Objective To analyze the microbiological characteristics of extrapulmonary nontuberculous mycobacterial(ENTM)infections in a tertiary hospital and to provide data to support clinical diagnosis and treatment of ENTM infections.Methods A retrospective analysis was conducted on mycobacterial culture results from West China Hospital,Sichuan University from 2020 to 2023.A total of 68 confirmed cases of ENTM infection were enrolled,with all of which meeting the diagnostic criteria for extrapulmonary infection outlined in the Guidelines for the Diagnosis and Treatment of Nontuberculous Mycobacterial Disease(2020).Demographic data,strain distribution,and drug susceptibility test results were analyzed.Microbial species identification was performed using mass spectrometry,and drug susceptibility was assessed using the microbroth microdilution method.Results Among the 68 ENTM cases,the male-to-female ratio was 1 to 1.2,with individuals aged 40-59 years being the main affected group population.The most common sites of infection were the skin and soft tissues.The primary specimen source was pus(33.8%,23 cases),followed by pathological tissues(26.5%,18 cases).The Department of Infectious Diseases was the main source of confirmed cases(29.4%,20 cases).Among the 68 EMTM cases,rapid-growing mycobacteria(RGM)accounted for 32.4%(22 cases),with Mycobacterium abscessus being the predominant species,while slowly-growing mycobacteria(SGM)accounted for 67.6%(46 cases),with Mycobacterium intracellulare and Mycobacterium marinum being the predominant species.RRGM exhibited higher minimum inhibitory concentration(MICs)for rifampicin and rifabutin but lower MICs for clarithromycin and amikacin.In contrast,SGM demonstrated low MICs for most antibiotics tested.Conclusion In this study,ENTM infections most commonly involve the skin and soft tissues,with SGM being the predominant pathogens and Mycobacterium intracellulare being the dominant species.RGM shows susceptibility to clarithromycin and amikacin,which provides a basis for empirical anti-infective therapy.Although SGM exhibits low MICs to most tested antimicrobial agents,combination regimens remain necessary in clinical practice,and the risk of treatment failure should be thoroughly evaluated.

This study aimed to investigate the molecular basis of polymyxin B resistance in clinical carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates. A total of 52 polymyxin B-resistant CRKP clinical isolates were collected at West China Hospital between 2018 and 2021. Polymyxin B susceptibility testing was performed using the broth microdilution method. Whole-genome sequencing was conducted to determine sequence types (STs), capsular loci, resistance genes, virulence genes and mutations in genes associated with polymyxin B resistance. Transcriptome sequencing was used to compare changes in gene expression between selected high-minimum inhibitory concentration (MIC) isolates after polymyxin B exposure and controls cultured without polymyxin B. The majority (98.08

This study investigated the clinical and molecular characteristics of Staphylococcus aureus (S. aureus) isolates from patients with coronavirus disease 19 (COVID- 19) at West China Hospital between December 1, 2022 and January 31, 2023. In total, 102 strains isolated from sputum, bronchoalveolar lavage fluid, endotracheal aspirates, and blood were collected from 102 patients and subjected to multilocus sequence typing and antimicrobial susceptibility testing. Eighteen virulence genes were also analyzed by polymerase chain reaction. Seventy-five patients were discharged and 27 died. The predominant comorbidities were hypertension, diabetes mellitus, and cardiac disease. Twenty-eight known sequence types (STs) and 10 novel ones (ST8773/CC398, ST9221/CC5, ST9222/CC59, ST9223/CC8, ST9224/CC22, ST9225/CC1, ST9226/CC5, ST9227/CC59, ST9228/CC59, ST9229/CC398) were identified. The dominant molecular types were ST15 (CC15), ST59 (CC59), and ST5 (CC5). Among the three most prevalent STs, ST5 was significantly more resistant to levofloxacin, moxifloxacin, ciprofloxacin, and sulfamethoxazole than were ST59 and ST15. ST59 and ST5 had higher rates of resistance to erythromycin and clindamycin than ST15. All isolates contained at least eight virulence genes. The hemolysin gene hlb was found to be more prevalent in ST59 (100

