Invasive pneumococcal disease (IPD) poses a severe threat to children, with molecular epidemiological shifts driven by vaccination and antimicrobial pressure. Long-term genomic surveillance of pediatric IPD isolates is critical for optimizing prevention strategies. A total of 119 invasive Streptococcus pneumoniae (S. pneumoniae) strains were collected from children (2011–2024) at a tertiary children’s hospital. Whole-genome sequencing (WGS) was used for serotyping, Global Pneumococcal Sequencing Cluster (GPSC)/ Sequence type (ST) typing, phylogenetic analysis, antimicrobial resistance (AMR) and virulence gene profiling, and pan-genome analysis. The top predominant serotypes were 19 F (26.1

Candidemia is life-threatening in children. Limited epidemiological and antifungal resistance data for children necessitate national surveillance. This multicenter retrospective study (2016-2024) analyzed 527 pediatric candidemia cases from 13 children's hospitals via the Infectious Disease Surveillance of Pediatrics (ISPED) network. Candida species caused 96.0% (527/549) of fungemia cases. Neonates and infants comprised 51.6% of cases (24.5% neonates and 27.1% infants). Non-albicans Candida species (NACs) dominated (74.0%), with the prevalence of Candida parapsilosis increasing from 21.2% in 2019 to 51.9% in 2024 (Z = 3.11, P = 0.002), while the prevalence of C. albicans decreased from 38.9% to 15.6% during the same period (Z = -2.25, P = 0.024). Azole susceptibility of NACs decreased significantly: C. parapsilosis fluconazole susceptibility decreased from 93.5% (2016-2018) to 63.6% (2022-2024) (P < 0.001), whereas voriconazole (79.5%-93.3%, P = 0.078) and itraconazole (80.0%-97.4%, P = 0.369) susceptibility remained high. Candida tropicalis showed low azole susceptibility, with significant decreases in susceptibility to fluconazole (61.5% in 2016-2018 to 35.0% in 2022-2024) and voriconazole (61.5% in 2016-2018 to 20.0% in 2022-2024; P < 0.001 for all). The susceptibility of wild-type Candida guilliermondii decreased toward fluconazole (100.0% in 2016-2018 and 2019-2021 to 38.9% in 2022-2024), voriconazole (100.0% in 2016-2018 and 2019-2021 to 27.8% in 2022-2024), and itraconazole (100.0% in 2016-2018 and 2019-2021 to 22.2% in 2022-2024) (P < 0.001 for all). All Candida species showed high susceptibility to amphotericin B and echinocandins (99.0% and 95.9%, respectively). Overall, there was a notable shift toward NACs, especially C. parapsilosis, C. tropicalis, and C. guilliermondii, accompanied by declining susceptibility to azoles (particularly in C. tropicalis and C. guilliermondii), which underscores the urgent need for enhanced antifungal stewardship and continuous resistance monitoring.

Objective Salmonella and its increasing antimicrobial resistance (AMR) threaten public health. This study analyzed the epidemiology and AMR profiles of pediatric Salmonella in China to support rational antibiotic use. Method A multicenter retrospective study included 17540 Salmonella isolates from ISPED (2017–2024). Antimicrobial susceptibility was tested by disk diffusion and MIC, and analyzed with WHONET. Results Most isolates were from feces, peaking in children aged 1–3 years and during June–October. S. typhimurium and S. enteritidis were predominant. High resistance was observed to ampicillin (77.8%), ampicillin/sulbactam (39.3%), and trimethoprim/sulfamethoxazole (39.3%), while levofloxacin remained highly effective. Resistance differed by serotype, sample type and region, with S. enteritidis showing rising resistance to fluoroquinolones and cephalosporins. Conclusion Treatment should be individualized according to Salmonella serotype, regional epidemiological characteristics and antimicrobial susceptibility. Continuous national antimicrobial resistance surveillance is vital to improve antibiotic stewardship and public health interventions. Based on the multicenter ISPED program, this study clarified the epidemiological features and antimicrobial resistance of Salmonella isolates among Chinese children from 2017 to 2024. The findings support targeted public health planning, rational antibiotic use in pediatrics, strengthened Salmonella surveillance, and policy development for food safety and childhood infectious disease prevention.

