ObjectiveTo investigate the clinical and health economic impacts of individual workflow components. The effects of phased process optimizations were quantified using empirical data.MethodsFrom August 2023 to October 2024, the outcomes before and after workflow optimization were compared. The control group comprised patients processed under conventional protocols, while the experimental group included those managed with optimized workflows.ResultsPhase I revealed significant temporal reductions through MALDI-TOF enhanced biofilm identification. The Gram-stain reporting time decreased from 33.3 h to 25.7 h (P < 0.05), species identification from 72.5 h to 42.6 h (P < 0.05). Phase II implementation of 24/7 processing via BacT/Alert Virtuo achieved marked improvements across all metrics, namely Gram-stain (37.4 h vs, 17.9 h), identification (42.6 h vs. 36.4 h) and AST reporting (68.4 h vs. 63.4 h) (all P < 0.05). Phase III optimization through Advanced Expert System (AES)-enabled automated preliminary AST reporting during off-hours significantly accelerated therapeutic guidance (63.4 h vs. 47.2 h, P < 0.05).ConclusionQuantitative analysis of these optimizations elucidated their differential impacts on blood culture workflows and prognostic determinants. These findings advocate for laboratory innovation as a driver of antimicrobial stewardship and precision medicine for management of microbial bloodstream infections.

PurposeThe present study aimed to investigate the overall clinical and molecular characteristics of hypermucoviscous Klebsiella pneumoniae (hmKP) infection in Yantai, China.MethodsA retrospective study was conducted in Yantai Yuhuangding Hospital from October 2024 to December 2024. As the inclusion criterion, all clinical isolates of K. pneumoniae were analyzed by a string test, in which an inoculation loop was used to generate sticky strings of >5 mm length from a K. pneumoniae colony. The isolates showing a positive test result were designated as hmKP. The clinical characteristics of patients with hmKP infection were retrospectively reviewed. Antibiotic susceptibility tests were performed for all hmKP isolates, and whole-genome sequencing studies were conducted for these isolates to determine their epidemiological characteristics.ResultsA total of 88 unique hmKP isolates were collected from 485 strains of K. pneumoniae, accounting for 18.1%. Patients with hmKP infection were distributed across different age groups, clinical departments, and specimen types. Whole-genome sequencing revealed the predominance of K1/ST23 and K2/ST65 clones in the hmKP group. Virulence determinants such as rmpA, rmpA2, iuc, iro, peg-344, and clb were commonly present in the hmKP isolates. All hmKP isolates carried multiple resistance genes; however, the antibiotic resistance phenotype did not fully match with the resistance genes. Additionally, two hypervirulent carbapenem-resistant Klebsiella pneumoniae(HCKP) strains were detected in this study.ConclusionHmKP infection is prevalent in Yantai, China, with dominant K1/ST23 and K2/ST65 clones carrying prevalent virulence genes. Vigilance is required to prevent the spread of HCKP in clinical practice.

PurposeTo evaluate the performance of targeted next-generation sequencing (tNGS) in pathogen detection in acute lower respiratory infection.MethodsThe retrospective study was conducted between July 2023 and May 2024 at the Yantai Yuhuangding Hospital. Patients with acute lower respiratory infections were included. Qualified sputum or bronchoalveolar lavage fluid samples were collected for tNGS and conventional microbiological tests(CMTs), including culture, staining, polymerase chain reaction (PCR), and reverse transcription-PCR (RT-PCR). The time required and cost were counted.ResultsA total of 968 patients were enrolled. Study analysis discovered 1,019 strains of bacteria, 259 strains of fungi, 302 strains of viruses, 76 strains of Mycoplasma pneumoniae, and two strains of Chlamydia psittaci using tNGS. In addition, tNGS also identified 39 mecA, four KPC, 19 NDM, and two OXA-48 genes. The positive rates for bacteria, fungi, viruses, mycoplasma, and chlamydia obtained using tNGS were significantly higher than those determined using traditional methods. Among them, tNGS showed high consistence with mycobacterium DNA test, influenza A (H1N1) virus nucleic acid test and COVID-19 nucleic acid test. Poor consistency between drug resistance genes and bacterial resistance phenotypes was found. In addition, tNGS also had advantages over traditional methods in terms of detection time and cost.ConclusionCompared to traditional methods, tNGS had higher sensitivity in detecting bacteria, fungi, viruses, and other pathogens in acute lower respiratory infection, and also had the advantages of timeliness and cost-effectiveness, making it a promising method for guiding clinical diagnosis.