Background:The rising global burden of invasive fungal infections and the growing issue of antifungal resistance present critical public health threats. By using multicenter surveillance data from Sichuan Province, we conducted the largest five-year study on fungemia to date. Our objective was to gain insights into regional differences in the distribution and resistance patterns of fungal pathogens. Methods:We performed a retrospective analysis of fungal bloodstream infections (BSIs) from 31 hospitals (2019-2023). Integrated clinical and laboratory data were analyzed using WHONET 5.6 to assess resistance patterns, and Microsoft Excel (with PivotTable functionality) was used to analyze epidemiological trends. Results:Annual fungal isolations increased steadily over the study period. Candida species accounted for 88.7% (1,805/2,034) of the bloodstream isolates, with C. albicans being the most common (38.4%, 694/1,805). The majority of patients were men (58.6%, 1,191/2,034) and aged 46 years or older (80.0%, 1,627/2,034). Intensive care unit (ICU) cases accounted for 36.8% (748/2,034) of the total. C. albicans showed the highest fluconazole susceptibility (91.2%, 633/694). Both C. albicans and the C. parapsilosis complex maintained >80% voriconazole susceptibility, followed by the voriconazole wild-type C. glabrata complex (69.3%). C. tropicalis exhibited high resistance to fluconazole (36.2%, 21/58) and voriconazole (34.8%, 20/58). Cryptococcus spp. displayed non-wild-type rates to amphotericin B (8.7%), flucytosine (5.8%), fluconazole (8.7%), voriconazole (8.0%), and itraconazole (4.1%). Different hospital types isolated varying fungal species. While C. albicans was the predominant species in 83.9% (26/31) of the hospitals, pediatric specialty centers exhibited distinct microbiological profiles, showing the highest isolation rates of the C. parapsilosis complex (χ2 = 18.34, p = 0.002). Conclusion:Our research conducted across several centers, revealed significant geographic variations in the spread of fungal diseases and antifungal resistance. It is important to understand local epidemiology to guide antifungal therapy and enhance stewardship programs.

Objective: Ceftazidime-avibactam (CZA) is a novel beta-lactam/ beta-lactamase inhibitor with activity against carbapenem-resistant Klebsiella pneumoniae (CRKP) that produce Klebsiella pneumoniae carbapenemase (KPC). In this study, we report the first cases of CZA resistance to develop during treatment of CRKP infections and identify the resistance mechanism. Methods: APB/EDTA and NG-Test CARBA5 were used to detect the production of carbapenemase, whole-genome sequencing (WGS) and conjugation experiment were used to identify potential resistance mechanisms of CZA-susceptible (HX1032) and- resistant (HX1192) K. pneumoniae isolates. Results: HX1192 K. pneumoniae was not recognized by APB/EDTA and NG-Test CARBA5 phenotypic assays, WGS revealed it carrying a novel KPC variant, KPC-179, molecular analysis highlighted a G394A mutation, and an ATC insertion at 543 in the bla KPC-2 gene, resulting in an A133T substitution and insertion of the amino acid S at Ambler position 183 in the protein sequence. Remarkably, this mutation restored susceptibility of imipenem (MIC = 0.25 mg/L). Conclusion: Our study highlights the importance of monitoring susceptibility during CZA treatment and accurately detecting KPC variants.

Background: Currently, EUCAST have issued guidelines for direct rapid antimicrobial susceptibility testing (RAST) on blood cultures. There were few reports on total laboratory automation (TLA) for RAST in China. Additionally, certain antibiotic discs used in China with specific concentrations lack EUCAST breakpoints. The purpose of this study is to use TLA to evaluate EUCAST RAST methods in Enterobacterales-containing blood cultures and to investigate the optimal breakpoints for a selection of antibiotics, including cefepime (EFP), cefotaxime (CTX), ceftazidime (CAZ), piperacillin-tazobactam (TZP), and cefoperazone/sulbactam (CSL). Methods: From April to August 2022, blood cultures positive for Enterobacterales (54 Escherichia coli and 60 Klebsiella pneumoniae) were analyzed. EUCAST RAST (4h, 6h, 8h) were performed using TLA and compared with Vitek 2 results. Results: EUCAST RAST's readable inhibition zone increased over time, with high categorical agreement with Vitek 2 (97.1%, 96.2%, 96.1% for E. coli , and 96.1%, 97.1%, 97.9% for K. pneumoniae) and low error rates. Based on the optimal breakpoints we defined, the categorical agreement for EFP, CTX, CAZ, and TZP against E. coli was greater than 90% at both 6 and 8 hours. However, the categorical agreement for CSL was 57.1% at 6 hours and 74.3% at 8 hours, primarily due to a higher proportion of minor errors (42.9% and 25.7%, respectively). For K. pneumoniae, the categorical agreement for all five antibiotics was greater than 90% at both time points. Conclusion: According to the CLSI-M52 standards, the detection performance of EUCAST RAST at 4h, 6h, and 8h was equivalent to that of Vitek 2. Except for ciprofloxacin in E. coli, the readable rates and categorical agreement of all antibiotics are good at 6h. For the optimal breakpoints we have established, all antibiotics except for CSL against E. coli achieve a categorical agreement of over 90%.

