Bronchoalveolar lavage fluid (BALF) metagenomic next-generation sequencing (mNGS) improves pathogen detection in severe pneumonia-related sepsis, but sampling is invasive and prone to false-positive results. Blood is easier to obtain, and broad-spectrum targeted NGS (tNGS) of microbial cell-free DNA may offer a practical alternative to BALF-based testing. We evaluated the diagnostic and prognostic value of blood-based bstNGS. In this retrospective cohort, 122 adults with suspected severe pneumonia-related sepsis and paired BALF and blood samples underwent BALF-mNGS, blood-bstNGS and blood-mNGS. Pathogens were adjudicated using a composite clinical reference. We assessed blood-BALF concordance, compared diagnostic performance across methods, and examined whether blood-bstNGS could down-weight likely false-positive BALF-only detections and stratify prognosis. BALF-mNGS identified 414 microorganisms; 51

Acinetobacter baumannii is a significant pathogen responsible for healthcare-acquired infections (HAIs), posing challenges due to its rising resistance to multiple antibiotics. Traditional diagnostic methods like bacterial cultures and antibiotic susceptibility testing (AST) are slow, necessitating the development of faster alternatives. This study aimed to create a predictive model for antibiotic resistance phenotypes of A. baumannii using clinical MALDI-TOF mass spectrometry (MS) spectra combined with machine learning techniques. A total of 3644 A. baumannii strains were analysed for resistance patterns to nine antibiotic classes. Eight machine learning models were trained and evaluated, with the best model showing over 83% accuracy in predicting resistance to carbapenems, penicillins, and quinolones. The model performed especially well for imipenem and ceftazidime, with accuracies of 84.90% and 84.64%, respectively. Multi-center validation confirmed the model's robustness, achieving 81.68% and 80.72% accuracy for imipenem and ceftazidime. These findings demonstrate the potential of integrating machine learning with MALDI-TOF MS for rapid, accurate profiling of A. baumannii's antimicrobial resistance in clinical settings.

Background:With the rise of anaerobic bacteremia and resistance to anaerobes for commonly used agents, the resistance patterns of many anaerobes have changed significantly among different geographic areas and medical facilities. This study investigated the clinical and epidemiologic characteristics of anaerobic bacteremia for therapeutic optimization at the local level. Methods:This retrospective observational study included all positive blood cultures (BC) from 2020 to 2024. For patients with anaerobic bacteria originating from BCs, clinical and microbiological data were collected. Results:In total, 239 anaerobic strains were isolated from 223 patients. Among BC-positive bacteria, the proportion of anaerobes accounted for 4.4% (239/5450), with a gradual increase from 3.0% in 2020 to 6.1% in 2024. The most common anaerobes were Bacteroides fragilis (34.7%) and Cutibacterium acnes (20.5%). The resistance rates of gram-negative anaerobes to penicillin, imipenem, and meropenem were 94.4%, 21.1%, and 35.2%, respectively, which were much higher than those of gram-positive anaerobes (16.7%, 0%, 0%). Among the 223 cases, abdominal disorders were the most frequent underlying condition (54.7%). In the empirical antibiotic therapy, 94.6% of the patients received β-lactam antibiotics, and the infection symptoms improved in 74.9% of the patients. For Bacteroides spp. bacteremia, the improvement rate in patients treated with carbapenems and β-lactam/β-lactamase inhibitor combinations was 78.1% and 40.0%, respectively. Conclusion:The study presents valuable data for monitoring and improving anaerobic bacteremia treatment in Southern of China.

