Abstract Infectious disease diagnostics has been transformed by metagenomic next‐generation sequencing (mNGS), an unbiased approach that detects bacteria, viruses, fungi, and parasites in a single assay. By sequencing all nucleic acids in a sample, mNGS overcomes the narrow detection scope and slow turnaround of conventional tests, substantially improving pathogen detection. In conditions such as meningitis/encephalitis, sepsis, and pneumonia, mNGS frequently identifies etiologies missed by routine diagnostic tests, thereby facilitating earlier pathogen‐directed therapy and, in selected settings, improving clinical management and outcomes. This approach is particularly valuable for immunocompromised, pediatric, and intensive care unit (ICU) patients with atypical infections. Currently, clinical mNGS workflows primarily rely on short‐read sequencing platforms (e.g., Illumina), whereas long‐read platforms (e.g., Nanopore, PacBio) offer advantages for rapid or high‐resolution applications. Optimized bioinformatics and stringent quality control are essential for reliable results. Beyond clinical diagnostics, mNGS provides valuable genetic data on antimicrobial resistance (AMR) and pathogen phylogeny, supporting public health and outbreak surveillance (e.g., wastewater monitoring and variant tracking). Current challenges include distinguishing colonization from infection, interpreting sequencing data quantitatively, and reducing cost and turnaround time. Looking ahead, emerging strategies such as targeted panels, rapid automated workflows, and host‑response integration are expected to further shorten time‑to‑result and improve diagnostic specificity. Parallel progress in ethical and regulatory frameworks remains essential to ensure responsible implementation. To support clinical adoption, a standardized framework for clinical interpretation of mNGS results, together with associated training, has been developed and implemented. Overall, mNGS is likely to become an increasingly important component of infectious disease diagnostics, with ongoing innovations expected to broaden its clinical and epidemiological impact.

Non-tuberculous mycobacterial pulmonary disease (NTM-PD) is an escalating global health concern with poorly defined immunological mechanisms, necessitating comprehensive profiling to guide therapeutic advances. We analyzed peripheral blood from 28 treatment-naïve NTM-PD patients (19 Mycobacterium avium complex, 9 Mycobacterium abscessus) and 27 matched controls using 42-marker mass cytometry (CyTOF) and Luminex multiplex assays. A random forest model identified predictive markers, while an in vitro murine macrophage model evaluated chemokine production. NTM-PD patients displayed significant immune shifts, including increased classical monocytes (CD14+ CD16-), reduced NKT-like cells (CD3+ CD56+), and elevated T-cell exhaustion markers (PD-1, TOX). This coincided with a Th1/Th2 balance shift characterized by heightened IL-13. Elevated IFN-γ-inducible chemokines CXCL9 and CXCL10 coexisted with this Th2-biased signature, indicating a complex, dysregulated inflammatory state. A model integrating immune-cell frequencies and cytokine profiles achieved robust diagnostic accuracy (AUC = 0.922) with prognostic potential. In vitro, NTM-infected macrophages produced substantial CXCL9 and CXCL10 levels relative to the LPS maximal activation benchmark, identifying them as a major cellular source. These findings propose an immunological framework wherein T-cell exhaustion and a Th2-biased microenvironment strongly correlate with NTM-PD pathogenesis. CXCL9, CXCL10, and IL-13 emerge as candidate therapeutic targets, while our predictive model offers a foundational approach for risk stratification.

Introduction: Nontuberculous mycobacteria such as Mycobacterium kansasii can mimic malignancy on imaging and pathology, leading to prolonged diagnostic uncertainty and inappropriate anticancer therapy. Case Report: A 76-year-old woman with remote right breast carcinoma (mastectomy and adjuvant therapy in 1996) had a persistent right chest-wall lesion with rib changes and encapsulated pleural effusion repeatedly interpreted as metastatic disease from 2017 to 2023, despite multiple biopsies showing only fibrous hyperplasia. In August 2024, fever and cough prompted re-evaluation. PET-CT demonstrated a hypermetabolic pleura-adjacent lesion (SUVmax 10.8) without distant metastases. Plasma metagenomic next-generation sequencing (mNGS) yielded a low-level M. kansasii signal; pleural fluid mNGS identified 146 reads (94% relative abundance), later confirmed by culture. Targeted anti-NTM therapy stabilized the infection; however, the patient developed severe varicella-zoster virus infection and cardiac complications and subsequently died. The death was attributed to these complications rather than the progression of the M. kansasii infection. Conclusion: Chronic M. kansasii pleural infection can masquerade as metastatic breast cancer for years. PET-CT alone is insufficient to distinguish infection from malignancy; careful imaging review combined with unbiased mNGS can establish the diagnosis and avert unnecessary anticancer therapy. Multidisciplinary collaboration is essential for timely recognition and management.

