Dietary intervention represents a promising strategy for managing post-surgical patients with Crohn’s disease (CD). This study aims to evaluate the effects of a modified Mediterranean diet (MMD) supplemented with partial enteral nutrition (PEN) for 4–5 weeks on quality of life in post-surgical CD patients, compared with exclusive enteral nutrition (EEN). The study was conducted at The Second Affiliated Hospital of Zhejiang University School of Medicine. The primary outcome was quality of life, measured using the 22-item inflammatory bowel disease quality-of-life questionnaire (IBDQOL-22) at the end of the intervention. Secondary outcomes included nutritional status and disease-related characteristics. Among 115 screened patients, forty-six were randomised to either the EEN group (n 24) or the MMD supplemented with PEN group (n 22). Twenty-three patients in the EEN group and twenty-two in the MMD supplemented with PEN group completed the study and were included for analysis. At the end of the intervention, both groups achieved similar 22-item inflammatory bowel disease quality-of-life questionnaire (IBDQOL-22) scores (EEN v. MMD supplemented with PEN: 88·43 (sd 9·17) v. 87·57 (sd 7·38), P = 0·734). In addition, both groups exhibited comparable nutritional status and disease-related characteristics (all P > 0·05). These results suggest that MMD supplemented with PEN provides comparable clinical benefits to EEN in post-surgical CD patients and may serve as an alternative nutritional strategy.

The rapid rise of multidrug-resistant Acinetobacter spp. poses a major global health threat. In Acinetobacter spp., carbapenem resistance is frequently mediated by OXA-type carbapenemases encoded by blaOXA genes, including blaOXA-24-like genes such as blaOXA-72. Outer membrane vesicles (OMVs) are nanoscale proteoliposomes secreted by Gram-negative bacteria that can facilitate plasmid transfer, yet the mechanisms limiting their dissemination remain unclear. Nationwide screening in China of 2,880 Acinetobacter clinical isolates identified 10 strains carrying blaOXA-24 and blaOXA-72 plasmids across three species (A. baumannii, A. pittii, and A. baylyi). Sequencing revealed nine distinct plasmids, most bearing a Rep_3/OrfX C-module backbone with blaOXA-pdif resistance modules (9/10). Among clinical strains, A2485 was identified as a high-OMV producer (2.74 ± 0.20-fold relative to ATCC 17978, P < 0.001). OMVs from A2485 transferred the blaOXA-72 plasmid to ATCC 17978 at 1.9 × 10⁻⁷ transformants per CFU, exceeding direct supernatant transfer at 3.2 × 10⁻⁸ transformants per CFU, and conferred resistance to meropenem, ceftazidime, and cefoperazone/sulbactam. Transfer was strictly donor-specific, with no transmission observed across 13 non-A. baumannii strains, and recipient strains failed to retransmit the plasmid, indicating a strong cross-species barrier and a non-reciprocal, donor-dependent process. Although all strains produced intact OMVs and encapsulated plasmid DNA, packaging efficiency varied considerably by host (~4.5-28.6 ng/μg). Strains with DNA loading (17978E/17978V: 28.62 and 23.98 ng/μg) equal to or exceeding that of donor A2485 (13.62 ng/μg) remained incapable of transfer. These findings demonstrate that dissemination is constrained by host-specific, post-packaging barriers rather than packaging efficiency, limiting resistance spread to specific lineages while enabling localized adaptation.IMPORTANCEAcinetobacter baumannii is a leading hospital-associated pathogen, and carbapenem resistance mediated by blaOXA-24-like genes poses a serious clinical challenge. Through nationwide screening of 2,880 clinical Acinetobacter isolates in China, we found that strains carrying blaOXA-24 and blaOXA-72 plasmids are relatively rare, occurring in only 10 isolates across three species. We provide the first evidence that outer membrane vesicle (OMV)-mediated plasmid transfer is subject to strict, host-specific barriers: the blaOXA-72 plasmid was successfully transferred among A. baumannii strains via OMVs, yet no transfer was observed to any of the 13 non-A. baumannii species tested. Transfer was also non-reciprocal-recipient strains that acquired the plasmid were unable to further disseminate it, whether via OMVs or supernatants. Critically, this restriction was not explained by DNA packaging efficiency, as strains with equal or greater plasmid loading than the donor remained incapable of transmission, pointing instead to post-packaging, donor-specific factors, such as membrane composition or vesicle biogenesis machinery. These findings clarify the sporadic distribution of blaOXA-24-like plasmids in China and challenge the conventional assumption that mobile genetic elements inherently carry broad dissemination potential, revealing that OMV-mediated resistance spread is constrained to specific bacterial lineages.