Our objective was to evaluate the ramifications of the 2019 coronavirus disease (COVID-19) pandemic on the microbial profile and antimicrobial resistance patterns of bacteria isolated from cerebrospinal fluid (CSF) specimens of patients with bacterial meningitis. We conducted a retrospective analysis of laboratory results and clinical records about positive CSF cultures reported by the SPARSS network from 2017 to 2023. The study covered three distinct periods: January 2017 to December 2019 (before the COVID-19 pandemic), January 2020 to December 2022 (during the COVID-19 pandemic), and January 2023 to December 2023 (after the COVID-19 pandemic), with a total of 5793 CSF isolates collected. Notably, the proportion of male patients (61.3%) was higher than that of females. After COVID-19, we observed a notable shift in the seasonal peak of CSF pathogens, with a delay of approximately 3 months. Remarkable alterations were evident in both pediatric and adult CSF isolate profiles. In children, the predominant pathogens included coagulase-negative Staphylococcus (CoNS), Streptococcus pneumonia, and Escherichia coli. Notably. After COVID-19, there was a significant decrease in the proportion of CoNS (p = 0.0039) and a notable increase in E. coli (p = 0.0067). In adults, the top three pathogens were CoNS, Acinetobacter baumannii, and Klebsiella pneumoniae. After the pandemic, we observed a significant reduction in the prevalence of A. baumannii (p = 0.0059), while the proportions of K. pneumoniae, Pseudomonas aeruginosa, Enterobacter cloacae, and Enterococcus faecalis increased significantly (p < 0.05). Additionally, among multidrug-resistant bacteria, the detection rate of carbapenem-resistant E. coli escalated (p = 0.0375). Antimicrobial susceptibility analysis indicated a declining trend in resistance rates for CoNS and A. baumannii to certain antibiotics following the pandemic. Conversely, resistance to imipenem in A. baumannii increased. In conclusion, the COVID-19 pandemic has significantly influenced the composition, antimicrobial resistance patterns, and epidemiological dynamics of CSF-isolated bacteria in Shandong province. To effectively address these changes, ongoing and dynamic surveillance of pathogen trends and antimicrobial resistance rate is essential.

Purpose:Burkholderia is a conditioned pathogen in the medical setting and mainly affects patients with cystic fibrosis. We found co-infection with Burkholderia cepacia complex (Bcc) in many patients with respiratory tract infections, including H7N9 and COVID-19. However, previous studies have not focused on co-infections with BCC and respiratory viruses. Therefore, this study attempted to clarify the evolution of COVID-19-Bcc and H7N9-Bcc in terms of genetic background, antibiotic resistance, and virulence phenotypes. Methods:This study retrospectively collected 49 Bcc isolated from patients with H7N9 and COVID-19 in a tertiary hospital of Zhejiang Province, of which 42 isolates were isolated from patients with H7N9, seven isolates were isolated from patients with COVID-19. The collected isolates were tested for antibiotic susceptibility, Galleria mellonella infection model, and whole-genome COVID-19-Bcc Characterization. Results:The test results of 49 strains of Bcc showed that the strains isolated from COVID-19 patients accounted for 57.1% of multidrug-resistance resistant strains. Statistical analysis of the median lethal time of G. mellonella showed that the median fatal time for COVID-19-Bcc was shorter and more virulent than that of H7N9-Bcc (P<0.05). The results of phylogenetic analysis indicated that COVID-19-Bcc may have evolved from H7N9-Bcc. Conclusion:In this study, co-infection with BCC in many patients with respiratory tract infections, including H7N9 and COVID-19, was first identified and clarified that COVID-19-Bcc may have evolved from H7N9-Bcc and has the characteristics of hypervirulence and multidrug resistance.