Invasive candidiasis (IC) is a severe infection primarily affecting immunocompromised patients and is associated with high mortality and substantial hospital costs. Accurate regional data on epidemiology and antifungal resistance of IC are crucial for effective clinical management. The China Hospital Invasive Fungal Surveillance Net (CHIF-NET) study is a laboratory-based multicenter study initiated in August 2009. This report presented updated data from August 2017 to December 2021, involving 76 hospitals across 28 provincial regions in China, and included a 12-year longitudinal analysis. Isolates from patients with IC were assigned to species level by matrix-assisted laser desorption ionization-time of flight mass spectrometry and internal transcribed spacer rDNA sequencing. Susceptibility testing was performed for nine antifungal agents using the broth microdilution method. A total of 11,679 Candida isolates were collected. Candida albicans was the most common Candida species (46.0%), followed by Candida tropicalis (17.6%), Candida parapsilosis sensu stricto (15.6%), and Candida glabrata sensu stricto (11.2%). Antifungal resistance rates showed notable variations among different Candida species, with the highest azole resistance observed in C. tropicalis isolates causing candidemia (42.5% to fluconazole and 38.9% to voriconazole). Cross- and multi-drug resistance to azoles and echinocandins was observed in all predominant Candida species. The species distribution of major Candida pathogens causing IC remained stable in China, while antifungal resistance increased, especially among non-albicans Candida species. Enhanced surveillance, accurate species identification, and strengthened antifungal stewardship are needed to address the growing challenge of antifungal resistance.

The type VI secretion system (T6SS) has been recognized as a novel virulence factor in Klebsiella pneumoniae. This study investigated the occurrence of T6SS genes in carbapenem-resistant Klebsiella pneumoniae (CRKP) strains during intestinal colonization and evaluated their effect on the development of bloodstream infections. The study encompassed 2,385 patients admitted to the intensive care unit (ICU) and subjected to routine screening for intestinal colonization with CRKP. PFGE was employed on CRKP strains isolated from both the patients’ intestine and blood cultures, confirming their genetic similarity. PCR was employed to detect the presence of carbapenemase genes, T6SS genes, and virulence genes. Quantitative real-time PCR was conducted to assess the expression levels of the core genes associated with the T6SS. The correlation between T6SS expression and sBSI was further investigated. Approximately 10

PurposeCandidozyma auris (C. auris) is an emerging fungal pathogen that is resistant to multiple drugs and poses a serious threat to global health. This study aimed to investigate the genetic diversity and antifungal resistance profiles of C. auris in southern China.MethodsA total of 108 clinical C. auris isolates were collected from eight hospitals in Guangdong Province between January 2023 and January 2024. All the isolates were identified via matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Phylogenetic analysis was conducted on the basis of the sequencing results of the RPB1 and D1/D2 genes. The mechanisms of resistance to fluconazole and echinocandins were investigated through sequencing of the ERG11 and FKS1 genes. Additionally, whole-genome sequencing was performed on echinocandin-resistant and echinocandin-sensitive isolates to analyse genetic homology among the strains.ResultsAll the strains were classified into two genetic clades, clade I and clade III, and all exhibited resistance to fluconazole. In the fluconazole-resistant strains, the amino acid substitutions Y132F and VF125AL were identified in the ERG11 gene. The resistance rates to caspofungin, micafungin, and anidulafungin were 7.4, 7.4, and 3.7%, respectively. Among the eight echinocandin-resistant strains, amino acid substitutions (S639Y, W691L, and S639F) were found within the HS1 hotspot region of the FKS1 gene. A phylogenetic tree was constructed on the basis of 403 SNPs and revealed two major clusters: Cluster A and Cluster B. Cluster A included the 16 isolates analyzed in this study. Cluster B consisted of 12 reference isolates retrieved from publicly available genomic databases.ConclusionGenetic clade I and clade III C. auris strains are prevalent in southern China and present high levels of resistance to fluconazole. Controlling the spread of C. auris in this region presents significant challenges for public health management.

