Antimicrobial resistance (AMR) is a great global health threat, with biofilm formation recognized as a key microbial survival strategy that promotes persistence and recurrent infections. Despite growing mechanistic insights, research on biofilm-associated AMR ((biofilm-AMR)) remains fragmented, limiting the development of broadly effective interventions. To address this gap, we conducted a bibliometric analysis of 17,198 publications from the Web of Science Core Collection (retrieved November 4, 2025) using Bibliometrix-Biblioshiny, CiteSpace, and Excel. Publication output accelerated sharply after 2015, alongside diversification of research themes and increasing interdisciplinary integration. High-output countries and institutions, predominantly in Asia, Latin America, and the Middle East, emphasize natural products, nanomaterials, anti-quorum-sensing strategies, and plant-derived antimicrobials, reflecting application-oriented approaches. In contrast, high-impact contributors in North America and Europe focus on clinical microbiology, resistance mechanisms, pathogen genomics, and hospital infection control, highlighting translational relevance. Trend analyses reveal key topics including quorum sensing, persister-cell biology, multidrug-resistant pathogens, and innovative interventions such as phage therapy, antimicrobial peptides, CRISPR-based antimicrobials, and nanotechnology-enabled drug delivery. Emerging directions include environmental AMR, One Health perspectives, and computational modeling. Despite mechanistic and technological advances, translational barriers persist due to biofilm heterogeneity and model limitations. Promoting interdisciplinary collaboration that integrates basic research, clinical microbiology, materials science, and computational approaches will be essential to accelerate clinical translation and develop effective, globally relevant strategies against AMR.

The emergence of hypervirulent carbapenem-resistant Klebsiella pneumoniae (Hv-CRKP) poses a critical global health threat, combining extreme antibiotic resistance with increased virulence. This “superbug” evolves via three primary genetic pathways: (i) hypervirulent K. pneumoniae acquiring carbapenem resistance plasmids, (ii) carbapenem-resistant K. pneumoniae acquiring virulence plasmids, and (iii) classical K. pneumoniae integrating resistance and virulence genes through fusion plasmids. Globally, Hv-CRKP exhibits multiregional dissemination, with particular prevalence in Asia, where China serves as one of the major epicenters dominated by the sequence type (ST) 11 clone, in contrast with the predominance of the ST258 clone in Europe and the Americas. Its virulence is orchestrated by multiple factors, including capsule polysaccharides, siderophore systems, the colibactin genotoxin and the Peg-344 protein. Resistance mechanisms involve carbapenemase expression, outer membrane porin mutations and efflux pump overexpression. The synergistic evolution of virulence and resistance in Hv-CRKP poses significant challenges to clinical antimicrobial therapy, necessitating the development of novel intervention strategies and innovative antimicrobial approaches. This review focuses mainly on the genetic evolution, global epidemiological variations and underlying drivers, virulence determinants and resistance mechanisms of Hv-CRKP. Furthermore, this review explores the evolution and divergence of their biological characteristics, providing critical insights for future research and clinical practice to combat this escalating global public health crisis.

The emergence of hypervirulent carbapenem-resistant Klebsiella pneumoniae (Hv-CRKP) poses a critical global health threat, combining extreme antibiotic resistance with increased virulence. This “superbug” evolves via three primary genetic pathways: (i) hypervirulent K. pneumoniae acquiring carbapenem resistance plasmids, (ii) carbapenem-resistant K. pneumoniae acquiring virulence plasmids, and (iii) classical K. pneumoniae integrating resistance and virulence genes through fusion plasmids. Globally, Hv-CRKP exhibits multiregional dissemination, with particular prevalence in Asia, where China serves as one of the major epicenters dominated by the sequence type (ST) 11 clone, in contrast to the predominance of the ST258 clone in Europe and the Americas. Its virulence is orchestrated by multiple factors, including capsule polysaccharides, siderophore systems, the colibactin genotoxin and the Peg-344 protein. Resistance mechanisms involve carbapenemase expression, outer membrane porin mutations and efflux pump overexpression. The synergistic evolution of virulence and resistance in Hv-CRKP poses significant challenges to clinical antimicrobial therapy, necessitating the development of novel intervention strategies and innovative antimicrobial approaches. This review focuses mainly on the genetic evolution, global epidemiological variations and underlying drivers, virulence determinants and resistance mechanisms of Hv-CRKP. Furthermore, this review explores the evolution and divergence of its biological characteristics, providing critical insights for future research and clinical practice to combat this escalating global public health crisis.