This study evaluated the thrombotic risk associated with SARS-CoV-2 infection among hospitalized patients with angiographically confirmed coronary artery disease (CAD). A prospective cohort design was used, including 2,078 CAD patients without coronavirus disease 2019 (COVID-19) admitted between January and April 2021 and 2,105 CAD patients with COVID-19 admitted between December 2022 and March 2023. The primary outcome was a composite of major thrombotic events. Patients with COVID-19 showed higher event incidence during 12-month follow-up (7.27% vs. 3.75%), with an adjusted hazard ratio (aHR) of 2.24. The risk was markedly elevated in the first 3 months after infection (hazard ratio [HR] 7.77), then declined but remained above baseline through 12 months. The findings indicate that SARS-CoV-2 infection is associated with a distinct temporal increase in thrombotic vulnerability among CAD patients, highlighting an early period of heightened risk that may inform post-infection monitoring strategies.

Despite the recommendation of purified water, dental unit waterlines (DUWLs) readily form biofilm and suffer persistent microbial contamination, threatening both patients and dental staff. This study aimed to evaluate the microbial contamination and practical effectiveness of chemical disinfection in reverse osmosis (RO) water-supplied DUWLs. A single-center, sequential longitudinal study involving 15 dental chairs and 60 terminal outlets was conducted. Two disinfection strategies were sequentially evaluated: shock disinfection with a chlorine-based agent and continuous disinfection using slightly acidic electrolyzed water (SAEW). Heterotrophic plate counts (HPCs) were quantified via R2A culture, and microbial communities were characterized by metagenomic next-generation sequencing (mNGS) on 12 water samples (four terminal outlets and two source-water points, both pre- and post-disinfection). Water quality assessment revealed severe microbial contamination at the terminal outlets, with 73.33% of samples exceeding the threshold (500 CFU/mL) and a median HPC level of 805 CFU/mL. Notably, mNGS identified nucleic acid sequences of Legionella pneumophila, Pseudomonas aeruginosa, and Acanthamoeba in four pre-disinfection terminal-outlet samples. Chlorine-based shock disinfection achieved 100% compliance immediately after treatment; however, by week 5, the percentage above the threshold value had risen to 73.33%, with a median HPC level of 600 CFU/mL. The continuous SAEW disinfection protocol sustained effective microbial control over 55 weeks, with an overall percentage above threshold value of only 3.33%. mNGS analysis further confirmed a reduction in microbial relative abundance following one year of continuous SAEW disinfection. In conclusion, purified RO water alone could not guarantee DUWL microbiological safety, and this study provided practical evidence to support decision-making for DUWL maintenance.

This study developed a novel core-shell nano-system aimed at addressing the clinical challenges posed by infective endocarditis (IE). The system combines ZIF-8 nanozymes and a polydopamine (PDA) coating, exhibiting excellent biocompatibility, antioxidative, anti-inflammatory, and antibacterial properties. In vitro experiments demonstrated that the system effectively inhibited the growth of S. aureus and significantly reduced inflammation and oxidative stress induced by bacterial infection. A mouse model of IE was constructed, and the therapeutic effects of the core-shell nano-system in vivo were assessed via tail vein injection. Experimental results indicated that the system not only significantly reduced the expression of thrombus components but also improved aortic wall cell infiltration and effectively cleared the invading S. aureus. This study provides new insights and methods for non-antibiotic treatment of IE, with significant clinical application potential.

