Objective:To analyze the current situation of medical consumables management policy in China,and to provide a reference for the refined management of medical consumables.Methods:Through the policy triangle model and policy tool theory,it comprehensively analyzes the reimbursement medical consumables catalogue and payment management policy of medical insurance in China,covering the policy background,content,process,and participant dimensions.Results:The use frequency of medical consumables policy tools is not balanced,the payment management rules need to be refined,and the participation of multi-stakeholders such as patients is lacking.Conclusion:It is necessary to further strengthen the foundational management of reimbursement medical consumables catalogue,improve the access mechanism of medical consumables for medical insurance,and explore the formulation of categorized payment standards and innovative payment mechanisms.

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 current situation of medical consumables management policy in China,and to provide a reference for the refined management of medical consumables.Methods:Through the policy triangle model and policy tool theory,it comprehensively analyzes the reimbursement medical consumables catalogue and payment management policy of medical insurance in China,covering the policy background,content,process,and participant dimensions.Results:The use frequency of medical consumables policy tools is not balanced,the payment management rules need to be refined,and the participation of multi-stakeholders such as patients is lacking.Conclusion:It is necessary to further strengthen the foundational management of reimbursement medical consumables catalogue,improve the access mechanism of medical consumables for medical insurance,and explore the formulation of categorized payment standards and innovative payment mechanisms.

Objective:To explore the feasibility of pressure tolerance threshold (PTO) in evaluating the effect of local anesthesia in patients undergoing transperineal prostate biopsy.Methods:Patients who underwent periprostatic nerve block prostate biopsy in Northern Jiangsu People's Hospital from March 2022 to October 2023 were prospectively enrolled.Inclusion criteria: ① suspicious prostate nodules detected by digital rectal examination, any prostate-specific antigen (PSA) value; ② transrectal prostate ultrasound (TRUS) or magnetic resonance imaging (MRI) showing suspicious lesions, any PSA; ③ the PSA >10 ng/ml; ④PSA 4-10 ng/ml, suspicious free/total PSA or suspicious PSA density. Inclusion was required if one of these criteria was met. Exclusion criteria: ① previous history of prostate biopsy or prostate surgery; ② severe cardiovascular and cerebrovascular diseases or coagulation disorders; ③ severe urinary tract infection; ④ taking analgesics within 24 hours before surgery; ⑤ unable to complete the pain score or refused to cooperate; ⑥ rectal stenosis or other rectal lesions detected by digital rectal examination.The PTO of all patients was measured by the same physician using a tenderness measuring instrument before puncture. Visual analogue scale (VAS) was used to evaluate the pain during the operation. According to the VAS score, the patients were divided into mild pain group (VAS score 0-3 points) and moderate to severe pain group (VAS score 4-10 points). The clinical data of the two groups were compared. The correlation between PTO and VAS score was further analyzed. The receiver operating characteristic (ROC) curve of PTO to predict pain during puncture was drawn, and the optimal cut-off value of PTO was calculated by the maximum Youden index.Results:A total of 304 patients were enrolled in this study, including 184 patients in the mild pain group and 120 patients in the moderate to severe pain group.There were no significant differences in age [69 (63, 73) years old vs. 69 (61, 74) years old], body mass index[24.0(22.9, 25.0)kg/m 2 vs. 23.9(22.8, 24.7)kg/m 2], PSA[14.6(10.5, 25.1)ng/ml vs. 14.0(10.5, 20.7)ng/ml], and hypertension[59.8%(110/184) vs.64.2%(77/120)]between the mild pain group and the moderate to severe pain group ( P> 0.05), while there were significant differences in PTO[(6.69±1.20)kgf/cm 2 vs.(5.13±0.92)kgf/cm 2], number of puncture needles[19(18, 22)needles vs. 22(20, 24)needles], prostate volume[36.5(26.6, 52.5)ml vs. 63.2(47.4, 89.4)ml], diabetes[35.3%(65/184) vs. 23.3%(28/120)], and major trauma experience[37.5%(69/184) vs.15.8%(19/120)] ( P<0.05). There was a high correlation between PTO and VAS score ( r=0.689, P<0.001). ROC curve analysis showed that when PTO was 5.99 kgf/cm 2, the accuracy of predicting moderate to severe pain during prostate biopsy was the highest. The AUC was 0.848, the Youden index was 0.675, the sensitivity and specificity were 89.2% and 78.3%, respectively. Conclusions:PTO can evaluate the effect of local anesthesia in patients undergoing transperineal prostate biopsy.PTO can be measured before surgery in patients undergoing transperineal prostate biopsy. When the patient's PTO is ≥5.99 kgf/cm 2, the patient's pain tolerance is better and the local anesthesia effect is feasible.When the patient's PTO is less than 5.99 kgf/cm 2, the patient's pain tolerance is poor, so the patient could be recommended to undergo spinal anesthesia or general anesthesia to reduce the pain during prostate biopsy.