BackgroundThough droplet digital PCR (ddPCR) has emerged as a promising tool for early pathogen detection in bloodstream infections (BSIs), more studies are needed to support its clinical application widely due to different ddPCR platforms with discrepant diagnostic performance. Additionally, there is still a lack of clinical data to reveal the association between pathogen loads detected by ddPCR and corresponding BSIs.MethodsIn this prospective study, 173 patients with suspected BSIs were enrolled. A multiplex ddPCR assay was used to detect 18 pathogens. The results of ddPCR testing were evaluated in comparison with blood cultures (BCs) and clinical diagnosis. Taking BC as the gold standard, receiver operating characteristic curve and Cohen’s kappa agreement were used to investigate whether the pathogen load could predict a corresponding culture-proven BSI for the top five microorganisms detected by ddPCR.ResultsOf the 173 blood samples collected, BC and ddPCR were positive in 48 (27.7%) and 92 (53.2%) cases, respectively. Compared to BC, the aggregate sensitivity and specificity for ddPCR were 81.3% and 63.2%, respectively. After clinical adjudication, the sensitivity and specificity of ddPCR increased to 88.8% and 86.0%, respectively. There were 143 microorganisms detected by ddPCR. The DNA loads of these microorganisms ranged from 30.0 to 3.2×105 copies/mL (median level: 158.0 copies/mL), 72.7% (104/143) of which were below 1,000 copies/mL. Further, statistical analysis showed the DNA loads of Escherichia coli (AUC: 0.954, 95% CI: 0.898-1.000, κ=0.731, cut-off values: 93.0 copies/mL) and Klebsiella pneumoniae (AUC: 0.994, 95% CI: 0.986-1.000, κ=0.834, cut-off values: 196.5 copies/mL) were excellent predictors for the corresponding BSIs. The DNA loads of Pseudomonas aeruginosa (AUC: 0.816, 95% CI: 0.560-1.000, κ=0.167), Acinetobacter baumannii (AUC: 0.728, 95% CI: 0.195-1.000), and Enterococcus spp. (AUC: 0.282, 95% CI: 0.000-0.778) had little predictive value for the corresponding culture-proven BSIs.ConclusionOur results indicate that the multiplex ddPCR is a promising platform as a complementary add-on to conventional BC. The DNA loads of E. coli and K. pneumoniae present excellent predictive value for the corresponding BSIs. Further research is needed to explore the predictive potential of ddPCR for other microorganisms.

BACKGROUND:Infections caused by Candida glabrata have raised increasing concerns, particularly due to the increasing resistance to echinocandins. OBJECTIVES:This study investigated echinocandins susceptibility trends in C. glabrata isolates and explored the mechanisms driving resistance. METHODS:We analyzed 418 strains of C. glabrata derived from hospitalized patients. Phenotypic resistance was assessed, and genotypic analysis was performed to identify mutations in the hotspot-1 and hotspot-2 regions of the FKS1 and FKS2 genes. Additionally, genotyping was conducted using multilocus sequence typing (MLST). RESULTS:The resistance rates to caspofungin, anidulafungin, and micafungin were 5.0%, 3.8%, and 4.0%, respectively, while fluconazole resistance was observed in 9.6% of the strains. Notably, 1.0% of the strains demonstrated resistance to both fluconazole and echinocandins. Mutations in the FKS genes were identified in 11 strains, predominantly in the FKS2-HS1 region. The most prevalent mutation was the F659 deletion (54.54%, 6/11), followed by S663F (18.18%, 2/11). Other mutations, including F659S, F659Y, and S663P, were also detected. These 11 mutated strains were classified into six distinct sequence types (STs), with ST208 being the most prevalent. CONCLUSION:The resistance rate of C. glabrata to echinocandins has been increasing annually in Guangdong province. Echinocandin resistance is associated with mutations in the FKS2 gene.