Invasive aspergillosis (IA), a life-threatening fungal infection predominantly caused by Aspergillus fumigatus, has emerged as a major global health threat, particularly in immunocompromised individuals. The rising resistance of A. fumigatus to existing antifungal therapies, coupled with the lack of an approved vaccine, highlights the urgent need for novel preventive strategies. This study aimed to design multi-epitope vaccines against IA using immunoinformatics approaches. Two highly conserved 1,3-beta-glucanosyltransferase proteins, essential for fungal cell wall remodeling, were identified as potential antigen targets via subtractive proteomics. From these, 13 optimal T-cell and 10 ideal B-cell epitopes were selected to develop two vaccine constructs, designated WLaf1 and WLaf2. Both vaccine constructs exhibited favorable physicochemical stability, antigenicity, and non-allergenicity. Molecular docking and molecular dynamics (MD) analyses suggested stable interactions between the vaccine constructs and innate immune receptors, including the TLR1–TLR2 heterodimer and TLR4, with WLaf1–TLR complexes showing relatively higher stability. Population coverage analysis indicated broad global applicability. Immune simulation analyses predicted robust humoral and cellular immune responses, with WLaf1 demonstrating predicted stronger antibody production, memory B-cell formation, and T-cell activation. Collectively, these computational findings suggest that both WLaf1 and WLaf2 represent potentially promising vaccine candidates against A. fumigatus, with WLaf1 exhibiting comparatively superior predicted performance. Further experimental and in vivo studies are required to validate the immunogenicity, safety, and protective efficacy of these vaccine candidates.

Praziquantel (PZQ) is the mainstay treatment for schistosomiasis, but its efficacy against juvenile schistosomes is limited, which can lead to treatment failure and reinfection. Artemisinin derivatives (ARTs) exhibit potent activity against juvenile worms, offering a complementary mechanism. However, the potential risk of accelerating artemisinin resistance, particularly in schistosomiasis-malaria co-endemic regions, warrants consideration when evaluating ART-based regimens. To find a more optimal regimen for the treatment of schistosomiasis, this meta-analysis evaluated the effectiveness of ARTs and PZQ in combination or as a single agent for the treatment of schistosomiasis. To evaluate the efficacy and safety of PZQ combined with ARTs compared with praziquantel alone for the treatment of schistosomiasis through a meta-analysis of randomized controlled trials. Randomized controlled trials (RCTs) of artemisinin derivatives in combination with praziquantel in the treatment of schistosomiasis were selected from computerized searches of PubMed, Embase, Cochrane Library, and Web of Science, up to November 2025. The inclusion criteria were randomized controlled trials involving participants diagnosed with Schistosoma mansoni, S. haematobium, or S. japonicum, who were treated with PZQ combined with ARTs or PZQ alone, and reporting on efficacy and safety outcomes. The primary outcome indicator was cure rate (CR), and secondary outcome indicators were egg count reduction rate and number of adverse events. The meta-analysis was performed using a random-effects model. Subgroup analyses were conducted to explore the impact of different types of schistosomes. A total of eight studies, involving 1595 patients with schistosomiasis, explored the cure rate of PZQ combined with ARTs and PZQ alone. The pooled result showed that PZQ combined with ARTs had a significantly higher cure rate than PZQ alone (RR 1.12; 95

