OBJECTIVES:Gram-negative bacteria (GNB) bloodstream infection (BSI) pose a significant clinical challenge in patients with haematological malignancy, further complicated by rising carbapenem-resistant GNB (CRGNB) prevalence. This study aims to investigate the prevalence and risk factors for GNB BSI and associated mortality in this population. METHODS:A retrospective study was conducted at a tertiary teaching hospital in southern China (2015-2023), including haematological malignancy patients with GNB BSI. Multivariate logistic analyses were performed to identify risk factors for CRGNB BSI and to establish a predictive model for 30-day mortality of GNB BSI. RESULTS:Among 351 patients with GNB BSIs, acute myeloid leukaemia (51.3 %) was the predominant underlying disease. Escherichia coli (28.8 %) and Klebsiella pneumoniae (29.7 %) were the most common GNB BSI and CRGNB BSI pathogens, respectively. Independent risk factors for CRGNB BSI included chronic liver disease, prior carbapenems therapy (≤30 days before BSI), a platelet count <30 × 109/l and albumin concentration <30 g/l before BSI. The 30-day mortality prediction model of GNB BSI incorporated CRGNB infection, platelet count <30 × 109/l and albumin concentration <30 g/l before BSI, demonstrating good discrimination (training cohort AUC: 0.828; validation cohort: 0.791). Calibration plots and decision curve analysis confirmed robust model performance. CONCLUSIONS:Identified factors enable risk stratification for CRGNB BSI and poor prognosis in GNB BSI, facilitating timely interventions to improve outcomes.

ABSTRACT The clustered regularly interspaced short palindromic repeats (CRISPR)‒CRISPR-associated protein (Cas) and restriction‒modification (R–M) systems are important immune systems in bacteria. Information about the distributions of these two systems in Klebsiella pneumoniae from different hosts and their mutual effect on antibiotic resistance and virulence is still limited. In this study, the whole genomes of 520 strains of K. pneumoniae from GenBank, including 325 from humans and 195 from animals, were collected for CRISPR‒Cas systems and type I R-M systems, virulence genes, antibiotic resistance genes, and multilocus sequence typing detection. The results showed that host origin had no obvious influence on the distributions of the two systems (CRISPR‒Cas systems in 29.8% and 24.1%, type I R-M systems in 9.8% and 11.8% of human-origin and animal-origin strains, respectively) in K. pneumoniae . Identical spacer sequences from different hosts demonstrated there was a risk of human–animal transmission. All virulence genes (yersiniabactin, colibactin, aerobactin, salmochelin, rmpADC , and rmpA2 ) detection rates were higher when only the CRISPR‒Cas systems were present but were all reduced when coexisting with type I R-M systems. However, a lower prevalence of most antibiotic-resistance genes was found when the CRISPR‒Cas systems were alone, and when type I R-M systems were coexisting, some of the antibiotic resistance gene incidence rates were even lower (quinolones, macrolides, tetracyclines and carbapenems), and some of them were higher instead (aminoglycosides, clindamycins, rifampicin-associated, sulfonamides, methotrexates, beta-lactamases and ultrabroad-spectrum beta-lactamases). The synergistic and opposed effects of the two systems on virulence and antibiotic-resistance genes need further study. IMPORTANCE K. pneumoniae is an important opportunistic pathogen responsible for both human and animal infections, and the emergence of hypervirulent and multidrug-resistant K. pneumoniae has made it difficult to control this pathogen worldwide. Here, we find that CRISPR‒Cas and restriction–modification systems, which function as adaptive and innate immune systems in bacteria, have synergistic and opposed effects on virulence and antibiotic resistance genes in K. pneumoniae . Moreover, this study provides insights into the distributions of the two systems in K. pneumoniae from different hosts, and there is no significant difference in the prevalence of the two systems among K. pneumoniae spp. In addition, this study also characterizes the CRISPR arrays of K. pneumoniae from different hosts, suggesting that the strains sharing the same spacer sequences have the potential to spread between humans and animals.