Objective:This study investigated the long-term trends in the distribution and antibiograms of ESKAPEEc pathogens in neonatal and pediatric bloodstream infections (BSIs), shifts in minimum inhibitory concentration (MIC) of vancomycin and linezolid in Staphylococcus aureus, along with the changing patterns of antimicrobial resistance phenotypes over time in China. This work provides a reference for the prevention and treatment of pediatric BSIs. Methods:A multicenter retrospective surveillance study was carried out from 2016 to 2023 at 12 tertiary pediatric hospitals across nine provinces and autonomous regions in China. The collected data were analyzed using GraphPad Prism 8 and WHONET 5.6. Temporal variations and linear trends were evaluated using chi-square or Fisher's exact tests. Results:A total of 10,051 ESKAPEEc strains accounted for 22.5% (10,051/44,675) of all BSIs, with 32.3% from neonatal BSIs and 67.7% from pediatric BSIs. The detection rate of ESKAPEEc pathogens increased for post the coronavirus disease 2019 (COVID-19) compared to the pre-COVID-19. Carbapenem resistance levels were 5.5% in Escherichia coli, 28.0% in Klebsiella pneumoniae, 16.0% in Enterobacter cloacae, 12.5% in Pseudomonas aeruginosa and 38.5% in Acinetobacter baumannii. Both Staphylococcus aureus and Enterococcus faecium remained fully susceptible to vancomycin and linezolid. Between 2016-2019 and 2020-2023, resistance to ceftazidime and gentamicin decreased in Escherichia coli and Klebsiella pneumoniae while resistance to imipenem and meropenem increased. Acinetobacter baumannii exhibited reduced resistance to most antibiotics except cefotaxime, levofloxacin and amikacin. Staphylococcus aureus displayed a declining resistance to macrolides and aminoglycosides but increasing resistance to fluoroquinolones, whereas Enterococcus faecium exhibited reduced resistance to all tested antibiotics. Compared to neonatal BSIs, Klebsiella pneumoniae from pediatric BSIs exhibited lower resistance to all β-lactams especially carbapenems (32.3% vs. 15.0%) while Acinetobacter baumannii displayed higher resistance to all tested agents. Methicillin-susceptible Staphylococcus aureus (MSSA) strains had lower vancomycin MIC ≥2 μg/mL levels compared to methicillin-resistant Staphylococcus aureus (MRSA) strains. Significant temporal differences were observed in MRSA isolates with linezolid MIC ≥2 μg/mL but not in MSSA isolates. The MIC50 of vancomycin in MRSA strains was either equal to or higher than in MSSA strains from 2016 to 2022. The most frequently detected bacteria in carbapenem resistance, extended-spectrum cephalosporin resistance, fluoroquinolone resistance and aminoglycoside resistance were Acinetobacter baumannii, Klebsiella pneumoniae, Escherichia coli and Acinetobacter baumannii respectively. Conclusions:The incidence of ESKAPEEc in BSIs has increased, and the rising resistance to imipenem and meropenem in Escherichia coli and Klebsiella pneumoniae underscores the need for continued surveillance. Carbapenems remain effective against Gram-negative ESKAPEEc, while vancomycin and linezolid remain effective against Gram-positive ESKAPEEc. Age-stratified strategies are essential to manage carbapenem-resistant Klebsiella pneumoniae in neonatal BSIs and carbapenem-resistant Acinetobacter baumannii in pediatric BSIs. The MIC values for vancomycin in MRSA strains remained stable over time, whereas a decreasing susceptibility trend to vancomycin in MSSA strains and linezolid MIC shifts were not observed. Our findings are expected to provide to treatment of bloodstream infections in children and evidence on best practices and resource sharing for policy consideration to healthcare providers at the local and international levels.

Segmented filamentous bacteria are essential for intestinal T helper 17 (Th17) cell induction, but their colonization in the adult intestine is controversial. Therefore, whether there are gut microbiota (GMs) that mediate Th17 cell generation in humans of different ages is elusive. Here, we reported that colonization of ubiquitous Alcaligenes faecalis was sufficient to induce intestinal Th17 cells. Alcaligenes faecalis proteins were endocytosed by CD4+ T cells in a manner dependent on the small GTPase CDC42, inhibiting the interaction between E2 ubiquitin-conjugating enzyme Ube2w and E3 ubiquitin ligase Trim21, thereby reducing Trim21 self-ubiquitination and degradation, which increased Trim21-induced E3 ubiquitin ligase Fbxw7 degradation and JunB accumulation, subsequently promoting Ahr and Rorc transcription, thus enhancing intestinal Th17 cell differentiation. Furthermore, outer membrane vesicles from Alcaligenes faecalis also induced intestinal Th17 cells in a Trim21-Fbxw7-axis-dependent manner. Altogether, these results reveal a vital role for the Trim21-Fbxw7 axis in intestinal Th17 cell enrichments among most humans.