OBJECTIVE:Ceftobiprole, a fifth-generation cephalosporin, is effective in treating complicated Staphylococcus aureus bacteraemia, including methicillin-resistant S. aureus (MRSA). This study compared ceftobiprole minimum inhibitory concentrations (MICs) determined by broth microdilution (BMD), agar dilution (AD), and Etest for MRSA isolates from a multicentre study in China. METHODS:The in vitro activity of ceftobiprole was evaluated against 60 MRSA isolates using AD and Etest, with BMD as reference. RESULTS:BMD showed 85% of MRSA isolates were susceptible to ceftobiprole (MIC90 = 4 mg/L), with 95% having MICs within ±1 log2 dilution of the EUCAST breakpoint (1-4 mg/L). Categorical agreement and essential agreement were suboptimal for both AD (85% and 85%) and Etest (81.7% and 80%). Eight of nine MRSA isolates classified as resistant by BMD were categorized susceptible by Etest, resulting in very major errors, whereas only three isolates classified as susceptible by BMD were miscategorized as resistant by Etest. Using the error-rate-bound method, high very major errors were observed for Etest (22.2%) and AD (25.0%), predominantly involving ST5 and ST239 MRSA lineages. CONCLUSIONS:This study demonstrates frequent clustering of MRSA isolates within the EUCAST-defined area of technical uncertainty, defined for ceftobiprole as an MIC of 2 mg/L, corresponding to the susceptibility breakpoint and its adjacent zone, where categorization is inherently unreliable. Methodological limitations of AD and Etest further increase the risk of misclassification and potential failure to detect resistance. These findings underscore the need for optimized susceptibility testing strategies and refined interpretive guidance to support accurate clinical use of ceftobiprole.

Emergence of ceftriaxone-resistant Neisseria gonorrhoeae strains expressing penA allele 60.001 poses a major threat to the efficacy of ceftriaxone-based therapies. This study in Hangzhou, China, investigated the molecular epidemiology and antimicrobial susceptibility of 479 N. gonorrhoeae isolates collected from 2019 to 2025 to track the evolution of this resistance. Antimicrobial susceptibility of N. gonorrhoeae isolates was determined by agar dilution method. Sequence types were identified by multi-locus sequence typing (MLST). Whole-genome sequencing and phylogenetic analysis were performed on high-level ceftriaxone-resistant isolates. While overall ceftriaxone resistance fluctuated, a significant and alarming resurgence of high-level resistance (MIC ≥ 0.5 mg/L) was observed in 2024 (35

Background: Crohn’s Disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract, which can lead to progressive bowel damage and disability. The incidence of CD in China has increased steadily over recent decades; however, most of the patient-reported outcome (PRO) instruments were developed based on the experiences of patients with CD from the United States. Their cultural relevance to Chinese patients with CD has not been systematically evaluated. Therefore, this study aimed to access and validate the original conceptual model of CD to reflect the experiences of Chinese patients with CD. Methods: A qualitative study was conducted using four focus group discussions, including three patient groups (n = 18) and one healthcare professional (HCP) group (n = 6) from China. Insights from Chinese patients with CD and relevant HCPs was collected through these focus group discussions. The study explored participants' perceptions of CD-related symptoms, impacts, and coping strategies to validate the relevance and cultural applicability of the original conceptual model of CD to Chinese patients. Results: Among 107 concepts in the original conceptual model, 100 concepts (93.5%) were validated by Chinese participants. All 27 high-frequency concepts were confirmed by at least two focus groups, indicating strong cross-cultural consistency. The discussions also identified high-frequency, most bothersome, and salient concepts in Chinese patients' experiences. Furthermore, 17 new concepts were incorporated, leading to the creation of a new conceptual model of CD tailored to the Chinese context. Conclusion: This study validated the cross-cultural relevance of the original CD conceptual model through focus groups in China and confirmed its applicability to Chinese patients with CD. These findings provide a theoretical foundation for applying established PRO and clinical outcome assessment instruments in the Chinese context and support development of a culturally adapted disease conceptual model tailored to Chinese patients with CD. Furthermore, it provides a basis for an in-depth understanding of the experiences of Chinese patients with CD.

