 2023.Methods:The clinical isolates of Gram-posttive bacteria from blood cultures were collected in member hospitals of National Bloodstream Infection Bacterial Resistant Investigation Collaborative System（BRICS）during January to December 2023. Antimicrobial susceptibility testing was performed using the dilution method recommended by the Clinical and Laboratory Standards Institute（CLSI）. Statistical analyses were conducted using WHONET 5.6 and SPSS 25.0 software.Results:A total of 4 385 Gram-positive bacterial isolates were obtained from 60 participating center. The top five pathogens were Staphylococcus aureus（ n=1 544，35.2%），coagulase-negative Staphylococci（ n=1 441，32.9%）， Enterococcus faecium（ n=574，13.1%）， Enterococcus faecalis（ n=385，8.8%），and α-hemolytic Streptococci（ n=187，4.3%）. The prevalence of methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococci（MRCNS）was 26.2%（405/1 544）and 69.8%（1 006/1 441），respectively. Notably，all Staphylococci remained susceptible to glycopeptide or daptomycin. Staphylococcus aureus demonstrated excellent susceptibility（>97.0%）to cephalobiol，rifampicin，trimethoprim-sulfamethoxazole，linezolid，minocycline，tigecycline，and eravacycline. No Enterococcus exhibiting resistance to linezolid were detected. Glycopeptide resistance was uncommon but more frequent in Enterococcus faecium（resistance to vancomycin and teicoplanin：both 1.7%）compared to Enterococcus faecalis（both 0.3%）. The detection rates of MRSA and MRCNS exhibited significant regional variations across the country（ χ2=17.674 and 148.650，respectively，both P<0.001）. No vancomycin-resistant Enterococci were detected in central China. Institutional comparison demonstrated higher prevalence of MRSA（ χ2=14.111， P<0.001）and MRCNS（ χ2=4.828， P=0.028）in provincial hospitals than that in municipal hospitals. Socioeconomic analysis identified elevated detection rates of both MRSA（ χ2=18.986， P<0.001）and MRCNS（ χ2=4.477， P=0.034）in less developed regions（per capita GDP

Objective:To report the results of bacterial resistant investigation collaborative system（BRICS）on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2023，and provide reference for clinical tretment of bloodstream infections and prevention and control of bacterial resistance.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of BRICS were collected during January 2023 to December 2023. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 were used to analyze the data.Results:During the study period，11 492 strains of Gram-negative bacteria were collected from 60 hospitals，of which 10 098（87.9%）were Enterobacterales and 1 394（12.1%）were non-fermentative bacteria. The top 5 bacterial species were Escherichia coli（50.0%）， Klebsiella pneumoniae（26.1%）， Pseudomonas aeruginosa（5.1%）， Acinetobacter baumannii complex（5.0%）and Enterobacter cloacae complex（4.1%）. The ESBL-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus mirablilis were 46.8%（2 685/5 741），18.3%（549/2 999）and 44.0%（77/175），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（76/5 741）and 15.0%（450/2 999）；32.9%（25/76）and 78.0%（351/450）of CREC and CRKP were sensitive to ceftazidime/avibactam combination，respectively. 94.7%（72/76）and 90.2%（406/450）of CREC and CRKP were sensitive to aztreonam/avibactam combination. Furthermore，57.9%（44/76）and 79.1%（356/450）were sensitive to imipenem/relebactam combination. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 64.6%（370/573），while more than 80.0% of CRAB complex was sensitive to tigecycline，eravacycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 17.0%（99/581）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of important Gram-negative bacteria resistance among different regions in China，with statistically significant differences in the prevalence of CREC，CRKP，CRPA and CRAB complex（ χ2=10.6，28.6，10.8 and 19.3， P<0.05）. The prevalence of ESBL-producing Escherichia coli， CREC，CRAB complex and CRKP were higher in provincial hospitals than those in municipal hospitals（ χ2=12.5，9.8，12.7 and 57.8，all P<0.01）. Conclusions:Gram-negative bacteria are the main pathogens causing bloodstream infections in China，and Escherichia coli is ranked in the top，while the trend of Klebsiella pneumoniae increases continuously with time. CRKP infection shows a slow upward trend，CREC infecton maintains a low prevalence level，and CRAB complex infection continues to exhibit a high prevalence rate. The composition and resistance patterns of pathogens causing bloodstream infections vary to some extent across different regions and levels of hospitals in China.