This study aimed to investigate the clinical features of Escherichia coli (E coli)-induced pediatric pyogenic meningitis and analyze the risk factors for imaging abnormalities. These findings provide evidence for early diagnosis and treatment to improve patient prognosis. A multicenter retrospective study was conducted, which included 321 confirmed cases of E coli meningitis. A total of 98.8% (317/321) of the patients had an age at onset of 1 year or younger. Imaging abnormalities were observed in 63.5% (202/318) of the patients and primarily included subdural effusion and/or abscess (28.9%), hydrocephalus or ventricular dilation (21.4%), and intracranial hemorrhage (18.9%). Multivariate logistic regression analysis revealed that initial cerebrospinal fluid (CSF) glucose concentration (odds ratio [OR] = 0.758, 95% confidence interval [CI] = 0.601-0.956, P = .019) and neurological symptom duration exceeding 1 week were independent risk factors for imaging abnormalities. Cerebrospinal fluid glucose levels and the duration of neurological symptoms are crucial indicators for assessing disease severity.

Background:Intracranial imaging abnormalities are highly prevalent in children with Group B Streptococcus (GBS) meningitis and are closely associated with disease severity and prognosis. This highlights the importance of investigating the clinical features of GBS meningitis and the risk factors for imaging abnormalities. This study aimed to identify the risk factors for imaging abnormalities in children with GBS meningitis, thereby providing a basis for the early identification of high-risk patients. Methods:A retrospective analysis of GBS meningitis was conducted involving 12 hospitals across China between January 2019 and December 2020, extending through 2024 for the Children's Hospital of Zhejiang University School of Medicine. Results:A total of 327 cases were included in this study, and the age ranged from 1 day to 4.5 years, with 90.5% under 3 months. Most patients exhibited typical cerebrospinal fluid (CSF) abnormalities, while in 4.0% of patients, the initial CSF cells appeared normal. Imaging abnormalities were developed in 65.2% (210/322) of patients, primarily subdural effusion (30.4%, 98/322). Patients with imaging abnormalities demonstrated higher rates of simultaneous positive CSF and blood cultures, lower CSF glucose (GLU) levels, elevated initial CSF protein concentrations, prolonged hospitalization, increased costs, lower cure rates, and higher incidence of neurological sequelae (P<0.05). Multivariate logistic regression analysis revealed simultaneous positive CSF and blood cultures [odds ratio (OR)=1.945, 95% confidence interval (CI): 1.131-3.346] and initial CSF GLU concentrations <1.57 mmol/L (OR=0.7, 95% CI: 0.557-0.880) as independent risk factors. Conclusions:Pediatric GBS meningitis predominantly affects infants under 3 months, with a high incidence of imaging abnormalities. Simultaneous positive CSF and blood cultures, and lower initial CSF GLU concentrations (<1.57 mmol/L) are independent risk factors for imaging abnormalities.

The respiratory tract related diseases are the main causes of death in children. Child pulmonary severe infection is the most important inducement for Respiratory tract related diseases. Therefore, it is necessary to understand the composition of the microbial community and the species correlation in children with severe pulmonary infection. In this study, the bronchoalveolar lavage fluid (BALF), blood and cerebrospinal fluid (CSF) samples of 782 children with severe infection in the early stage were systematically analyzed by amplicon-sequencing technology to reveal the distribution of microbial community and its clinical correlation. Results reveal significantly higher bacterial abundance in BALF than in blood/cerebrospinal fluid, with community structures shaped by tissue microenvironments, geographical disparities, age, and clinical symptoms. Neonatal BALF harbors simplified microbiota dominated by probiotics, while diversity increases with age, showing marked differences between 1-3 and 6-12-year-olds. Sepsis samples exhibit reduced microbial diversity, with Staphylococcus and Moraxella enrichments in the CST-4 cluster. Respiratory symptom progression correlates with microbiota succession from oral colonizers to respiratory pathogens. Third-generation sequencing-derived co-occurrence networks illustrate synergistic interactions among opportunistic pathogens, providing a basis for ecological targeted therapy. This study provides a key basis for breaking through the limitations of traditional diagnosis, establishing a precise diagnosis and treatment system based on third-generation sequencing, and developing ecological targeted treatment strategies.

