Background: Chronic hepatitis B-related cirrhosis is a progressive liver disease that can lead to decompensation, recurrent portal hypertension-related events, impaired liver function, and poor long-term outcomes. Recompensation has recently been recognized as a clinically meaningful treatment goal in selected patients with decompensated cirrhosis. Compound Biejia Ruangan Tablets (CBRT), an antifibrotic traditional Chinese medicine formulation, may provide additional benefits when combined with antiviral therapy. Objectives: To evaluate the therapeutic efficacy and safety of CBRT in achieving recompensation after decompensation in chronic hepatitis B-related liver cirrhosis. Methods: Sixty individuals with chronic hepatitis B-related liver cirrhosis who experienced their first decompensation event were enrolled and randomly assigned to an observation group or a control group, with 30 patients in each group. The observation group received CBRT, four tablets per dose, three times daily, combined with one entecavir tablet nightly. The control group received one entecavir tablet in addition to standard diuretics and hepatoprotective medications. The treatment duration was 6 months in both groups. General conditions and clinical symptoms were recorded. Laboratory assessments included liver function tests, the FIB-4 index, platelet count, total protein, albumin, hepatitis B surface antigen titer, hepatitis B virus DNA, and four indices of liver fibrosis, which were measured before and after treatment. Decompensation events within 1 year and serious outcomes, including death and liver transplantation, were also recorded during follow-up. Results: Both the observation and control groups showed decreases in hepatitis B surface antigen titer, hepatitis B virus DNA load, and total bilirubin compared with pretreatment levels. Compared with the control group, the observation group showed greater improvements in albumin, FIB-4, liver fibrosis indices, and platelet count (P < 0.05). The incidence of decompensation events was higher in the observation group than in the control group, with minimal adverse events reported in both groups. Conclusions: As an adjunct to antiviral therapy for chronic hepatitis B-related liver cirrhosis, CBRT may help delay disease progression, reduce the risk of recurrent decompensation-related events, and improve liver function and clinical symptoms. These findings provide a useful reference for comprehensive clinical care.

Background: Talaromyces marneffei is an opportunistic fungal infection with marked geographical endemicity. While traditionally associated with HIV infection, its incidence is increasing in non-endemic areas, driven by improved diagnostics and a growing population of immunocompromised hosts. Methods: This retrospective study analyzed six cases (5 male, 1 female) of Talaromyces marneffei infection managed at Shaoxing People's Hospital between 2023 and 2024, focusing on clinical manifestations, diagnostic approaches, and therapeutic outcomes. Results: Among the six patients (median age 44.5 years, range 24-69 years), four were HIV-negative and two were HIV-positive. Non-HIV patients (4/6) presented with fever (4/4), productive cough (3/4), and lymphadenopathy (3/4), with underlying conditions including diabetes, autoimmune disorders, and myelofibrosis. Laboratory findings included lymphocytopenia, elevated CRP/ESR, and hypoalbuminemia. Imaging showed pulmonary infiltrates (3/4), hilar/mediastinal lymphadenopathy (3/4), and abscess (1/4). HIV-positive patients exhibited anemia, abdominal pain, disseminated lymphadenopathy, and splenomegaly, with reduced CD4+ T-cell percentages and elevated IgG. Due to atypical presentations, four cases were initially misdiagnosed. Diagnosis was confirmed via NGS (4/6), NGS plus culture (1/6), or histopathology (1/6). Treatment was individualized: severe cases received extended amphotericin B lipid complex (ABLC) (cumulative dose up to 31.8g in case1) induction followed by azole maintenance; milder cases received oral itraconazole alone. Two patients continue maintenance therapy; four discontinued after improvement with no relapse. All patients improved, and there were no deaths. Conclusion: This series highlights the diagnostic challenges of Talaromyces marneffei infection in non-endemic areas, especially among non-HIV immunocompromised hosts. NGS was essential for early detection. Individualized antifungal therapy-tailored to immune status and disease severity achieved favorable outcomes, underscoring the importance of personalized treatment strategies.

Japanese spotted fever(JSF)is an infectious disease caused by Rickettsia japonica,with nonspecific clinical symptoms and a high risk of misdiagnosis.We reported a case of JSF,in which Rickettsia japonica was detected in blood cells by metagenomic next-generation sequencing.The patient recovered after treatment with doxycycline.This report provides a reference for the clinical diagnosis and treatment of JSF.

