Pseudomonas aeruginosa is a Gram-negative opportunistic bacterium responsible for severe infections such as pneumonia, septicemia, and keratitis. It poses a significant treatment challenge due to its extensive antibiotic resistance and its capacity to form biofilms, which provide bacterial communities with a protective barrier against antibiotics. An increasing number of studies have identified phage therapy as a potential therapeutic solution amidst the current crisis of antibiotic resistance in medicine. Here, we isolated three novel phages in the campus environment and selected one, PW01, for detailed analysis. Host range was determined against clinical isolates, and biological features were evaluated through growth kinetics and biofilm inhibition assays. Whole genome sequencing and annotation were conducted to confirm its lytic nature. In vivo efficacy was assessed using a murine wound infection model. PW01 displayed a relatively broad host spectrum and effectively suppressed bacterial growth in vitro. It disrupted established biofilms and showed genomic features consistent with a strictly lytic lifestyle. In mice, treatment with PW01 combined with antibiotics resulted in greater bacterial reduction compared with either treatment alone. These findings demonstrate that PW01 possesses both in vitro and in vivo activity against P. aeruginosa and support the potential of phage-antibiotic combination therapy as an effective strategy against multidrug-resistant (MDR) infections.

OBJECTIVE:To investigate the phenotype and genotype characteristics of Pseudomonas aeruginosa isolates from wound infections. METHODS:Seventy-six P. aeruginosa strains isolated from wound infections in a university hospital were analysed. Antimicrobial susceptibility testing, biofilm formation assays, and whole-genome sequencing were performed on all strains. The virulence of potential hypervirulent strains was assessed using a Galleria mellonella infection model. RESULTS:Among the 76 tested strains, 49 (64.5%) were susceptible to all tested antibiotics. The β-lactamase-encoding gene positivity rate was 57.9%, while the OprD gene mutation rate was 1.3%. All isolates were classified into 56 distinct multilocus sequence types. Serotype distribution revealed O11 (22.37%, 17/76), O16 (19.74%, 15/76), and O1 (18.42%, 14/76) as the most prevalent. The exoU gene was predominantly associated with serotype O11. Over 80% of strains harboured biofilm-related virulence genes, and all exhibited strong biofilm-forming capacity. Six exoU+/exoS+ strains (serotype O4) were identified, with ST1965 and ST3418 demonstrating potential hypervirulence in the infection model. CONCLUSIONS:P. aeruginosa isolates from wound infections displayed sporadic genomic profiles, high antibiotic susceptibility, and robust biofilm formation. The emergence of exoU+/exoS+ hypervirulent clones (ST1965 and ST3418), characterized by enhanced virulence and biofilm production, highlights their potential to cause treatment-refractory infections and severe clinical outcomes. Continuous surveillance and tailored therapeutic approaches are imperative for managing infections caused by these clones.

Introduction: The aim of this study was to develop and validate a clinical prediction model for Clostridioides difficile associated diarrhea (CDAD) based on routine laboratory tests. Methodology: Data from 121 CDAD patients and 123 patients with non-CDAD who presented at the First Affiliated Hospital of Nanjing Medical University between May 2017 and January 2022 were used to create a nomogram based on logistic regression. In addition, 109 stool samples from diarrhea patients in Jurong People's Hospital were collected to detect Clostridioides difficile toxin genes. The performance of the prediction model was assessed by the area under the curve (AUC), Hosmer-Lemeshow goodness of fit, and decision curve analysis (DCA). Results: The following variables were included in the new multivariate regression model: white blood cell (WBC), lymphocyte (LY), hemoglobin (HGB), mean corpuscular volume (MCV), activated partial thromboplastin time (APTT), D-dimer, urea, creatinine (Cr), and uric acid (UA). The AUC of the prediction model was 0.793 (95% CI = 0.737–0.849) for the derivation sets and 0.708 (95% CI = 0.506–0.910) for the validation set. The calibrated values were 0.874 and 0.543, respectively. The nomogram showed better net benefit when prediction probability values were above 0.1 in the DCA curve. Conclusions: A new diagnostic prediction model for CDAD was established. Clinicians can use the nomogram to initially assess the likelihood of CDAD when the patient suffers diarrhea, to ensure timely specific laboratory tests, and appropriate diagnostic and treatment measures.