Objective:To report the nationwide surveillance results of pathogenic profiles and antimicrobial resistance patterns of Gram-positive bloodstream infections in China in 2023.Methods:The clinical isolates of Gram-posttive bacteria from blood cultures were collected in member hospitals of National Bloodstream Infection Bacterial Resistant Investigation Collaborative System（BRICS）during January to December 2023. Antimicrobial susceptibility testing was performed using the dilution method recommended by the Clinical and Laboratory Standards Institute（CLSI）. Statistical analyses were conducted using WHONET 5.6 and SPSS 25.0 software.Results:A total of 4 385 Gram-positive bacterial isolates were obtained from 60 participating center. The top five pathogens were Staphylococcus aureus（ n=1 544，35.2%），coagulase-negative Staphylococci（ n=1 441，32.9%）， Enterococcus faecium（ n=574，13.1%）， Enterococcus faecalis（ n=385，8.8%），and α-hemolytic Streptococci（ n=187，4.3%）. The prevalence of methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococci（MRCNS）was 26.2%（405/1 544）and 69.8%（1 006/1 441），respectively. Notably，all Staphylococci remained susceptible to glycopeptide or daptomycin. Staphylococcus aureus demonstrated excellent susceptibility（>97.0%）to cephalobiol，rifampicin，trimethoprim-sulfamethoxazole，linezolid，minocycline，tigecycline，and eravacycline. No Enterococcus exhibiting resistance to linezolid were detected. Glycopeptide resistance was uncommon but more frequent in Enterococcus faecium（resistance to vancomycin and teicoplanin：both 1.7%）compared to Enterococcus faecalis（both 0.3%）. The detection rates of MRSA and MRCNS exhibited significant regional variations across the country（ χ2=17.674 and 148.650，respectively，both P<0.001）. No vancomycin-resistant Enterococci were detected in central China. Institutional comparison demonstrated higher prevalence of MRSA（ χ2=14.111， P<0.001）and MRCNS（ χ2=4.828， P=0.028）in provincial hospitals than that in municipal hospitals. Socioeconomic analysis identified elevated detection rates of both MRSA（ χ2=18.986， P<0.001）and MRCNS（ χ2=4.477， P=0.034）in less developed regions（per capita GDP

Objective:To report the results of bacterial resistant investigation collaborative system（BRICS）on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2023，and provide reference for clinical tretment of bloodstream infections and prevention and control of bacterial resistance.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of BRICS were collected during January 2023 to December 2023. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 were used to analyze the data.Results:During the study period，11 492 strains of Gram-negative bacteria were collected from 60 hospitals，of which 10 098（87.9%）were Enterobacterales and 1 394（12.1%）were non-fermentative bacteria. The top 5 bacterial species were Escherichia coli（50.0%）， Klebsiella pneumoniae（26.1%）， Pseudomonas aeruginosa（5.1%）， Acinetobacter baumannii complex（5.0%）and Enterobacter cloacae complex（4.1%）. The ESBL-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus mirablilis were 46.8%（2 685/5 741），18.3%（549/2 999）and 44.0%（77/175），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（76/5 741）and 15.0%（450/2 999）；32.9%（25/76）and 78.0%（351/450）of CREC and CRKP were sensitive to ceftazidime/avibactam combination，respectively. 94.7%（72/76）and 90.2%（406/450）of CREC and CRKP were sensitive to aztreonam/avibactam combination. Furthermore，57.9%（44/76）and 79.1%（356/450）were sensitive to imipenem/relebactam combination. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 64.6%（370/573），while more than 80.0% of CRAB complex was sensitive to tigecycline，eravacycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 17.0%（99/581）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of important Gram-negative bacteria resistance among different regions in China，with statistically significant differences in the prevalence of CREC，CRKP，CRPA and CRAB complex（ χ2=10.6，28.6，10.8 and 19.3， P<0.05）. The prevalence of ESBL-producing Escherichia coli， CREC，CRAB complex and CRKP were higher in provincial hospitals than those in municipal hospitals（ χ2=12.5，9.8，12.7 and 57.8，all P<0.01）. Conclusions:Gram-negative bacteria are the main pathogens causing bloodstream infections in China，and Escherichia coli is ranked in the top，while the trend of Klebsiella pneumoniae increases continuously with time. CRKP infection shows a slow upward trend，CREC infecton maintains a low prevalence level，and CRAB complex infection continues to exhibit a high prevalence rate. The composition and resistance patterns of pathogens causing bloodstream infections vary to some extent across different regions and levels of hospitals in China.