Purpose:Klebsiella pneumoniae harbors a gene cluster, polyketide synthase island (PKS), which is responsible for colibactin synthesis which induces double-stranded DNA breaks and associated with increased pathogenicity and cancer development. However, there is limited information on pks-positive K. pneumoniae in cancer patients in China. This study aimed to investigate the prevalence and molecular characteristics of K. pneumoniae harboring the pks island in patients with cancer in China and to explore its potential pathogenicity and clinical significance. Methods:Among 279 nonrepetitive K. pneumoniae isolated from all cancer patients in China, the presence of pks genes were determined by PCR and the molecular characteristics were detected by whole-genome sequencing. Clinical characteristics and antimicrobial susceptibility were also investigated. Results:The pks gene cluster was detected in 35 (12.54%) of the 279 isolates. All isolates were less resistant to most antimicrobial agents, and there were no significant differences in the rates of susceptibility between pks-positive and pks-negative isolates to most antibiotics, except for sulfonamides. Among pks-positive isolates, ST23 (19, 54.29%) and K1 (17, 48.57%) were the dominant sequence types and serotypes, respectively, and the majority harbored multiple virulence genes, including aerobactin, enterobactin, salmochelin, and yersiniabactin. Conclusion:The distribution of pks-positive K. pneumoniae in different types of cancer combined with its hypervirulent determinants highlighted the potential pathogenicity of genotoxins, which requires close clinical attention and epidemic tracking.

High-resolution and efficient typing for Laribacter hongkongensis (L. hongkongensis) is essential for epidemiological investigation of such emerging foodborne pathogens. Clustered regularly interspaced short palindromic repeats (CRISPR) typing is an innovative molecular method that shows great promise for L. hongkongensis typing. Here, we explored the CRISPR typing method by combining CRISPR1 and CRISPR2 loci to characterize a collection of 109 L. hongkongensis isolates from humans and animals and compared it to current molecular methods such as pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). The results showed that all three methods have high discriminatory power (diversity index was 0.9902 for PFGE, 0.9663 for CRISPR and 0.9562 for MLST); strong congruence was observed between them (Rand index was 0.969 between CRISPR and PFGE, 0.953 between CRISPR and MLST, 0.958 between PFGE and MLST). CRISPR typing could well distinguish the isolates in the same STs or PFGE profiles, and the genetic information contained by the CRISPR array is useful for deep phylogenetic typing. We demonstrate that rapid CRISPR typing is a practical genetic fingerprinting tool with high resolution, comparable ease of use and lower cost, ability to track the source of various groups of L. hongkongensis strains and indication of genetic characteristics.

Background: Acinetobacter baumannii (A. baumannii) is an widespread pathogen and carbapenem-resistant strains are great threat to hospitalized patients. This study is aimed to investigate the clinical characteristics, antimicrobial resistance patterns, and risk factors associated with carbapenem resistance in nosocomial, healthcare-associated (HCA), and community-acquired (CA) A. baumannii infections. Methods: This study retrospectively reviewed cases in a tertiary hospital in southern China between January 1, 2019, and December 31, 2021. Univariate and multivariate logistic regression analyses were performed to identified the risk factors of carbapenem resistance in nosocomial, HCA and CA A. baumannii infections. Results: A total of 391 patients with A. baumannii infection were included. Of these patients, 96 (24.6%) had nosocomial infections, 215 (55.0%) had HCA infections, and 80 (20.5%) had CA infections. The overall 30-day mortality rates of nosocomial and HCA infection patients was significantly higher than that of CA infection (P<0.05). The incidence of antimicrobial resistance was also higher in nosocomial and HCA bacteremia than that in CA bacteremia (P<0.05). Logistic regression analysis identified age >= 60 years, urethral catheterization, and exposure to two or more antibiotics as the independent risk factors for carbapenem-resistant A. baumannii (CRAB) infection in the nosocomial infection group and exposure to two or more antibiotics and endotracheal intubation in the HCA infection group. However, malignant tumors and hematological diseases were identified as protective factors against CRAB infection in the HCA group. Conclusion: These data suggest that HCA A. baumannii infection is quite different from CA infection, with antimicrobial resistance and 30-day mortality rates similar to those of nosocomial infections. Additionally, the risk factors for CRAB development in the CA, HCA, and nosocomial groups were not the same, which may provides the help for controlling practices and instruction empirical clinical medication.