Purpose:Elizabethkingia spp. infections have recently increased, and they are difficult to treat because of intrinsic antimicrobial resistance. This study aimed to investigate the clinical characteristics of patients with pulmonary infection with Elizabethkingia spp. and reveal the risk factors for infection and death. Patients and Methods:In this retrospective case-control study, patients were divided into infection and control groups based on the bacterial identification results. Patients in the infection group were further divided into survival and death groups according to their hospital outcomes. Clinical characteristics between different groups were compared. We further analyzed antimicrobial susceptibility testing results of the isolated strains. Results:A total of the 316 patients were divided into infection (n = 79), 23 of whom died, and control (n = 237) groups. Multivariate logistic regression analysis showed that glucocorticoid consumption (OR: 2.35; 95% CI: 1.14-4.81; P = 0.02), endotracheal intubation (OR: 3.74; 95% CI: 1.62-8.64; P = 0.002), and colistin exposure (OR: 2.50; 95% CI: 1.01-6.29; P = 0.046) were significantly associated with pulmonary infection with Elizabethkingia spp. Advanced age (OR: 1.07, 95% CI: 1.00-1.15; P = 0.046), high acute physiology and chronic health evaluation (APACHE) II score (OR: 1.21; 95% CI: 1.01-1.45; P = 0.037), and low albumin level (OR: 0.73, 95% CI: 0.56-0.96; P = 0.025) were significantly associated with in-hospital mortality of infected patients. Elizabethkingia spp. was highly resistant to cephalosporins, carbapenems, macrolides, and aminoglycoside, and was sensitive to fluoroquinolones, minocycline, and co-trimoxazole in vitro. Conclusion:Glucocorticoid consumption, tracheal intubation, and colistin exposure were associated with pulmonary infection with Elizabethkingia spp. for critically ill patients. Patients with advanced age, high APACHE II score, and low albumin level had higher risk of death from infection.

ABSTRACT Opportunistic fungal infections, particularly caused by Candida albicans , remain a common cause of high morbidity and mortality in immunocompromised patients. The escalating prevalence of antifungal drug resistance necessitates the immediate exploration of alternative treatment strategies to combat these life-threatening fungal diseases. In this study, we investigated the antifungal efficacy of firsocostat, a human acetyl-CoA carboxylase (ACC) inhibitor, against C. albicans . Firsocostat alone displayed moderate antifungal activity, while combining it with voriconazole, itraconazole, or amphotericin B exhibited synergistic effects across almost all drug-sensitive and drug-resistant C. albicans strains tested. These observed synergies were further validated in two mouse models of oropharyngeal and systemic candidiasis, where the combination therapies demonstrated superior fungicidal effects compared to monotherapy. Moreover, firsocostat was shown to directly bind to C. albicans ACC and inhibit its enzymatic activity. Sequencing spontaneous firsocostat-resistant mutants revealed mutations mapping to C. albicans ACC, confirming that firsocostat has retained its target in C. albicans . Overall, our findings suggest that repurposing firsocostat, either alone or in combination with other antifungal agents, holds promising potential in the development of antifungal drugs and the treatment of candidiasis.

Volume 68, no. 1, e01131-23, 2023, https://doi.org/10.1128/aac.01131-23. Upon review, we discovered errors in Fig. 4C and Fig. S2, where the HE stain image of the uninfected group and the oropharyngeal candidiasis image of Vehicle/Day 7, respectively, were incorrectly placed during the sorting process. Figure 4C and Fig. S2 should appear as shown in this correction. These corrections do not change the conclusions drawn in the study.

