ObjectiveTo explore the epidemiological characteristics of EnE and the molecular traits of the Klebsiella pneumoniae(KP).MethodsWe revived 40 strains of the KP, utilized whole-genome sequencing technology to understand their molecular epidemiological characteristics.ResultsAmong 103 EnE patients (69.90% male, 56.31% left eye), vision loss was the chief complaint (96.12%). Extraocular infections were present in 63.11% of patients, most commonly liver abscess (45.00%). KP comprised 81.82% of culture-positive cases. Among 40 KP strains analyzed, 82.5% were hypervirulent KP (hvKP). Phylogenetic analysis revealed the dominance of ST23-K1 lineages. Intravitreal injection was associated with a significantly reduced risk of poor visual prognosis (RR = 0.061, 95%CI: 0.005–0.442) and emerged as an independent protective factor.ConclusionsThe incidence of EnE showed an increasing trend, primarily driven by hvKP ST23-K1. A comprehensive search for systemic infection foci, particularly liver abscesses, is essential. A negative string test result does not exclude hvKP. Timely intravitreal antimicrobial injection is a critical modifiable factor for improving visual prognosis.

The incidence of infections caused by rare pathogens has increased in recent years. This necessitates the development of effective diagnostic and therapeutic approaches. In this study, we report the first documented case of Aspergillus steynii-induced pulmonary infection in humans. We evaluated the morphological and molecular characteristics of this fungus to elucidate its role in human infections. A 47-year-old woman with immunosuppression after bone marrow transplantation developed symptoms of pulmonary infection. The pathogen was identified as A. steynii through culture techniques, microscopy, mass spectrometry, multigene molecular identification, and whole-genome sequencing. Antifungal susceptibility testing was performed, and comparative genomic analysis was conducted to assess the phylogenetic relationship and genomic characteristics of A. steynii and other pathogenic Aspergillus species. Genomic analysis revealed a high degree of similarity with other pathogenic Aspergillus species. Furthermore, we identified 470 unique gene families primarily associated with ABC transporter pathways linked to multidrug resistance. The strain was sensitive to triazoles and echinocandins but exhibited elevated minimum inhibitory concentrations (MICs) for amphotericin B, flucytosine, and fluconazole. In addition, multiple potential drug resistance genes were identified, indicating the potential for multidrug resistance. The emergence of A. steynii in humans poses new clinical challenges and risks, including cross-species transmission and multidrug resistance. The potential for A. steynii infections, particularly in immunosuppressed patients, highlights the importance of early diagnosis and timely intervention to reduce the risk of misdiagnosis or delayed treatment. Thus, our findings have the potential to improve the clinical and differential diagnosis of this infection and facilitate the development of effective therapeutic approaches.

Background Invasive pulmonary fungal infections (IPFIs) pose significant diagnostic challenges, particularly in immunocompromised patients. Accurate and timely diagnosis is crucial to improve outcomes. While metagenomic next-generation sequencing (mNGS) is widely utilized, it is expensive and affected by host DNA interference. Targeted next-generation sequencing (tNGS) offers a cost-effective and efficient alternative for fungal pathogen detection. Methods We developed the Fi-tNGS assay, a targeted next-generation sequencing method, specifically designed to detect 64 fungal species. Analytical performance was validated by assessing its limit of detection (LoD), reproducibility, and resistance to host DNA interference. Subsequently, a prospective clinical study was conducted, enrolling 104 patients with suspected IPFIs. Clinical diagnostic performance was evaluated by comparing Fi-tNGS, mNGS, and conventional microbial culture against a comprehensive diagnostic standard. Results Fi-tNGS detected 109 pathogens, compared to 110 for mNGS and 77 for culture. The sensitivity and specificity of tNGS were 89.7% and 94.2%, respectively, outperforming culture (65.8% sensitivity, 100% specificity). Combining culture with tNGS or mNGS significantly improved sensitivity to 94.8% and 94.0%, respectively. These findings demonstrate the added diagnostic value of NGS methods for IPFIs. Conclusions tNGS provides accurate and efficient fungal pathogen detection, with sensitivity comparable to mNGS and superior to culture. Its cost-effectiveness and shorter turnaround time highlight its potential as a practical tool for the rapid and precise diagnosis of IPFIs in clinical settings.