Microorganisms living with higher organisms are valuable sources of bioactive substances like antibiotics, which could assist them competing for more and better nutrients or space. Here, we focused on a marine animal-associated bacterium, ‘Aliisedimentitalea scapharcae’ KCTC 42119T, which was isolated from ark shell collected from Gang-Jin bay of South Korea. We evaluated its biosynthetic potentials of medicinal secondary metabolites by de novo genome sequencing. The complete genome of strain KCTC 42119T sequenced is 5,083,900 bp and is comprised of one circular chromosome and four circular plasmids. Functional genome analysis by antiSMASH v7.1.0 showed that there are nine biosynthetic gene clusters encoded on the chromosome. The annotated secondary metabolites include antibiotic corynecin, cytoprotective ectoine and antineoplastic ET-743 (Yondelis), which suggested strain KCTC 42119T possesses potentials to synthesize a series of secondary metabolites of pharmaceutical utility. Genome analysis of ‘A. scapharcae’ also provides more insights into mining bioactive substances from animal-associated microorganisms.

肺炎克雷伯菌是临床常见的条件致病菌,根据其毒力差异,将其分为经典肺炎克雷伯菌(cKP)和高毒力肺炎克雷伯菌(hvKP).高毒力肺炎克雷伯菌可感染无基础疾病的年轻患者,易引起多部位感染,致病力强.多项研究发现,不同地区高毒力肺炎克雷伯菌的流行情况有很大差异,主要流行型别及感染率均有所不同.近年来多耐药高毒力肺炎克雷伯菌在各地陆续报道,且呈逐渐增多趋势,为临床救治带来极大挑战.本综述旨在深入探讨hvKP的流行病学、毒力影响因素、耐药性及其发生机制,以期为hvKP的预防和临床治疗提供有效的理论依据.

During an attempt to screen secondary metabolites of pharmaceutical utility, we sequenced the complete genome of type strain of a novel marine bacterial genus, named genus Hyphococcus. The type strain, Hyphococcus flavus MCCC 1K03223T, was isolated from bathypelagic seawater of South China Sea at a depth of 2500 m. The complete genome of strain MCCC 1K03223T is composed of a circular chromosome of 3,472,649 bp with a mean G + C content of 54.8%. Functional genomic analysis showed that this genome encodes five biosynthetic gene clusters, which were annotated to synthesize medicinally important secondary metabolites. Secondary metab-olites annotated include ectoine which acts cytoprotection, ravidomycin which is an antitumor antibiotic and three other different metabolites of terpene type. The secondary metabolic potentials of H. flavus revealed in this study provide more evidences on mining bioactive substances from marine bathypelagic microorganisms.

Novel bacterial resources are valuable for studying bacterial taxonomy, bacterial evolution, and genome mining of novel antibiotics, antitumor agents, and immune modulators. In this study, we de novo sequenced the type strain of a novel bacterial family, Temperatibacteraceae fam. Nov., belonging to class Alphaproteobacteria of phylum Pseudomonadota. The type strain, Temperatibacter marinus NBRC 110045T, is mesophilic and was isolated from surface seawater around Muroto city of Japan at a depth of 0.5 m. Here, the sequenced complete genome of strain NBRC 110045T is composed of a circular chromosome of 3,184,799 bp with a mean G + C content of 43.71%. Genome analysis was applied to reveal the genetic basis of its cellular activities. Cellular regulation and signaling was analyzed to infer the regulatory mechanism of its limited growth temperature range. Genomic features of the novel family Temperatibacteraceae may expand our knowledge on environmental adaptation, genetic evolution and natural product discovery of marine bacteria.