Objective:To explore the feasibility of pressure tolerance threshold (PTO) in evaluating the effect of local anesthesia in patients undergoing transperineal prostate biopsy.Methods:Patients who underwent periprostatic nerve block prostate biopsy in Northern Jiangsu People's Hospital from March 2022 to October 2023 were prospectively enrolled.Inclusion criteria: ① suspicious prostate nodules detected by digital rectal examination, any prostate-specific antigen (PSA) value; ② transrectal prostate ultrasound (TRUS) or magnetic resonance imaging (MRI) showing suspicious lesions, any PSA; ③ the PSA >10 ng/ml; ④PSA 4-10 ng/ml, suspicious free/total PSA or suspicious PSA density. Inclusion was required if one of these criteria was met. Exclusion criteria: ① previous history of prostate biopsy or prostate surgery; ② severe cardiovascular and cerebrovascular diseases or coagulation disorders; ③ severe urinary tract infection; ④ taking analgesics within 24 hours before surgery; ⑤ unable to complete the pain score or refused to cooperate; ⑥ rectal stenosis or other rectal lesions detected by digital rectal examination.The PTO of all patients was measured by the same physician using a tenderness measuring instrument before puncture. Visual analogue scale (VAS) was used to evaluate the pain during the operation. According to the VAS score, the patients were divided into mild pain group (VAS score 0-3 points) and moderate to severe pain group (VAS score 4-10 points). The clinical data of the two groups were compared. The correlation between PTO and VAS score was further analyzed. The receiver operating characteristic (ROC) curve of PTO to predict pain during puncture was drawn, and the optimal cut-off value of PTO was calculated by the maximum Youden index.Results:A total of 304 patients were enrolled in this study, including 184 patients in the mild pain group and 120 patients in the moderate to severe pain group.There were no significant differences in age [69 (63, 73) years old vs. 69 (61, 74) years old], body mass index[24.0(22.9, 25.0)kg/m 2 vs. 23.9(22.8, 24.7)kg/m 2], PSA[14.6(10.5, 25.1)ng/ml vs. 14.0(10.5, 20.7)ng/ml], and hypertension[59.8%(110/184) vs.64.2%(77/120)]between the mild pain group and the moderate to severe pain group ( P> 0.05), while there were significant differences in PTO[(6.69±1.20)kgf/cm 2 vs.(5.13±0.92)kgf/cm 2], number of puncture needles[19(18, 22)needles vs. 22(20, 24)needles], prostate volume[36.5(26.6, 52.5)ml vs. 63.2(47.4, 89.4)ml], diabetes[35.3%(65/184) vs. 23.3%(28/120)], and major trauma experience[37.5%(69/184) vs.15.8%(19/120)] ( P<0.05). There was a high correlation between PTO and VAS score ( r=0.689, P<0.001). ROC curve analysis showed that when PTO was 5.99 kgf/cm 2, the accuracy of predicting moderate to severe pain during prostate biopsy was the highest. The AUC was 0.848, the Youden index was 0.675, the sensitivity and specificity were 89.2% and 78.3%, respectively. Conclusions:PTO can evaluate the effect of local anesthesia in patients undergoing transperineal prostate biopsy.PTO can be measured before surgery in patients undergoing transperineal prostate biopsy. When the patient's PTO is ≥5.99 kgf/cm 2, the patient's pain tolerance is better and the local anesthesia effect is feasible.When the patient's PTO is less than 5.99 kgf/cm 2, the patient's pain tolerance is poor, so the patient could be recommended to undergo spinal anesthesia or general anesthesia to reduce the pain during prostate biopsy.

Objective To analyze the effects of vesicoprostatic muscle(VPM)reconstruction on the early urinary control recovery and safety of patients undergoing robot-assisted radical prostatectomy(RARP).Methods A total of 128 patients who underwent RARP in our hospital during Sep.1,2021 and Aug.31,2023 were enrolled and divided into the non-reconstruction group(n=64)and reconstruction group(n=64)using random number table method.The reconstruction group received Montsouris+VPM reconstruction surgery,while the non-reconstructive group underwent Montsouris surgery only.Urinary control and perioperative data were collected with telephone interview,outpatient follow-up and inpatient records.The two groups were matched using overlap weighting and the Kaplan-Meier method was used to calculate urinary incontinence rates at 1,2 and 3 months after extubation.Early urinary control(3 months after extubation),operation time,intraoperative bleeding,positive rate of incision margin,and incidence of early postoperative complications(＜30 days)(Clavien-Dindo scale)were compared between the two groups.Results The recovery rate of urinary control at 1,2 and 3 months after extubation was significantly higher in the reconstruction group than that in the non-reconstruction group(33.9％vs.11.2％;46.7％vs.16.1％;70.6％vs.45.6％,P＜0.05),but the positive rate of resection margin was lower(16.1％vs.41.7％,P＜0.05).There were no significant differences in operation time,intraoperative bleeding and early postoperative complications between the two groups(P＞0.05).Conclusion VPM reconstruction can improve urinary control recovery in RARP patients early after extubation without increasing the risk of surgery.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.