Staphylococcus aureus, commonly colonizing the mucous membranes and skin of humans, is a prevalent pathogen responsible for Skin and Soft Tissue Infections (SSTIs), with a notably high prevalence of methicillin-resistant Staphylococcus aureus (MRSA). The antimicrobial resistance profiles of MRSA vary across different regions, with differences in population structure and epidemiological characteristics over time and geography. Molecular typing is frequently employed to investigate the population structure and transmission features among strains. The purpose of this study is to investigate the molecular epidemiological characteristics, virulence genes, and drug resistance of MRSA isolated from patients with skin and soft tissue infections in the Shaoxing region. Seventy-seven MRSA strains isolated from patients with SSTIs in the Shaoxing area from 2017 to 2022 were subjected to drug sensitivity testing using the VITEK 2 Compact fully automated system. The study utilized next-generation sequencing to conduct Staphylococcal Chromosome Cassette mec (SCCmec) typing, Staphylococcal Protein A (SPA) typing, Multilocus Sequence Typing (MLST), and investigate virulence genes in MRSA strains. The variations in antimicrobial resistance, virulence genes, and molecular typing among different genders and age groups were analyzed. The findings revealed that the resistance rate of MRSA to penicillin was 100%, while it was 61.04% for erythromycin and 59.74% for clindamycin. The resistance rate to other antibiotics was below 20%. MLST typing is mainly dominated by ST59 (22.08%) and ST398 (18.18%), while SCCmec typing is predominantly represented by IV (38 strains) and V (27 strains). SPA typing is mainly characterized by t437 (19.48%) and t34 (14.29%). The major clones of SSTIs in the Shaoxing area are ST59-t437-IV and ST398-t34-V. The strains carry 17 enterotoxin genes, with the highest detection rates found in sek and seq (32.47%), PVL (12.99%), and tst (7.79%).This study demonstrates that skin and soft tissue infections in the Shaoxing region are caused mainly by ST59-t437-IV and ST398-t34-V strains, which carry multiple virulence genes. PVL is identified as a significant virulence factor in MRSA strains.

The emergence and global dissemination of carbapenem-resistant Klebsiella spp. have seriously threatened global public health. Few genomic analyses of ceftazidime-avibactam-resistant and carbapenem-resistant Klebsiella spp. (CAR-CRKS) have been performed to date. This was a retrospective study of 12 CAR - CRKS isolates from 99 Klebsiella spp. collected in a Chinese tertiary hospital between 2018 and 2020. K. pneumoniae (eight cases, 66.67%), K. variicola (two cases, 16.67%), and K. quasipneumoniae (two cases, 16.67%) were identified in these isolates. Most of these patients had underlying hepatobiliary diseases or a history of receiving interventional procedures, and were hospitalised recurrently. The isolates were sensitive to amikacin, tigecycline, and polymyxin. blaIMP-4 was detected in six isolates, whereas blaNDM-1, blaNDM-5 and blaNDM-9 were detected in three, two, and one isolates, respectively. Only one strain harboured the rmpA, and exhibited a hypermucinous phenotype. The aerobactin (iucABCD) and yersiniabactin genes were absent in most of the strains. The strains containing blaIMP-4 exhibited higher virulence. These findings are of great significance for understanding the characteristics of CAR - CRKS and developing treatment strategies.

To investigate the role of Peg13 in modulating the inflammatory response in sepsis, we established Lipopolysaccharide (LPS)-induced 293T cells and mouse models. Peg13 expression was assessed at various time points after infection using RT-qPCR. The levels of high mobility group box 1 (HMGB1) and interleukin-6 (IL-6) were quantified through ELISA. A total of 44 septic patients and 36 healthy participants were recruited to measure Peg13 and HMGB1 levels in the blood. Peg13 demonstrated significant down-regulation in the supernatant of LPS-induced 293T cells and in the blood of LPS-induced mice. Moreover, the levels of proinflammatory cytokines HMGB1 and IL-6 were elevated in both the supernatant of LPS-induced cell models and blood specimens from LPS-induced murine models, and this elevation could be notably reduced by Peg13 suppression. In a clinical context, Peg13 and HMGB1 levels were higher in septic patients compared to healthy subjects. Peg13 exhibited a negative correlation with HMGB1, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) among septic patients. Peg13 mitigates the inflammatory response by reducing the release of proinflammatory cytokines HMGB1 and IL-6 in sepsis, presenting a potential therapeutic target for alleviating inflammation in sepsis treatment.