OBJECTIVE:Methicillin-resistant coagulase-negative staphylococci are important nosocomial pathogens. Studies on daptomycin (DAP) resistance in coagulase-negative staphylococci focus on Staphylococcus epidermidis, but few on Staphylococcus capitis despite its clinical and epidemiological importance. This study investigates the DAP susceptibility and underlying resistance mechanisms of methicillin-resistant S. capitis (MRSC) isolated from patients. METHODS:Clinical MRSC strains collected in China between 2018 and 2020 were analysed. The minimum inhibitory concentrations (MICs) were determined by agar dilution and broth microdilution methods. Molecular typing of S. capitis was performed using multilocus sequence typing. Whole-genome sequencing was performed to analyse mutations between DAP-resistant and -susceptible strains, which were further validated by phenotypic assays. RESULTS:A total of 101 MRSC strains were analysed, of which 99.01% (100/101) were DAP-susceptible, and 48.51% (49/101) exhibited reduced susceptibility (MIC > 0.5 µg/mL) - including 1 strain (0.99%) that was resistant (MIC = 4 µg/mL). ST1 (38.61%), ST6 (35.64%), and ST3 (6.93%) were dominant. ST6 strains were significantly more susceptible to DAP than ST1 (P < 0.001). No cross-resistance was observed between DAP and vancomycin (P = 0.604) or teicoplanin (P = 0.143). In the DAP-resistant strain, two novel mutations (mprF-A784L, yycF-H120P) were identified. Complementation of mutant mprF restored DAP resistance (MIC = 2 µg/mL) while increasing susceptibility to β-lactams. This 'seesaw effect' provides valuable insights for the treatment of MRSC infections. CONCLUSIONS:This study provides in vitro DAP activity data for S. capitis and identifies novel mprF mutations affecting its susceptibility to DAP and β-lactams.

IMPORTANCE:In Crohn's disease (CD) patients treated with biologics preoperatively, the optimal strategy for postoperative biologic management remains unclear. DESIGN:This was a retrospective multicenter study involving CD patients with ileocolonic anastomosis from 9 medical centers. Patients were divided into "the consistent group" (postoperative biologic previously used before surgery) and "the switched group" (postoperative biologic not used preoperatively). The primary endpoint was postoperative endoscopic recurrence (ER), which was defined as the first endoscopy performed between 6 and 18 months after surgery. Propensity score matching (PSM) was used to minimize baseline differences between groups, and conditional logistic regression was applied to identify factors associated with ER. RESULTS:In total, 227 patients were included in the study, of whom 177 were in the consistent group. No significant difference was observed in the rate of ER between the switched group and the consistent group (30.0% vs 40.7%, P = .170). In patients with ≤2 risk factors defined by established guidelines, the switched group showed a lower ER rate (20.6% vs 40.0%, P = .038). After 1:1 PSM, the switched group had a lower ER rate (29.4% vs 61.8%, P = .027). Conditional logistic regression analysis revealed that switching biologics was associated with a lower risk of ER (odds ratio = 0.31, 95% confidence interval, 0.11-0.85, P = .023). CONCLUSIONS:In CD patients with preoperative biologic exposure, both continuing and switching biologic therapy postoperatively were effective in preventing ER, with switching showing improved endoscopic outcomes after adjustment for confounders.

Inflammatory bowel disease (IBD) with the primary two forms, Crohn's disease and ulcerative colitis, has been considered as immune-mediated disorders (IMDs). IMDs,however, consist of a wide spectrum of gastrointestinal (GI) and extraintestinal disorders, in addition to the classic forms of IBD. Dysregulated innate and adaptive immunities are involved in IMDs. For example, abnormal innate immunity plays a major role in the pathogenesis of autoinflammatory diseases, while dysregulated adaptive immunity exerts the role in autoimmune enteropathy. There are overlaps in etiopathogenetic pathways, clinical presentations, endoscopic features, and histologic characteristics between classic IBD, autoimmune disorders, and autoinflammatory disorders. IMDs can be triggered by factors, such as bowel altering surgery and certain medications. Immune checkpoint inhibitors are known to cause IBD-like, immune-mediated colitis. The association between GI IMDs and extraintestinal IMDs is mutual and multi-persective.