IntroductionPseudomonas aeruginosa is present throughout nature and is a common opportunistic pathogen in the human body. Carbapenem antibiotics are typically utilized as a last resort in the clinical treatment of multidrug-resistant infections caused by P. aeruginosa. The increase in carbapenem-resistant P. aeruginosa poses an immense challenge for the treatment of these infections. Bacteriophages have the potential to be used as antimicrobial agents for treating antibiotic-resistant bacteria.Methods and ResultsIn this study, a new virulent P. aeruginosa phage, Phage_Pae01, was isolated from hospital sewage and shown to have broad-spectrum antibacterial activity against clinical P. aeruginosa isolates (83.6%). These clinical strains included multidrug-resistant P. aeruginosa and carbapenem-resistant P. aeruginosa. Transmission electron microscopy revealed that the phage possessed an icosahedral head of approximately 80 nm and a long tail about 110 m, indicating that it belongs to the Myoviridae family of the order Caudovirales. Biological characteristic analysis revealed that Phage_Pae01 could maintain stable activity in the temperature range of 4~ 60°C and pH range of 4 ~ 10. According to the in vitro lysis kinetics of the phage, Phage_Pae01 demonstrated strong antibacterial activity. The optimal multiplicity of infection was 0.01. The genome of Phage_Pae01 has a total length of 93,182 bp and contains 176 open reading frames (ORFs). The phage genome does not contain genes related to virulence or antibiotic resistance. In addition, Phage_Pae01 effectively prevented the formation of biofilms and eliminated established biofilms. When Phage_Pae01 was combined with gentamicin, it significantly disrupted established P. aeruginosa biofilms.ConclusionWe identified a novel P. aeruginosa phage and demonstrated its effective antimicrobial properties against P. aeruginosa in both the floating and biofilm states. These findings offer a promising approach for the treatment of drug-resistant bacterial infections in clinical settings.

目的 探讨药敏结果"中介"是否纳入"耐药"统计对多药耐药菌(MDRO)监测数据的影响.方法 选择南京医科大学第一附属医院2020年1月-2022年6月微生物送检标本中分离出的医院重点监测MDRO,分别将"中介"纳入耐药和"中介"不纳入耐药统计,对比分析两种情况下MDRO检出率、MDRO感染例次发生率、感染构成比.结果 国内不同指南和共识的MDRO定义中,对于中介是否纳入耐药统计存在差异;参与调研的20所医疗机构,15所判定MDRO时将药敏结果中介纳入耐药统计,5所判定MDRO时未将药敏结果中介纳入耐药统计;中介纳入和不纳入耐药的情况下,CRKP、CRECO、CRAB、MRSA的检出率差异无统计学意义,中介纳入耐药时的CRPA检出率(42.45％)高于中介不纳入耐药时检出率(34.17％)(P＜0.001);中介纳入和不纳入耐药的情况下,CRKP、CRECO、CRAB、MRSA的感染例次发生率差异无统计学意义,中介纳入耐药时的CRPA感染例次率(0.26％)高于中介不纳入耐药时检出率(0.22％)(P＜0.001);中介纳入和不纳入耐药的情况下,CRKP、CRE-CO、CRAB、CRPA、MRSA的感染构成比差异无统计学意义.结论 MDRO判定时,中介纳入和不纳入耐药统计的情况下,CRPA检出率、CRPA感染例次发生率差异显著.建议相关部门统一 MDRO监测标准,进一步提升数据监测的同质化水平.