OBJECTIVE:Klebsiella pneumoniae are common pathogens causing bloodstream infection (BSI) that increasingly express carbapenem resistance worldwide. To date, no study has precisely investigated the impact of carbapenem resistance in K. pneumoniae (CRKP) BSI on mortality. METHODS:This retrospective study included 87 patients with CRKP BSI and 321 patients with carbapenem-susceptible K. pneumoniae (CSKP) BSI from 2015 to 2020. Propensity score analyses with stabilized inverse probability of treatment weighting (IPTW-S) was applied to balance covariates. The hazard ratio for 30-day mortality associated with carbapenem resistance was estimated using Cox regression and Kaplan-Meier curves. RESULTS:The 30-day crude mortality rates were 43.7% in patients with CRKP BSI and 17.8% in patients with CSKP BSI (P < .001). Age ≥55 years, underlying hematological malignancies and hemodialysis were independently associated with mortality in CRKP BSI. A skin or soft-tissue infection source, urinary catheter, and underlying chronic obstructive pulmonary disease were predictors of mortality in CSKP BSI. The group characteristics were well balanced after IPTW-S. The adjusted hazard ratio for 30-day mortality for CRKP BSI was 1.607 (interquartile range, 0.814-3.171). CONCLUSIONS:Carbapenem resistance was not associated with a significant increase in 30-day mortality in KP BSI; patient and disease factors were primary determinants of outcomes.

Steam disinfection is a trusted method of decontamination and leave no residues, but yet has not been commonly applied for hospitals environment decontamination, hence we aimed to evaluate whether steam mop is an effective device for against pathogens on natural contaminated hospital floors (polyvinyl chloride, PVC) and artificially contaminated (Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii and Candida albicanson) PVC and cloth. The number of microorganisms was significantly reduced after the procedure (p < 0.05) on all hospital floors. Steaming for 15, 10 and 5 seconds could achieve full elimination of all high-, moderate-, and low concentration microorganisms on PVC, respectively, whereas 10, 5 and 10 seconds for cloth. High-, moderate-, and low concentrations microorganism on PVC were completely killed after the first, second and third routine mopping respectively. These results imply that steam mop could be an efficient and environment-friendly alternative for hospitals floors and cloth towels disinfection.

Antiviral intervention in hepatitis B virus (HBV)-infected pregnant women can effectively reduce mother-to-child transmission. However, the immunological characteristics of pregnant women with chronic HBV infection and the effects of antiviral intervention during pregnancy on maternal immune response remain unknown. We aimed to investigate these effects by comparing mothers who received antiviral intervention during pregnancy with those who did not. Pregnant women positive for hepatitis B surface antigen and hepatitis B e-antigen (HBsAg+ HBeAg+) were enrolled at delivery, including 34 received prophylactic antiviral intervention during pregnancy (AVI mothers) and 15 did not (NAVI mothers). T lymphocyte phenotypes and functions were analysed using flow cytometry. At delivery, maternal regulatory T cell (Treg) frequency in AVI mothers was significantly higher than that in NAVI mothers (P < 0.002), and CD4+ T cells in AVI mothers displayed a decreased ability to secrete IFN-γ (P = 0.005) and IL-21 (P = 0.043), but an increased ability to secrete IL-10 and IL-4 (P = 0.040 and P = 0.036), which represented a higher Treg frequency, enhanced Th2 response and suppressed Th1 response. Treg frequency among AVI mothers was correlated negatively with serum HBsAg and HBeAg levels. After delivery, the ability of CD4+ T cells or CD8+ T cells to secrete IFN-γ or IL-10 was similar and no significant difference in Treg frequency was found between the two groups. Prophylactic antiviral intervention during pregnancy has an effect on T cell immunity in pregnant women, which was characterised by increased maternal Treg frequency, enhanced Th2 response and suppressed Th1 response at delivery.

Abstract Background The long-term epidemiological surveillance of carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection (BSI) is limited in China, and the impact of carbapenem resistance on mortality remains unknown. This study aimed to investigate the prevalence, factors and outcomes of CRKP BSI, and examine the attributable mortality of carbapenem resistance. Methods This retrospective study enrolled 87 patients with CRKP BSI and 321 patients with carbapenem-susceptible Klebsiella pneumoniae (CSKP) BSI from 2015 to 2020. Multivariate logistic regression was performed to identify risk factors for infection and mortality. Stabilized inverse probability of treatment weighting was applied to balance covariates. Cox regression and Kaplan-Meier curves were used to estimate the attributable mortality of carbapenem resistance. Results An alarming increasing trend of CRKP BSI was observed during the six years. Longer hospitalization stay, intensive care unit stay, blood purification and antibiotic exposure were risk factors for CRKP BSI, whereas primary BSI and underlying diabetes were factors for CSKP BSI. The crude 30-day mortality of CRKP BSI was independently associated with age ≥ 55 years, underlying hematological malignancies and blood purification, while the infection source from skin and soft tissue, urinary catheter and underlying chronic obstructive pulmonary disease were predictors for CSKP BSI. The hazard ratios reflecting the impact of carbapenem resistance on 30-day mortality was 1.586 (0.791–3.182). Conclusions The 30-day mortality was not attributed to carbapenem resistance in KP BSI. Infection control policies for severely ill patients with prolonged hospitalizations and intensive care and patients with blood purification should be strengthened for CRKP BSI management.