Objective:This study aimed to investigate the clinical and microbiological characteristics of invasive and noninvasive Klebsiella pneumoniae liver abscesses (KPLAs) and elucidate the risk factors for invasive KPLA. Methods:We conducted a case-control study involving 50 patients with invasive KPLA and 50 patients with noninvasive KPLA from two medical centers between 2019 and 2024. Demographic and clinical data were collected for all patients from the hospital medical records system. Univariate and multivariate analyses were then performed to compare the characteristics of invasive and noninvasive KPLAs. In addition, antimicrobial resistance testing and whole-genome sequencing were performed for 50 K. pneumoniae strains from one medical center. Results:The comparison of patients with invasive and noninvasive KPLAs revealed that diabetes mellitus, smoking history, drinking history, smaller maximum diameter of abscess, neutrophil count, fasting blood glucose, blood urea nitrogen, and length of hospital stay were independent risk factors for invasive KPLA. Phylogenetic analysis revealed that K. pneumoniae strains from patients with invasive and noninvasive KPLAs were intermingled. ST23 with K1 serotype was the predominant sequence type (66.0%), followed by ST65 with K2 serotype. Multilocus sequence types, capsular serotypes, antimicrobial resistance patterns, virulence genes, and SNPs of K. pneumoniae strains isolated from patients with invasive and noninvasive KPLAs showed no significant differences between the two patient groups. Conclusion:Overall, our results indicate that patients' contaminant conditions, such as poor glycemic control, smoking history, and drinking history, rather than bacterial virulence, contribute to the development of invasive KPLA.

Bloodstream Infection(BSI) are one of the leading causes of infection-related mortality worldwide. However, epidemiological data related to BSI in China remain very limited. Based on the Global Burden of Disease(GBD) database, a systematic analysis was conducted on the epidemic trends, pathogen spectrum, and the current status of Antimicrobial Resistance(AMR) related to BSI in China for the year 2021. Additionally, an Autoregressive Integrated Moving Average(ARIMA) time series model was constructed to predict the trend of the disease burden associated with BSI in China from 2022 to 2035. In terms of pathogens, the top five pathogens causing deaths due to BSI in China are as follows: Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. There are significant differences in the pathogens causing BSI across different age groups. The disease burden is heaviest in the elderly population aged 70 and above. Among children under five years old, Staphylococcus aureus, Streptococcus pneumoniae, and Candida species are predominant. From 1990 to 2021, although there has been a gradual decline in mortality rates due to BSI across different age groups (with an approximately 52.4

The global rate of Amphotericin B (AmB) resistance in Candida auris has surpassed 12%. However, there is limited data on available clinical treatments and microevolutionary analyses concerning reduced AmB sensitivity. In this study, we collected 18 C. auris isolates from five patients between 2019 and 2022. We employed clinical data mining, genomic, and transcriptomic analyses to identify genetic evolutionary features linked to reduced AmB sensitivity in these isolates during clinical treatment. We identified six isolates with a minimum inhibitory concentration (MIC) of AmB below 0.5 µg/mL (AmB0.5) and 12 isolates with an AmB-MIC of 1 µg/mL (AmB1) or ≥ 2 µg/mL (AmB2). All five patients received 24-hour AmB (5 mg/L) bladder irrigation treatment. Evolutionary analyses revealed an ERG3 (c923t) mutation in AmB1 C. auris. Additionally, AmB2 C. auris was found to contain a t2831c mutation in the RAD2 gene. In the AmB1 group, membrane lipid-related gene expression (ERG1, ERG2, ERG13, and ERG24) was upregulated, while in the AmB2 group, expression of DNA-related genes (e.g. DNA2 and PRI1) was up-regulated. In a series of C.auris strains with reduced susceptibility to AmB, five key genes were identified: two upregulated (IFF9 and PGA6) and three downregulated (HGT7, HGT13,and PRI32). In this study, we demonstrate the microevolution of reduced AmB sensitivity in vivo and further elucidate the relationship between reduced AmB sensitivity and low-concentration AmB bladder irrigation. These findings offer new insights into potential antifungal drug targets and clinical markers for the "super fungus", C. auris.