Pertussis resurgence has been reported worldwide in the past two decades. Pertussis is still endemic and difficult to control though with universal vaccination in children. The resurgence may be related to multiple variables, such as increased disease awareness and laboratory tests, waning of immunity following vaccination, and/or genetic mutations of Bordetella pertussis. For better pertussis prevention, diagnosis, and management, we called up an expert panel to develop this expert consensus to provide new concepts in diagnosis and treatment for clinical practice. The expert groups collected clinical evidence, summarized their clinical experiences, evaluated preliminary recommendations or guidelines, and then organized open-ended discussions to form the recommendations. This consensus was developed by reviewing the literature and studies in databases, including PubMed, Cochrane, EMBASE, the China Biomedical Database, and the Chinese Journal Full-text Database up to May 2024. The search terms included “pertussis” or “whooping cough”, “children”, “diagnosis”, and “treatment”. The burden of pertussis has also changed from infants to school children and adults, and these age groups have consequently become the main source of infection for vulnerable population including infants and newborns. In China, a high prevalence of erythromycin-resistant Bordetella pertussis (ERBP) has been reported in the past decade. ERBP may lead to failed clinical empirical treatment with macrolides, which poses a great challenge for pertussis management and control. For better management of pertussis, a flow diagram for diagnosis and treatment of pertussis was presented in this consensus. This consensus also described the diagnostic criteria for pertussis, high-risk cases, and severe pertussis. Macrolides can still be used to treat confirmed erythromycin-sensitive B. pertussis (ESBP) infections, whereas oral trimethoprim–sulfamethoxazole therapy is the initial treatment option for children older than two months. For infants younger than two months, severe patients, or those exhibiting a high degree of sulfonamide allergy, intravenous administration of piperacillin or cefoperazone–sulbactam is advised. This expert consensus provides a comprehensive guidance and a reference for the diagnosis and treatment of pertussis in children.

ObjectiveTo analyze the clinical epidemiological characteristics including clinical features, disease prognosis of pneumococcal meningitis (PM), and drug sensitivity of S. pneumoniae isolates in Chinese children.MethodsA retrospective analysis was performed on the clinical, laboratory microbiological data of 160 hospitalized children less than 15 years of age with PM from January 2019 to December 2020 in 33 tertiary hospitals in China.ResultsA total of 160 PM patients were diagnosed, including 103 males and 57 females The onset age was 15 days to 15 years old, and the median age was 1 year and 3 months. There were 137 cases (85.6%) in the 3 months to <5 years age group, especially in the 3 months to <3 years age group (109 cases, 68.2%); S. pneumoniae was isolated from cerebrospinal fluid (CSF) culture in 95(35.6%), and 57(35.6%) in blood culture. The positive rates of S. pneumoniae detection by CSF metagenomic next-generation sequencing (mNGS)and antigen detection method were 40.2% (35/87) and 26.9% (21/78). Fifty-five cases (34.4%) had one or more predisposing factors of bacterial meningitis; and 113 cases (70.6%) had one or more extracranial infection diseases Fever (147, 91.9%) was the most common clinical symptom, followed by vomiting (61, 38.1%) and altered mental status (47,29.4%). Among 160 children with PM, the main intracranial imaging complications were subdural effusion and (or) empyema in 43 cases (26.9%), hydrocephalus in 24 cases (15.0%), cerebral abscess in 23 cases (14.4%), intracranial hemorrhage in 8 cases (5.0%), and other cerebrovascular diseases in 13 cases (8.1%) including encephalomalacia, cerebral infarction, and encephalatrophy. Subdural effusion and (or) empyema and hydrocephalus mainly occurred in children < 1 years old (90.7% (39/43) and 83.3% (20/24), respectively). 17 cases with PM (39.5%) had more than one intracranial imaging abnormality. S. pneumoniae isolates were completely sensitive to vancomycin (100.0%, 75/75), linezolid (100.0%,56/56), ertapenem (6/6); highly sensitive to levofloxacin (81.5%, 22/27), moxifloxacin (14/17), rifampicin (96.2%, 25/26), and chloramphenicol (91.3%, 21/23); moderately sensitive to cefotaxime (56.1%, 23/41), meropenem (51.1%, 23/45) and ceftriaxone (63.5, 33/52); less sensitive to penicillin (19.6%, 27/138) and clindamycin (1/19); completely resistant to erythromycin (100.0%, 31/31). The cure and improvement rate were 22.5% (36/160)and 66.3% (106/160), respectively. 18 cases (11.3%) had an adverse outcome, including 6 cases withdrawing treatment therapy, 5 cases unhealed, 5 cases died, and 2 recurrences. S. pneumoniae was completely susceptible to vancomycin (100.0%, 75/75), linezolid (100.0%, 56/56), and ertapenem (6/6); susceptible to cefotaxime, meropenem, and ceftriaxone in the order of 56.1% (23/41), 51.1% (23/45), and 63.5 (33/52); completely resistant to erythromycin (100.0%, 31/31).ConclusionPediatric PM is more common in children aged 3 months to < 3 years old. Intracranial complications mostly occur in children < 1 year of age with fever being the most common clinical manifestations and subdural effusion and (or) empyema and hydrocephalus being the most common complications, respectively. CSF non-culture methods can facilitate improving the detection rate of pathogenic bacteria. More than 10% of PM children had adverse outcomes. S. pneumoniae strains are susceptible to vancomycin, linezolid, ertapenem, levofloxacin, moxifloxacin, rifampicin, and chloramphenicol.