Adequate safe margin in tongue cancer radical surgery is one of the most important prognostic factors. However, the role of peritumoral tissues in predicting lymph node metastasis (LNM) and prognosis using radiomics analysis remains unclear.

Laribacter hongkongensis is a foodborne organism that is associated with gastroenteritis and diarrhea in humans. Here we describe the structural characteristics and potential function of CRISPR systems to obtain insight into the genotypic diversity of L. hongkongensis. Specifically, we analyzed the genomic content of six L. hongkongensis genomes and identified two CRISPR loci (CRISPR1 and CRISPR2) belonging to the I-F subtype of CRISPR systems. CRISPR1 was flanked on one side by cas genes and a 170 bp-long putative leader sequence, while CRISPR2 arrays located further and processed by the same cas genes. Then a combination of PCR and sequencing was used to determine the prevalence and distribution of the two CRISPR arrays in 112 L. hongkongensis strains isolated from patients, animals, and water reservoirs. In total, the CRISPR1-Cas system of complete subtype I-F was detected in 91.5% (108/118) of the isolates, whereas CRISPR2 locus existed in 72.0% (85/118). Ten strains only possessed part of the cas genes of subtype I-F and four of them with CRISPR2 array. The two loci contained highly conserved and identical direct repeat sequences which were stable in their RNA secondary structure. Additionally, 2564 total spacers including 980 unique spacers arranged in 59 alleles were identified. Homology analysis showed only 1.8% (18/980) of the spacers matched with plasmid or phage. CRISPR polymorphism present in human isolates and frog isolates was more closely related and more extensive than that of fish isolates based on spacer polymorphism. The elucidation of the structural characteristics of the CRISPR-Cas system may be helpful for further studying the specific mechanism of adaptive immunity and other biological functions mediated by CRISPR in L. hongkongensis. The conservation of CRISPR loci and hypervariable repeat-spacer arrays imply the potential for molecular typing of L. hongkongensis.

Background Klebsiella pneumoniae ( K. pneumoniae ) is a common pathogen associated with hospital and community-onset infections. This study aimed to compare the clinical and microbiological characteristics of nosocomial, healthcare-associated (HCA), and community-acquired (CA) K. pneumoniae infections. Methods Clinical data were extracted from electronic medical records and analyzed retrospectively. Antimicrobial susceptibility and extended-spectrum beta-lactamase (ESBL) production were determined for all identified strains. Carbapenemase and ESBL genes were amplified by PCR. Genotyping of carbapenem-resistant K. pneumoniae (CRKP) and ESBL-producing strains was performed by pulsed-field gel electrophoresis (PFGE). Results Of 379 K. pneumoniae infections, 98 (25.9%) were nosocomial, 195 (51.5%) were healthcare-associated, and 86 (22.6%) were community-acquired. Hematological malignancy (OR = 4.467), and hypertension (OR = 2.08) and cerebral vascular disease (OR = 2.486) were associated with nosocomial and HCA infections respectively, when compared to CA infections. Overall, the incidence of antimicrobial resistance for the majority of agents tested was similar between nosocomial and HCA infections ( P > 0.05) and both groups had a higher incidence than CA infections ( P < 0.05). Moreover, 95.1% (78/82) of CRKP strains were isolated from the nosocomial and HCA groups. The bla KPC was the most prevalent carbapenemase gene among CRKP strains (80.5%, 66/82). ESBL-producing strains were prevalent among nosocomial (40.8%), HCA (35.9%) and CA groups (24.4%). The bla CTX-M-9-group and bla CTX-M-1-group genes were predominant in nosocomial (65.0%) and CA strains (66.7%), respectively. PFGE results showed ESBL-producing and CRKP strains were genetically diverse. Identical PFGE profiles were observed among HCA and nosocomial strains. Conclusions Nosocomial and HCA K. pneumoniae infections presented similar clinical features and antimicrobial resistance, and both two types of infections were different to CA infections. CRKP and ESBL-producing strains were disseminated mainly in HCA and nosocomial groups, and showed a clonal diversity. The cross transmission of CRKP was existed among HCA and nosocomial patients. This finding suggests that similar empirical therapy should be considered for patients with nosocomial and HCA K. pneumoniae infections and bacterial resistance surveillance of these infections is necessary.