Primary and secondary humoral and cellular immune deficiencies occur in both adult and pediatric populations, although primary immune deficiencies are predominantly seen in infants or young children. The relationship between immune deficiency, gastrointestinal (GI) infections, and GI inflammation is complex and reciprocal. Patients with primary or secondary immune deficiencies often have GI manifestations from microbial infections, concurrent autoimmune disorders, or immune deficiency per se. The GI presentations may mimic that in inflammatory bowel disease (IBD) The classic example is common variable immune deficiency. IBD, particularly in those treated with immunosuppressive medications, may develop secondary immune deficiencies, with a typical example being immunoglobulin (Ig) deficiency. Refractory disease course of IBD may be attributed to the immune deficiency. In clinical practice, intravenous Ig infusion has been used for the treatment of refractory IBD or refractory pouchitis with a favorable outcome. Endoscopy and histology along with serology, genetic testing, and microbiology are valuable for the differential diagnosis between primary or secondary immune deficiency, immune deficiency with superimposed infections, IBD, and immune deficiency concomitantly with underlying IBD.

Drug-resistant bacterial infections pose a serious threat to global health, driving the development of antibacterial strategies beyond classic antibiotics. Host defense peptide mimetic polymeric antibiotics have emerged as promising candidates to combat drug resistance, however, navigating the vast chemical space of polymers remains a significant challenge due to complex structure-activity relationships, while data-driven approaches are further constrained by polymer complexity and scarce labeled data. To address this, we develop PolyCLOVER, a framework that integrates multi-stage self-supervised learning, active learning, and high-throughput experimentation to iteratively discover polymeric antibiotics with potent antibacterial activity and low toxicity. Applied to a combinatorial library of ~100,000 poly(β-amino ester)s, the framework uncovers three lead compounds that self-assemble into stable nanoparticles (SANPs) with minimum inhibitory concentrations of 4 μg/mL and 8 μg/mL against multidrug-resistant S. aureus and A. baumannii, respectively. These SANPs also serve as adjuvant antibiotic carriers, restoring bacterial sensitivity to penicillin G. In vivo studies demonstrate their therapeutic efficacy both as monotherapies and in combination therapies with antibiotics. PolyCLOVER may become a powerful framework for discovery of new polymeric biomaterials without reliance on external datasets.

BACKGROUND:The aim of this study was to determine if Crohn's disease (CD) and ulcerative colitis (UC) manifest similarly in different parts of the world. METHODS:Investigators of cohort studies from around the world were contacted to provide the most recent data from their CD and UC cohorts. Each cohort provided summated and averaged data on pre-specified variables. The Montreal Classification was used for phenotype assessment. Age at diagnosis was stratified into less than 17 years, 17-39 years, and >39 years. Disease location for CD was stratified as ileum only, colon only, ileocolon, upper gastrointestinal and proximal small bowel disease, and perineal penetrating disease. Disease behavior for CD was stratified into inflammatory disease, stricturing disease, and penetrating disease. Location for UC was stratified into proctitis, left-sided colitis, and extensive including subtotal and pancolitis. Reports were classified geographically as Asia, Latin America, South Africa, and "Western" (ie, North America, Europe, and Oceania). These categories were collapsed to "Western" and "non-Western" for analyses. RESULTS:Data from 54 868 patients with IBD were included. For CD, data were available from nine Western cohorts, 12 Asian cohorts, three Latin American cohorts, and one African cohort. For UC, eight Western cohorts were compared with 11 Asian cohorts, three Latin cohorts, and one African cohort. The demographic and phenotypic distribution for CD and UC in comparisons between Western and non-Western countries were no different. Western cohorts had longer disease durations than non-Western cohorts. CONCLUSION:No significant differences were seen in any phenotypic data between the cohorts, suggesting that IBD is similar worldwide.