OBJECTIVES:To investigate the clinical characteristics and prognosis of pneumococcal meningitis (PM), and drug sensitivity of Streptococcus pneumoniae (SP) isolates in Chinese children.METHODS:A retrospective analysis was conducted on clinical information, laboratory data, and microbiological data of 160 hospitalized children under 15 years old with PM from January 2019 to December 2020 in 33 tertiary hospitals across the country.RESULTS:Among the 160 children with PM, there were 103 males and 57 females. The age ranged from 15 days to 15 years, with 109 cases (68.1%) aged 3 months to under 3 years. SP strains were isolated from 95 cases (59.4%) in cerebrospinal fluid cultures and from 57 cases (35.6%) in blood cultures. The positive rates of SP detection by cerebrospinal fluid metagenomic next-generation sequencing and cerebrospinal fluid SP antigen testing were 40% (35/87) and 27% (21/78), respectively. Fifty-five cases (34.4%) had one or more risk factors for purulent meningitis, 113 cases (70.6%) had one or more extra-cranial infectious foci, and 18 cases (11.3%) had underlying diseases. The most common clinical symptoms were fever (147 cases, 91.9%), followed by lethargy (98 cases, 61.3%) and vomiting (61 cases, 38.1%). Sixty-nine cases (43.1%) experienced intracranial complications during hospitalization, with subdural effusion and/or empyema being the most common complication [43 cases (26.9%)], followed by hydrocephalus in 24 cases (15.0%), brain abscess in 23 cases (14.4%), and cerebral hemorrhage in 8 cases (5.0%). Subdural effusion and/or empyema and hydrocephalus mainly occurred in children under 1 year old, with rates of 91% (39/43) and 83% (20/24), respectively. SP strains exhibited complete sensitivity to vancomycin (100%, 75/75), linezolid (100%, 56/56), and meropenem (100%, 6/6). High sensitivity rates were also observed for levofloxacin (81%, 22/27), moxifloxacin (82%, 14/17), rifampicin (96%, 25/26), and chloramphenicol (91%, 21/23). However, low sensitivity rates were found for penicillin (16%, 11/68) and clindamycin (6%, 1/17), and SP strains were completely resistant to erythromycin (100%, 31/31). The rates of discharge with cure and improvement were 22.5% (36/160) and 66.2% (106/160), respectively, while 18 cases (11.3%) had adverse outcomes.CONCLUSIONS:Pediatric PM is more common in children aged 3 months to under 3 years. Intracranial complications are more frequently observed in children under 1 year old. Fever is the most common clinical manifestation of PM, and subdural effusion/emphysema and hydrocephalus are the most frequent complications. Non-culture detection methods for cerebrospinal fluid can improve pathogen detection rates. Adverse outcomes can be noted in more than 10% of PM cases. SP strains are high sensitivity to vancomycin, linezolid, meropenem, levofloxacin, moxifloxacin, rifampicin, and chloramphenicol.