Clostridioides difficile infection (CDI) remains a major cause of antibiotic-associated colitis and is characterized by excessive intestinal inflammation, epithelial barrier disruption and impaired mucosal repair. Although sodium butyrate (NaB), a microbiota-derived short-chain fatty acid, has demonstrated anti-inflammatory and barrier-protective properties, the immunological mechanisms underlying its protective effects during CDI remain incompletely understood. In this study, we investigated the role of NaB in regulating macrophage polarization and epithelial repair using murine CDI models, primary bone marrow-derived macrophages, THP-1-derived macrophages, Caco-2 epithelial cells and macrophage-epithelial co-culture systems. NaB treatment significantly alleviated CDI-associated weight loss, colonic shortening, histopathological injury and inflammatory cytokine production while restoring epithelial barrier integrity and tight junction protein expression. Mechanistically, NaB promoted macrophage polarization towards an anti-inflammatory M2 phenotype, characterized by increased CD206 and IL-10 expression and reduced CD86 and IL-1β expression. These immunomodulatory effects were accompanied by suppression of PI3K/Akt/mTOR signalling in both colonic tissues and macrophages. Pharmacological inhibition and activation studies further supported the involvement of this pathway in NaB-mediated macrophage reprogramming. Importantly, conditioned medium from NaB-treated macrophages enhanced epithelial viability, migration and barrier-associated protein expression, whereas IL-10 neutralization partially abolished these protective effects, highlighting a critical role for macrophage-epithelial crosstalk. Collectively, our findings demonstrate that low-dose NaB protects against CDI-induced intestinal injury through coordinated regulation of macrophage polarization and epithelial barrier repair, at least in part via modulation of PI3K/Akt/mTOR signalling. These results identify NaB as a promising host-directed therapeutic strategy for CDI and provide new insights into microbiota-derived metabolite-immune interactions during intestinal inflammation.

Globally, the outbreaks of infectious diseases have exerted an extremely profound and severe influence on health security and the economy. During the critical phases of epidemics, devising effective intervention measures poses a significant challenge to both the academic and practical arenas. There is numerous research based on reinforcement learning to optimize intervention measures of infectious diseases. Nevertheless, most of these efforts have been confined within the differential equation based on infectious disease models. Although a limited number of studies have incorporated reinforcement learning methodologies into individual-based infectious disease models, the models employed therein have entailed simplifications and limitations, rendering it incapable of modeling the complexity and dynamics inherent in infectious disease transmission. We establish a decision-making framework based on an individual agent-based transmission model, utilizing reinforcement learning to continuously explore and develop a strategy function. The framework’s validity is verified through both experimental and theoretical approaches. Covasim, a detailed and widely used agent-based disease transmission model, was modified to support reinforcement learning research. We conduct an exhaustive exploration of the application efficacy of multiple algorithms across diverse action spaces. Furthermore, we conduct an innovative preliminary theoretical analysis concerning the issue of “time coverage”. The results of the experiment robustly validate the effectiveness and feasibility of the methodological framework of this study. The coping strategies gleaned therefrom prove highly efficacious in suppressing the expansion of the epidemic scale and safeguarding the stability of the economic system, thereby providing crucial reference perspectives for the formulation of global public health security strategies.

Methicillin-resistant Staphylococcus aureus (MRSA) nasal screening by polymerase chain reaction (PCR) is a rapid diagnostic tool with a high negative predictive value for pneumonia caused by MRSA. MRSA remains an important emerging pathogen in China and at present, there is little published data on the effect of rapid MRSA test results on antibiotic utilization for pneumonia. A total of 300 inpatients who met the criteria of pneumonia in a tertiary general hospital were randomly assigned to a notification group (NG, n = 150) or a control group (CG, n = 150). Nasal swabs were collected and tested with the Xpert SA Nasal Complete Test (Cepheid, Sunnyvale, CA) to determine MRSA colonization status. Attending clinicians were immediately informed of test results for patients in NG while results were not released to an attending physician in CG. Subsequently, relevant medical records were collected and analyzed. Patients in the NG received a shorter duration of antimicrobial therapy compared to the CG (5.66 vs. 7.87 days, P < 0.001). Fewer renal injuries (1.33