Introduction: The spread of carbapenem-resistant Klebsiella pneumoniae (CRKP) is a substantial severe global public health burden. Non-carbapenemase-producing CRKP (non-CP-CRKP) is increasingly recognized as the source of severe infections. Methodology: We analyzed the genotypic, and phenotypic profiles of non-CP-CRKP strains with the whole-genome sequences isolated between 2017 and 2019 and the clinical characterization of non-CP-CRKP infection. Results: A total of 91 CRKP strains were collected, of which 5 (5.49%) strains were non-CP-CRKP. Four strains were from male patients; three strains were isolated from the bile of patients who underwent biliary interventional surgery and four had a history of antibiotic exposure. Three strains were sequence type (ST)11, one was ST1, and one was ST5523. The non-CP-CRKP strains were insusceptible to ertapenem. Three strains were susceptible to amikacin. All the strains were susceptible to imipenem, meropenem, tigecycline, ceftazidime/avibatam and polymyxin B. The β-lactamases of non-CP-CRKP predominantly included blaCTX-M, blaSHV, and blaTEM subtypes. Two site mutations in ompK36 (p.A217S and p.N218H) and four in ompK37 (p.I70M, p.I128M, p.N230G, and m233_None234insQ) were detected accounting for carbapenem resistance. Plasmids IncFI and IncFII were found in most strains. Genes encoding aerobactin, yersiniabactin and allantoin utilization were not detected in several isolates, and all non-CP-CRKP strains did not carry rmpA gene. Conclusions: Non-CP-CRKP infected patients had a history of previous antibiotic exposure or invasive procedures. Non-CP-CRKP strains were insusceptible to ertapenem. The mechanism of resistance includes β-lactamases production and the site mutations in ompK36 and ompK37. Several virulence genes were not detected in non-CP-CRKP.

Sepsis-induced cardiomyopathy (SIC) leads to high mortality and has no effective treatment strategy. Atractylenolide Ⅰ (AT-I) is a sesquiterpene lactone compound and possesses various biological activities such as anti-inflammatory and organ protection. This study was designed to explore the role and the mechanism of AT-I in SIC. CCK-8 assay was used to assess the viability of AT-I-treated RAW 264.7 cells and immunofluorescence assay was used to detect M1 marker CD86. The expressions of M1 markers Cox2, iNOS and CD11b and PARP1/NLRP3 signaling pathway-related proteins were detected using western blot. The transfection efficiency of oe-PARP1 was examined with RT-qPCR and western blot. The ROS activity in H9c2 cells was detected using DCFH-DA assay and western blot was used to detect the expressions of inflammation- and oxidative stress-related proteins. The apoptosis of H9c2 cells was detected using flow cytometry and western blot. The present study found that AT-I inhibited LPS-induced M1 polarization in RAW 264.7 cells through the downregulation of PARP1/NLRP3 signaling pathway, thereby inhibiting the oxidative stress and apoptosis of H9c2 cells. In conclusion, AT-I might be a promising therapeutic agent for SIC by suppressing macrophage polarization through the modulation of PARP1/NLRP3 signaling pathway.

Gram-negative bacteria are increasingly recognized as the sauce of severe infections. In recent years, epidemiological data has indicated that the drug resistance rate of Gram-negative bacteria has significantly increased. We analyzed the epidemiological surveillance data of gram-negative bacteria in Shaoxing City in 2021 by retrospectively collecting drug susceptibility data of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterobacter cloacae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Burkholderia cepacian from thirteen tertiary hospitals. A total of 24,142 strains were collected from thirteen hospitals. The isolation rates of E. coli, K. pneumoniae, P. aeruginosa, A. baumannii, P. mirabilis, E. cloacae, and B. cepacian were 29.25%, 18.83%, 11.03%, 8.43%, 3.80%, 3.12%, and 0.75%, respectively. Among them, 2.86% were carbapenem-resistant E. coli, 12.98% were CRKP, 31.27% were CRPA, and 34.77% were CRAB. Carbapenem-resistant Enterobacterales were more sensitive to ceftazidime-avibactam and polymyxin. The drug resistance rates of P. aeruginosa and A. baumannii to polymyxin were 0 and 1.3%, but the resistance rates to ceftazidime-avibactam were 10.5% and 26.0%, respectively. Based on results from epidemiological data, CRKP had a high isolation rate and non-fermenting bacteria had a high resistance rate to ceftazidime-avibactam. All hospitals should strengthen monitoring and enact continuous intervention to reduce the generation and spread of drug-resistant bacteria.