Objective:To analyze the distribution of ocular bacterial pathogens and their antibiotic resistance status at a tertiary-care hospital and to provide a reference for the appropriate use of antibiotics.Methods:Retrospective analysis was conducted with bacteria isolated from the ophthalmic samples sent for lab analysis at a tertiary-care hospital from 2012 to 2021. The suspected bacterial strains were identified with automated systems for microbial identification and susceptibility analysis and matrix-assisted laser desorption/ionization time-of-flight mass spectrometer. VITEK 2 Compact, an automated microbial identification and antibiotic susceptibility analysis system, was used for antimicrobial susceptibility testing.Results:A total of 1556 ophthalmology bacteria culture samples were collected, 574 of which showed bacterial growth, presenting an overall positive rate of 36.89%. Of the isolated bacteria, Gram-positive cocci, Gram-positive bacilli, Gram-negative bacilli, and Gram-negative cocci accounted for 63.15% (377/597), 18.76% (112/597), 17.09% (102/597), and 1.00% (6/597), respectively. Among the bacteria isolated in different years over the course of a decade, Gram-positive cocci always turned out to be the main cause of eye infections. Of the Gram-positive cocci, 73.47% (277/377) were isolated from patients with endophthalmitis, with the most important species being Staphylococcus epidermidis, which was followed by Streptococcus viridans. The rest, or 26.53% (100/377), of the Gram-positive cocci were isolated from patients with external eye infections, with the main isolated strains being Staphylococcus epidermidis, Streptococcus viridans, and Staphylococcus aureus. More than 70% of Staphylococcus epidermidis isolated from both endophthalmitis and external eye infections were resistant to methicillin. No strains resistant to vancomycin, linezolid, or tigecycline were detected. Staphylococcus epidermidis isolated from patients with external eye infections had a low rate of resistance to levofloxacin (2/27 or 7.41%), whereas those isolated from patients with endophthalmitis had a higher resistance rate (43/127 or 33.86%). The difference in drug resistance rate between the two groups was statistically significant (P<0.05).Conclusion:The chief ocular bacterial pathogens identified in a tertiary-care hospital were Gram-positive cocci, among which, Staphylococcus epidermidis was the most common species. The Staphylococcus epidermidis identified in the hospital had a high rate of resistance to oxacillin, but remained highly sensitive to vancomycin, linezolid, and tigecycline. The endophthalmitis caused by Staphylococcus epidermidis in the hospital can be treated empirically with vancomycin and then the treatment plan can be further adjusted according to the results of the drug susceptibility test. However, the establishment of the breakpoint of drug susceptibility test is mainly based on the model of bloodstream infection and has limited reference value for the treatment of eye infection. The required drug distribution concentration at the infection site can be achieved by dose increase or local administration.