Objective: Aim to investigate the pathogens distribution and drug resistance of gram-negative bacteria causing bloodstream infection (BSIs) in Infectious Disease Surveillance of Pediatric from 2016 to 2022. The prevalence of four important drug resistance phenotypes was studied: difficult-to-treat resistance, fluoroquinolone resistance, carbapenem resistance, and extended-spectrum cephalosporin resistance, and to provide reference basis for preventing and treating BSIs diseases in children. Methods: Strain identification and antimicrobial susceptibility tests were independently performed at each hospital. Data were analyzed using Whonet 5.6 and GraphPad Prism 8 software. The Mann-Whitney U-test was used to examine and compare temporal changes. Results: A total of 39977 BSIs strains were isolated, with 27.1% of the negative bacteria causing BSIs (10824 strains). The highest bacteria detected were E. coli and S. maltophilia in the neonatal and pediatric groups. The detection rate of carbapenem-resistant-K. K. pneumoniae niae (CRKPN) in neonate group was 31.4%, significantly increased compared with pediatric group, whose detection rate was 24.7%. The rates of resistance to levofloxacin and trimethoprim/sulfamethoxazole were significantly lower in neonatal groups than pediatric groups in BSIs caused by K. pneumoniae. . To imipenem and meropenem were 3.6% and 3.9% among neonatal isolates, which was lower than 4.7% and 5.8 among pediatric BSIs caused by E. coli. . Isolated from neonatal BSIs caused by A. baumannii showed lower resistance ratios to all the agents tested than those from pediatric. However, only the prevalence of piperacillin/tazobactam resistance was statistically lower than that in pediatric BSIs caused by P. aeruginosa. . The average detection rates of carbapenem resistance, extended-spectrum cephalosporin resistance, and fluoroquinolone resistance for K. pneumoniae and E. coli were 28.1%,41.4%,11.6% and 4.0%,24.3%,31.1%, respectively. Conclusion: The detection rate of gram-negative pathogens showed an increasing trend among the bloodstream infection. The detection rate of CRKPN assumed a downward trend in 2018. There are differences types of pathogens between the neonatal group and the pediatric group, The detection rate of CRKPN in the neonate group was significantly higher than pediatric group. The first average detection rates for carbapenem resistance, extended-spectrum cephalosporin resistance, and fluoroquinolone resistance were obtained for A. baumannii, K. pneumoniae, , and Escherichia coli, , respectively. Those data showed a high level of antimicrobial resistance, which has posed an urgent threat to Children's health, suggested that effective monitoring of antimicrobial resistance and antimicrobial stewardship among children in China are required.

AbstractT‐cell haematological malignancies progress rapidly and have a high mortality rate and effective treatments are still lacking. Here, we developed a drug delivery system utilizing 293T cell‐derived extracellular vesicles (EVs) modified with an anti‐CD7 single‐chain variable fragment (αCD7/EVs). Given the challenges of chemotherapy resistance in patients with T‐cell malignancy, we selected cytochrome C (CytC) and Bcl2 siRNA (siBcl2) as therapeutic agents and loaded them into αCD7/EVs (αCD7/EVs/CytC/siBcl2). We found that αCD7/EVs efficiently targeted and were internalized by human T‐ALL Molt‐4 cells. In addition, the interaction between αCD7 and CD7 switched the EV entry pathway in Molt‐4 cells from macropinocytosis‐dependent endocytosis to clathrin‐mediated endocytosis, thereby reducing EV‐lysosome colocalization, ultimately improving CytC delivery efficiency and increasing the cytotoxicity of nascent EVs from EV‐treated Molt‐4 cells. Notably, αCD7/EVs/CytC/siBcl2 demonstrated similar efficacy against both Molt‐4 and chemotherapy‐resistant Molt‐4 cells (CR‐Molt‐4). Furthermore, αCD7/EVs/CytC/siBcl2 exhibited high safety, low immunogenicity and minimal impact on human T cells. Therefore, αCD7/EVs/CytC/siBcl2 are promising therapeutic approaches for treating CD7+ T‐cell malignancies.

Summary Community-acquired bacterial meningitis (CABM) is the main cause of morbidity and mortality in children. The epidemiology of CABM is regional and highly dynamic. To clarify the diagnostic status and epidemiological characteristics of children with CABM in this region, and pay attention to the disease burden, so as to provide evidence for the prevention and treatment of CABM. By retrospective case analysis, the clinical data of 918 CABM cases in children aged 0–14 years in Zhejiang Province from January, 2019 to December, 2020 were collected. The etiological diagnosis rate of CABM in children was 23.1%, the annual incidence rate 4.42–6.15/100,000, the annual mortality rate 0.06–0.09/100,000,the cure and improvement rate 94.4%, and the case fatality rate 1.4%. The total incidence of neuroimaging abnormalities was 20.6%. The median length of stay for CABM children was 20(16) days, with an average cost of 21,531(24,835) yuan. In addition, the incidence rate was decreased with age. Escherichia coli(E.coli) and g roup B Streptococcus agalactiae(GBS) were the principal pathogens in CABM infant<3 months(43.3%, 34.1%), and Streptococcus pneumoniae(S. pneumoniae) was the most common pathogen in children ≥ 3 months(33.9%). In conclusion, the annual incidence and mortality of CABM in children aged 0–14 years in Zhejiang Province are at intermediate and low level. The distribution of CABM incidence and pathogen spectrum are different in age; the incidence of abnormal neuroimaging is high; and the economic burden is heavy.