Objective To investigate the clinical value of IFN-γ and IL-27 levels in cerebrospinal fluid（CSF） for diagnosis of acute meningitis. Methods CSF samples were collected from 150 patients with suspected meningitis who were admitted to Shaoxing People’s Hospital from January 2015 to December 2020, including 65 cases of viral encephalitis（VE）, 28 cases of bacterial meningitis（BM）, 23 cases of tuberculous meningitis（TBM）, 12 cases of cryptococcal meningitis（CM）, and 22 non-meningitis cases（control group）. The CSF levels of WBC, protein, adenosine deaminase（ADA）, glucose, chloride, IFN-γ and IL-27 were detected and compared among groups. Multivariate logistic regression analysis was used to identify the independent influencing factors for VE, BM, TBM and CM, and ROC curve analysis was used to evaluate the diagnostic efficacy of these factors for various types of acute meningitis. Results Except chloride, there were statistically significant differences in the other 6 indexes of cerebrospinal fluid in 5 groups（all P＜0.05）. Multivariate logistic regression analysis showed that CSF WBC, protein, ADA and IFN-γ levels were independent influencing factors for TBM（all P＜0.05）. CSF protein,ADA and IL-27 levels were independent influencing factors for CM（all P＜0.05）. No independent influencing factors were found for VE and BM. ROC analysis showed that the AUC, sensitivity, and specificity of IFN-γ or IFN-γ in combination with other 3 indicators for diagnosis of TBM were 0.933, 0.957, 0.843 and 0.944, 0.957, 0.772, respectively. AUC, sensitivity, and specificity of CSF IL-27 or IL-27 in combination with protein and ADA for diagnosis of CM were 0.838, 0.573, 0.935 and 0.844, 0.833,0.341, respectively（all P＜0.05）. Conclusion CSF IFN-γ combined with WBC, protein and ADA has a high diagnostic value for TBM, and CSF IL-27 combined with protein and ADA has a certain diagnostic value for CM.

目的 比较社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)与医院获得性耐甲氧西林金黄色葡萄球菌(HA-MRSA)的分子分型、毒力基因及耐药基因.方法 选取2019年1月至2020年12月绍兴市人民医院收治的34例门诊及住院患者,共分离获得耐甲氧西林金黄色葡萄球菌(MRSA)34株,其中CA-MRSA 7株(占20.6％),HA-MRSA 27株(占79.4％).采用头孢西丁纸片扩散法进行药敏试验,全基因组测序法进行分子分型[包括葡萄球菌mec盒式染色体(SCCmec)分型、葡萄球菌A蛋白(spa)分型、多位点基因序列类型(MLST)分型]、毒力基因及耐药基因检测.结果 CA-MRSA对庆大霉素、左氧氟沙星、利福平、磷霉素、四环素均敏感,对复方新诺明的敏感率为85.7％;HA-MRSA对庆大霉素、利福平、复方新诺明、四环素的敏感率均在80％以上.两种不同来源菌株对各种常用抗菌药物敏感率以及SCCmec、spa、MLST分型比例比较,差异均无统计学意义(均P＞0.05).CA-MRSA的lukF-PV、lukS-PV检出率均明显高于HA-MRSA菌株(均P＜0.05),sea检出率明显低于CA-MRSA菌株(P＜0.05).HA-MRSA的环丙沙星耐药基因gyrA检出率明显高于CA-MRSA菌株,差异有统计学意义(P＜0.05).CA-MRSA同时携带1～6种抗菌药物耐药基因,头孢西丁-青霉素-克林霉素-红霉素为优势耐药谱;HA-MRSA同时携带1～9种抗菌药物耐药基因,头孢西丁-青霉素-克林霉素-红霉素、阿米卡星-妥布霉素-头孢西丁-青霉素-环丙沙星-克林霉素-红霉素和庆大霉素-阿米卡星-妥布霉素-头孢西丁-青霉素-环丙沙星-四环素-克林霉素-红霉素为优势耐药谱.结论 本院CA-MRSA分离率较高,其携带毒力基因lukF-PV、lukS-PV的比例高于HA-MRSA.