Gastrointestinal tumors are among the most prevalent and deadly cancers worldwide and have been increasingly associated with the gut microbiota. Particularly, colorectal cancer (CRC) has become a focal point for unraveling the complex interplay between microbial dynamics and gastrointestinal tumor development, as extensive studies have shown that gut microbiota dysbiosis is closely associated with CRC, affecting energy harvest, metabolism, and mucosal and systemic immune responses. Clostridioides difficile ( C. difficile ) is the major causative agent of gut microbiota dysbiosis, with toxins A and B being its main pathogenic factors. These toxins reportedly trigger a complex cascade of host cellular responses, leading to diarrhea, inflammation, and tissue necrosis. However, recent experimental evidence suggests that chronic infection with C. difficile is a previously unrecognized contributor to colonic tumorigenesis. In this concise review, we summarize the hypothetical models and provide a comprehensive overview of the mechanisms linking the microbiota to colorectal carcinogenesis, focusing on the reasonable extrapolation of the interaction between C. difficile and CRC. Understanding the significance of C. difficile as a potential pro-carcinogenic bacterium and its potential role as a biomarker in CRC is crucial for advancing our knowledge in preventing tumorigenesis, recurrence, and gastrointestinal tumor metastasis.

OBJECTIVES:This study aims to explore the associations of the neutrophil-to-lymphocyte ratio (NLR) and the systemic inflammatory response index (SIRI) with all-cause mortality among adults with nasal colonisation of Staphylococcus aureus (S. aureus). DESIGN:A cross-sectional study. SETTING:The National Health and Nutrition Examination Survey (2001-2004). PARTICIPANTS:A total of 10 600 adults aged 18 years or older were included in this study, of whom 2805 were colonised with nasal S. aureus. PRIMARY AND SECONDARY OUTCOME MEASURES:All-cause mortality was considered as primary outcomes. Survey-weighted Cox proportional hazards models were applied to evaluate the associations of NLR and SIRI with all-cause mortality after adjustment for confounders. Predictive performance was assessed using time-dependent receiver operating characteristic (ROC) curves, and survival differences were illustrated by Kaplan-Meier (K-M) analysis. Restricted cubic spline (RCS) models further examined potential non-linear associations. RESULTS:During a median follow-up of 197 months, 595 deaths occurred. The fully adjusted Cox model showed that elevated NLR (1.87 (1.32, 2.65), p<0.001) and SIRI (1.88 (1.43, 2.48), p<0.001) were significantly associated with increased all-cause mortality risk. These associations were consistent across subgroup analyses by sex, age, education, race, family poverty income ratio, smoking, drinking, diabetes, cancer and long-term care. K-M curves showed significantly lower survival rates in high NLR and SIRI groups (p<0.0001). RCS analysis revealed non-linear relationships between NLR and SIRI, with all-cause mortality (p>0.05). CONCLUSIONS:Elevated NLR and SIRI levels are positively associated with higher all-cause mortality risk among adult individuals with nasal S. aureus colonisation.

Infections, particularly sepsis, are a global health threat and a leading cause of mortality among elderly patients (≥ 60 years) in intensive care units (ICUs). The variable immune responses in this vulnerable population warrant deeper investigation. This multicenter prospective study included elderly patients with infections admitted to the ICUs of four hospitals between May 2023 and October 2024. Patients were classified into sepsis and non-sepsis infection groups based on a ≥2-point increase in Sequential Organ Failure Assessment (SOFA) score. Baseline immune and inflammatory markers were compared between groups. Logistic regression analyses were used to assess associations with mortality. Subgroup analyses were conducted by sex, age, infection site, and pathogen type. Among 1,152 elderly patients with infections in the ICUs, 640 with sepsis were older (70.0 vs.72.0 years), were predominantly male (55.3