Domain-specific anti-Drosophila DNA topoisomerase II antibodies were generated, affinity purified and used for confocal laser scanning immunofluorescence microscopy. Except for the nucleolus, DNA topoisomerase II is distributed throughout interphase nuclei. In adult accessory glands as well as third instar larval neural ganglion and imaginal disk nuclei, DNA topoisomerase II shows areas of co-localization with chromatin adjacent to areas of extrachromosomal distribution. These observations made in a variety of tissues under different fixation conditions and with a number of molecular probes support the notion that DNA topoisomerase II is a component of a substantially extrachromosomal network that functions to organize interphase chromatin within nuclei.

We have read with interest the recent paper of Tu H et al1Tu H Tu S Gao S Shao A Sheng J Current epidemiological and clinical features of COVID-19; a global perspective from China.J Infect. 2020; 81 (Epub 2020/04/22PubMed PMID: 32315723; PubMed Central PMCID: PMCPMC7166041): 1-9https://doi.org/10.1016/j.jinf.2020.04.011Abstract Full Text Full Text PDF PubMed Scopus (192) Google Scholar, which suggesting that healthcare workers have a high risk of infection when providing clinical care for patients with coronavirus disease 2019 (COVID-19). As of February 12, 2020, more than 3,000 healthcare workers in Hubei Province, China, have been infected, and most of them are from non-infectious disease departments2Network CN.Infection of Over 3000 Medical Staff in Hubei 2020 [cited2020 March 31]. Available from: http://www.chinanews.com/m/sh/2020/03-06/9116170.shtml?ivk_sa=1023197a.Google Scholar. A total of 110 of 9684 healthcare workers were diagnosed with COVID-19 in Tongji Hospital, a large comprehensive tertiary hospital in Wuhan, with an infection rate of 1.1%3Lai X Wang M Qin C Tan L Ran L Chen D et al.Coronavirus disease 2019 (COVID-2019) infection among health care workers and implications for prevention measures in a tertiary hospital in Wuhan.China. JAMA Network Open. 2020; 3 (e209666–e)https://doi.org/10.1001/jamanetworkopen.2020.9666Crossref Scopus (300) Google Scholar. Here, we would like to share our study that reported the results of mass screenings among healthcare workers from a comprehensive tertiary hospital and assessed the infection status during different periods, which was a key step in tracking hospital infection and preventing the spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). This single-center study included 1059 cases of healthcare workers in Renmin Hospital of Wuhan University. All the subjects had been screened twice for SARS-CoV-2, the first from March 8 to April 19, 2020, and the second from May 13 to June 10, 2020. The blood samples and nasopharyngeal swabs from each participant were collected respectively for the SARS-CoV-2-specific serological test and RT-PCR test. According to the manufacturer's instructions, the anti-SARS-CoV-2 IgG and IgM were detected using the Diagnostic Kit for IgM/IgG Antibody to Coronavirus (Colloidal Gold Method) (Livzon Diagnostics Inc.). The presence of SARS-CoV-2 RNA in nasopharyngeal swab samples were detected using real-time RT-PCR assay with the Chinese Control and Prevention (China CDC) recommended Kit (DAAN Gene Co., Ltd. of Sun Yat-sen University). All analyses were performed using SPSS statistical software version 20.0 (IBM Corp). Among the 1059 healthcare workers, 262 were male (24.7%) and 797 were female (75.3%). The median age was 32.69 (± 7.7) years. As shown in Table 1, the positive rates of SARS-CoV-2 RNA among these healthcare workers were 1.8% from March 8 to April 19, and decreased to 0.3% from May 13 to June 10, with significantly statistical difference (χ2 = 11.759, P = 0.001). The positive rates of SARS-CoV-2-IgM antibodies were 3.5% from March 8 to April 19, and decreased to 1.4% from May 13 to June 10, with significantly statistical difference (χ2 = 9.542, P = 0.002). The positive rates of SARS-CoV-2-IgG antibodies were 11.7% from March 8 to April 19, and decreased to 9.3% from May 13 to June 10, with no statistical difference (χ2 = 3.133, P = 0.077). Among the 19 healthcare workers who were positive for SARS-CoV-2 RNA form March 8 to April 19, only one remained positive form May 13 to June 10, and the rest turned negative (94.7%). Among the 37 healthcare workers with IgM positive from March 8 to April 19, 15 (40.5%) healthcare workers remained positive from May 13 to June 10, and 22 (59.5%) healthcare workers turned negative. Among 124 healthcare workers with IgG positive from March 8 to April 19, 89 (71.8%) healthcare workers remained positive from May 13 to June 10, and 35 healthcare workers turned