Introduction The incidence of Mycobacterium abscessus complex (MABC) infections is rising, becoming a major pathogen of nontuberculous mycobacteria responsible for pulmonary disease (PD) and extrapulmonary disease (ED). However, studies on the clinical characteristics of MABC-ED remain limited. Methods A 7-year retrospective analysis was conducted on MABC-ED cases at Zhongshan Hospital in Shanghai, China. We analyzed predisposing factors, clinical features, metagenomic sequencing (MS) results, drug susceptibility testing (DST), and genomic characteristics of MABC-ED patients, comparing the data with those of PD cases. Results Among 17 MABC-ED patients, 15 had predisposing risk factors and underlying conditions, with 2 of 3 patients with rheumatic disease showing poor prognosis. The diagnostic performance of metagenomic sequencing for MABC-ED was comparable to that for MABC-PD. However, MABC-ED samples exhibited distinct microbiome features and a more diverse mycobacterial community structure compared to PD. Resistance rates among extrapulmonary MABC isolates were observed as follows: 0% (amikacin), 20% (macrolides), 30% (linezolid), and 40% (cefoxitin). One case showed paradoxical results between erm (41) T28 sequevar and susceptibility phenotype. Genomic analysis revealed no specific dominant circulating clones (DCC) for MABC-ED isolates. Conclusion MABC-ED patients commonly present with risk factors and underlying diseases. Metagenomic sequencing diagnosis of MABC-ED poses challenges, and DST and whole genome sequencing data indicate diversity among MABC-ED isolates. Our study provides detailed data on MABC-ED, contributing to a better understanding of its disease characteristics.

OBJECTIVE:This study aimed to update the incidence of device-associated healthcare-associated infections (DA-HAIs), and to characterize pathogen distribution and carbapenem-resistant Enterobacteriaceae (CRE) detection among ICU patients in Shanghai, China. METHODS:Prospective surveillance in 223 ICUs using standardized International Nosocomial Infection Control Consortium methodology (INICC) protocols collected patient-level data on demographics, microbiology, device use, and DA-HAIs. Trends, annual percent change (APC) and average annual percent change (AAPC) were estimated using Joinpoint regression models. RESULTS:The overall DA-HAIs incidence density in ICUs was 1.67 per 1000 catheter-days for catheter-associated urinary tract infection (CAUTI) (95% CI: 1.62-1.73), 0.59 per 1000 central line-days for central line-associated bloodstream infection (CLABSI) (95% CI: 0.56-0.63), and 4.63 per 1000 ventilator-days for ventilator-associated pneumonia (VAP) (95% CI: 4.51-4.76). Significant reductions were observed in VAP (AAPC: -15.36%; P < 0.001) and CLABSI (AAPC: -11.23%; P < 0.001). Pathogen distributions varied by infection type, with Enterococcus faecium (17.22%) and Klebsiella pneumoniae (16.63%) predominating in CAUTI patients, Klebsiella pneumoniae (26.87%) in CLABSI patients, and Acinetobacter baumannii (37.60%) in VAP patients. The overall CRE detection rate was 33.67% in CAUTI patients, 37.56% in CLABSI patients, and 35.24% in VAP patients. CONCLUSIONS:Although DA-HAI rates showed significant declines, the persistently high CRE prevalence underscores substantial antimicrobial resistance challenges in Chinese ICUs.

This article was to summarize the treatment course and prognosis of immunocompetent and immunocompromised patients with pulmonary cryptococcal infections and to analyse the relevant factors. The chisquared test was used to test for differences in categorical variables, and the independent samples t test was used to compare continuous variables. Multivariable analyses using the Cox proportional hazards model were used to estimate the effect of prognostic factors on treatment time and improvement time. A total of 243 patients were included in the analysis. Immunocompetent patients with diffuse imaging infiltrates had an extension of the treatment course within six months (P = 0.048) and an extension of the improvement days within four weeks (P = 0.008). In immunocompromised patients, an antigen assay ≥ 40 (P = 0.013) is an unfavourable factor leading to an extension of treatment by nine months. The serum antigen assay in 26/98 (26.53%) immunocompetent patients who did not turn negative when the treatment had finished was significantly lower than that in 14/29 (48.28%) immunocompromised patients (P = 0.027). All patients who underwent surgical resection had a good prognosis. Diffuse imaging infiltrates suggest longer treatment days and a longer improvement time in immunocompetent patients. Higher serum antigen levels in immunocompromised patients indicate longer treatment. Serum antigen assays in immunocompromised patients are difficult to negative.