Background: BSI are one of the leading causes of infection-related mortality worldwide. However, epidemiological data related to BSI in China remain very limited. Methods: Based on the GBD database, a systematic analysis was conducted on the epidemic trends, pathogen spectrum, and the current status of AMR related to BSI in China for the year 2021. Additionally, an ARIMA time series model was constructed to predict the trend of the disease burden associated with BSI in China from 2022 to 2035. Results: In terms of pathogens, the top five pathogens causing deaths due to BSI in China are as follows: Staphylococcus aureus, Escherichia coli , Streptococcus pneumoniae , Pseudomonas aeruginosa , and Acinetobacter baumannii . There are significant differences in the pathogens causing BSI across different age groups. The disease burden is heaviest in the elderly population aged 70 and above. Among children under five years old, Staphylococcus aureus, Streptococcus pneumoniae, and Candida species are predominant. From 1990 to 2021, there was a gradual decline in the mortality rate among BSI patients across different age groups. However, as age increases, the burden of BSI gradually increases, particularly in individuals aged 70 and above, where the disease burden is significantly higher compared to other populations. Conclusion: From 1990 to 2035, the overall mortality rate of BSI is gradually declining. However, the future changes in BSI mortality rates will primarily be influenced by population size and changes in age structure. BSI and its associated health issues remain significant challenges that require ongoing attention.

INTRODUCTION:Drug resistance to echinocandins, first-line drugs used to treat Candida auris infection, is rapidly emerging. However, the accumulation of mutations in genes other than FKS1 (before an isolate develops to resistance via FKS1 mutations), remains poorly understood. Methods: Four clinical cases and 29 isolates associated with the incremental process of echinocandin resistance were collected and analyzed using antifungal drug susceptibility testing and genome sequencing to assess the evolution of echinocandin resistance. FINDINGS:Six echinocandin minimum inhibitory concentration (MIC)-elevated C. auris strains and seven resistant strains were isolated from the urinary system of patients receiving echinocandin treatment. Meanwhile, phylogenetic analyses illustrated that the echinocandin-resistant strains were closely related to other strains in the same patient. Genomic data revealed that the echinocandin-resistant strains had FKS1 mutations. Furthermore, three categories (ECN-S/E/R) of non-synonymous mutant SNP genes (such as RBR3, IFF6, MKC1, MPH1, RAD2, and MYO1) in C. auris appeared to be associated with the three-stage-evolutionary model of echinocandin resistance in C. glabrata: cell wall stress, drug adaptation, and genetic escape (FKS mutation). INTERPRETATION:Echinocandin-resistant C. auris undergoes spatial and temporal phase changes closely related to echinocandin exposure, particularly in the urinary system. These findings suggest that FKS1 mutations mediate an evolutionary accumulation of echinocandin resistance followed by modulation of chromosome remodelling and DNA repair processes that ultimately lead to FKS1 hot spot mutations and the development of drug resistance. This study provides an in-depth exploration of the molecular pathways involved in the evolution of Candida auris echinocandin resistance.

目的 了解2015-2021年国内主要地区医疗机构临床分离链球菌属细菌对抗菌药物的耐药性.方法 对国内主要地区51所医院临床分离的链球菌属采用纸片扩散法(K-B法)或E试验方法或自动化商业药敏测试系统,按CHINET统一监测方案进行抗菌药物敏感性试验,并按2022年CLSI折点标准统计分析总结.结果 2015-2021年共收集到89 684株链球菌属细菌,包括肺炎链球菌35 254株(39.3％),β溶血链球菌42 563株(47.6％),草绿色链球菌11 767株(13.1％).42 563株β溶血链球菌中A群、B群以及未能鉴定分型的链球菌分别为39.8％、52.8％、7.4％.非脑脊液样本儿童患者分离的25 552株肺炎链球菌中青霉类敏感、中介、耐药(PSSP、PISP、PRSP)菌株的检出率分别为86.2％～97.7％、1.7％～6.5％和0.6％～7.3％,在成人患者7 997株中的检出率分别为92.0％～95.1％、3.8％～5.3％和1.4％～2.7％.脑脊液分离肺炎链球菌PRSP占比81.2％.无论是脑脊液或非脑脊液分离儿童和成人的肺炎链球菌对红霉素和克林霉素高度耐药,耐药率均在90％以上.β溶血链球菌对青霉素和头孢曲松均敏感,未发现耐药菌株;草绿色链球菌对青霉素的耐药率为5.7％～8.5％.46.3％～55.0％的B群β溶血链球菌对左氧氟沙星耐药,其他链球菌对左氧氟沙星仍十分敏感.链球菌属细菌中未发现利奈唑胺和万古霉素的耐药株.结论 青霉素仍是链球菌属非中枢神经系统感染的首选药物.链球菌属持续对红霉素、克林霉素高浓度耐药.