目的 分析非多药耐药菌(Non-MDRO)型耐碳青霉烯类铜绿假单胞菌(CRPA)的临床分布特点,并提出其分层防控模式的建议.方法 选择南京医科大学第一附属医院2020年1月-2022年6月临床标本中分离的CRPA、耐碳青霉烯类肠杆菌目细菌(CRE)、耐碳青霉烯类鲍氏不动杆菌(CRAB)为研究对象,根据MDRO定义,将其分别分为Non-MDRO组和多药耐药菌(MDRO)组,对比分析Non-MDRO组比例.分析Non-MDRO组CRPA临床分布、影响因素以及耐药性特点.结果 医院感染重点监测的MDRO,针对铜绿假单胞菌(PA),2015年之前均为多药耐药铜绿假单胞菌(MDR-PA),2015年之后则都是CRPA;CRPA中Non-MDRO占比62.15％(770/1 239),CRE 和 CRAB 中 Non-MDRO 占比则分别为 0.51％(9/1 758)和 0.91％(21/2 308);Logistic 多因素分析结果显示年龄和病区分布是Non-MDRO型CRPA的影响因素(P＜0.05);CRPA中Non-MDRO组耐药率低于MDRO组(均P＜0.05),其中Non-MDRO组除了对碳青霉烯类药物耐药率较高外,其余抗菌药物耐药率均低于20％.结论 非MDRO型CRPA基数较大,危害较小,且占据一定的防控资源,建议根据情况对CRPA进行分层防控管理,即耐药菌并不多见、防控资源宽松的医疗机构可以将CRPA全部纳入常规重点监测菌,而对于部分耐药菌泛滥、防控资源紧张的大型三甲医院,则可以将重点监测菌中的CRPA更改为MDR-PA或难治型耐药菌(DTR)-PA.

Objective:To investigate the transmission pathway of a MRSA prevalence in a pancreatic surgery ward in a Chinese teaching hospital.Methods:Molecular epidemiology investigations were carried out combined PFGE, MLST, SCCmec typing and whole-genome sequencing for 20 successive MRSA isolates (2 isolates from the ward environment). Resistance and virulence genes were detected using specific PCR. Bacterial identification and AST were performed using the Vitek 2 Compact System. Clinical data of enrolled cases were retrieved from electronic case records.Results:From January 2020 to May 2020, successive isolated 20 MRSA strains were clarified to 2 PFGE patterns (A = 19, B = 1) in the ward. Both isolates from environment and patients belonged to sequence type ST5-SCCmec II-spa type t311. MRSA-related resistance genes mecA, blaZ, ermA, ant(4')-Ia and norA were found in each clone. All 20 isolates carried tst, hlg, hla, eta, eap, fnbA and seo virulence genes, other virulence genes such as sea, sec, seb, seg, sei, sem, sen, ebpS and fnbB were also found in partial stains. All patients had fever symptom, 27.8% were accompanied by diarrhea, 88.9% had undergone surgery or invasive procedures within 30 days. Finally, 94.4% of these patients recovered.Conclusion:This study confirmed a prevalence of ST5-MRSA-II-t311 clone in a surgery ward, indicated MRSA is a risk factor for post-surgery nosocomial infection and hand hygiene and environmental surveillance should not be ignored.

Abstract Polymyxin resistance is conferred by MCR‐1 (mobile colistin resistance 1)‐induced lipopolysaccharide (LPS) modification of G− bacteria. However, the peptide MSI‐1 exerts potent antimicrobial activity against mcr‐1‐carrying bacteria. To further investigate the potential role of MCR‐1 in improving bacterial virulence and facilitating immune evasion, and the immunomodulatory effect of peptide MSI‐1, we first explored outer membrane vesicle (OMV) alterations of mcr‐1‐carrying bacteria in the presence and absence of sub‐MIC MSI‐1, and host immune activation during bacterial infection and OMV stimulation. Our results demonstrated that LPS remodelling induced by MCR‐1 negatively affected OMV formation and protein cargo by E. coli. In addition, MCR‐1 diminished LPS‐stimulated pyroptosis but facilitated mitochondrial dysfunction, further aggravating apoptosis in macrophages induced by OMVs of E. coli. Similarly, TLR4‐mediated NF‐κB activation was markedly alleviated once LPS was modified by MCR‐1. However, peptide MSI‐1 at the sub‐MIC level inhibited the expression of MCR‐1, further partly rescuing OMV alteration and attenuation of immune responses in the presence of MCR‐1 during both infection and OMV stimulation, which can be exploited for anti‐infective therapy.

当前,细菌耐药已成为全球公共健康领域的重大挑战,其中尤以碳青霉烯类耐药肠杆菌目细菌(carbapenem-resistant Enterobacterales, CRE)引起的感染形势最为严峻.碳青霉烯类抗生素包括亚胺培南、美罗培南和厄他培南等,是治疗多重耐药革兰阴性杆菌所致感染最有效的抗菌药物之一.