Abstract Objective This study aimed to investigate the potential risk factors associated with disseminated cryptococcosis in HIV-negative individuals. Methods A total of 106 HIV-negative patients with cryptococcal disease were enrolled. The observation group consisted of patients with disseminated cryptococcosis (DC), whereas the control groups included patients with pulmonary cryptococcosis (PC) and cryptococcal meningitis (CM). Univariate and multivariate logistic regression algorithms were used to explore the significant clinical and laboratory characteristics that affect the progression of cryptococcal infections. Finally, receiver operating characteristics (ROC) curves are applied to assess the diagnostic value of identified risk factors.LE: Kindly check the edit made in the title.I agree Results Of the 106 patients, 57 were diagnosed with pulmonary cryptococcosis, 22 with cryptococcal meningitis, and 27 with disseminated cryptococcosis. The logistic regression equation included five variables: diabetes, decompensated liver cirrhosis, long-term use of immunosuppressive agents, decreased serum albumin level, and elevated plasma cytokine IL-10 level. The ROC curves showed that albumin (AUC > 0.7), IL-10 (AUC > 0.7) and decompensated liver cirrhosis (AUC > 0.6) have relatively high diagnostic capacity in predicting the progression of Cryptococcus. Conclusion This study identified elevated IL-10 levels as an independent risk factor for developing disseminated cryptococcosis in the control groups. Furthermore, decompensated liver cirrhosis and decreased serum albumin independently affected the progression of cryptococcosis in the CM and PC groups, respectively.

目的 了解金黄色葡萄球菌血流感染的特点.方法 收集2013年1月—2020年12月99例由金黄色葡萄球菌所致血流感染的患者资料,对其特点进行回顾性分析.结果 48例院内获得性金黄色葡萄球菌血流感染患者中,院内获得性耐甲氧西林金黄色葡萄球菌(HA-MRSA)感染占54.2％.51例社区获得性金黄色葡萄球菌血流感染患者中,社区相关性耐甲氧西林金黄色葡萄球菌(CA-MRSA)占15.7％.患者主要来自感染科(21.2％)、肾内科(17.2％)和重症监护病房(9.1％).61～80岁患者耐甲氧西林金黄色葡萄球菌(MRSA)血流感染比例最高.MRSA组未发现对万古霉素、利奈唑胺、替考拉宁、替加环素耐药菌株.复方新诺明对所有CA-MRSA菌株敏感,利福平对所有HA-MRSA菌株敏感.金黄色葡萄球菌血流感染患者最多的基础疾病是糖尿病(27.3％)和慢性肾病(19.2％).多因素结果分析显示,脓毒性休克是预后不良的独立危险因素.结论 HA-MRSA检出率高,糖尿病和慢性肾病基础疾病者多见,脓毒性休克是预后不良的独立危险因素.

Objective:This study aimed to investigate the prevalence, molecular types, and virulence genes of methicillin-resistant Staphylococcus aureus (MRSA) causing skin and soft tissue infections (SSTIs) in the Shaoxing region.Methods:MRSA strains were collected from patients with SSTIs in Shaoxing People's Hospital from January 2019 to December 2019. We conducted SCCmec typing, Staphylococcus protein A (SPA) typing, multilocus sequence typing (MLST), and virulence gene analysis using whole-genome sequencing on all MRSA strains.Results:The detection rate of community-acquired MRSA (CA-MRSA) isolated from SSTI patients in our hospital was 33.3% (6/18). The primary SCCmec types of CA-MRSA strains were IV and V, with IVg(2B) and V(5C2&5) accounting for 16.7% each. Hospital-acquired MRSA (HA-MRSA) strains primarily exhibited SCCmec types IVa(2B) (25.0%), followed by II(2A) (16.7%), V(5C2) (16.7%), and V(5C2&5) (8.3%). SPA typing indicated that CA-MRSA strains causing SSTIs were predominantly t437 (14.3%), t034 (14.3%), t309 (14.3%), t4549 (14.3%), and t7637 (14.3%). The primary SPA type of HA-MRSA strains was t311 (16.7%). MLST typing revealed that the main sequence types (STs) of CA-MRSA strains causing SSTIs were ST22 (33.3%), followed by ST398, ST59, ST88, and ST630, each accounting for 16.7%. The principal STs of HA-MRSA strains were ST398 (16.7%), ST59 (16.7%), ST88 (16.7%), and ST5 (16.7%), followed by ST22, ST630, ST6, and ST188, each at 8.3%. The primary clones of CA-MRSA strains causing SSTIs were ST59-t437-IVg(2B) (16.7%) and ST630-t4549-V(5C2&5) (16.7%), while the primary clones of HA-MRSA strains were ST59-t437-IVa(2B), ST630-t4549-V(5C2&5), ST6-t304-IVa(2B), ST5-t311-II(2A), ST59-t172-IVa(2B), ST398-t571-V(5C2), ST398-t034-V(5C2), and ST5-t311-II(2A), each accounting for 8.3%. The detection rate of the lukSF-PV virulence gene was higher in CA-MRSA strains (50.0%) than in HA-MRSA strains (16.7%).Conclusions:The isolation rate of CA-MRSA strains causing SSTIs was high in Shaoxing People's Hospital, with ST59-t437-IVg(2B) and ST630-t4549-V(5C2&5) being the predominant clones. MRSA strains exhibited multiple virulence genes, with the lukSF-PV gene having a higher detection rate in CA-MRSA strains, signifying its importance as a virulence factor in CA-MRSA.