Objective To analyze the related factors that influence the stone free rate ( SFR) in flexible ureteroscopic lithotripsy ( FURL ) and develop a stone free index ( SFI ) model to estimate and predict the outcome of FURL.Methods A total of 393 patients receiving FURL were included in this study from May 2013 to August 2014.All patients′and calculous characteristics were recorded.It was evaluated the correlation of one-stage SFR with body mass index, the degree of hydronephrosis, the sterile urine, the renal insufficiency, the stone location, the stone number, the cumulative stone diameter ( CSD) , the stone density, the average of CT values, the minimum angle of pelvis ureter long axis with lamp long axis, the average length of stone located calyx-neck, and the minimum ratio of stone located calyx-neck′width with calyx′width.Multivariate regression analysis was used to analyze the relationship between preoperative characteristics and the SFR.Results The one-stage postoperative SFR in our study was 92.4% ( 363/393).We found that the staghorn stone, bacteriuria, CSD, average of CT values, the average length of stone located calyx-neck, the minimum ratio of stone located calyx-neck′width with calyx′width were significantly correlated with the postoperative SFR ( P <0.05 ) .We used logistic regression analysis to determine statistical significant variables and to create predictable mathematical model.The SFI system was consist of four stone characteristics, including the staghorn stone, the cumulative stone diameter, the average length of stone located calyx-neck, and the minimum ratio of stone located calyx-neck′width with calyx′width.The SFI had a high ROC curve (AUC=0.867) for predicting the one-stage postoperative stone free outcome.SFI score >7.5 meant a relatively high SFR ( SFR>85%) of FURL.Conclusions A SFI model using preclinical data was developed to predict the postoperative outcome of FURL, as well as the one-stage SFR.This model needs further prospective studies in the future.

OBJECTIVE: To analyze the anatomical and developmental characteristics of nasal sinuses in 1-2 years old children; and provide potential evidence for the diagnosis and treatment of sinusitis in 1-2 years old children. METHOD: Coronal CT scans of 60 cases (1-2 years old children) were studied with the imaging station. Reference datas were identified on these images using imaging station. The gasification conditions of the sinuses were identified and measured. RESULT: 100% of the frontal sinuses were not developed, while 100% of the maxillary sinuses were developed. The mean of the transverse and vertical diameters for the left side of the maxillary sinuse was (13.32 ± 2.88) mm and (13.55 ± 2.43) mm, respectively. While those for the right side were (13.63 ± 2.75) mm and (13.59 ± 2.13) mm, respectively. The anterior and posterior ethmoid sinuses were 100% developed. The mean transverse and vertical diameters for the left side of the anterior ethmoid sinus were (3.94 ± 0.86) mm and (11.92 ± 1.67) mm, respectively. While those mean for its right side were (3.88 ± 0.88) mm and (12.18 ± 1.86) mm, respectively. The mean transverse and vertical diameters for the left side of the posterior ethmoid sinus were (6.02 ± 1.07) mm and (10.51 ± 1.43) mm, respectively. While those for the right side were (5.91 ± 1.20) mm and (10.51 ± 1.55) mm, respectively. 88.3% (106 sides) of the sphenoid sinuses were developed, while 11.7% (14 sides) were not developed. The mean transverse and vertical diameters for the left side of the sphenoid sinus were (5.18 ± 2.15) mm and (5.78 ± 1.86) mm, respectively. While those for the right side were (4.91 ± 2.24) mm and (5.89 ± 2.03) mm, respectively. CONCLUSION The nasal sinuses in 1-2 years old children have been already developed. The development of the maxillary and ethmoid sinuses was clear and definite. The pneumatization of the sphenoid sinus was defined in many babies; however, the pneumatization of the frontal sinus was not defined in all babies. Acute rhinosinusitis in 1-2 years old children is not uncommon. Therefore, definite diagnosis and positive treatment of such cases are essential for avoidance of serious complications.
Ethmoid Sinus ; anatomy & histology ; Frontal Sinus ; anatomy & histology ; Humans ; Infant ; Maxillary Sinus ; anatomy & histology ; Sinusitis ; diagnosis ; therapy ; Sphenoid Sinus ; anatomy & histology ; Tomography, X-Ray Computed