Significance Statement Autosomal dominant polycystic kidney disease (ADPKD) is caused by mutations in PKD1 and PKD2 (PKD1/2) in renal tubular epithelium. PKD1/2 somatic mutations were previously implicated in cyst formation, but studies of this second-hit model in ADPKD had significant technical limitations. Comprehensive analysis of renal cyst epithelium by whole-genome sequencing identified pathogenic inactivating somatic mutations of PKD1/2 in all 24 patients and in 93% of their 90 cysts. Short variant mutations occurred in 77% of cysts, and another 18% acquired chromosomal loss of heterozygosity encompassing PKD1/2, frequently at chromosomal fragile sites or in regions comprising chromosome microdeletion diseases/syndromes. These findings support a cellular recessive mechanism for renal cystogenesis in ADPKD caused by inactivating germline and somatic variants of PKD1/2. Background Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder characterized by the development of multiple cysts in the kidneys. It is often caused by pathogenic mutations in PKD1 and PKD2 genes that encode polycystin proteins. Although the molecular mechanisms for cystogenesis are not established, concurrent inactivating germline and somatic mutations in PKD1 and PKD2 have been previously observed in renal tubular epithelium (RTE). Methods To further investigate the cellular recessive mechanism of cystogenesis in RTE, we conducted whole-genome DNA sequencing analysis to identify germline variants and somatic alterations in RTE of 90 unique kidney cysts obtained during nephrectomy from 24 unrelated participants. Results Kidney cysts were overall genomically stable, with low burdens of somatic short mutations or large-scale structural alterations. Pathogenic somatic ?second hit? alterations disrupting PKD1 or PKD2 were identified in 93% of the cysts. Of these, 77% of cysts acquired short mutations in PKD1 or PKD2; specifically, 60% resulted in protein truncations (nonsense, frameshift, or splice site) and 17% caused non-truncating mutations (missense, in-frame insertions, or deletions). Another 18% of cysts acquired somatic chromosomal loss of heterozygosity (LOH) events encompassing PKD1 or PKD2 ranging from 2.6 to 81.3 Mb. 14% of these cysts harbored copy number neutral LOH events, while the other 3% had hemizygous chromosomal deletions. LOH events frequently occurred at chromosomal fragile sites, or in regions comprising chromosome microdeletion diseases/syndromes. Almost all somatic ?second hit? alterations occurred at the same germline mutated PKD1/2 gene. Conclusions These findings further support a cellular recessive mechanism for cystogenesis in ADPKD primarily caused by inactivating germline and somatic variants of PKD1 or PKD2 genes in kidney cyst epithelium.

目的 探讨胶体金免疫层析法(CrAg-LFA)检测隐球菌荚膜抗原在隐球菌病中的诊断价值,并分析隐球菌病患者的临床特征.方法 回顾性分析2018年6月至2020年6月于南京医科大学第一附属医院进行CrAg-LFA检测的住院患者共1623例.计算CrAg-LFA对隐球菌病诊断的灵敏度、特异度、阳性预测值和阴性预测值.同时,分析隐球菌病患者的一般资料、临床表现、实验室检查及治疗.结果 1623例研究对象中最终诊断为隐球菌病的患者共46例,其中41例为肺隐球菌病,隐球菌脑膜炎2例,播散性隐球菌病、隐球菌败血症及髂骨隐球菌感染各1例.CrAg-LFA对隐球菌病诊断的灵敏度为84.8％,特异度为99.4％.其中,血清CrAg-LFA在肺隐球菌病诊断中的灵敏度为85.4％,特异度为100.0％,阳性预测值为100.0％,阴性预测值为99.6％;脑脊液CrAg-LFA检测在隐球菌脑膜炎诊断中的灵敏度和特异度均为100.0％.46例隐球菌病患者中有基础疾病的共30例(65.2％).有55.6％的肺隐球菌病患者出现了总IgE的升高.结论 CrAg-LFA检测在隐球菌病的诊断中具有重要的临床价值,对隐球菌病患者的临床特征进行分析可指导用药并评估预后.