Background: Nontuberculous mycobacterial pulmonary disease (NTM-PD) is an increasingly prevalent chronic infection, where the host immune status plays a crucial role in disease susceptibility and progression. The complex pulmonary microenvironment, characterized by diverse microbial communities and host immune interactions, exhibits distinct features that may be fundamentally altered by the patient’s underlying immune state. Methods: A total of 111 sputum specimens and 64 bronchoalveolar lavage fluid (BALF) specimens were collected from 143 patients diagnosed with NTM-PD under different immune states. Metagenomic sequencing was performed on these specimens to characterize and compare the pulmonary microenvironmental features among NTM-PD patients with a distinct immune status through comprehensive bioinformatic analyses. Results: The immunosuppressed group exhibited a lower α-diversity in sputum specimens (p < 0.05). Principal Coordinates Analysis (PCoA) of β-diversity for sputum and BALF specimens revealed significant differences between the groups (p < 0.05). Linear discriminant analysis Effect Size (LEfSe) analysis identified species enriched in the immunosuppressed group. A co-occurrence network analysis indicated that the immunosuppressed group had more structured and actively connected networks compared to the control group. The Mantel test confirmed that the abundance of these species enriched was associated with clinical immune–inflammation-related indicators in patients. Conclusions: Our study reveals the pulmonary microenvironment in immunosuppressed patients with NTM-PD. Further work is required to explore the two-way relationship between micro-organisms and immune and inflammatory responses, with the influence on patient outcomes.

ABSTRACT Quorum sensing (QS) plays a crucial role in regulating key traits, including the upregulation of phage receptors, which leads to heightened phage susceptibility in Pseudomonas aeruginosa . As a result, higher cell densities typically increase the risk of phage invasions. This has led to speculation that bacteria may have evolved strategies to counterbalance this increased susceptibility. Additionally, non-synonymous mutations in LasR, the master regulator of QS, are common among cystic fibrosis patients, but the impact of these mutations on phage interactions remains poorly understood. Here, we systematically investigated the role of QS in shaping these interactions using bacterial strains with functional or altered QS systems. In the QS-functional strain ZS-PA-35, disruption of the Las system reduces cell susceptibility to the type IV pili-dependent phage phipa2, delaying bacterial lysis during the early logarithmic growth phase. At high cell densities, Las-induced dormancy further inhibits phage proliferation despite enhanced phage adsorption. Notably, nutrient supplementation fully restores phage proliferation in the strains with a functional Las system. In contrast, the QS-deficient strain ZS-PA-05, carrying a LasR mutation, fails to regulate phage-host interactions via QS. Moreover, our findings reveal that within mixed microbial populations, cells benefit from the presence of closely related kin, which collectively reduce prey density and limit phage-host interaction frequencies under nutrient-rich conditions. These results underscore the flexibility of QS-regulated defense strategies, highlighting their critical role in optimizing bacterial resilience against phage predation, particularly in heterogeneous communities most vulnerable to phages. IMPORTANCE Bacteria have developed various strategies to combat phage infection, posing challenges to phage therapy. In this study, we demonstrate that Pseudomonas aeruginosa strains with functional or altered quorum sensing (QS) systems may adapt different survival tactics for prolonged coexistence with phages, contingent upon bacterial population dynamics. The dynamics of phage infection highlight the influence of intrinsic heterogeneity mediated by QS, which leads to the emergence of different phage-host outcomes. These variants may arise as a result of coevolutionary processes or coexistence mechanisms of mutational and non-mutational defense strategies. These insights enhance our comprehension of how bacteria shield themselves against phage attacks and further underscore the complexity of such approaches for successful therapeutic interventions.