We retrospectively collected drug susceptibility data of Klebsiella pneumoniae from six tertiary hospitals in Shaoxing City in 2019 and performed a comparative analysis of drug resistance among different hospitals, sexes, ages, and specimens. In total, 1954 strains were identified. The antibiotic resistance rate varied from 4.42% to 36.18%. Most K. pneumoniae were still susceptible to carbapenems and tigecycline, with resistance rates of less than 10%. Drug resistance was relatively mild in Shaoxing Traditional Chinese Medicine Hospital and Shaoxing Maternal and Children Health Hospital, but most severe in Affiliated Hospital of Shaoxing University. Specimens were primarily obtained from elderly and male patients, and the resistance rate increased with age. The specimens were mostly collected from the respiratory and urinary tracts. No carbapenem-resistant strains were collected in 112 isolates from patients under 20 years of age. The ratio of carbapenem-resistant K. pneumoniae isolates was highest in blood-isolated strains (23.86%), and that of extended-spectrum beta-lactamase positive strains was highest in non-blood-sterile body fluids (37.37%). The resistance spectrum of K. pneumoniae varied between hospitals in the same area. Elderly and male patients, non-sterile body fluids, and blood source strains should be seriously considered in empirical treatment.Highlights Prevention and control should be strengthened in hospitals with high rate of drug resistance.Strengthen screening of drug-resistant bacteria in specific populations.Transferred patients should be alerted to the bacterial drug resistance status.

目的 分析多重耐药肺炎克雷伯菌(MDR-KP)血流感染(BSI)的临床分布及耐药情况,为促进临床合理治疗MDR-KP引起的BSI提供指导.方法 根据绍兴市人民医院(浙江大学绍兴医院)2005-2020年血液样本中分离出的405株肺炎克雷伯菌(KP)的药敏结果,筛选出134例MDR-KP,收集临床资料、药敏数据进行统计分析.结果 MDR-KP检出率为0.49％～4.20％.≤40岁组检出率最高,占46.67％.MDR-KP来源前3位的科室分别为ICU(23.88％)、肝胆外科(23.13％)和血液科(9.70％).体外药敏试验结果显示,MDR-KP对临床常用抗生素如第1～3代头孢菌素类、β-内酰胺类/酶抑制剂类、头霉素类、喹诺酮类、单酰胺环类、磺胺类的总体不敏感率高,仅对碳青霉烯类、氨基糖苷类、甘氨酰环肽类不敏感率低于50％.碳青霉烯类药物的不敏感率呈上升趋势,美罗培南、亚胺培南、厄他培南总体不敏感率分别为8.62％、19.40％、24.78％.结论 MDR-KP在BSI中的检出率及耐药率呈上升趋势,对多种常用抗菌药物耐药率高,应加强对分离率高的科室及人群的监测.

目的 了解住院患者胆汁分离肺炎克雷伯菌(Klebsiella pneumoniae,KP)的耐药状况.方法 收集2005年—2021年绍兴市人民医院住院患者胆汁分离的KP,并根据年度及年龄分组统计药敏结果及分析产超广谱β内酰胺酶、多重耐药、耐碳青霉烯酶菌株状况.结果 共收集非重复KP 994株,占胆汁所有分离菌株的13.75％.随着年度和患者年龄的增加,胆汁KP占胆汁细菌构成比均呈一定下降趋势,对哌拉西林、头孢曲松、头孢哌酮/舒巴坦、呋喃妥因、碳青霉烯类的不敏感率呈上升趋势.对喹诺酮类、替加环素的不敏感率在年龄组间无明显变化趋势.对丁胺卡那霉素的不敏感率在年度和年龄组间均呈下降趋势.ESBL-KP、MDR-KP的总检出率分别为30.99％、62.88％,在年龄组间呈上升趋势.CR-KP的总检出率为5.94％,在年度和年龄组间均呈上升趋势.结论 胆汁分离KP对主要抗菌药物的不敏感率呈上升趋势,不同年龄的人群存在差别,CR-KP分离率升高明显.

