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 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 microbiota composition and diversity between autogenous and anautogenous Culex pipiens pallens, so as to provide insights into unraveling the pathogenesis of autogeny in Cx. pipiens pallens. Methods Autogenous and anautogenous adult Cx. pipiens pallens samples were collected at 25 ℃, and the hypervariable regions of the microbial 16S ribosomal RNA (16S rRNA) gene was sequenced on the Illumina NovaSeq 6000 sequencing platform. The microbiota abundance and diversity were evaluated using the alpha diversity index, and the difference in the microbiota structure was examined using the beta diversity index. The microbiota with significant differences in the abundance between autogenous and anautogenous adult Cx. pipiens pallens samples was identified using the linear discriminant analysis effect size (LEfSe). Results The microbiota in autogenous and anautogenous Cx. pipiens pallens samples belonged to 18 phyla, 28 classes, 70 orders, 113 families, and 170 genera, and the dominant phyla included Proteobacteria, Bacteroidetes, and so on. At the genus level, Wolbachia was a common dominant genus, and the relative abundance was (77.6 ± 11.3)% in autogenous Cx. pipiens pallens samples and (47.5 ± 8.5)% in anautogenous mosquito samples, while Faecalibaculum (0.4% ± 0.1%), Dubosiella (0.5% ± 0.0%) and Massilia (0.5% ± 0.1%) were specific species in autogenous Cx. pipiens pallens samples. Alpha diversity analysis showed that higher Chao1 index and ACE index in autogenous Cx. pipiens pallens samples than in anautogenous samples (both P values > 0.05), and lower Shannon index (P > 0.05) and Simpson index (P < 0.05) in autogenous Cx. pipiens pallens samples than in anautogenous samples. LEfSe analysis showed a total of 48 significantly different taxa between autogenous and anautogenous Cx. pipiens pallens samples (all P values < 0.05). Conclusion There is a significant difference in the microbiota diversity between autogenous and anautogenous Cx. pipiens pallens.

BACKGROUND:Biliary stricture following liver transplantation is mainly focus on biliary stoma stricture; while, balloon dilatation temporarily keeps biliary tract open but not works out a solution at all.OBJECTIVE: To discuss the diagnosis and treatment of postoperative biliary stricture after orthotopie liver transplantation by the endoscope technique.DESIGN, TIME AND SETTING: A case analysis, which was performed at Dalian Liver and Gall Surgical Institute. Ten patients hospitalized from the Department of Liver and Gall Surgery of Dalian Friendship Hospital and four patients hospitalized from the Department of Organ Transplantation of Tianjin First Central Hospital were diagnosed as biliary stricture after orthotopic liver transplantation.PARTICIPANTS: Among 14 patients, 10 males and 4 females with mean age of 46 years provided end-to-end biliary anastomose.METHODS: Fourteen cases of postoperative biliary stricture after orthotopic liver transplantation were analyzed and diagnosed by endoscope technique. And by endoscope technique, the stricture was supported with tube after balloon dilatation.MAIN OUTCOME MEASURES: Bile duct mucous membrane under T-tube radiography and endoscope; calculary distribution and bile duct mucous membrane at stoma; healing of biliary stoma of donors and recipients; inflammatory edema and stricture; recheck of above-mentioned parameters after stricture expansion by endoscopic stone extraction technique.RESULTS: Thirteen cases of postoperative biliary stricture after orthotopic liver transplantation were analyzed and diagnosed by endoscope technique, including one was induced by calculus, and one non-stoma stricture. One case was treated with balloon dilation; biliary infection and jaundice occurred in 2 cases after endoscopic sphincterotomy (EST) + basket lithotripsy + endoscopic nasobiliary drainage (ENBD), so operations or fibrocholedochoscope treatments had to be carried out. By T tube radiography, in 1 case there was strip-like negative simulacrum or no stricture, well-healed anastomosis and good mucous membranel transition; poor or no intrahepatic visualization were found in 2 cases, so anastomosis dilation was processed after the calculi removal by fibrocholedochoscope, stricture disappeared in 3 or 4 months; in 8 cases there were blur extrahepatic or intrahepatic biliary visualization, cord-like, column or branch-like negative simulacrum in biliary ducts and sign of non-anastomosis stricture, after removal of calculi, anastomosis stricture and congestion, edema were found, all these disappeared after average 2.5 months of dilation; the other 1 case was found stricture by T the radiography, but no calculi was found with fibrocholedochoscope, finally the Ttube was removed after 2 months of stricture dilation.CONCLUSION: Endoscopy is significant to directly reflect and reliably diagnose postoperative biliary stricture and effectively treat biliary stricture by anastomosis dilation.