PURPOSE:We analyzed the pathogenic fungal epidemiology and antifungal susceptibility from 2018 to 2021 in Shandong Province, China, to provide the basis for empiric antifungal therapy. METHODS:Fungal isolates were collected from 54 hospitals in Shandong province from 2018 to 2021 through the Shandong Province Pediatric bacterial & fungal Antimicrobial Resistance Surveillance System (SPARSS), WHONET v5.6 and SPSS software v20.0 were used for statistical analysis. RESULTS:A total of 15,348 strains of fungi were collected, with Candida accounting for 78.25 %, followed by Aspergillus at 15.45 %, and other species at 6.27 %. Candida albicans was the predominant Candida species, but more than half of the Candida isolates were non-albicans species, with C. tropicalis being the most dominant (22.74 %), followed by C. glabrata (17.50 %) and C. parapsilosis (11.02 %). The composition of fungi varied significantly among different age groups. Children had a higher proportion of C. albicans (47.30 %) compared to non-children (32.06 %). The non-wild-type phenotype rate of Candida for Amphotericin B was less than 3 %, while Cryptococcus neoformans was 16.67 %. In addition, less than 6 % of C. albicans and C. parapsilosis were resistant to fluconazole and voriconazole, and 96.30 % of C. glabrata were SDD to fluconazole. We also found that 80.56 % of C. glabrata and 83.70 % of C. krusei were voriconazole WT/susceptibility phenotype. However, the susceptibility rates of C. tropicalis to fluconazole/voriconazole decreased from 70.40 %/46.40 % in 2018 to 62.30 %/35.20 % in 2021. The comprehensive susceptibility rate to fluconazole of C. albicans, C. tropicalis, C. parapsilosis and C. glabrata isolated from the blood has decreased from 69.36 % to 56.62 %. CONCLUSIONS:The study reveals that the composition and antifungal susceptibility of pathogenic fungi in Shandong Province differ from other regions. Moreover, the resistance to azoles is more severe, especially in C. tropicalis. These findings indicate the need for region-specific antifungal treatment strategies to combat fungal infections effectively.

目的 了解糖尿病患者肠道肺炎克雷伯菌(Klebsiella pneumoniae,KP)定植率、耐药性以及分子流行病学特征.方法 收集烟台某医院内分泌科就诊的糖尿病患者粪便,分离培养和鉴定KP,使用拉丝试验测定其黏液表型,使用K-B纸片扩散法测定其耐药性,通过全基因组测序分析其荚膜血清型、毒力基因和多位点序列分型.结果 收集145份糖尿病患者的粪便标本,检出50株KP,检出率为34.48％,检出率在性别、糖尿病病程长短、血糖控制方面差异均无统计学意义.50株KP中高黏液表型菌株18株.检出的KP菌株对大部分常用抗生素耐药率较低.50株KP分析出26种血清型,其中K1血清型(20.00％,10/50)占比最高.K1血清型在高黏液表型KP中的比例(44.44％,8/18)明显高于非高黏液表型KP(6.25％,2/32).高黏液表型KP在毒力基因all、arc、clb、fdr、fyu、glc、glx、hyi、iro、irp、iuc、iut、mce、rmpA、rmpA2、ybb、ybt和ylb的携带率高于非高黏液表型KP.多位点序列分型中分析出34种ST型,ST23检出率最高(14.00％,7/50),且均为K1血清型.结论 烟台地区糖尿病患者肠道中肺炎克雷伯菌当前定植率较高,耐药率较低,高黏液表型KP携带更多的毒力基因,K1-ST23菌株己初步占优势.