Background Methicillin-resistant Staphylococcus aureus (MRSA) can cause invasive infections with significant mortality in neonates. This study aimed to analyze the clinical characteristics and antibiotic resistance profiles of invasive MRSA infections and determine risk factors associated with invasive MRSA infections in newborn inpatients. Methods This multicenter retrospective study of inpatients from eleven hospitals in the Infectious Diseases Surveillance of Pediatrics (ISPED) group of China was performed over a two-year period (2018–2019). Statistical significance was calculated by applying the χ2 test or by Fisher’s exact test in the case of small sample sizes. Results A total 220 patients were included. Among included cases, 67 (30.45%) were invasive MRSA infections, including two deaths (2.99%), while 153 (69.55%) were noninvasive infections. The invasive infections of MRSA occurred at a median age of 8 days on admission, which was significantly younger compared to 19 days in noninvasive cases. Sepsis (86.6%) was the most common invasive infection, followed by pneumonia (7.4%), bone and joint infections (3.0%), central nervous system infection (1.5%), and peritonitis (1.5%). Congenital heart disease, low birth weight infant (<2500 g), but not preterm neonates, and bronchopulmonary dysplasia, were more commonly found in invasive MRSA infections. All these isolates were susceptible to vancomycin and linezolid and were resistant to penicillin. Additionally, 69.37% were resistant to erythromycin, 57.66% to clindamycin, 7.04% to levofloxacin, 4.62% to sulfamethoxazole-trimethoprim, 4.29% to minocycline, 1.33% to gentamicin, and 3.13% were intermediate to rifampin. Conclusion Low age at admission (≤8 days), congenital heart disease, and low birth weight were associated with invasive MRSA infections in neonates, and no isolates resistant to vancomycin and linezolid were found. Determining these risks in suspected neonates may help identify patients with imminent invasive infections who may require intensive monitoring and therapy.

Background This multi-center study aimed to identify factors affecting fever and delayed defervescence in bacterial meningitis (BM) patients under 3 years of age because of the variability of fever in this patient population. Methods Only BM patients under 3 years treated at 49 centers in China from November 2018 to end-April 2021 were included in the study. Univariate and multivariate logistic regression analyses were performed to determine factors associated with afebrile presentation and fever of delayed defervescence. Results A total of 863 BM patients under 3 years were included in the study. Coagulase negative staphylococcus was associated with afebrile presentation (OR = 1.176), while septicaemia and ear-nose-throat infections were associated with fever ( P < 0.05). The patients with fever were assigned into early and delayed defervescence groups based on defervescence time (less than and more than or equal to one week). Furthermore, Streptococcus agalactiae meningitis (OR = 1.124), concomitant gastrointestinal infection (OR = 1.276), encephalomalacia (or = 1.339), and subdural effusion (OR = 1.454) were independently associated with delayed defervescence (all P < 0.05). Conclusions The findings can aid in the efficient utilization of fever in auxiliary diagnosis and evaluating the condition of the disease.

背景 中国儿童细菌耐药监测组(ISPED)每年对纳入的 12 家成员单位的儿童耐药监测数据进行汇总和分析,了解儿童感染性病原学变化和耐药现状.目的 分析 2022 年我国儿童细菌感染和耐药现状,旨在指导儿童抗菌药物合理应用.设计 横断面调查.方法 菌株来源于 2022 年 1 月 1 日至 12 月 31 日ISPED成员单位细菌室,抗菌药物敏感试验采用自动化细菌鉴定及药敏分析仪或扩散纸片法,肺炎链球菌青霉素药物敏感性试验采用E-test法,结果判断采用美国临床实验室标准化委员会(CLSI)2022 年标准.主要结局指标 儿童人群菌群分布特征及主要分离株对抗菌药物耐药性变化,多重耐药菌(MDROs)的检出情况.结果 2022 年ISPED单位共分离到 50 399 株临床菌株,革兰阳性菌和阴性菌的比例分别为 38.8%和 61.2%.前 10 位分离株分别是:大肠埃希菌(14.3%)、流感嗜血杆菌(11.8%)、金黄色葡萄球菌(11.4%)、肺炎链球菌(11.3%)、卡他莫拉菌(7.3%)、凝固酶阴性葡萄球菌(6.8%)、肺炎克雷伯菌(5.3%)、铜绿假单胞菌(4.4%)、鲍曼不动杆菌(2.3%)及粪肠球菌(2.1%).大肠埃希菌是新生儿、学龄期和青春期儿童主要分离菌,流感嗜血杆菌是婴儿主要分离菌,肺炎链球菌是幼儿和学龄前期儿童主要分离菌.青霉素不敏感菌株(PNSP)在脑脊液和非脑脊液来源肺炎链球菌中的比例分别为 88.9%和 6.6%.甲氧西林耐药金黄色葡萄球菌(MRSA)、碳青霉烯类耐药的肠杆菌目细菌(CRE)、铜绿假单胞菌(CR-PA)和鲍曼不动杆菌(CR-AB)检出率分别为 32.8%、4.5%、7.6%和 24.3%.MRSA、CRE 和CR-PA在新生儿组检出率分别为 33.2%、6.4%和 11.3%,高于非新生儿组的 32.6%、4.2%和 7.5%;CR-AB在新生儿组的检出率为 10.9%,低于非新生儿组的 26.3%.结论 2022 年MDROs检出率较往年呈现下降趋势,应高度警惕和防范MRSA、CRE和CR-PA在新生儿中的定植、感染与传播.