Objective:To investigate the characteristics of the pathogens isolated from the specimens of tumor patients and detection rates of multidrug-resistant bacteria in a hospital in the past five years, so as to provide references for infection prevention and control. Methods:The results of pathogenic culture and in vitro susceptibility of the strains isolated from the specimens collected between January 2019 and December 2023 from tumor patients were retrospectively collected, and the trends of the data were analyzed and summarized. Results:A total of 16393 strains were isolated from 80386 specimens, producing a detection rate of 20.4%. After excluding the duplicate strains isolated from the same patients, Escherichia coli (14.5%), Klebsiella pneumoniae (13.2%), Staphylococcus aureus (9.4%), Acinetobacter baumannii complex (9.3%), and Pseudomonas aeruginosa (7.7%) predominated the 7951 (81.1%) bacterial strains. Among the 1857 (18.9%) fungal strains, Candida albicans (56.5%), Candida tropicalis (9.0%), and Candida parapsilosis (8.0%) were the most common ones. The specimen sources differed among the prevalent species, and the species distribution varied among specimens from different types of tumors (P<0.05). The detection rates of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae were 2.5% (29/1152) and 12.3% (129/1050), respectively. The detection rate of methicillin-resistant Staphylococcus aureus was 22.0% (165/749), maintaining an upward trend in the last four years (P<0.01). The detection rates of carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa were 40.3% (298/739) and 8.8% (54/612), respectively. Conclusion:Gram-negative bacteria were the prevalent pathogens of tumor patients. The detection rate of multidrug-resistant bacteria was relatively high, and the detection rate of methicillin-resistant Staphylococcus aureus showed an upward trend.

Objective:To investigate the clinical characteristics and molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolated from patients with bloodstream infections in a large tertiary-care general hospital in Southwest China.Methods:A total of 131 strains of non-repeating CRKP were collected from the blood cultures of patients who had bloodstream infections in 2015-2019. The strains were identified by VITEK-2, a fully automated microbial analyzer, and matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry. The minimum inhibitory concentration (MIC) was determined by microbroth dilution method. The common carbapenemase resistant genes and virulence factors were identified by PCR. Homology analysis was performed by multilocus sequencing typing. Whole genome sequencing was performed to analyze the genomic characteristics of CRKP without carbapenemase.Results:The 131 strains of CRKP showed resistance to common antibiotics, except for polymyxin B (1.6% resistance rate) and tigacycline (8.0% resistance rate). A total of 105 (80.2%) CRKP strains carried the Klebsiella pneumoniae carbapenemase (KPC) resistance gene, 15 (11.4%) strains carried the New Delhi Metallo-β-lactamase (NDM) gene, and 4 (3.1%) isolates carried both KPC and NDM genes. Sequence typing (ST) 11 (74.0%) was the dominant sequence type. High detection rates for mrkD (96.2%), fimH (98.5%), entB (100%), and other virulence genes were reported. One hypervirulent CRKP strain was detected. The seven strains of CRKP that did not produce carbapenemase were shown to carry ESBL or AmpC genes and had anomalies in membrane porins OMPK35 and OMPK36, according to whole genome sequencing.Conclusion:In a large-scale tertiary-care general hospital, CRKP mainly carries the KPC gene, has a high drug resistance rate to a variety of antibiotics, and possesses multiple virulence genes. Attention should be paid to CRKP strains with high virulence.

Nocardiosis, despite its rarity and underreporting, is significant due to its severe impact, characterized by high morbidity and mortality rates. The development of a precise, reliable, rapid, and straightforward technique for identifying the pathogenic agent in clinical specimens is crucial to reduce fatality rates and facilitate timely antimicrobial treatment. In this study, we aimed to identify Nocardia spp. in clinical isolates, using MALDI-TOF MS as the primary method, with molecular methods as the gold standard. Clinical Nocardia isolates were identified using 16S rRNA/hsp65/gyrB/secA1/rpoB gene sequencing. Identification performance of the Bruker MALDI Biotyper 3.1 (V09.0.0.0_8468) and MBT Compass 4.1 (V11.0.0.0_10833) for Nocardia identification was evaluated. Seventy-six Nocardia isolates were classified into 12 species through gene sequencing. The MALDI Biotyper 3.1 (V09.0.0.0_8468) achieved 100