Limited data exist regarding lysogenic phages carried by M. abscessus, as well as regarding their roles played in diseases. Strains identified as M. abscessus from patients were collected. Prophages, virulence factors, and antibiotic resistance genes present in genomes were predicted, and correlations between prophages, virulence factors, antibiotic resistance genes, and clinical patient prognoses were analyzed. A total of 145 prophage sequences were detected in 56 M. abscessus strains. Prophages contained more virulence factors and antibiotic resistance genes, compared to known mycobacteriophages. The average sequence similarity among prophage sequences from a single patient was significantly higher than that among prophages from different patients or between prophages and known phages. The study showed that M. abscessus commonly carries prophages, which are enriched in virulence factors and antibiotic resistance genes relative to known phages, but their relationship to clinical prognoses requires further study. Prophages present in strains from different patients were highly diverse and exhibited low similarity with known mycobacterial phages.

With the rise of antibiotic resistance, nosocomial infections caused by Pseudomonas aeruginosa present a significant challenge to healthcare systems. Prophages integrated into bacterial chromosomes play a key role in generating phenotypic and genotypic diversity, influencing bacterial pathogenicity and complicating antimicrobial treatment strategies. Recent advances in high-throughput sequencing have facilitated the precise localization of prophages within bacterial genomes. However, the mechanisms by which prophages influence host phenotypes remain poorly understood, particularly in clinical polylysogens. In this study, we conducted a comprehensive investigation of prophages predicted in the clinical P. aeruginosa isolate ZS-PA-05 in the absence of an external trigger, focusing on their contribution to bacterial phenotype through the use of prophage deletion mutants. Our findings indicate that ZS-PA-05 harbors both active and cryptic prophages, each exhibiting unique spontaneous induction rates. Notably, the absence of certain prophages significantly affects bacterial growth, motility, biofilm formation, antibiotic susceptibility, and phage proliferation, as well as virulence. Intriguingly, the deletion of prophage Y significantly increased pyocyanin production, enhancing interspecies competition and cell line survival, despite impaired bacterial growth. This underscores the complexity of prophage-host interactions and emphasizes the role of prophages in bacterial adaptation, with far-reaching implications for antimicrobial therapies and beyond.IMPORTANCEUpon infecting a bacterial host, phages can follow one of two developmental pathways: the lytic or lysogenic cycle. In the lysogenic state, prophages remain dormant, integrating into the bacterial genome and being vertically transmitted through binary fission. These prophages profoundly influence bacterial phenotypic and genetic diversity and contribute to the structuring of microbial communities. Here, we systematically assess the beneficial and detrimental impacts of prophage carriage in the clinical multilysogen Pseudomonas aeruginosa strain ZS-PA-05. Our results reveal marked variation in spontaneous induction frequencies among co-resident prophages and demonstrate prophage-driven phenotypic heterogeneity. By uncovering key aspects of prophage-host interactions, this study highlights the critical role of prophages in shaping the behavior of clinical isolates, particularly in the context of antimicrobial interventions such as antibiotic and phage therapies.

N-acetylcysteine (NAC) and ambroxol hydrochloride (AMB) are commonly prescribed alongside antibiotics to alleviate sputum retention in lower respiratory tract infections, which are often caused by bacterial pathogens. With the rising threat of antibiotic resistance, phage therapy has emerged as a promising alternative alongside. However, no studies have explored the potential interactions between phages and these mucoactive agents despite their frequent concurrent use during phage therapy. Therefore, investigating the potential synergy and its subsequent impact on phage infection dynamics could enhance clinical strategies for treating bacterial infections with phages. Our study utilized Pseudomonas aeruginosa strain ZS-PA-35 and Klebsiella pneumoniae strain Kp36, alongside their respective phages, to investigate their interactions in the presence of NAC or AMB. Our findings indicate that, under specific conditions, these mucoactive agents can function as adjuvants to lytic phages, enhancing bacterial susceptibility to phage infection and facilitating subsequent phage proliferation. Our study revealed that these synergistic interactions are strongly influenced by the physiological characteristics of the phages, the surrounding microenvironments, and the physiology of host tissues, as varying outcomes of phage-host interactions were observed among different phages and across distinct media. Taken together, our results emphasize the complexity of interactions between phages and NAC or AMB, underscoring the need for caution when using combination treatments.IMPORTANCEN-acetylcysteine (NAC) and ambroxol hydrochloride (AMB) are used in medical treatment of patients with acute and chronic bronchitis. Often, the choice of NAC or AMB is empirically determined by physicians. However, the potential impact of combining NAC or AMB with phage therapy remains unclear. To address this gap, a comprehensive understanding of their interplay is crucial to determine any potential synergistic effects. This study aims to elucidate how NAC or AMB influence phages targeting different receptors, thereby affecting their antibacterial activity against Pseudomonas aeruginosa and Klebsiella pneumoniae. Our results suggest that, under certain conditions, NAC or AMB provides an adjuvant effect by rendering the cells more susceptible to phage infection. These results contribute to advancing our understanding of the clinical combination of mucoactive agents and phage therapy, offering insights for optimizing treatment efficacy.