negative (28.2%). During the second screening from May 13 to June 10, there were 2 new cases positive for SARS-CoV-2 RNA, 10 new cases positive for IgG, and no new case positive for IgM.Table 1The positive rates of serology and RT–PCR tests among healthcare workers in different periods. (N = 1059)March 8 to April 19May 13 to June 10χ2P valueRNA+ (%)19 (1.8%)3 (0.3%)11.7590.001IgM+ (%)37 (3.5%)15 (1.4%)9.5420.002IgG+ (%)124 (11.7%)99 (9.3%)3.1330.077RT-PCR, reverse transcription-polymerase chain reaction Open table in a new tab RT-PCR, reverse transcription-polymerase chain reaction During the prevalence of COVID-19, healthcare workers are at high risk of infection due to exposure to droplets or aerosols from patients' respiratory tracts. This study showed that the positive rates of SARS-CoV-2 RNA and IgM in healthcare workers from March 8 to April 19 were higher than the periods from May 13 to June 10. This is because that people's understanding of the virus and the knowledge of infection control were relatively insufficient during the early outbreak. After the first screening, the routine infection control practices and contact precautions were released and implemented according to the WHO and CDC guidelines4China NHCo. New coronavirus pneumonia prevention and control program (Trial 7th edn). March 3, 2020 [cited 2020 Aug 6]. Available from: http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989/files/ce3e6945832a438eaae415350a8ce964.pdf.Google Scholar,5Organization WH.The infection prevention and control in medical facilities when novel coronavirus infection is suspected. 2020 [cited 2020 Aug 6]. Available from: https://apps.who.int/iris/bitstream/handle/10665/330674/9789240000957-chi.pdf.Google Scholar. The importance of compliance with and proper training in infection control procedures were emphasized during these situations. Healthcare workers were urged to wear the correct personal protective equipment (PPE), such as surgical masks or N-95 respirators, disposable isolation gowns, disposable patient inspection gloves, work hat, goggles or marks and shoe covers, according to the risk level6Notice of the general office of the National Health Commission on Further Strengthening the protection of medical personnel during the period of epidemic prevention and control: National Health Commission of the People's Republic of China; 2020. Available from: http://www.gov.cn/zhengce/zhengceku/2020-02/20/content_5481310.htm.Google Scholar. The work schedules with appropriate numbers and lengths of shifts were provided for healthcare workers to ensure that they get adequate rest while coping with the increased workload. As is observed from the second screening, the infection rates were significantly decreased and the nosocomial infection were effectively controlled, which suggested that reasonable medical intervention measures and standardized personal protection protocols are very necessary for infection prevention and control. Hospital services should improve emergency capacity, timely formulate protection guidelines, and provide adequate supplies of protective equipments. In this study, the infections among healthcare workers mainly peaked in the early stage of the Wuhan outbreak. Fewer new infections were detected in the second screening from May 13 to June 10. The presence of IgM antibodies was relatively short-lived and 59.5% cases became seronegative for IgM in the second screening. The presence of IgG antibodies lasted longer and 71.8% cases remained seropositive for IgG in the second screening. Shu H et al. had reported that the IgM fell to below the baseline level at about day 36, while IgG still maintained a relatively high level7Shu H Wang S Ruan S Wang Y Zhang J Yuan Y et al.Dynamic Changes of Antibodies to SARS-CoV-2 in COVID-19 patients at early stage of outbreak.Virol Sin. 2020; (Epub 2020/07/29PubMed PMID: 32720214; PubMed Central PMCID: PMCPMC7383121): 1-8https://doi.org/10.1007/s12250-020-00268-5Crossref PubMed Scopus (26) Google Scholar. Therefore, IgM was suitable for the detection of early infections, while IgG was a sensitive indicator for the detection of past infections. Mass screening of healthcare workers and rapid identification of potentially infected staff through serological tests contributed to protecting healthcare workers and reducing cross-infection. In conclusion, early screening and standardized personal protection measures can effectively reduce the risk of cross-infection. The infection control guidelines designed for different levels of exposure risk have important implications for worker protection and nosocomial infection control. None. We would like to thank all participants involved in this study.