OBJECTIVES:To investigate the relationship between the virulence and the carbapenem resistance phenotype of Klebsiella pneumoniae from blood infection, and to identify carbapenem-resistant and hypervirulent Klebsiella pneumoniae (CR-HVKP)strains. METHODS:A total of 192 Klebsiella pneumoniae strains were isolated from blood culture of patients with bloodstream infections from 2016 to 2019, of which 96 isolates were carbapenem-resistant Klebsiella pneumoniae (CRKP) and 96 were carbapenem-sensitive Klebsiella pneumoniae (CSKP). The drug susceptibility was detected by VITEK-2 automatic microbial analyzer; carbapenemase genes, virulence genes and capsule typing were detected by polymerase chain reaction; the high viscosity phenotype of strains was detected by string test, and the genome characteristics of CR-HVKP were detected by whole genome sequencing. Serum killing and biofilm formation test were used to further verify the virulence of CR-HVKP. RESULTS:There were significant differences in drug resistance to common antibiotics, except for minocycline between CSKP and CRKP isolates (all P<0.05). 92 out of 96 CRKP isolates carried carbapenemase genes, mainly blaKPC-2. The string tests were positive in 4 isolates of CRKP and 36 isolates of CSKP (P<0.05). The detection rates of virulence genes Kfu, aerobictin, iutA, ybtS, rmpA, magA, allS, and capsule antigen K1 and K2 in CSKP group were significantly higher than those in CRKP group (all P<0.05). One HVKP strain was detected in the CRKP group (CR-HVKP) and 36 HVKP was detected in the CSKP group (P<0.05). The CR-HVKP strain belonged to the MLST412, serotype K57, expressed iutA, entB, mrkD, fimH, and rmpA virulence genes, and showed strong biofilm formation and significantly increased serum resistance. Whole genome sequencing results showed that this CR-HVKP isolate carried blaSHV-145, blaTEM-1, blaCTX-M-3, fosA6, oqxA5, oqxB26, and aac(3)-IId resistance genes, accompanied by abnormalities in outer membrane protein K (OmpK) 35 and OmpK36. CONCLUSIONS:The drug resistance of CRKP is significantly higher than that of CSKP, while CRKP carrying fewer virulence genes in both number and types compared to CSKP. A new MLST type of carbapenem-resistant and hypervirulent Klebsiella pneumoniae strain has been detected, which requires clinical awareness and epidemiological monitoring.

We aim to validate and evaluate a new rapid and simplified method, called Blood-rsCDM, for the detection and characterization of carbapenemase using 3-aminophenylboronic acid (APBA) and ethylenediaminetetraacetic acid (EDTA) β-lactamase inhibitors from positive blood cultures. We utilized a panel of 172 Enterobacterales strains, including blaKPC (77), blaNDM (48), blaIMP (9), blaVIM (2), blaOXA-181 (2), blaKPC and blaNDM (6), as well as 28 carbapenem-susceptible Enterobacterales isolates, to assess the performance of Blood-rsCDM and the EDTA-carbapenem inactivation method (eCIM). Carbapenemase class was determined using specific inhibitors at 4 h and 6 h by Blood-rsCDM. Blood-rsCDM exhibited a sensitivity of 97.9

ObjectivesThe objective of this study was to provide the clinic with rapid and accurate results of antimicrobial susceptibility testing for the treatment of patients with bloodstream infections. To achieve this, we applied the Clinical and Laboratory Standards Institute (CLSI) blood culture direct rapid antimicrobial susceptibility test (rAST) to assess the susceptibility of the most common Enterobacterales found in blood cultures.MethodsIn this study, we utilized the CLSI blood culture direct rapid antimicrobial susceptibility test to assess the susceptibility (rAST) of the most common Enterobacterales present in blood cultures. We chose this method for its simplicity in analysis, and our aim was to predict minimum inhibitory concentrations (MICs) using the rAST. As a benchmark, we assumed that Broth Macrodilution method (BMD) results were 100% accurate. For data evaluation, we employed the terms categorical agreement (CA), very major errors (VME), and major errors (ME).ResultsOur findings demonstrate that the CLSI rAST method is reliable for rapidly determining the in vitro susceptibility of Enterobacterales to common antimicrobial drugs in bloodstream infections. We achieved a concordance rate of 90% in classification within a 10-hour timeframe. We identified a total of 112 carbapenem-resistant Enterobacterales (CRE) strains, and there was no significant difference in the detection rate of CRE at 6, 10, and 16 hours. This suggests that CRE can be identified as early as 6 hours.ConclusionThe CLSI rAST is a valuable tool that can be utilized in clinical practice to quickly determine the susceptibility of Enterobacterales to antimicrobial drugs within 10 hours. This capability can greatly assist in the clinical management of patients with bloodstream infections.