Differential diagnosis of inflammatory bowel disease (IBD) and gastrointestinal (GI) cancers is critical for the management and prognosis. GI cancer, particularly GI lymphoma, shares multiple endoscopic features with Crohn's disease and ulcerative colitis, making the differential diagnosis challenging. Besides, long-standing IBD or the use of immunosuppressive agents (especially purine analogs), predispose the patient to the development of colitis-associated neoplasia or lymphoproliferative disorders. The dentification of neoplastic lesions on the background chronic GI inflammatory is important. Furthermore, radiation therapy for IBD- or non-IBD-associated malignancy can result in radiation enteritis or colitis with endoscopic features mimicking those in IBD. Finally, polyposis in the GI tract can also present endoscopic features resembling that of IBD.

Cryptococcal pneumonia predominantly occurs in immunocompromised patients, but its incidence among immunocompetent individuals has been increasing in recent years. However, cases of co-infection with Cryptococcus neoformans and community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in immunocompetent hosts remain exceedingly rare. This study reports on a previously healthy 30-year-old male who presented with 20-days cough and 1-day fever. Through nanopore targeted sequencing (NTS) of bronchoalveolar lavage fluid (BLAF) and traditional microbial culture, he was ultimately diagnosed with a co-infection of C. neoformans and CA-MRSA. The patient showed significant improvement after treatment with oral linezolid (0.6 g twice daily) for 2 weeks and oral fluconazole (400 mg once daily) for 6 months. This case highlights that even immunocompetent individuals can simultaneously contract multiple community-acquired pathogens, while also underscoring the clinical utility of NTS in the early diagnosis of co-infections and detection of resistance genes.

Background: Although Upadacitinib has proven success in inflammatory bowel diseases (IBD), there is less data on its efficacy and safety in Asian patients with refractory IBD. Methods: This multicenter study evaluated the real-world effectiveness and safety of UPA in patients with refractory IBD. This multicenter retrospective cohort analysis included adult refractory IBD patients who received UPA therapy at three tertiary hospitals from January 2023 to March 2025. Clinical, endoscopic, and laboratory outcomes were effectiveness goals. Safety measures included AEs and and rates of discontinuation. Results: A total of 80 eligible patients were enrolled, including 52 with CD and 28 with UC. During the induction period, for CD: steroid-free clinical remission: 59.6%; clinical response: 61.5%; endoscopic remission: 30.8%; endoscopic response: 57.7%. For UC, steroid-free clinical remission: 67.9%; clinical response: 71.4%; endoscopic remission: 46.4%; endoscopic response: 60.7%. In the maintenance phase (12 months), CD had 78.8% steroid-free clinical remission and 75.0% endoscopic remission. UC had 85.7% steroid-free clinical remission and 78.6% endoscopic remission. Inflammatory indicators and nutritional parameters improved significantly. The incidence of adverse events in CD and UC was 23.1% and 14.3%, respectively, and the discontinuation rates during the 12-month maintenance treatment period were 7.1% and 21.5%, respectively. The most common adverse reaction is acne (8.75%). Conclusion: UPA demonstrated robust real-world effectiveness and an acceptable safety profile in Asian patients with refractory IBD.

Despite being a common complication of Crohn's disease (CD), evidence regarding the use of ustekinumab (UST) for treating symptomatic strictures in China remains limited. This study evaluated the effectiveness of UST in this population and identified the predictors of successful therapy. This cohort study enrolled adults with CD initiating UST therapy for symptomatic strictures confirmed by endoscopy or imaging. The primary outcome at Week 52 was continued UST therapy without prohibited adjunctive treatments. A clinical prediction model was developed, and its performance was evaluated for identifying baseline factors associated with treatment success. Of the 73 patients screened between June 2022 and April 2024, 54 were included. At Week 52, 44 (81.5%) achieved treatment success, with most demonstrating improvements in obstructive symptom score, CD Activity Index (CDAI), endoscopic and computed tomography enterography (CTE) findings, and biochemical parameters. Nonsmoking status and C-reactive protein (CRP) levels predicted treatment success, with the model demonstrating 86.4% discriminative ability. No severe adverse events were reported, except for one case of leukemia (2%) and two cases of serious infections (4%). The study highlighted that UST effectively alleviated intestinal strictures in CD, with most patients achieving symptom remission, improved stricture morphology, and reduced inflammation.