Background:Rapid and precise aetiological diagnosis is crucial for managing pneumonia. We aimed to develop and validate deep learning (DL) models for differentiating ten pneumonia aetiologies on chest computed tomography images. Methods:We enrolled 1,091 pneumonia patients with 1 of 10 definite aetiological diagnoses between October 1st, 2015 and June 30th, 2022 in this retrospective study. We trained and validated two DL models: a classic 3D-DenseNet model (DenseNet) and a novel large vision model (LVM). The models were tested on a data from 183 nonoverlapping patients for external dataset. Model performance was assessed using the area under the curve (AUC) of the Top1 diagnosis and the accuracy of the Top1, Top2, and Top3 diagnoses. Comparisons were also performed between the DL models and eight experienced radiologists and pulmonologists. Results:The LVM combined with non-imaging model (LVM+) had a greater average prediction performance than DenseNet combined with non-imaging model (DenseNet+), radiologists' results with non-imaging data (radiologists+) and pulmonologists' results with non-imaging data (pulmonologists+), with Top1 AUCs of 0.872, 0.851, 0.643 and 0.644, respectively. The Top1, Top2, and Top3 accuracies of LVM+ were 0.527, 0.701 and 0.820, respectively, similarly outperforming DenseNet+, radiologists+ and pulmonologists+. The two models performed similarly in the external test sets, with the Top1 AUCs of 0.743 for DenseNet and 0.775 for LVM. The classification-related confusion matrix of LVM/DenseNet with or without non-imaging model showed a significant advantage in identifying pulmonary non-tuberculous mycobacterium pulmonary disease (PNTM), pulmonary tuberculosis (PTB) and Pneumocystis jirovecii pneumonia (PJP). Conclusions:This study presents a comprehensive classification closely aligned with pneumonia diagnosis in realistic clinical settings. We expect this method to be applied clinically to foster novel approaches to improve the accuracy in diagnosing pneumonia.

Abstract Background Data on extrapulmonary nontuberculous mycobacterial disease (ENTM) in China is lacking. We aim to explore the microbiological and clinical characteristics of ENTM in a general hospital. Methods Laboratory extrapulmonary samples positive for nontuberculous mycobacteria in Zhongshan Hospital, Fudan University between Jan. 2017 and Dec. 2021 were retrospectively searched. The respective patient data were reviewed and followed until Dec. 2022. Thirty-three confirmed ENTM cases were included. Demographic, microbiological, clinical characteristics, as well as treatment and prognosis were analyzed. Results A total of 33 confirmed ENTM cases were included. The average age was (49±16.3) years. Twenty-three cases (69.7%) were female and one third of the patients were immunocompromised. Skin and soft tissue infection, bone and joint infection, and disseminated NTM disease were the most common types (57.6%, 18.2%, and 15.6%). Healthcare-associated infections accounted for 51.5% (17/33) of the cases. Mycobacterium abscessus complex (42.4%) among rapidly growing mycobacteria (RGM) was the most common causative species. Patients received combination therapy with an average of (3.5±0.8) drugs for 6.3 (4.3,9.6) months. Most cases recovered (69.7%) or improved clinically (18.2%). Compared with RGM, infections with slowly growing mycobacteria (SGM) were seen in older individuals (60.2±15.0 vs 42.6±14.0, P<0.05) and were more often community-acquired (83.3% vs 28.6%, P<0.05). Conclusion Skin and soft tissue infection is the most common type of ENTM, with Mycobacterium abscessus complex being the most important causative species. SGM infections affect older population and are more often community-acquired. Treatment of ENTM is challenging and lacks standardized protocol, future researches are warranted. Disclosures All Authors: No reported disclosures