目的 了解2015-2021年我国不同地区51家医院分离的不动杆菌属分布情况和耐药变迁趋势.方法 按CHINET耐药监测方案,采用纸片扩散法或自动化仪器法对收集的菌株进行药敏试验,按CLSI 2021 年版标准判读药敏结果,采用WHONET 5.6 软件进行数据分析.结果 在此期间共分离到不动杆菌属 143 393 株,其中鲍曼不动杆菌是最常见的菌种,占所有不动杆菌属的 89.6%.呼吸道样本分离最常见的是不动杆菌属,占所有样本分离株的 73.0%.94.0%的菌株分离自住院患者,其中ICU分离的菌株占 35.5%.除米诺环素、替加环素和多黏菌素B外,不动杆菌属对其他抗菌药物如β内酰胺类、氨基糖苷类和氟喹诺酮类等耐药率较高.不同等级医院和不同科室分离的不动杆菌属对抗菌药物的耐药率存在差异.2015-2021 年鲍曼不动杆菌对头孢哌酮-舒巴坦和哌拉西林-他唑巴坦耐药率呈现上升趋势,而对替加环素和米诺环素的耐药率呈现下降趋势.碳青霉烯类耐药的鲍曼不动杆菌分离率较高,在三级医院达75.2%.结论 不动杆菌属是医院感染的重要病原菌,对临床常用抗菌药物呈现较高的耐药性.对于多重耐药不动杆菌属感染,可以采用多黏菌素B、替加环素和米诺环素等抗菌药物治疗.

Background: Intracranial infection by Acinetobacter baumannii (A. baumannii) after neurosurgery has always been a difficult problem for neurosurgeons. This study analyzed risk factors that discriminated A. baumannii from other bacteria causing intracranial infection after neurosurgery. It also examined the differences in the cerebrospinal fluid (CSF) indexes to explore their value in the early diagnosis of intracranial infection by A. baumannii.Methods: We retrospectively reviewed ten years (January 2011 to May 2021) of postoperative central nervous system (CNS) infections in the First Hospital of China Medical University. According to the pathogen, CNS infections were divided into A. baumannii group and other species of bacteria group. We collected clinical and laboratory information of patients, and statistical analysis was performed with SPSS 26.0. Risk factors were screened by univariate analysis, and independent risk factors were screened by multiple logistic regression analysis. Finally, CSF-Pro, CSF-Glu, CSF-Cl, CSF-monocytes (%), CSF-multinucleated cells (%) levels, and CSF multinucleated cells%/monocytes% in the different groups were analyzed.Results: A total of 155 patients were included, 62 cases (40%) of intracranial infection by A. baumannii and 93 cases (60%) by other species of bacteria. The analysis showed that indwelling nasogastric tubes (P<0.001, OR = 4.231), indwelling peripherally inserted central catheters (PICCs) (P = 0.041, OR = 2.765), and CSF drainage obstruction (P = 0.003, OR = 3.765) were independent risk factors for intracranial infection by A. baumannii after neurosurgery. Indwelling ventriculoperitoneal shunt (VPS) was a protective factor (P = 0.033, OR = 0.22). In addition, compared with other bacterial groups, the A. baumannii group had higher CSF-pro and CSF-multinucleated cells (%) levels and lower CSF-Glu and CSF-monocytes (%) levels, and the difference was statistically significant (P < 0.01).Conclusions: Our results elucidate risk factors and differences in CSF indexes for intracranial infection by A. baumannii after neurosurgery that could be detected and prevented early to reduce mortality.