The multidrug-resistant fungal pathogen Candida auris poses an increasing global health threat due to its high transmissibility and persistence in healthcare environments. We aimed to explore the potential cases of mixed C. auris-strain colonizations or infections in China and to investigate the genetic and biological diversity of the associated isolates. C. auris isolates from 5 colonization or infection cases were distinguished by colony morphology and verified by D1/D2-ITS alignment. Phylogenetic and genomic diversity analysis of all isolates were conducted using whole genome sequences. Comparative biological analysis of all isolates, including cellular and colony morphology, antifungal susceptibility, biofilm formation, SAP activity, and both in vitro and in vivo survival capabilities were performed. Five cases of potential mixed C. auris-strain colonization or infections in China were identified. Comparative genomic analysis revealed these cases involved strains from two distinct genetic clades (I and III) or strains from the same clade but with genetic alterations. Comparative biological analysis demonstrated the strains from mixed colonization or infections exhibit differences in several key aspects, including colony morphology, biofilm formation, SAP activity, and both in vitro and in vivo survival capabilities. Comparative analyses revealed notable differences in biofilm formation, environmental survival, and secretion of virulence factors between the co-colonizing or co-infecting strains of C. auris. These biological and genetic disparities may present significant challenges for the diagnosis and treatment of C. auris infections, as strains with different genetic backgrounds may exhibit varying abilities to colonize host or environmental niches.

BackgroundStrongyloides stercoralis is an opportunistic pathogenic parasite. Most individuals with normal immune function may not exhibit significant symptoms, and the signs are atypical, which can easily lead to missed diagnoses and delayed treatment. People with underlying diseases and weakened immunity are prone to develop severe conditions after infection with Strongyloides stercoralis.Case presentationWe report an immunocompromised patient in whom the pathogen was initially not detectable using traditional parasitic detection techniques. However, Strongyloides stercoralis was identified in both the alveolar lavage fluid and blood through metagenomic next-generation sequencing. Subsequently, Strongyloides stercoralis was detected in the alveolar lavage fluid after multiple rounds of testing using traditional microscopic examination techniques. Based on the mNGS results and other examination findings, the patient was diagnosed with Strongyloides stercoralis in combination with concurrent multiple pathogens infections. After the combined drug therapy of Meropenem, Vancomycin, and Albendazole, the patient’s condition was gradually brought under control.ConclusionThis case demonstrates the advantage of integrating traditional detection methods with metagenomics next-generation sequencing technology in the etiological diagnosis of immunocompromised individuals. It is conducive to clarifying the etiological diagnosis of patients and thereby facilitating the timely initiation of corresponding treatments.

PURPOSE:This study aims to investigate the clinical and molecular epidemiological characteristics of bloodstream infections caused by Candida tropicalis. METHODS:This retrospective study analyzed the clinical data of patients diagnosed with C. tropicalis bloodstream infections from January 2020 to December 2022. Antifungal susceptibility testing was performed. Multilocus sequence typing (MLST) was used to analyze strain homology, and mutation analysis of the ERG11 (azole resistance-associated) and FKS1 (echinocandin resistance-associated) genes was conducted. RESULTS:Among the 26 cases of C. tropicalis bloodstream infections, hematologic malignancies were the most common underlying condition, with an overall mortality rate of 38.5%. Resistance rates to voriconazole and fluconazole were 30.8%, while the isolates exhibited high susceptibility to echinocandin drugs and amphotericin B. All fluconazole-resistant strains contained mutations in the ERG11 gene, with Y132F and S154F being the most frequent mutation sites. The mortality rate in fluconazole-resistant patients (37.5%) was similar to that of susceptible or dose-dependently susceptible patients (38.8%). A total of 20 distinct sequence types (DSTs) were identified among the 26 strains, all of which were previously known, indicating significant genetic diversity. The most abundant type was DST376. CONCLUSION:Hematologic malignancies are the most common underlying disease of C. tropicalis bloodstream infections. The isolated strains demonstrate significant genetic diversity and a high level resistance to fluconazole.