目的 了解中性粒细胞缺乏(粒缺)与非粒细胞缺乏(非粒缺)恶性肿瘤及血液病患者感染病原菌的分布及耐药性特点.方法 对2016年7月1日-2017年8月31日于南京医科大学第一附属医院血液科、肿瘤科住院恶性肿瘤及血液病粒缺与非粒缺患者的临床分离株进行分析,所分离的菌株采用API鉴定系统或VITEK-2 Compact全自动细菌鉴定仪进行细菌鉴定,采用VⅡEK-2 Compact全自动细菌鉴定仪或纸片扩散法进行药敏试验,用SPSS23.0版软件进行数据统计.结果 粒缺与非粒缺患者的送检标本分别分离出细菌154株和308株.粒缺与非粒缺患者革兰阴性菌、革兰阳性菌均分别占79.9％,19.5％.粒缺患者血液标本分离铜绿假单胞菌所占比例显著高于非粒缺患者(17.0％比5.6％,P＜0.05),其痰液标本中各菌株检出率与非粒缺患者差异无统计学意义(P＞0.05).粒缺患者耐甲氧西林金黄色葡萄球菌(M RSA)及耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率与非粒缺患者差异无统计学意义(均P＞0.05).两组均未检出万古霉素、利奈唑胺耐药的革兰阳性菌.粒缺患者耐碳青霉烯肠杆菌科细菌(CRE)的检出率与非粒缺患者比较差异无统计学意义(22.7％比10.3％,P＜0.05),而粒缺患者不发酵糖革兰阴性杆菌检出率与非粒缺患者比较差异无统计学意义(35.8％比24.8％,P＞0.05).结论 该院粒缺和非粒缺感染患者病原菌的分布和耐药情况与国内外报道不尽相同,临床应根据本地区、医院病原菌的分布和耐药性特点来选择恰当、有效的经验性抗感染治疗药物.

This article reported two cases of myopathy type very long-chain acyl coenzyme A dehydrogenase deficiency patients, whose clinical manifestations were mainly repeated rhabdomyolysis. In case 1, with fluctuating muscle weakness and myalgia, pathology of skeletal muscle biopsy showed a small amount of degenerative and necrotic muscle fibers, and some muscle fibers had slightly increased fat components. ACADVL gene complex heterozygous mutation was found by second-generation sequencing. Case 2 showed increased polyacylcarnitine and decreased free carnitine by tandem mass spectrometry. Clinical onset muscle weakness, muscle pain and repeat rhabdomyolysis suggested to consider myopathy type very long-chain acyl coenzyme A dehydrogenase deficiency. Because of no specific performance in lower limb muscle magnetic resonance imaging and skeletal muscle biopsy pathology, the case needed to be differentiated from other metabolic myopathy, and tandem mass spectrometry detection and the second generation sequencing are helpful to diagnosis and differential diagnosis.

Background: Candida auris can form long-lasting colonies in the hospital environment and on human skin. There is limited evidence regarding the efficacy of different methods and products for disinfecting hospitals and colonized patients to prevent the spread of C. auris. Methods: The minimum inhibitory concentration of three disinfectant products ("84" disinfectant, IodineTincture disinfectant, and quaternary ammonium) and 75% ethanol against C. auris and other Candida species were measured. A pig skin model was used to evaluate the efficacy of three hand hygiene products in killing pathogens. The killing effect of ultraviolet-C (253.7 nm) and the LK/CXD bed unit ozone disinfection machine on C. auris was also evaluated. Results: Thirty seconds of pig skin washing with bacteriostatic hand sanitizer followed by drying and 15 s of ethanol-based gel can completely eradicate the colonization of C. auris (3.00 log io CFU). The antifungal activity of ultraviolet-C to C. auris inoculated on bed sheets was significantly reduced (P < 0.01) at a distance of 1 m. Candida glabrata and C. auris showed greater resistance to ozone than other Candida species. The ozone could completely eradicate C. auris (3.60 log(10) CFU) on bed sheets at dosage of 300 mg/m(3) for 40 min of exposure. Conclusions: We recommend extending the disinfection times of ultraviolet-C and ozone and emphasizing the effectiveness of washing skin with soap, drying skin, and then applying an ethanol-based gel to remove C. auris from skin. (C) 2020 The Author( s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences.