Purpose:To investigate the epidemiological features of Klebsiella pneumoniae infection of the hepatobiliary system of patients in Yantai, China.Methods:This retrospective study was conducted from January to December 2019 in Yantai Yuhuangding Hospital. Patients for whom K. pneumoniae was isolated from the hepatobiliary system were considered for inclusion. The clinical features and genetic analyses were conducted to explore the epidemiological characteristics.Results:A total of 88 cases were enrolled, including 69 cases of hypervirulent K. pneumoniae (hvKP) and 19 cases of classical K. pneumoniae (cKP). Community-acquired infections, fever, liver abscess, and C-reactive protein (CRP) and procalcitonin (PCT) levels were significantly higher, while biliary tract disease was lower in the hvKP group compared with the cKP group. Among the 69 hvKP infections, 61 developed a liver abscess. Community-acquired infections, fever, and CRP and PCT levels were higher, whereas biliary tract disease and malignancy were lower in the liver abscess group compared with the non-liver abscess group. All strains were susceptible to the majority of antibiotics tested. All hvKP strains possessed the bla SHV, oqxA, oqxB and fosA resistance genes. K1 and K2 accounted for 78% of hvKP strains. K1 strains belonged to sequence types ST23 and ST700, whereas K2 strains belonged to ST65, ST86 and ST5212. K1 isolates possessed the most virulence determinants, followed by K2 and non-K1/K2 isolates. K2 isolates lacked the allS gene, which was rare in non K1/K2 isolates, but present in most K1 isolates. The mceG gene was only detected in K1 isolates. AllS and virulence determinants were significantly more prevalent in the liver abscess group than in the non-liver abscess group.Conclusion:The prevalence of hvKP among K. pneumoniae infections of the hepatobiliary system is high in Yantai, China. Greater vigilance of hvKP infection is required in clinical and microbiological laboratories.

目的 分析携带不同碳青霉烯酶的耐碳青霉烯类肠杆菌科细菌(carbapenem-resistant Enterobacteriaceae,CRE)对头孢他啶/阿维巴坦(cerftazidime-avibactam,CZA)的药物敏感性,为临床合理精准用药提供依据.方法 采用药敏纸片扩散法(K-B法)对烟台毓璜顶医院2018～2020年临床分离并保存的98株非重复CRE菌株进行CZA的药敏试验,并对CZA抑菌圈在20～22mm的菌株用微量肉汤稀释法(broth microdilution method,BMD)进行验证,聚合酶链反应(polymerase chain reaction,PCR)方法检测其碳青霉烯酶型,分析产不同碳青霉烯酶的CRE菌株对CZA的药物敏感性.结果 烟台毓璜顶医院CRE菌株以产金属β-内酰胺酶为主,占72.45％,总体对CZA敏感率为23.47％.CZA对单产丝氨酸酶(blaKPC,blaOXA-48)的CRE敏感率为100％,对单产金属酶(blaNDM,blaVIM,blaIMP)的CRE耐药率为100％,对同时产丝氨酸酶和金属酶的CRE菌株和对不产酶的CRE菌株敏感率分别为25.0％和83.3％.结论 携带不同碳青霉烯酶的CRE菌株对CZA的药物敏感性不同,CZA体外药敏试验有必要在临床开展,同时需增加酶型检测方法指导临床精准用药.