BACKGROUND:On October 25, 2022, the World Health Organization (WHO) released its first Fungal Priority Pathogen List (FPPL), classifying Cryptococcus neoformans (C. neoformans), Candida auris (C. auris), Aspergillus fumigatus (A. fumigatus), and Candida albicans (C. albicans) as "critical priority" pathogens due to their substantial clinical impact and increasing antifungal resistance. Although bibliometric analyses have been conducted for individual fungal pathogens, a comprehensive and comparative assessment of all four critical pathogens remains lacking. To address this gap, we conducted an integrated bibliometric analysis to analyze global research trends and publication characteristics related to these pathogens, aiming to enhance global awareness and support future preparedness efforts on this important issue. METHODS:We conducted a comprehensive search of the Web of Science Core Collection (WoSCC) database, focusing on English-language review and research articles published from 1983 to 2023. Search terms included the pathogens' names and their Medical Subject Headings (MeSH) terms in the title. The data, including full records and cited references, were exported and analyzed using Microsoft Excel, VOSviewer, CiteSpace, and the Bibliometrix-Biblioshiny package in RStudio. RESULTS:A total of 19,785 publications were analyzed, showing an increasing trend in fungal research, with developed countries leading in output. Emerging economies, notably China and Brazil, also showed increasing contributions. Key research areas for C. neoformans included capsule formation, oxidative stress, and clinical impacts such as meningitis. For C. auris, studies focused on multidrug resistance, infection control, and diagnostics. A. fumigatus research emphasized antifungal resistance, virulence, and clinical outcomes, while C. albicans studies highlighted biofilm formation, antifungal resistance, and host immune interactions. Antifungal resistance, particularly in emerging pathogens like C. auris, remains a critical concern. CONCLUSIONS:This analysis demonstrated a growing interest in fungal research and highlighted the need for more focus on fungus-host interactions, environmental adaptation, epidemiology of emerging pathogens, and enhanced international collaboration.

Klebsiella pneumoniae is ubiquitous in animals, humans, and the environment, facilitating the dissemination of antimicrobial resistance (AMR) and virulence traits. Most studies are primarily focused on human clinical isolates, leaving critical gaps in understanding non-human reservoirs and cross-species transmission risks. We combined large-scale genomic analyses with in vitro and in vivo infection models to characterize the evolutionary dynamics of 2809 K. pneumoniae isolates sourced from 8 host species across 57 countries. We examined the potential for cross-host transmission of K. pneumoniae, explored its AMR and virulence characteristics across different hosts, and evaluated the temporal evolution of AMR and virulence. Here, we demonstrate that the rise in AMR strongly correlates with the global expansion of multidrug-resistant (MDR) sequence types, while the increase in virulence is partially driven by the acquisition of key virulence loci in certain MDR clones. Population structure analyses show no distinct genetic boundaries between human- and animal-derived strains, strengthening the evidence for cross-species transmission potential. These findings underscore the urgent need for a One Health approach to address the dual threat of AMR and hypervirulence, providing critical insights to guide global surveillance and public health interventions. Klebsiella pneumoniae is a bacterium that can be found in different hosts, including livestock, humans and the environment. They can develop antibiotic resistance (making medicines less effective) and make infections harder to treat. Past studies mainly focused on bacterial strains that infect humans, leaving a knowledge gap about their presence in animals or whether they can spread between animals and humans. Here, we studied over 2800 bacterial strains from 8 hosts (including cows, pigs, and humans) across 57 countries, examining how they change, spread, and become more harmful. We found that antibiotic-resistant strains are spreading globally, fueling resistance. Some antibiotic-resistant bacteria acquire genes that render them more infectious. We also found that K. pneumoniae strains found in humans and animals are genetically similar, suggesting potential for cross-host transmission. This calls for careful surveillance of K. pneumoniae strains to prevent crossover. Huang, Yao et al. analyse Klebsiella pneumoniae genomes originating from human, animal, and environmental sources across the globe, demonstrating overlapping populations and increasing antibiotic resistance. The rise of strains with both high virulence and multidrug resistance calls for coordinated One Health surveillance.