Introduction Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious threat to public health worldwide. In December 2015, the Infectious Disease Surveillance of Pediatrics (ISPED) program was organized to monitor bacterial epidemiology and resistance trends in children. Methods This retrospective study was conducted from January 2016–December 2021 on patients at eleven ISPED-group hospitals. Results From 2016–2021, a total of 13024 MRSA isolates were obtained from children. The most common age group for patients with MRSA infection was less than 3 years old, and newborns were an important group affected by MRSA infection. MRSA was most commonly isolated from the lower respiratory, an abscess, a secretion, or blood in neonates and from the lower respiratory, an abscess, or the upper respiratory in non-neonates. All isolates were susceptible to vancomycin and linezolid and resistant to penicillin; additionally, 76.88%, 54.97%, 22.30%, 5.67%, 5.14%, 3.63%, and 1.42% were resistant to erythromycin, clindamycin, tetracycline, levofloxacin, sulfamethoxazole-trimethoprim (TMP-SMX), gentamicin, and rifampin, respectively. Between 2016 and 2021, a significant increase was seen in the levofloxacin- and TMP-SMX-resistance rates (from 5.45% to 7.14% and from 4.67% to 6.50%, respectively) among MRSA isolates, along with a significant decrease in the rates of resistance to erythromycin (from 82.61% to 68.08%), clindamycin (from 60.95% to 46.82%), tetracycline (from 25.37% to 17.13%), gentamicin (from 4.53% to 2.82%), and rifampin (from 1.89% to 0.41%). Discussion The antibiotic-resistance rates varied among MRSA isolated from different sources. Because of the high antibiotic resistance rate to clindamycin, this antibiotic is not recommended for empirical treatment of MRSA infections, especially in osteomyelitis.

Objective: To explore the epidemiological and pathogenic characteristics of children with community-acquired bacterial meningitis. Methods: A multicenter, retrospective study was conducted among CABM patients under 15 years old from 33 hospitals in China from 2019 to 2020. The medical record, laboratory, and microbiological data were collected and analyzed. Results: A total of 1610 children with CABM were identified and presented at a median onset age of 45 days of whom 955 (59.3%) were males. CABM occurred mostly in infants 1 year of age (84.0%, 1352/1610). In etiology-confirmed cases, the pathogens were isolated from CSF culture in 515 (32.0%), 400 (24.8%) in blood culture, and 186 (11.6%) both in CSF and blood culture. In total, 126 pathogens were identified through CSF mNGS in 330 CABM cases; 21 S. pneumoniae isolates were detected in 83 CABM cases by antigen detection method. Major pathogens were E. coli (195, 24.7%), GBS (170, 21.5%), and S. pneumoniae (157, 19.9%). GBS (29.3%, 22/75) was the first pathogen of CABM in neonates aged 0-6 days old, while E. coli (44.7%, 76/170) in 7 to 28 days of age; S. pneumoniae (96.2%, 151/157) was the most common pathogen in 3 months old cases. About 9.7% (19/195) strains of E. coli produced ultra-broad-spectrum beta -lactamases. The common intracranial imaging complications were subdural effusion and (or) empyema in 349 (21.7%), hydrocephalus in 233 (14.5%), and cerebral abscess in 178 (11.1%). A total of 389 (24.2%) cases were completely cured and 1088 (67.6%) cases improved. Among 166 patients (10.3%) with adverse outcomes, 32 cases (2.0%) died, and 37 cases (2.3%) relapsed. Conclusion: The onset age of CABM in children is usually within 1 year of age, especially <3 months. The primary pathogens in infants less than 3 months old are E. coli and GBS, and the dominant pathogen in children older than 3 months old is S. pneumoniae. Subdural effusion and (or) empyema and hydrocephalus are common complications. CABM should not be excluded even if CSF leukocyte counts are within normal range. Due to the low detection rate of pathogens in children with CABM, standardized CSF bacteriological examination should be paid more attention to increase the pathogen detection rate. Non-culture CSF detection methods may facilitate pathogenic diagnosis.