Cefoperazone/sulbactam (CSL) and piperacillin/tazobactam (TZP) are commonly used in clinical practice in China because of their excellent antimicrobial activity. CSL and TZP-nonsusceptible Enterobacteriaceae are typically resistant to extended-spectrum cephalosporins such as ceftriaxone (CRO). However, 11 nonrepetitive Enterobacteriaceae strains, which were resistant to CSL and TZP yet susceptible to CRO, were collected from January to December 2020. Antibiotic susceptibility tests and whole-genome sequencing were conducted to elucidate the mechanism for this rare phenotype. Antibiotic susceptibility tests showed that all isolates were amoxicillin/clavulanic-acid resistant and sensitive to ceftazidime, cefepime, cefepime/tazobactam, cefepime/zidebactam, ceftazidime/avibactam, and ceftolozane/tazobactam. Whole-genome sequencing revealed three of seven Klebsiella pneumoniae strains harbored bla SHV-1 only, and four harbored bla SHV-1 and bla TEM-1B. Two Escherichia coli strains carried bla TEM-1B only, while two Klebsiella oxytoca isolates harbored bla OXY-1-3 and bla OXY-1-1, respectively. No mutation in the β-lactamase gene and promoter sequence was found. Outer membrane protein (Omp) gene detection revealed that numerous missense mutations of OmpK36 and OmpK37 were found in all strains of K. pneumoniae. Numerous missense mutations of OmpK36 and OmpK35 and OmpK37 deficiency were found in one K. oxytoca strain, and no OmpK gene was found in the other. No Omp mutations were found in E. coli isolates. These results indicated that narrow spectrum β-lactamases, TEM-1, SHV-1, and OXY-1, alone or in combination with Omp mutation, contributed to the resistance to CSL and TZP in CRO-susceptible Enterobacteriaceae. Antibiotic susceptibility tests Antibiotics Breakpoint, (μg/ml) Klebsiella pneumoniae Escherichia cou Klebriehd axyoca E1 E3 E4 E7 E9 E10 E11 E6 E8 E2 E5 CRO ≤1≥4 ≤0.5 ≤0.5 ≤0.5 ≤0.5 1 ≤0.5 1 ≤0.5 ≤0.5 1 1 CAZ 4 ≥16 1 2 1 4 4 4 4 2 4 1 1 FEP ≤2 216 1 1 0.25 1 2 2 2 0.5 2 1 1 AMC ≤8 ≥32 ≥128 ≥128 ≥128 ≥128 ≥128 ≥128 ≥128 ≥128 ≥128 ≥128 ≥128 CSL ≤16 ≥64 64 64 64 64 ≥128 128 ≥128 64 128 128 ≥128 TZP ≤16 ≥128 ≥256 ≥256 ≥256 ≥256 2256 2256 ≥256 ≥256 ≥256 ≥256 ≥256 FPT ≤2 ≥16 1 0.5 0.06 0.125 2 1 2 0.25 1 0.125 0.25 FPZ ≤2 216 0.25 0.25 0.06 0.125 0.25 0.25 1 0.125 0.25 0.125 0.125 CZA ≤8 216 1 0.5 0.25 0.25 1 0.25 1 0.5 0.5 0.5 0.25 CZT ≤2 28 2 1 0.5 1 2 2 2 1 1 2 2 CROceftriaxone, CAZceftazidime, FEPcefepime, AMC:amoxicillin clavulanic-acid, CSLcefoperazone/sulbactam, TZP:piperadllin/tazobactam, FPT:cefepime tazobactam, FPZ:cefepime/zidebactam, CZA:ceftazidime/avibactam, CZTceftolozane/tazobactam Gene sequencing results Number Strain ST p-Lactamase gene Promoter sequence mutation Omp mutation El Kpn 45 blaSHV-1, blaTEM-lB none OmpK36, OmpK3 7 E3 Kpn 45 blaSHV-1, blaTEM-lB none OmpK36. OmpK3 7 E4 Kpn 2854 blaSHV-1 none OmpK36, OmpK3 7 E7 Kpn 2358 blaSHV-1 - blaTEM-lB none OmpK36, OmpK3 7 E9 Kpn 2358 blaSHV-1. blaTEM-lB none OmpK36. OmpK3 7 E10 Kpn 18 9 blaSHV-1 none OmpK36. OmpK3 7 Ell Kpn 45 blaSHV-1 none OmpK36, OmpK3 7 E6 Eco 88 blaTEM-lB none none ES Eco 409 blaTEM-1B none none E2 Kox 194 blaOXY-1-3 none OmpK36 mutations. OmpK35 and OmpK 37 deficiency E5 Kox 11 blaOXY-1-1 none no OmpK (OmpK3 5, OmpK36 and OmpK37) gene found.

Brucellosis remains a major public health problem worldwide. It is commonly found in most developed and developing countries, such as the Mediterranean region, the Middle East, and Latin America. In China, brucellosis is mainly distributed in some of the northern provinces and is relatively rare in Shandong province. Brucellosis has a variety of clinical manifestations, with fever, sweating, fatigue, and migratory joint pain being the most common. Because of the non-specific clinical symptoms, brucellosis is often misdiagnosed as other diseases. Here, we report a rare case of brucellosis of thoracic vertebrae misdiagnosed as thoracic malignant tumor and present a review of related literature.