OBJECTIVE To investigate the characteristics of growth and metabolism and the in vivo toxicity of Candida auris under different conditions. METHODS We observed the growth of Candida auris and Candida albicans under routine culture conditions and in different pH and salt concentrations, and compared their activities of sugar fermentation using microbiochemical reaction tubes. Four-week-old nude mice were randomized into Candida auris infection group (n=5), Candida albicans infection group (n=5) and control group (n=5) for intragastric administration of 0.3 mL suspension the two Candida species (5×109 cfu/mL) or 0.3 mL normal saline. Samples of the liver, kidney, intestine, feces and blood were taken for analysis of the in vivo distribution and toxicity of Candida albicans by fungal culture and histopathological examination. RESULTS Candida auris exhibited logarithmic growth at 8-24 h after inoculation and showed stable growth after 24 h. Candida auris showed optimal growth within the pH value range of 5-7 with a growth pattern identical to that of Candida albicans. Candida auris grew better than Candida albicans in media containing 5% and 10% NaCl, and could ferment glucose, sucrose, trehalose and sorbitol. Candida auris could be isolated from the feces, blood, liver and kidney of infected nude mice, and the liver had the highest fungal load (5.7 log10 cfu/g). Candida auris could cause pathological changes in the liver and intestine of the mice, but with a lesser severity as compared with Candida albicans. CONCLUSIONS Candida auris exhibits optimal growth in mildly acidic or neutral conditions with a high salt tolerance, and can potentially penetrate the intestinal barrier into blood and lead to tissue injuries in hosts with immunosuppression.

Objective: To investigate the impact of immediate cessation of antiviral therapy on postpartum liver function and the factors influencing postpartum abnormality in mothers with chronic hepatitis B virus infection. Methods: A retrospective cohort study was conducted. One hundred eighty-eight pregnant women with HBV DNA level > 2×106 IU/ml were enrolled from June 2014 to June 2018. Demographic information and clinical data of liver function and HBV DNA load during gravidity, intrapartum and postpartum period were collected. According to the antiviral treatment recommendations during pregnancy, the women were divided into three groups, namely, tenofovir (TDF), telbivudine (LdT) and control group. Liver function abnormalities among the three groups were compared within 6 months after delivery, and the factors influencing abnormal liver function were analyzed by unconditional logistic regression. Results: Of the 188 cases, 72 cases were in the TDF group, 80 cases in the LdT group, and 36 cases in the control group. Pregnant women in the TDF and LdT groups received oral TDF (300 mg/d) and LdT (600 mg/d) from 28 ± 4 weeks of gestation till delivery. Among the 188 patients, 30 (16.0%) had abnormal postpartum liver function abnormality. The incidence of postpartum liver function abnormality [alanine aminotransferase (ALT) > 2 × upper limit of normal (ULN)] in the TDF, LdT, and control groups was 19.4%, 12.5%, and 16.7%, respectively. The postpartum peak levels of ALT (median, range) in the three groups were 34.5 (12.0-946.0) U/L, 37.5 (12.0-733.8) U/L, and 39.0 (7.0-513.0) U/L, respectively. There was no significant difference between the two indexes among the three groups (P > 0.05). There was no statistically significant difference in the degree of postpartum liver function abnormalities between the three groups (P = 0.944). Most of the liver function abnormalities were mild to moderate (2 × ULN≤ALT < 10 × ULN), and usually resolved spontaneously or by treatment. Univariate and multivariate analysis showed that baseline ALT level during pregnancy was an independent factor associated with postpartum liver function abnormality (OR = 1.031, CI 95%: 1.005-1.058; χ(2) = 5.340, P = 0.021), whereas age, antiviral therapy, HBeAg-positivity, baseline HBV DNA levels, gravidity, parity, preterm delivery and delivery mode were not significantly associated with postpartum liver function abnormality. Conclusion: Cessation of antiviral therapy after delivery did not significantly increase the risk of postpartum liver function abnormality in pregnant women with chronic HBV infection. The ALT level during pregnancy is a factor influencing postpartum liver function abnormality.