Environmental contamination by carbapenem-resistant gram-negative bacteria (CR-GNB) contributes to healthcare-associated infections in intensive care unit (ICU). However, contamination in areas away from isolated patients remains inadequately characterized, and local epidemiological data are limited. A comprehensive surveillance study was conducted in the ICU of a tertiary hospital from January 2019 to December 2022. Monthly collections included clinical specimens (sputum, urine, blood) and environmental samples (inanimate surfaces, healthcare workers’ hands). Gram-negative bacteria were cultured, and carbapenem sensitivity testing was performed. Among 5,097 clinical specimens collected over the 4-year study period, 898 (17.6%) GNB isolates and 405 (8.0%) CR-GNB isolates were detected, with Klebsiella pneumoniae and carbapenem-resistant Acinetobacter baumannii (CRAB) being the most common species. From 2,215 environmental samples, 144 (6.5%) GNB and 90 (4.1%) CR-GNB strains were identified, predominantly A. baumannii and CRAB. The overall CR-GNB environmental contamination rates were highest on work coats (6.8%), followed by nonisolated patient medical devices (5.8%), nonisolated patient bed units (4.3%), mobile phones (4.1%), doctors’ offices and nurses’ stations (3.6%), and healthcare workers’ hands (2.0%). Spearman’s correlation analysis revealed a significant positive correlation between the monthly number of positive A. baumannii or CRAB isolates from environmental samples and clinical specimens. CR-GNB, particularly CRAB, contaminates ICU environments, including nonisolated patient areas and healthcare stations, highlighting the need for enhanced environmental surveillance in the ICU.

Clostridium difficile infection (CDI) is a leading cause of hospital-acquired infections, particularly in high-risk environments like intensive care units (ICUs). Effective prevention requires comprehensive interventions, including antimicrobial stewardship, infection control measures, and healthcare worker training to mitigate infection rates. We conducted a three-phase prospective intervention in two intensive care units of Xiangya Hospital over six months (January through June 2019, with every two months being a phase), involving 776 diarrhea patients and 72 cases of hospital-onset C. difficile infection (HO-CDI). The primary outcome was the change in HO-CDI incidence, defined as the number of confirmed HO-CDI cases per 10,000 ICU days. Secondary outcomes included the proportion of patients with diarrhea who had HO-CDI, improvements in healthcare workers’ knowledge, attitudes, and practices (KAP) regarding CDI, as well as changes in antimicrobial use. We created a C. difficile infection prevention and control knowledge questionnaire and surveyed all healthcare workers before and after the training for the correctness of each question, and the pre- and post-intervention questionnaires assessed knowledge of CDI prevention. Antimicrobial usage was tracked across the three phases. The proportion of patients with diarrhea who had HO-CDI in three phases (13.3

It is generally believed that Carbapenem-resistant Enterobacterales (CRE) colonization is primarily responsible for systemic infection in humans. However, there is no consensus on whether decolonization should be recommended in clinical practice. In China, the specific situation of CRE colonization and consequent systemic infection in hospitalized patients necessitates further exploration. We conducted a cohort study and analyzed various clinical characteristics of inpatients with intestinal CRE colonization. A risk prediction model for consequent CRE infection was established and externally validated. Our prediction model is freely available online at https://creinfection.shinyapps.io/dynnomapp/. 839 intestinal CRE colonization samples from inpatients were included. 317 cases of intestinal CRE colonization were enrolled, 25.9% of whom developed systemic infections. The consequent CRE infection rates of Klebsiella pneumoniae and Escherichia coli were 27.0% and 32.3%. The departments at high risk for subsequent CRE infection were respiratory medicine, hematology, and intensive care unit. Secondary infection after intestinal CRE colonization in inpatients can significantly prolong the length of hospital stay (26 days vs. 33 days, P < 0.001), increase the total medical cost (144735.34(sic) vs. 281852.34(sic), P < 0.001), and has poor (85.11% vs. 52.44%, P < 0.001) efficacy and high mortality (5.96% vs. 18.29%, P = 0.001). Our study makes a significant contribution to comprehensively specify CRE infection, because these results can facilitate early identification of high-risk hospitalized patients, timely implementation to decolonize treatment interventions, ultimately achieve the goal of CRE nosocomial infection prevention and control.