A foreign body was found in left bronchi of a 8-month infant. A fish bone of 26 mm long was pulled out with bronchoscopy under general anesthesia. This kind of surgery done in infant is more challenging than that done in child.
Anesthesia, General ; Bronchi ; Bronchoscopy ; methods ; Foreign Bodies ; surgery ; Humans ; Infant

OBJECTIVE: To analyze the anatomical and developmental characteristics of nasal sinuses in infants; and provide potential evidence for the diagnosis and treatment of sinusitis in infants. METHOD: Coronal CT scans for 36 infants (72 sides) were studied with the imaging station. Reference data were identified on these images using imaging station. The gasification conditions of the sinuses were identified and measured. RESULT: 100% of the frontal sinuses were absent, while 100% of the maxillary sinuses were developed. The mean of the transverse and vertical diameters for the left side of the maxillary sinuses was (8.69 +/- 3.75) mm and (9.37 +/- 2.36) mm, respectively. While those for the right side were (8.95 +/- 2.79) mm and (9.06 +/- 2.66) mm, respectively. All of the anterior and posterior ethmoid sinuses were developed. The mean transverse and vertical diameters for the left side of the anterior ethmoid sinus were (3.63 +/- 1.17) mm and (8.21 +/- 2.72) mm, respectively. While those mean for its right side were (3.48 +/- 1.32) and (8.28 +/- 2.62) mm, respectively. The mean transverse and vertical diameters for the left side of the posterior ethmoid sinus were (4.09 +/- 1.13) mm and (6.61 +/- 1.36) mm, respectively. While those for the right side were (4.01 +/- 1.28) mm and (6.63 +/- 1.97) mm, respectively. 30.6% (22 sides) of the sphenoid sinuses were developed, while 69.4% (50 sides) were not. CONCLUSION The nasal sinuses in infants have already developed. The development of the maxillary and ethmoid sinuses was clear and definite. The pneumatization of the sphenoid sinus was defined in some babies, however, the pneumatization of the frontal sinus was not defined in all babies.
Female ; Humans ; Infant ; Male ; Paranasal Sinuses ; diagnostic imaging ; Tomography, X-Ray Computed

OBJECTIVE: To evaluate clinical and imaging character of chronic rhinosinusitis in the children with chronic cough and to discuss the treatment of them. METHOD: Fifty-three children with chronic cough were examined by otolaryngologists and evaluated by computed tomography (CT) scan. Some of them were also evaluated by nasal endoscope. There was not any finding of lung in chest X-ray in Adhese children and children with immunodeficiency were ruled out from the study. The children with chronic sinusitis were treated according to general protocols for 6 to 8 weeks, among them those with adenoid vegetation accepted adenoidectomy. RESULT: Forty-three cases of 53 children with chronic cough, aged from 2 years and 10 months to 13 years old (average 7 years old), were proved with sinusitis by CT. The main symptom of them was chronic cough. Thirty-five cases of these 43 children were with purulence, among them, 8 cases with mucoid in middle meatus, 28 cases with folliculosis in posterior oropharynx, and 6 children with adenoid vegetation. Clinical stage of 19 cases of 53 children were belonged to I type 3 stage, 19 cases belonged to I type 2 stage, 5 cases belonged to I type 1 stage. The maxillary sinus was most frequently involved, followed by the ethmoid sinus, the frontal sinus, the sphenoid sinus. All of the 43 children with sinusitis accepted treatment for 6 to 8 weeks. After treatment, 81.4% of patients were fully recovered, 18.6% significantly improved, 4 with adenoidectomy and 2 with tympanostomy tubes. CONCLUSION The relationship between chronic sinusitis and chronic cough in children was closer than that in adults. It is very easy to make misdiagnosis because of other symptoms.
Adolescent ; Child ; Child, Preschool ; Chronic Disease ; Cough ; diagnosis ; etiology ; therapy ; Endoscopy ; Female ; Humans ; Male ; Sinusitis ; complications ; diagnosis ; therapy ; Tomography, X-Ray Computed