Objective This study investigated the perceived clinicians’ roles in penicillin allergy assessment among medical staff in tertiary hospitals in China.Design This was a multicentre cross-sectional survey.Setting The study was conducted at 89 tertiary hospitals in eastern and western China from March to May 2024.Participants A survey was conducted involving 8493 medical staff from tertiary hospitals in eastern and western China using multistage sampling.Outcome measures A self-designed questionnaire was used to assess evaluation status of penicillin allergy assessment, including allergy history assessment and recording, skin test result evaluation during hospitalisation, allergic reaction recording at discharge and awareness of allergy assessment teams.Results Among 8493 healthcare professionals (doctors 40.0%, nurses 56.3%, pharmacists 3.7%), significant gaps existed in penicillin allergy documentation: while 92.0% acknowledged the need to document specific drug names, only 66.2% practised this (nurses 62.2% vs pharmacists 82.0%, p<0.01). Nurses dominated skin test evaluation (95.3% participation), with 77.5% of all staff endorsing their primary role. For ambiguous test results, 54.6% preferred multi-person consensus (nurses 63.9%, p<0.01). Post-discharge documentation prioritised drug names (94.4%) over clinical indications (70.3%). Pharmacists demonstrated superior documentation awareness (p<0.05). Only 45.5% confirmed having an antimicrobial allergy assessment team, though clinical pharmacists (89.2%) and specialist nurses (88.2%) were deemed essential members.Conclusions Currently, the assessment and recording methods for antimicrobial allergies by the medical staff of tertiary hospitals in China are not sufficiently accurate. Nurses play a key role in the assessment of antimicrobial allergies. Thus, medical staff, especially nurses, should receive more vigorous training, and structured assessment tools for antimicrobial allergies based on clinical decision support systems should be devised for them. Our findings also reiterate the need to establish penicillin allergy assessment teams at the hospital level.

Purpose:To present a rare case of pulmonary cryptococcosis that exhibited radiological findings consistent with interstitial pneumonia in a patient diagnosed with IgA (Immunoglobulin A) nephropathy. Patients and Methods:A 66-year-old man was admitted to the hospital with interstitial lung disease. The cryptococcal capsular antigen test was positive in both serum and bronchoalveolar lavage fluid. Histopathological examination of the bronchoscopically obtained lung biopsy and positive culture results revealed the presence of Cryptococcus yeast, while no Cryptococcus species were detected in the cerebrospinal fluid. Collectively, these findings confirmed the diagnosis of pulmonary cryptococcosis. Results:The fluconazole dosage was tailored according to the patient's renal function, and the lesions in the right lung were significantly improved following one month of antifungal therapy. Conclusion:This case illustrates that in immunocompromised patients, pulmonary cryptococcosis may manifest with imaging findings resembling interstitial pneumonia. Therefore, clinicians should consider pulmonary cryptococcosis in the differential diagnosis of interstitial pneumonia, particularly in immunocompromised individuals.

The incidence of nontuberculous mycobacterial pulmonary disease (PNTM) is rising, but the available treatments have limitations. Currently, the understanding of the ecology of the airway microbiota in PNTM is limited, especially regarding community structure, dynamics, and their relationship with clinical outcomes. We used metagenomic sequencing to characterize the lung microbiota in bronchoalveolar lavage fluid (BALF). We evaluated the prognosis of patients with PNTM through respiratory specimen cultures and chest CT scans. PNTM exhibit distinct airway microbiota characteristics compared to controls, however, no significant differences were observed in NTM species. A Dirichlet multinomial mixture model was used to identify two distinct community types (pneumotypes) and investigate their association with host immunity and prognosis. At the 13-month median follow-up, pneumotype 1 (including Mycobacterium, opportunistic pathogens, and anaerobes) presented a lower probability of sustained culture conversion (hazard ratio = 0.29; 95