Background and aim Suicide is nearly always associated with underlying mental disorders. Risk factors for suicide attempts (SAs) in patients with bipolar disorder (BD) misdiagnosed with major depressive disorder (MDD) remain unelucidated. This study was to evaluate the prevalence and clinical risk factors of SAs in Chinese patients with BD misdiagnosed with MDD. Methods A total of 1487 patients with MDD from 13 mental health institutions in China were enrolled. Mini International Neuropsychiatric Interview (MINI) was used to identify patients with BD who are misdiagnosed as MDD. The general sociodemographic and clinical data of the patients were collected and MINI suicide module was used to identify patients with SAs in these misdiagnosed patients. Results In China, 20.6% of patients with BD were incorrectly diagnosed as having MDD. Among these misdiagnosed patients, 26.5% had attempted suicide. These patients tended to be older, had a higher number of hospitalizations, and were more likely to experience frequent and seasonal depressive episodes with atypical features, psychotic symptoms, and suicidal thoughts. Frequent depressive episodes and suicidal thoughts during depression were identified as independent risk factors for SAs. Additionally, significant sociodemographic and clinical differences were found between individuals misdiagnosed with MDD in BD and patients with MDD who have attempted suicide. Conclusions This study highlights the importance of accurate diagnosis in individuals with BD and provide valuable insights for the targeted identification and intervention of individuals with BD misdiagnosed as having MDD and those with genuine MDD, particularly in relation to suicidal behavior.

This study aims to use bibliometric methods to explore the evolving landscape, hotspots, and emerging frontiers of pertussis vaccine research, providing deeper insights into the current research landscape and guiding future vaccine development efforts. We conducted a comprehensive search of the Web of Science Core Collection database (WoSCC) from January 1, 1994, to December 31, 2023, employing search terms related to vaccination (vacc* or immun*) and pertussis (pertussis, Whooping Cough, Bordetella pertussis, B. pertussis, Bordetella pertussis infection, or B. pertussis infection) in the Title or Author keywords fields. Bibliometrics analysis of pertussis research was performed utilizing the bibliometrix-biblioshiny package in RStudio, alongside CiteSpace and VOSviewer software. In total, 2,623 records were analyzed, comprising 89.63

Clostridioides difficile strains of sequence type (ST) 37, primarily including PCR ribotype (RT) 017, are prevalent in mainland China. Our study aimed to compare the major virulence factors of an epidemic C. difficile isolate of ST37 type (Xy06) from China with the well-characterized C. difficile reference strains R20291 (RT027) and CD630E (ST54), as well as a Chinese ST54 strain (Xy07) isolated from the same hospital. The Xy06 genome was predicted to harbor two complete prophages and several transposon-like elements. Comparative analysis of PaLoc revealed a truncated tcdA gene, a functional tcdB gene, a functional tcdC gene, and well-conserved tcdR and tcdE genes. Phenotypic comparisons showed that Xy06 was a robust producer of TcdB, readily sporulated and germinated, and strongly bound to human gut epithelial cells. In a mouse model of C. difficile infection, Xy06 was more virulent than strains CD630E and Xy07 and was comparable to strain R20291 in virulence. Our data suggest the potential threat of the epidemic ST37 strains in China.