目的 调查某院心脏大血管外科重症监护病房(下简称心外ICU)聚集性碳青霉烯类耐药肠杆菌科细菌(CRE)感染事件,为医院感染防控提供依据.方法 对南京医科大学第一附属医院心外ICU 2019年6月-7月检出CRE的患者进行流行病学调查,给予控制措施,评价防控效果.结果 该病区在2019年6-7月出现5例患者检出CRE共9株,其中4例患者为医院感染,1例患者为CRE定植,CRE医院感染例次率高于4-5月,差异有统计学意义(P＜0.05).9株CRE中8株病原菌为肺炎克雷伯菌(药敏谱一致),1株为大肠埃细菌.CRE来源分析77.78％(7/9)来自于心外ICU本身.共采集标本60份,包括水池区域24份、A床床单元16份、B床床单元8份、C床床单元4份、护理移动掌上电脑(PAD)和标本传输物流系统各4份.共10个位点的标本检测出CRE,其中CRE显色平板培养出9株CRE,麦康凯平板培养出2株CRE.采取综合控制措施结合针对性加强清洁消毒,复查未检测出CRE.控制后的5个月CRE检出及感染数量下降,效果显著.结论 CRE显色平板结合麦康凯平板在CRE流行病学调查中可更有效且全面的培养出CRE,通过环境采样明确具体定植位点,并进行针对性干预,可高效去除CRE在环境中的定植.

OBJECTIVE:Nosocomial infection caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) is a great threat to severely ill patients. Here we report an outbreak of K. pneumoniae ST15 isolates co-producing KPC-2, CTX-M-15, and SHV-28 in the cardiac surgery intensive care unit (CSICU) of a tertiary hospital.MATERIALS AND METHODS:From November 2019 to August 2020, all non-duplicated CRKP isolates were collected from the CSICU. The VITEK-2 compact system was used for bacterial identification and antimicrobial susceptibility testing. Clinical data were retrieved from electronic case records. All strains were also subjected to antibiotic resistance genes detection. Clonal relationships were analyzed by multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE).RESULTS:A total of 28 non-duplicated CRKP isolates were collected, including 23 strains belonging to ST15 and 5 strains belonging to ST11. All ST15 isolates were susceptible to amikacin, tigecycline, polymyxin B and ceftazidime/avibactam, but resistant to carbapenems, cephalosporins, quinolones, tobramycin and gentamicin. The detection of resistant determinants showed that 21 strains of ST15 CRKP co-harboured blaKPC-2, blaCTX-M-15, blaSHV-28, blaTEM-1, blaOXA-1 and aac(6')-Ib-cr. All the 28 CRKP isolates were classified into five PFGE patterns (A, B, C, D and E), of which type A and B belonged to ST15 and type C, D and E belonged to ST11. PFGE type A was the predominant clonotype of this nosocomial infection and belonged to ST15.CONCLUSION:K. pneumoniae ST15 co-producing KPC-2, CTX-M-15, SHV-28, TEM-1, OXA-1 and aac(6')-Ib-cr is the predominant clone spread in the CSICU. Surveillance and comprehensive infection control measures should be strengthened in clinical practice.

In recent years, increasing evidence has shown that bacteriophages (phages) can inhibit infection caused by multidrug-resistant (MDR) bacteria. Here, we isolated a new phage, named vB_ShiP-A7, using MDR Shigella flexneri as the host. vB_ShiP-A7 is a novel member of Podoviridae, with a latency period of approximately 35 min and a burst size of approximately 100 phage particles/cell. The adsorption rate constant of phage vB_ShiP-A7 to its host S. flexneri was 1.405 × 10–8 mL/min. The vB_ShiP-A7 genome is a linear double-stranded DNA composed of 40,058 bp with 177 bp terminal repeats, encoding 43 putative open reading frames. Comparative genomic analysis demonstrated that the genome sequence of vB_ShiP-A7 is closely related to 15 different phages, which can infect different strains. Mass spectrometry analysis revealed that 12 known proteins and 6 hypothetical proteins exist in the particles of phage vB_ShiP-A7. Our results confirmed that the genome of vB_ShiP-A7 is free of lysogen-related genes, bacterial virulence genes, and antibiotic resistance genes. vB_ShiP-A7 can significantly disrupt the growth of some MDR clinical strains of S. flexneri and Escherichia coli in liquid culture and biofilms in vitro. In addition, vB_ShiP-A7 can reduce the load of S. flexneri by approximately 3–10 folds in an infection model of mice. Therefore, vB_ShiP-A7 is a stable novel phage with the potential to treat infections caused by MDR strains of S. flexneri and E. coli.