目的 探讨草绿色链球菌引起感染性心内膜炎(IE)的病原学特征和临床特点.方法 选取2016年6月至2021年12月中国医科大学附属第一医院收治的57例血培养阳性IE患者的临床资料.分析其病原菌构成及草绿色链球菌的耐药情况;将患者分为草绿色链球菌组和非草绿色链球菌组,对2组临床特点进行对比.结果 血培养分离病原菌,草绿色链球菌32株,占56.1％,其中戈登链球菌株数最多(11株).草绿色链球菌耐药性分析结果显示,草绿色链球菌对红霉素和阿奇霉素的耐药性最高,分别为81.3％和78.1％;未见青霉素G、万古霉素、利奈唑胺耐药菌株,青霉素G中介率达28.1％.临床特点分析结果显示,2组先天性心脏病(非主动脉二叶畸形先心病)、入院前病程、二尖瓣赘生物以及心功能不全结果有统计学差异(P＜0.05).结论 草绿色链球菌是IE的最常见致病菌;青霉素仍是经验治疗草绿色链球菌IE的首选药物;病程长、生长二尖瓣赘生物和未发生心功能不全的临床特点对IE患者发生草绿色链球菌感染的病原体评估具有一定的提示作用.

IntroductionCandida auris is a newly emerging pathogenic fungus of global concern and has been defined by the World Health Organization (WHO) as a member of the critical group of the most health-threatening fungi. MethodsThis study reveals and reports for the first time that a rough morphotype C. auris strain causes urinary tract infections in non-intensive care unit (ICU) inpatients. Furthermore, the morphology, the scanning electronmicroscopy (SEM), Whole-genome resequencing and RNA sequencing of C. auris possessing rough morphotype colonies compared to their smooth morphotype counterparts. ResultsThe newly identified phenotypic variation of C. auris appears round, convex, dry, and burr-like with a rough texture. SEM shows that rough type C. auris has a rough and uneven colony surface with radial wrinkles and irregular spore arrangement. Cells of the rough morphotype C. auris naturally aggregate into clusters with tight connections in the liquid, and it seems that the cell division is incomplete. A genome-wide analysis of the rough type C. auris confirmed its genetic association with the smooth type of C. auris prevalent in China (Shenyang) two years ago; however, single nucleotide polymorphism (SNP) mutations of five genes (ACE2, IFF6, RER2, UTP20, and CaO19.5847) were identified more recently. RNA-seq revealed IFF2/HYR3, DAL5, PSA31, and SIT1 were notably up-regulated, while multiple cell wall-associated genes (ALS1, MNN1, PUL1, DSE1, SCW11, PGA38, RBE1, FGR41, BGLI, GIT3, CEP3, and SAP2) were consistently down-regulated in rough morphotype C. auris. DiscussionThe rough phenotypic variation of C. auris is likely to be related to the structural and functional changes in cell wall proteins. This novel rough morphotype C. auris will provide a basis for further studies concerning the evolutionary characteristics of C. auris.

Introduction:Candida palmioleophila is a rare human pathogenic fungus, which has been poorly characterized at the genome level. In this study, we reported the first fatal case of C. palmioleophila infection in China and investigate the microevolution of C. palmioleophila in the human host environment.Methods:A series of C. palmioleophila stains were collected from the patient at different time points for routine microbial and drug sensitivity testing. The first C. palmioleophila isolate 07202534 was identified by de novo whole genome sequencing. The in vitro and in vivo genetic evolutionary characteristics of C. palmioleophila were discussed based on the analysis of bioinformatics data.Results:The six C. palmioleophila isolates displayed dose-dependent sensitivity to fluconazole. The C. palmioleophila genome contained homologous genes such as CDR1 and MDR1, which were recognized to be related to azole resistance. In addition, amino acid variation was detected at F105L and other important sites of ERG11. In addition, the mean divergence time between C. palmioleophila and Scheffersomyces stipites CBS 6054 was 406.04 million years, indicating that C. palmioleophila originated earlier than its closest relative. In addition, the six strains of C. palmioleophila isolated form the patient had higher homology and fewer mutation sites, which indicated the stability in C. palmioleophila genome. We also found that C. palmioleophila had a wide natural niche and may evolve slowly.Discussion:We believe that this study will contribute to improve our understanding of the genetic evolution, pathogenicity, and drug resistance of C. palmioleophila and will aid in the prevention and control of its spread.