近年来,多重耐药菌(MDR)日益流行,但相关治疗方法有限,抗菌药物相互作用相关研究成为热点.体外联合药物敏感性试验可以判断2种及以上抗菌药物是否有协同作用,为临床联合使用抗菌药物提供参考.目前,临床常用体外联合药物敏感性试验方法有时间-杀菌曲线(TKA)、棋盘稀释法(CB)、E试验和纸片法.文章就上述方法进行综述,为临床应用提供参考.

Background: To investigate the genotype and clinical characteristics of carbapenem-resistant Enterobacteriaceae (CRE) strains in southwest China and provide information on the treatment stopping the spread of the infection.Methods: The clinical information of CRE isolates was collected from 19 hospitals in 12 cities across Sichuan Province, China, between June 2018 and April 2019. The isolates were detected by DNA sequencing of genes encoding carbapenem enzymes and multilocus sequence types (MLSTs).Results: A total of 166 nonrepetitive CRE isolates were isolated during the study period from sputum, blood, urine, and other samples. Klebsiella pneumoniae carbapenemase (KPC) was dominant in Klebsiella pneu-moniae (53.9%), followed by New Delhi metallo-beta-lactamase (NDM) (42.1%). A total of 43 STs were detected. The most common ST of K. pneumoniae was ST11, and that of Escherichia coli was ST410. Pairwise single nucleotide polymorphism (SNP) distances and the likelihood of local transmission by epidemiology were plotted for each species. About 65% of these pairs had <= 20 pairwise SNPs.Conclusion: A large number of CRE strains carried carbapenemase. Although NDM-ST12 K. pneumoniae should not be disregarded, KPC-ST11is the predominant strain. Thus, the possibility of transmission be-tween E. coli and K. pneumoniae could not be ignored.(c) 2022 Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. CC_BY_4.0

目的 通过对热带念珠菌所致血流感染的临床特征及实验室检查结果进行分析,为临床预防及诊治提供一定的参考依据.方法 收集2018年1月至2020年12月四川大学华西医院热带念珠菌血流感染患者的临床资料,回顾性统计分析患者的临床特征及实验室检查结果等.结果 27例热带念珠菌血流感染患者均有基础疾病且伴有2种及以上危险因素,(1,3)-β-D-葡聚糖试验对辅助诊断热带念珠菌血流感染有很好的灵敏度,其余炎性指标如超敏C反应蛋白、降钙素原、白细胞介素-6均有不同程度增高;27株热带念珠菌对唑类抗真菌药物的敏感率依次为伊曲康唑(77.8％)、伏立康唑(48.2％)、氟康唑(48.2％)、泊沙康唑(37.0％),对两性霉素B、卡泊芬净、米卡芬净敏感率均是100％.结论 热带念珠菌血流感染常发生于有基础疾病且合并多种危险因素的患者,针对临床高危患者,应及时完善实验室检查以明确诊断;热带念珠菌对唑类药物的敏感性较差,临床治疗时应重视药敏结果、合理用药、及时控制患者症状.

The aim of this study was to investigate the current status of candidemia and evaluate the clinical characteristics, risk factors and outcomes among different species. We conducted a retrospective study by univariate and multivariate analysis between Candida albicans and non-albicans Candida (NAC) species in a Chinese national medical center from 2016 to 2020. Among the 259 episodes, C. albicans (38.6%) was the leading species, followed by C. tropicalis (24.3%), C. parapsilosis (20.5%), and C. glabrata (12.4%). Most C. albicans and C. parapsilosis were susceptible to nine tested antifungal agents, whereas C. tropicalis showed 30.2~65.9% resistance/non-wild-type to four azoles with great cross-resistance, indicating that fluconazole should not be used for empirical antifungal treatment. In multivariable models, the factor related to an increased risk of NAC was glucocorticoid exposure, whereas gastrointestinal hemorrhage and thoracoabdominal drainage catheters were associated with an increased risk in C. albicans. Subgroup analysis revealed leukemia and lymphoma, as well as glucocorticoid exposure, to be factors independently associated with C. tropicalis in comparison with C. albicans candidemia. No significant differences in 7-day mortality or 30-day mortality were observed between C. albicans and NAC. This study may provide useful information with respect to choosing empirical antifungal agents and exploring differences in molecular mechanisms.