目的 评估质谱快速鉴定联合直接药敏试验在肠杆菌目细菌血流感染诊断中的临床应用价值.方法 收集2020年4月—7月南京医科大学第一附属医院镜检为革兰阴性杆菌的血培养阳性培养物,采用基质辅助激光解吸电离飞行时间质谱(MALDI?TOF MS)直接鉴定,根据欧洲药敏试验委员会(EUCAST)发布的阳性血培养液直接快速药敏(RAST)指南对大肠埃希菌和肺炎克雷伯菌进行快速药敏试验和4 h、6 h和8 h药敏结果判读.将鉴定结果与Vitek 2 Compact全自动微生物鉴定和药敏系统结果比较.结果 126例血培养阳性标本中经常规鉴定后共有肠杆菌目细菌104株,质谱快速鉴定检出率为96.2％(100/104).共有90株肠杆菌目细菌进行血培养RAST,包括肺炎克雷伯菌50株和大肠埃希菌40株.肠杆菌目细菌在4 h、6 h、8 h时判读的药敏结果与常规药敏试验结果的符合率分别为76.0％(453/596)、92.4％(551/596)、94.0％(560/596);6 h判读药敏符合率优于4 h(χ2=15.566,P<0.001),与8 h差异无统计学意义(χ2=0.495,P=0.482);肺炎克雷伯菌在4 h、6 h和8 h判读的药敏符合率均高于大肠埃希菌(87.4％vs 48.8％;95.7％vs 87.8％;94.6％vs 93.1％),且在4 h和6 h判读时的差异有统计学意义(χ2=105.839,P<0.001;χ2=12.947,P<0.001);耐碳青霉烯类肠杆菌目细菌(CRE)在4 h、6 h、8 h的检出率差异无统计学意义(χ2=0.528,P=0.768),药敏结果符合率差异无统计学意义(χ2=1.908,P=0.385).结论 肠杆菌目细菌血培养阳性标本质谱快速鉴定准确性高,6 h可作为肠杆菌目细菌RAST药敏判读的最佳时间点,4 h即可判断是否存在CRE感染并推测其整体抗菌谱.

Background: The epidemiology of Clostridioides difficile infection(CDI) in China is different from western countries and the characteristics of CDI among inflammatory bowel disease (IBD) in China may be unique. The aim of this study was to investigate the molecular epidemiology and to find out the risk factors of CDI among IBD inpatients in Jiangsu Province, China. Methods: Patients with IBD admitted to the First Affiliated Hospital with Nanjing Medical University from August 2013 to December 2018 were enrolled. IBD patients were matched with non IBD patients according to age and gender. Diarrhea samples were sent for CDI diagnosis and the molecular epidemiology investigation was performed. Finally, patients’ information was collected and logistic regression analysis was performed to analyze the independent risk factors of CDI in IBD patients. Results: In this study, the incidence of CDI in IBD patients was much higher than that in non IBD patients (24.6% vs. 9.0%) and community acquired infection was the main kind. The predominant type of epidemic strain of C. difficile in this study was ST54. The shorter history of IBD and recent use of quinolone antibiotics were independent risk factors for CDI among diarrhea patients with IBD. Conclusion: If the duration of IBD is within one year or quinolone antibiotics have been used recently, clinicians should consider the possibility of IBD patients complicated with CDI and adjust the treatment plan.