Abstract Orbital apex syndrome is a life-threatening disease that is very rarely caused by anaerobic bacterial infections. In particular, Peptostreptococcus stomatis , a newly discovered species of Peptostreptococcus species, which is commonly thought to be associated with the development of colorectal cancer (CRC) in patients and oral squamous cell carcinoma (OSCC). However, there is no report that other site infections and bacteremia was caused by this organism. We firstly herein report a case of P.stomatis bacteremia in a 63-year-old woman who was diagnosed with left orbital apex syndrome and cellulitis of both eyelids originated from a dental reparation. This report illustrates the importance of using traditional methods and experience for identification when MALDI-TOF MS failed, which still facilitates the timely selection of appropriate antibiotics for treatment, thus achieving a favorable outcome.

IntroductionCandida auris, a fungal pathogen first reported in 2009, has shown strong resistance to azole antifungal drugs and has caused severe nosocomial outbreaks. It can also form biofilms, which can colonize patients’ skin and transmit to others. Despite numerous reports of C. auris isolation in various countries, many studies have reported contradictory results.MethodA bibliometric analysis was conducted using VOSviewer to summarize research trends and provide guidance for future research on controlling C. auris infection. The analysis revealed that the United States and the US CDC were the most influential countries and research institutions, respectively. For the researchers, Jacques F. Meis published the highest amount of related articles, and Anastasia P. Litvintseva’s articles with the highest average citation rate. The most cited publications focused on clade classification, accurate identification technologies, nosocomial outbreaks, drug resistance, and biofilm formation. Keyword co-occurrence analysis revealed that the top five highest frequencies were for ‘drug resistance,’ ‘antifungal susceptibility test,’ ‘infection,’ ‘Candida auris,’ and ‘identification.’ The high-frequency keywords clustered into four groups: rapid and precise identification, drug resistance research, pathogenicity, and nosocomial transmission epidemiology studies. These clusters represent different study fields and current research hotspots of C. auris.ConclusionThe bibliometric analysis identified the most influential country, research institution, and researcher, indicating current research trends and hotspots for controlling C. auris.

Abstract Orbital apex syndrome is a life-threatening disease that is very rarely caused by anaerobic bacterial infections. In particular, Peptostreptococcus stomatis, a newly discovered species of Peptostreptococcus species, which is commonly thought to be associated with the development of colorectal cancer (CRC) in patients and oral squamous cell carcinoma (OSCC). However, there is no report that other site infections and bacteremia was caused by this organism. We firstly herein report a case of P.stomatis bacteremia in a 63-year-old woman who was diagnosed with left orbital apex syndrome and cellulitis of both eyelids originated from a dental reparation. This report illustrates the importance of using traditional methods and experience for identification when MALDI-TOF MS failed, which still facilitates the timely selection of appropriate antibiotics for treatment, thus achieving a favorable outcome.

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.

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.

OBJECTIVE:To investigate the clinical characteristics and molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection at a medical center in northeast China, especially after coronavirus disease (COVID-19) pandemic.METHODS:Fifty-one patients were diagnosed with CRKP bloodstream infection between January 2015 and December 2020, among which 42 isolates were available for further study. Species identification and antibiotic susceptibilities were tested with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and VITEK 2 systems. Carbapenemase genes, virulence genes and MLST genes were detected by polymerase chain reaction. Moreover, the string test and serum killing assay were performed to evaluate the virulence of the CRKP isolates.RESULTS:During the six-year period, the detection rate of CRKP in bloodstream infection showed an increasing trend, with the intensive care unit, hematology and respiratory medicine wards mainly affected. Molecular epidemiology analyses showed that KPC-2 was the dominant carbapenemase gene. In addition, the dominant sequence type (ST) of CRKP shifted from ST11 to ST15 strains, which were all sensitive to amikacin in contrast to the ST11 stains. Furthermore, ST15 CRKP strains were positive for the KfuB virulence gene and more resistant to serum killing compared to the ST11 CRKP strains. Nonetheless, the mortality rate of patients infected with ST11 and ST15 CRKP did not show any significant differences.CONCLUSION:A shift in the dominant sequence type of CRKP bloodstream infections from ST11 to ST15 was observed during the years 2015-2020. Compared to ST11, the ST15 CRKP strains showed amikacin sensitivity, positivity for KfuB gene, and serum resistance, which may indicate stronger virulence.

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.

目的 探讨2019年中国医科大学附属第一医院临床分离菌株对常用抗菌药物的耐药率,为临床经验性抗感染治疗提供依据.方法 收集2019年1月至12月我院检验科分离的非重复细菌,按统一方案进行菌株鉴定及药敏检测,应用Whonet?5.6软件对数据进行分析.结果 ?2019年共收集5?061株非重复菌株,其中,革兰阳性菌占31.4％,革兰阴性菌占68.6％.葡萄球菌属中耐甲氧西林金黄色葡萄球菌?(MRSA)?和耐甲氧西林凝固酶阴性葡萄球菌?(MRCNS)?的检出率分别为32.3％和82.3％,粪肠球菌对多数抗菌药物的耐药率均低于屎肠球菌.肠杆菌科细菌对碳青霉烯类的耐药率分别为:肺炎克雷伯菌18.9％、阴沟肠杆菌7.0％、大肠埃希菌?1.3％、奇异变形杆菌1.0％.鲍曼不动杆菌对美罗培南和亚胺培南的耐药率分别为81.2％和82.0％.结论 我院临床分离的常见细菌对不同抗菌药物呈不同耐药率,应充分了解细菌耐药监测结果 ,合理使用抗菌药物并加强医院感染管理.