目的 分析某综合性医院微生物标本送检情况,临床微生物室标本细菌的分布及耐药情况,给予临床医师对感染性疾病的预防与抗菌药物的使用提供依据.方法 回顾病史纳入数据分析,选取2019年1月1日至2019年12月31日临床送检微生物标本,分析细菌分离菌株的分布,采用WH1ONET5.6软件,根据美国临床和实验室标准化协会(CLSI)2020更新标准,分析细菌体外药敏实验数据.结果 2019年微生物室分离非重复菌株15908例,以革兰阴性菌为主,占68.7％(10938/15908),常见分离菌株前5位依次是大肠埃希菌15.2％(2426/15908)、肺炎克雷伯菌12.3％(1958/15908)、鲍曼不动杆菌9.3％(1482/15908)、金黄色葡萄球菌9.1％(1453/15908)和铜绿假单胞菌8.4％(1337/15908);分离菌在各类标本中的分布,呼吸道标本占约36.8％(5857/15908)、尿液标本占约17.8％(2826/15908)、伤口分泌物标本占约16.0％(2544/15908)、血液标本占约12.0％(1912/15908)以及其他无菌体液标本(脑脊液、胸腹水、胆汁)占约16.7％(2659/15908);多重耐药菌方面,产超广谱β.内酰胺酶的大肠埃希菌(ESBL-E.coil)和肺炎克雷伯菌(ESBL-K.pn)检出率分别为56.4％和47.2％,耐碳青霉烯鲍曼不动杆菌(CRAB)检出率为61.2％,耐碳青霉烯肺炎克雷伯菌(CRKP)检出率为16.2％,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为27.6％,耐万古霉素肠球菌(VRE)为1.3％.结论 本院在2019年微生物标本分离病原菌数量及种类较多,耐药细菌同2018年相比,耐碳青霉烯类肠杆菌检出率有所下降,但甲氧西林(苯唑西林)耐药的金黄色葡萄球菌(MRSA)检出率升高较为明显,临床医生在治疗过程中抗生素选择性有限,应根据实验室药敏结果及时更改治疗方案;院感工作者应加强感染管理,并监测耐药细菌的分布变化和临床医生抗菌药物使用情况,从而控制和减少院内感染的风险.

ObjectiveTo investigate the source of Klebsiella pneumoniae (KP) isolated in a hospital in the past decade and the in vitro drug susceptibility, and to provide clinical references for the treatment of KP-associated infection. MethodsThe detection rate, the sources of the specimens, and in vitro susceptibility to antimicrobial agents of KP isolated from clinical specimens in a hospital between January 2012 and December 2021 were retrospectively analyzed. Resistance rate of the extended-spectrum β-lactamases-producing isolates vs. that of the non-enzyme-producing ones, and the resistance rate of imipenem-resistant strains vs. that of imipenem-susceptible ones were compared and analyzed. Carbapenase inhibitor enhancement test was used to identify the types of the carbapenemases.ResultsIn total, 34 573 strains of KP were isolated from 1 684 668 clinical specimens, accounting for 14.6% of bacterial isolates. There were 16 888 non-repeated strains of KP. The main specimen sources of the isolates were sputum (10 274/16 888, 60.8%), blood (1 913/16 888, 11.3%) and urine (1 876/16 888, 11.1%). The proportion of extended-spectrum β-lactamases-producing isolates increased from 29.6% (409/1 382) in 2012 to 38.9% (967/2 487) in 2021, and the resistance rate to antimicrobial agents was higher than that of non-enzyme-producing ones (P<0.05). The proportion of imipenem-resistant strains increased from 3.2% (44/1 382) in 2012 to 23.4% (583/2 487) in 2021, and the resistance rate to antimicrobial agents was higher than that of imipenem-susceptible strains (P<0.05). Serine carbapenase-producing strains accounted for 91.1% (920/1010).ConclusionThe resistance to antimicrobial agents of KP strains isolated from clinical specimens increased. It is necessary to monitor the in vitro drug susceptibility and the type of the carbapenemases of the isolates in order to provide guidance for the clinical usage of antibiotics.