目的 探讨2396株肠球菌属细菌的临床分布特点及耐药情况,为临床抗感染工作提供有力的参考依据.方法 回顾性分析本院2015-2020年住院患者临床分离的肠球菌资料,梳理出肠球菌临床分布及对不同抗菌药物的耐药情况,运用统计学方法分析并总结.结果 2396株肠球菌中屎肠球菌874株,粪肠球菌1204株,鹑鸡肠球菌123株,铅黄肠球菌76株,鸟肠球菌70株;分离标本来自于尿液1070株(占44.65％),胆汁747株(占31.17％),引流液263株(占10.97％);2396株肠球菌在外科共检出1662株(占69.36％),内科462株(占19.28％).屎肠球菌对利奈唑胺、喹努普汀/达福普汀耐药率低于10％;对替加环素、替考拉宁、万古霉素耐药率低于5％;高浓度庆大霉素、高浓度链霉素耐药率(P＜0.001)均呈现逐年下降趋势.粪肠球菌对环丙沙星、氨苄西林耐药率低于23％;铅黄肠球菌对呋喃妥因耐药率均低于5％.粪肠球菌对四环素、喹努普汀/达福普汀的6年整体耐药率高于屎肠球菌.结论 检出2396株肠球菌以屎肠球菌和粪肠球菌为主,主要来自尿液、胆汁和引流液.6年来粪肠球菌对临床常用抗菌药物的耐药率明显低于屎肠球菌,利奈唑胺、替加环素及万古霉素耐药菌已出现,应引起重视,督促临床合理选择抗菌药物.

目的 了解临床胆汁标本分离肠球菌的菌种分布及耐药趋势变化.方法 通过回顾性分析方法 ,对某医院住院患者送检胆汁标本分离出的856株肠球菌的分布及其耐药性进行分析.结果 856株胆汁来源肠球菌中,以粪肠球菌和屎肠球菌为主,构成比分别占46.5％和26.9％.屎肠球菌对红霉素、青霉素G和氨苄西林等抗菌药物耐药率均>50％.粪肠球菌庆大霉素、青霉素G、氨苄西林和左氧氟沙星等抗菌药物比较敏感,耐药率均<20％.6年间屎肠球菌对左氧氟沙星耐药率逐年下降(χ2=13.470,P=0.019),粪肠球菌对青霉素(χ2=14.269,P=0.014)、氨苄西林(χ2=20.906,P=0.001)耐药率逐年下降.粪肠球菌和屎肠球菌各检出耐万古霉素菌株4株和3株、耐利奈唑胺菌株26株和8株.结论 该医院临床胆汁标本分离的肠球菌以粪肠球菌和屎肠球菌为主,对常用抗菌药物的耐药率逐年下降,检出万古霉素、利奈唑胺耐药菌株.

目的 调查下呼吸道肺炎克雷伯菌(KP)的临床分布和耐药特性及其变化趋势,为临床防治提供依据.方法 收集2015年1月-2019年12月绍兴市人民医院住院患者下呼吸道标本中分离出的2672株KP,使用全自动细菌鉴定仪进行细菌鉴定及配套药敏卡和K-B法进行药敏试验;对其临床分布特点及其对抗菌药物的耐药情况进行调查分析.结果 下呼吸道标本中共检出KP2672株,其中占前3位的科室是重症监护室、呼吸内科、神经外科,分别检出518株(19.4％),423株(15.8％),337株(12.6％);不敏感率呈上升趋势的抗菌药物有亚胺培南、哌拉西林/他唑巴坦、替加环素等.MDR菌株分布最多的科室为重症监护室、呼吸内科和神经内科,分别占22.7％、16.2％和12.8％.结论 下呼吸道KP耐药性有增加趋势,了解临床科室分布及其对各类抗菌药物的耐药情况,能够指导临床合理使用抗菌药物.