Background Candida auris is a new pathogen called “superbug fungus” which caused panic worldwide. There are no large-scale epidemiology studies by now, therefore a systematic review and meta-analysis was undertaken to determine the epidemic situation, drug resistance patterns and mortality of C. auris . Methods We systematically searched studies on the clinical report of Candida auris in Pubmed, Embase and Cochrane databases until October 6, 2019. A standardized form was used for data collection, and then statics was performed with STATA11.0. Results It showed that more than 4733 cases of C. auris were reported in over 33 countries, with more cases in South Africa, United States of America, India, Spain, United Kingdom, South Korea, Colombia and Pakistan. C. auirs exhibited a decrease in case count after 2016. Clade I and III were the most prevalent clades with more cases reported and wider geographical distribution. Blood stream infection was observed in 32% of the cases, which varied depending on the clades. Resistance to fluconazole, amphotericin B, caspofungin, micafungin and anidulafungin in C. auris were 91, 12, 12.1, 0.8 and 1.1%. The overall mortality of C. auris infection was 39%. Furthermore, subgroup analyses showed that mortality was higher in bloodstream infections (45%), and lower in Europe (20%). Conclusions Over 4000 cases of C. auris were reported in at least 33 countries, which showed high resistance to fluconazole, moderate resistance to amphotericin B and caspofungin, high sensitivity to micafungin and anidulafungin. The crude mortality for BSI of C. auris was 45% which was similar to some drug-resistant bacteria previously reported. In conclusion, C. auris displayed similar characteristics to some drug resistance organisms. This study depicts several issues of C. auris that are most concerned, and is of great significance for the clinical management.

AbstractBackgroundCandida aurisis a new pathogen called “superbug fungus” which caused panic worldwide. There are no large-scale epidemiology studies by now, therefore a systematic review and meta-analysis was undertaken to determine the epidemic situation, drug resistance patterns and mortality ofC. auris.MethodsWe systematically searched studies on the clinical report ofCandida aurisin Pubmed, Embase and Cochrane databases until October 6, 2019. A standardized form was used for data collection, and then statics was performed with STATA11.0.ResultsIt showed that more than 4733 cases ofC. auriswere reported in over 33 countries, with more cases in South Africa, United States of America, India, Spain, United Kingdom, South Korea, Colombia and Pakistan.C. auirsexhibited a decrease in case count after 2016. Clade I and III were the most prevalent clades with more cases reported and wider geographical distribution. Blood stream infection was observed in 32% of the cases, which varied depending on the clades. Resistance to fluconazole, amphotericin B, caspofungin, micafungin and anidulafungin inC. auriswere 91, 12, 12.1, 0.8 and 1.1%. The overall mortality ofC. aurisinfection was 39%. Furthermore, subgroup analyses showed that mortality was higher in bloodstream infections (45%), and lower in Europe (20%).ConclusionsOver 4000 cases ofC. auriswere reported in at least 33 countries, which showed high resistance to fluconazole, moderate resistance to amphotericin B and caspofungin, high sensitivity to micafungin and anidulafungin. The crude mortality for BSI ofC. auriswas 45% which was similar to some drug-resistant bacteria previously reported. In conclusion,C. aurisdisplayed similar characteristics to some drug resistance organisms. This study depicts several issues ofC. auristhat are most concerned, and is of great significance for the clinical management.

Although Meyerozyma guilliermondii complex is an uncommon cause of invasive candidiasis worldwide, reported cases, mainly regarding bloodstream infections, increased over years, and patients with cancer who have undergone recent surgery are most commonly affected. However, the clinical characteristics and outcomes of candidemia caused by M. guilliermondii complex remain poorly understood. A retrospective case–control study was conducted to evaluate the clinical characteristics and mortality of candidemia caused by M. guilliermondii complex in cancer patients undergoing surgery. Demographic and clinical data were collected from the hospital medical records system with a standardized data collection form and were analyzed with SPSS 20.0. Sixty-six cancer patients who have undergone recent surgery and were diagnosed with candidemia caused by M. guilliermondii complex were included in the study. Regarding the clinical manifestations, most patients’ body temperatures ranged from 38 to 40 °C, with a median fever duration of 4 (IQR: 3–6) days. Multivariate analysis indicated that the presence of central venous catheter (OR: 6.68; 95% CI 2.80–15.94) and gastric tube (OR: 3.55; 95% CI 1.22–10.34) were independent risk factors for M. guilliermondii complex fungemia. The 30-day crude mortality of candidemia caused by M. guilliermondii complex was 12.1%, twice that of the control group. Moreover, increased WBC count, age ≥ 60 years, septic shock, and ICU admission were identified as predictors of mortality through univariate analysis. These findings will provide a foundation for the clinical management of candidemia caused by M. guilliermondii complex in post-surgical cancer patients.