ObjectiveThis study aimed to evaluate and compare the performance of metagenomic next-generation sequencing (mNGS) and real-time polymerase chain reaction (RT-PCR) for the detection of Mycobacterium tuberculosis (MTB) in patients with suspected tuberculosis (TB).MethodsSamples from patients undergoing routine clinical testing for MTB using both mNGS and RT-PCR were included. The diagnostic agreement between the two methods was assessed. Discordant results were further validated using the Xpert MTB/RIF assay on cryopreserved aliquots.ResultsA total of 556 samples from suspected TB patients were analyzed. The majority were lower respiratory tract specimens, including bronchoalveolar lavage fluid (BALF; 94.06%), sputum (3.24%), and extrapulmonary samples (2.70%). Compared with Xpert MTB/RIF and clinical diagnosis as composite reference standard, both mNGS and RT-PCR showed high sensitivity (92.31% and 90.38%, respectively) and perfect specificity (100%). There was a high level of agreement between mNGS and RT-PCR, with a positive agreement of 82.69%, negative agreement of 98.25%, overall agreement of 98.38%, and a kappa value of 0.896 (P < 0.001). Concordance was higher in samples with lower RT-PCR cycle threshold (Ct) values: 100% at Ct ≤ 15, 100% at 15<Ct ≤ 20, 76.47% at 20<Ct ≤ 25. Among concordant positive samples (n=43), mNGS SMRNs showed a strong negative correlation with RT-PCR Ct values (r = -0.668, P < 0.001). Analysis of nine discordant cases identified five mNGS-positive/RT-PCR-negative samples with low SMRNs (median: 7 vs. 1788 in concordant positives), four of which were confirmed by Xpert MTB/RIF to have extremely low bacterial loads. The remaining four mNGS-negative/RT-PCR-positive samples exhibited higher Ct values (median: 22.97 vs. 17.06 in concordant positives), and three of these were also verified by Xpert MTB/RIF to contain extremely low bacterial concentrations.ConclusionBoth RT-PCR and mNGS demonstrate high overall agreement for MTB detection, with concordance strongly influenced by microbial burden. These findings support the complementary use of these methods in the diagnosis of TB.

OBJECTIVES:Resistance against ceftazidime-avibactam (CZA) in carbapenem-resistant Pseudomonas aeruginosa (CRPA) is emerging. This study was aimed at detecting the prevalence and molecular characteristics of CZA-resistant CRPA clinical isolates in Guangdong Province, China. METHODS:The antimicrobial susceptibility profile of these strains was determined. A subset of 16 CZA-resistant CRPA isolates was analysed by whole-genome sequencing (WGS). Genetic surroundings of carbapenem resistance genes and pan-genome-wide association analysis were further studied. RESULTS:Of the 250 CRPA isolates, CZA resistance rate was 6.4% (16/250). The minimum inhibitory concentration (MIC) of CZA range was from 0.25 to >256 mg/L. MIC50 and MIC90 were 2/4 and 8/4 mg/L, respectively. Among the 16 CZA-resistant CRPA strains, 31.3% (5/16) of them carried class B carbapenem resistance genes, including blaIMP-4, blaIMP-45, and blaVIM-2, located on IncP-2 megaplasmids or chromosomes, respectively. Pan-genome-wide association analysis of accessory genes for CZA-susceptible or -resistant CRPA isolates showed that PA1874, a hypothetical protein containing BapA prefix-like domain, was enriched in CZA-resistant group significantly. CONCLUSIONS:Class B carbapenem resistance genes play important roles in CZA resistance. Meanwhile, the PA1874 gene may be a novel mechanism involving in CZA resistance. It is necessary to continually monitor CZA-resistant CRPA isolates.

The emerging human fungal pathogen Candida auris has become a serious threat to public health. This pathogen has spread to 10 provinces in China as of December 2023. Here we describe 312 C. auris-associated hospitalizations and 4 outbreaks in healthcare settings in China from 2018 to 2023. Three genetic clades of C. auris have been identified during this period. Molecular epidemiological analyses indicate that C. auris has been introduced and local transmission has occurred in multiple instances in China. Most C. auris isolated from China (98.7%) exhibited resistance to fluconazole, while only a small subset of strains were resistant to amphotericin B (4.2%) and caspofungin (2.2%).