目的 探讨2018至2020年沈阳地区肠杆菌目细菌分布及其耐药率,了解本地区肠杆菌目细菌分布及其耐药情况.方法 选取沈阳市2018年1月至2020年12月参加全国细菌耐药监测网?(CARSS)?的医院,按照CARSS网技术方案进行菌株鉴定及药物敏感性试验,采用Whonet?5.6软件对数据进行分析.结果 2018至2020年共分离细菌40821株.其中,大肠埃希菌占38.8％,肺炎克雷伯菌占32.5％.主要分离自血液?(32.7％)、尿液?(34.5％)?及痰?(11.5％).大肠埃希菌超广谱β-内酰胺酶?(ESBLs)?的检出率痰最高,血液次之,尿液最低;?肺炎克雷伯菌ESBLs的检出率尿液最高,血液次之,痰最低.大肠埃希菌对亚胺培南、美罗培南的耐药率均为2.1％,肺炎克雷伯菌对亚胺培南、美罗培南耐药率分别为10％和11.6％.结论 本地区肠杆菌目细菌对多种抗菌药物存在不同程度耐药,应定期监测本地区耐药情况,为合理选用抗菌药物提供依据.

Objective To investigate the susceptibility and resistance of clinical isolates collected from hospitals in several regions of China.Methods These clinical strains were collected from 51 hospitals.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were analyzed according to CLSI 2021 breakpoints.Results A total of 301 917 clinical isolates were collected from January to December 2021,of which gram negative organisms and gram positive cocci accounted for 71.4% and 28.6% respectively.Methicillin-resistant strains in S.aureus （MRSA）,S.epidermidis and other Staphylococcus species （except S.pseudintermedius and S.schleiferi） accounted for 30.0%,80.7% and 77.7% respectively.MR strains showed much higher resistance rates to most of other antimicrobial agents than MS strains.However,92.4% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole,while 90.7% of MRSE strains were susceptible to rifampin.No staphylococcal strains were found resistant to vancomycin.E.faecalis strains demonstrated much lower resistance rates to most of the drugs tested than E.faecium.A few strains of both Enterococcus species were resistant to vancomycin.The prevalence of PSSP was 97.8% in the non-meningitis S.pneumoniae isolates from children and 95.1% in the non-meningitis S.pneumoniae isolates from adults.The Enterobacterales strains were still highly susceptible to carbapenems.Overall,less than 13% of these strains were resistant to carbapenems.K.pneumoniae isolates showed increasing resistance rates to imipenem and meropenem,from 3.0% and 2.9% in 2005 to 25.0% and 26.3% in 2018.However,the resistance rates of Klebsiella pneumoniae to imipenem and meropenem decreased since 2019.About 65.6% and 66.5% of Acinetobacter spp.were resistant to imipenem and meropenem,respectively.Overall,23.0% and 18.9% of the Pseudomonas aeruginosa isolates were resistant to imipenem and meropenem,respectively.Conclusions Bacterial resistance to commonly used antibiotics is still on the rise.However,the prevalence of carbapenem-resistant K.pneumoniae and P.aeruginosa is decreasing in recent years.It is suggested that strengthening the monitoring of bacterial resistance and multidisciplinary teamwork are effective in controlling the spread of drug-resistant bacteria.

Candida auris is an emerging pathogenic fungal species found worldwide. Since April 2016, C. auris colonization/infection cases have been found in a general hospital in Shenyang, China. The genome-based phylogenetic studies of these isolates remain undefined. In the current study, the microbiological characteristics and antifungal susceptibility of these C. auris isolates, which were collected in Shenyang during the three-year period (2016-2018), were investigated. Whole-genome sequencing was applied to investigate the genetic variation and molecular epidemiological characteristics. A total of 93 C. auris isolates, including 92 clinical isolates and 1 environmental screening isolate were identified. Among the investigated wards, the C. auris cases were the most prevalent (97.4%, 37/38) in four intensive care units (ICUs). The Shenyang isolates carrying the VF125AL mutation in the key drug-resistance gene ERG11 were mainly fluconazole resistant and formed a distinct subclade under the South African clade according to the phylogenetic and population structural analyses. In addition, the Shenyang subclade was found to be closely related to the British subclade in the aspect of genetic distance. As a conclusion, this study provides an important clue for revealing the origin of C. auris found in Shenyang and could also contribute to improve the understanding of the epidemiological characteristics of C. auris worldwide.