Introduction: In the middle income country China, we performed a prospective study aimed at evaluating the individual and combined diagnostic accuracy of PCT, CRP and neutrophil CD64 expression for differential diagnosis of sepsis-3 in critically ill patients at the time of ICU admission.Materials and methods: We analyzed the CRP and PCT concentrations from 66 patients with sepsis and 24 non-septic ICU controls according to sepsis-3. In addition, CD64 on neutrophils was measured using quantitative flow cytometry.Results: The sensitivity values of CD64, CRP and PCT were 77.27% (95% CI, 65.00-86.32), 87.88% (95% CI, 76.96-94.25) and 65.15% (95% CI, 52.34-76.19), respectively, and the specificity values were 91.67% (95% CI, 71.53-98.54), 58.33% (95% CI, 36.94-77.20) and 87.50% (95% CI, 66.54-96.71), respectively. The efficiency of various combinations of tests was also evaluated; the combination of PCT and CD64 in parallel testing balanced the sensitivity (84.85%) and specificity (83.33%) well and had the maximum Youden index (0.682).Conclusion: Our data supported the potential of CD64, either alone or in combination with CRP/PCT, for routine clinical diagnosis of sepsis-3 in ICU populations in China.

Trichosporon are naturally found in external environments and are a part of the normal flora of the human skin, respiratory tract, and gastrointestinal tract. Disseminated Trichosporon infection occurs sporadically in patients with immunodeficiency, and is mainly manifested as blood, urine, catheter, and thorax/peritoneum infections, rarely as lymphatic, liver and spleen infections. Elevated blood eosinophil granulocyte from Trichosporon infection have rarely been reported. Here, we report a rare Case of eosinophilia associated with lymphatic and liver and spleen infections due to Trichosporon asahii in an immunocompetent patient. No reports of eosinophilia from Trichosporon infections other than lung, to our knowledge, have been published.

Objective:To analyze the distribution of clinically isolated fungal strains and their resistance to common antifungal drugs in Shandong province.Methods:Through the Shandong Children’s Bacterial & Fungal Drug Resistance Surveillance and Research Collaborative Network, a total of 1 030 fungi were collected in 46 hospitals of Shandong province from January 1 to December 31, 2018. The source and type of strains were analyzed, and antifungal drug sensitivity tests were performed by using the micro-dilution method. Whonet 5.6 and SPSS 22.0 were applied to analyze the data.Results:The overall main strains were Candida albicans (38.74%, 399/1 030), Candida tropicalis (16.99%, 175/1 030) and Candida parapsilosis (16.41%, 169/1 030); the main fungi strains in child patients were C. albicans (52.50%, 63/120), C. parapsilosis (12.50%, 15/120) and C. tropicalis (9.17%, 11/120); the main fungi strains in adult patients were C. albicans (36.37%, 331/910), C. tropicalis (17.03%, 155/910) and C. parapsilosis (15.27%, 139/910). The isolation rate of main Candida strains from January to March and August to December was much higher than that of other months. The drug resistance rates of C. albicans to fluconazole and voriconazole were 7.14% and 7.43%, respectively, and the drug resistance rates to itraconazole were 50.44%. The resistance rates of C. tropicalis to fluconazole, voriconazole and itraconazole were 29.05%, 23.29% and 48.65%, respectively. The sensitivity rates of C. parapsilosi to fluconazole, voriconazole and itraconazole were 93.06%, 93.75% and 94.44%, respectively. Candida glabrata showed a dose-dependent sensitivity rate of 2.33% to fluconazole. Analysis of 244 blood fungi strains showed that non-candida albicans bacteremia accounted for 70.08%. In the pathogen spectrum covering 92.22%, fluconazole was sensitive to 64.65% of the pathogens, voriconazole was 68.88%, and amphotericin B was 88.75%. After quantification, the effective rates of fluconazole, voriconazole and amphotericin B in the clinical treatment of fungal bacteremia were 70.10%, 74.69% and 96.23%, respectively. Among them, the sensitivity rate of voriconazole to C. tropicalis was lower than that of fluconazole. Conclusions:Candida is the main clinical fungus isolates in hospitals of Shandong province. The resistance rate of C. tropicalis to azole antifungal drugs is on the rise, and the sensitivity of other Candida species to clinically used antifungal drugs is basically stable.