Candida auris is an emerging multidrug-resistant fungal pathogen worldwide. To date, it has not been reported in Guangdong, China. For the first time, we reported 7 cases of C. auris candidemia from two hospitals in Guangdong. The clinical and microbiological characteristics of these cases were investigated carefully. Two geographic clades, i.e. III and I, were found popular in different hospitals by whole genome sequencing analyses. All C. auris isolates from bloodstream were resistant to fluconazole, 5 of which belonged to Clade III harbouring VF125AL mutation in the ERG11 gene. The isolates with Clade I presented Y132F mutation in the ERG11 gene as well as resistance to amphotericin B. All isolates exhibited strong biofilm-forming capacity and non-aggregative phenotype. The mean time from admission to onset of C. auris candidemia was 39.4 days (range: 12 - 80 days). Despite performing appropriate therapeutic regimen, 42.9% (3/7) of patients experienced occurrences of C. auris candidemia and colonization after the first positive bloodstream. C. auris colonization was still observed after the first C. auris candidemia for 81 days in some patient. Microbiologic eradication from bloodstream was achieved in 85.7% (6/7) of patients at discharge. In conclusion, this study offers a crucial insight into unravelling the multiple origins of C. auris in Guangdong, highlighting great challenges in clinical prevention and control.

BackgroundThe burden of cryptococcosis in mainland China is enormous. However, the in vitro characterization and molecular epidemiology in Guangdong, a key region with a high incidence of fungal infection in China, are not clear.MethodsFrom January 1, 2010, to March 31, 2019, clinical strains of Cryptococcus were collected from six medical centres in Guangdong. The clinical information and characteristics of the strains were analysed. Furthermore, molecular types were determined.ResultsA total of 84 strains were collected, mostly from male and young or middle-aged adult patients. Pulmonary and cerebral infections (82.1%) were most common. All strains were Cryptococcus neoformans, grew well at 37°C and had capsules around their cells. One melanin- and urea- and one melanin+ and urea- variants were found. Although most strains exhibited a low minimum inhibitory concentration (MIC) value for voriconazole (mean: 0.04 μg/mL) and posaconazole (mean: 0.12 μg/mL), the results for these isolates showed a high degree of variation in the MIC values of fluconazole and 5-fluorocytosine, and resistance was observed for 4 out of 6 drugs. A significant proportion of these strains had MIC values near the ECV values, particularly in the case of amphotericin B. The proportion of strains near the clinical breakpoints was as follows: fluconazole: 3.66%; voriconazole: 3.66%; itraconazole: 6.10%; posaconazole: 13.41%; amphotericin B: 84.15%; 5-fluorocytosine: 2.44%. These strains were highly homogeneous and were dominated by the Grubii variant (95.2%), VNI (94.0%), α mating (100%), and ST5 (89.3%) genotypes. Other rare types, including ST4, 31, 278, 7, 57 and 106, were also found.ConclusionPhenotypically variant and non-wild-type strains were found in Guangdong, and a significant proportion of these strains had MIC values near the ECV values towards the 6 antifungal drugs, and resistance was observed for 4 out of 6 drugs. The molecular type was highly homogeneous but compositionally diverse, with rare types found. Enhanced surveillance of the aetiology and evolution and continuous monitoring of antifungal susceptibility are needed to provide references for decision-making in the health sector and optimization of disease prevention and control.