目的 目前我国侵袭性酵母菌发病率呈明显上升趋势,本研究旨在分析中国医院侵袭性真菌监测网(China Hos-pital Invasive Fungal Surveillance Net,CHIF-NET)2012年流行病学数据.方法 研究数据来自中国的22家三级医院,共收集到1619株念珠菌.研究采用基质辅助激光解析电离飞行时间质谱,结合ITS测序技术进行菌种鉴定,用美国临床和实验室标准协会(CLSI)推荐的纸片扩散法(kirby-Bauer,K-B)测定氟康唑和伏立康唑药物敏感性.结果 本研究标本类型中来自于外周血液标本的菌株626株,占38.67％,来自其他部位(包括腹水、脓肿、静脉导管、脑脊液、肺泡灌洗液、胆汁、胸水、组织、关节积液和胃液)标本993株,占61.33％,其中分离自腹水的菌株354株占21.87％,分离自脓肿的菌株159株占9.82％,分离自其余标本类型的菌株数量较少(＜8％).1619株念珠菌分离自除血液以外其他部位的菌种,以白念珠菌为主(491株占49.45％),其次为热带念珠菌(164株占16.52％),其余种数量较少(＜11％).检出侵袭性酵母菌患者中男性1006株占62.1％,女性612株占37.8％,年龄范围0～94岁,其中≥65岁患者498株占30.76％.在侵袭性念珠菌感染中,绝大部分白念珠菌对氟康唑和伏立康唑敏感[耐药率(R)＜1％],其次为近平滑念珠菌(R＜6％)及热带念珠菌(R＜7％).另外,不同念珠菌在不同的医疗机构有分布差异.结论 中国侵袭性酵母菌感染的分布与多种因素有关,包括感染部位、地域、年龄等,故仍需持续监测.

A striking feature of pathogenic Candida species is morphological plasticity that facilitates environmental adaptation and host infection. Candida auris is an emerging multidrug-resistant fungal pathogen first described in Japan in 2009. In this study, we demonstrate that clinical isolates of C. auris have multiple colony and cellular morphologies including the yeast, filamentous, aggregated, and elongated forms. This phenotypic diversity has been observed in eight clinical isolates of C. auris representing four major genetic clades, suggesting that it could be a general characteristic. We further demonstrate that different cell types of C. auris exhibit distinct antifungal resistance and virulence properties in a Galleria mellonella infection model. Our findings imply that morphological diversity is an important biological feature of C. auris and could be a contributor to its emergence and rapid prevalence worldwide.LAY SUMMARY:Candida auris is an emerging multidrug-resistant fungal pathogen. Morphological analyses indicate that filamentation is a general feature of clinical isolates of C. auris. This ability is associated with antifungal resistance and virulence.

目的 探讨2019年辽宁地区血流感染病原菌分布及其耐药情况.方法 选取辽宁省2019年1月至12月33家医院血培养分离株,按照全国细菌耐药监测网(CARSS)技术方案进行菌株鉴定及药物敏感性试验,采用Whonet 5.6软件对数据进行分析.结果 2019年共分离细菌6584株,其中革兰氏阳性菌1508株(占22.8％),革兰氏阴性菌5082株(占77.2％),常见分离菌为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、屎肠球菌和鲍曼不动杆菌.耐甲氧西林金黄色葡萄球菌(MRSA)检出率为18.4％.大肠埃希菌、肺炎克雷伯菌对三、四代头孢菌素耐药率分别为59.8％和44.9％,耐碳青霉烯大肠埃希菌、肺炎克雷伯菌的检出率分别为2.7％和12.9％.鲍曼不动杆菌对亚胺培南、美罗培南的耐药率分别为73.7％和71.6％.结论 辽宁地区血液中分离的病原菌存在不同程度耐药,应定期监测病原菌谱及耐药状况,为合理选用抗菌药物提供依据.