Background: Rhizomucor pusillus is one of the major pathogens in mucormycosis. Infection due to R. pusillus is rare and has a high mortality rate, especially disseminated mucormycosis infections. Rapid and accurate pathogen identification is important for the development of targeted antifungal therapies. Case Presentation: We presented a case of disseminated R. pusillus infection, identified through metagenomics next-generation sequencing (mNGS), in a 4-year-old patient with acute lymphoblastic leukemia. On days 22, 23, and 28, R. pusillus was detected in bronchoalveolar lavage fluid, blood, and hydrothorax, respectively, through mNGS. The patient developed lung, pleural, and blood disseminated lesions caused by R. pusillus infection. Subsequently, the patient was treated with antifungal therapy, including posaconazole, amphotericin B, and isacconazole, with supportive treatment. However, with the continuous deterioration of symptoms, the patient's family decided to give up treatment. The patient eventually died of multiple-organ failure on day 34. Conclusion: mNGS facilitates prompt diagnosis of disseminated R. pusillus infections. The successful application of mNGS provided a new perspective for the clinician, underscoring the technique's potential for rapid diagnostic etiology. mNGS has the capability to identify pathogens at the species level, which is a significant asset in guiding clinical medication decisions.

Objective To investigate the species distribution and the antifungal susceptibility of fungi originating from positive blood cultures in Guangdong, so as to provide a basis for the rational use of antifungal drugs in clinical fungal bloodstream infections.MethodsAll data were collected for retrospective study from monitoring units of the Guangdong Fungal Disease Surveillance Network between 2019-2021, including clinical characteristics, species distribution and antifungal susceptibility.ResultsA total of 3 589 fungi strains were isolated, most of which were Candida spp.（86.5%,3 105/3 589）. The most common species was Candida albicans（36.6%, 1 315/3 589）, followed by Candida tropicalis（17.4%,1 626/3 589） and Candida parapsilosis（14.5%, 520/3 589）. There were 42.1%（1 512/3 589） of strains isolated from ICU. The proportions of Candida albicans strains were 40.0%-50.0% among ICU, general surgery, organ transplantation and emergency department. Candida tropicalis（60.0%, 144/240） was the most common species in hematology department. Both Cryptococcus neoformans（35.4%, 69/195） and Talaromyces marneffei（35.9%, 70/195） were common in infection department. All of the Candida isolates were of wild-type（WT） phenotype to amphotericin B. Resistance rates of caspofungin and micafungin for Candida spp. ranged from 0.0% to 4.2%. The resistance rates of Candida tropicalis to fluconazole and voriconazole were 42.3% and 38.9%, which were significantly higher than other common Candida spp. The cryptococcus neoformans strains were totally of WT phenotype to fluconazole and voriconazole.Conclusions Candida albicansis the most common species originating from positive blood cultures in Guangdong Province. Common Candida strains are highly sensitive to echinocandins and amphotericin B. Candida tropicalis has a high resistance rate to triazole drugs.

目的 评价头孢他啶/阿维巴坦(CAZ-AVI)、多黏菌素B和替加环素对耐碳青霉烯类肺炎克雷伯菌(CRKP)的体外抗菌效应研究,指导临床正确选择并合理使用抗菌药物.方法 收集2018-2021年期间从广东地区8家三级综合医院临床分离的对碳青霉烯类耐药的肺炎克雷伯菌172株,采用聚合酶链反应(PCR)以及NG-Test®CARBA5检测菌株的5种常见碳青霉烯酶耐药基因;采用微量肉汤稀释法药敏试验分别检测CAZ-AVI、多黏菌素B和替加环素的单药最低抑菌浓度(minimal inhibitory concentration,MIC)值.结果 172株CRKP对CAZ-AVI耐药率为13.4％,对多黏菌素B的耐药率为1.7％,对替加环素耐药率为1.2％.PCR检测172株CRKP菌株产碳青霉烯酶基因,其中产碳青霉烯酶菌株166株(96.5％).以PCR检测产碳青霉烯酶基因为参考方法,NG-Test®CARBA5检测碳青霉烯酶基因型KPC、NDM、VIM、IMP和OXA-48-like,显示特异性为100％,灵敏度为99.4％.结论 CAZ-AVI、多黏菌素B以及替加环素对本地区CRKP菌株具有较好的体外抗菌活性,对采用NG-Test® CARBA5试验检测CRKP产碳青霉烯酶的耐药基因型,有利于早期指导临床实现个体化精准治疗.