BackgroundStreptococcus pneumoniae pericarditis is rare and lethal, yet how the pathogen evolves within the host during blood-to-pericardium spread remains unknown.MethodsTwo ST876 serotype 14 strains, hz23B (blood) and hz23P (pericardial effusion), were isolated from one purulent pericarditis patient. We determined antimicrobial susceptibility test (AST) by broth microdilution, performed whole-genome sequencing and mutation detection, multi-locus sequencing typing, and phylogenetic analysis against 1429 global serotype 14 genomes, modeled protein structures for unique mutations, and quantified growth under anaerobic/low-nutrient conditions, plus adherence and invasion on nasopharyngeal and lung epithelial cell lines.ResultsBoth isolates showed an identical AST profile, where a multidrug-resistant phenotype was observed. Genomes differed by only 36 SNPs, while hz23P acquired CiaH_W192L (transmembrane kinase loss) and FabT_E21A (DNA-binding reduction). These changes conferred hz23P’s enhanced growth in THY and BSA+G under anaerobic stress (p < 0.0001) but significantly reduced adherence (p < 0.0001) and invasiveness (p < 0.01) compared with hz23B. Global screening identified ST876 as a unique clone that carries pericarditis-linked mutations and successfully dominated China due to multidrug resistance.ConclusionsWe provide the first real-time evidence that ST876 serotype 14 pneumococci evolve within the host to survive the pericardial environment by attenuating virulence and energy. The global screen underscores the urgent need for surveillance targeting this multidrug-resistant and virulent clone.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) poses an enduring severe threat to global health, but its long-term epidemiological trends and multi-dimensional drivers remain unclear. Methods: Using MICROBE, GLASS, EARS-Net, CAESAR, IQVIA MIDAS and World Bank data, we analyzed spatiotemporal trends in MRSA prevalence and mortality across 204 countries (1990–2021) and projected age-specific mortality to 2035. A linear mixed-effects model was used to examine associations of antibiotic consumption and social determinants of health with MRSA burdens. Findings: From 1990 to 2021, global MRSA-attributable death counts increased from 57 197 to 129 547, and age‑standardized mortality rates rose from 1‧40 to 1‧61 per 100 000. Age-specific mortality fell sharply in young children, particularly those aged 2–4 years (AAPC: –2‧50%), but rose most in adults aged 30–44 years (AAPC: 1‧20%) and those over 90 years (1‧20%–1‧40%). MRSA burdens remained disproportionately concentrated in countries with a lower Socio-demographic Index (SDI), yet high-SDI countries were still far from optimal control levels. Overuse of carbapenems and cephalosporins, along with PM2.5 exposure and climate warming, significantly increased MRSA burdens, whereas higher health expenditure, safely managed water and sanitation, expanded forest coverage, investment in education, and internet access served as protective factors. By 2035, MRSA burdens among adults were projected to remain substantial, particularly in Central Europe, Eastern Europe, Central Asia, South Asia, North Africa, and the Middle East. Interpretation: These findings highlight the imperative for integrated, multisectoral interventions that transcend antimicrobial stewardship alone and target environmental, socioeconomic and health literacy determinants to alleviate the global MRSA burdens.

Background: The transmission of carbapenem-resistant Pseudomonas aeruginosa (CRPA) between hospital environment and patients poses significant challenges for clinical management. The COVID-19 pandemic may have influenced bacterial transmission dynamics in intensive care units (ICU). This study aimed to prospectively investigate the temporal and spatial spread of P. aeruginosa after a COVID-19 upsurge period in China. Methods: We routinely screened for P. aeruginosa in both the environment and patients in a newly-opened 21-bed tertiary teaching hospital ICU in eastern China from October 2022 to April 2023, during which a COVID-19 upsurge occurred from December 2022 to January 2023. Whole-genome sequencing and antibiotic susceptibility testing were performed on all non-repetitive P. aeruginosa isolates. Results: Among 1694 environmental samples, 40 (2.36%) samples were CRPA. In 1576 nasopharyngeal and rectal samples (from 353 patients), 108 samples (6.86%) were CRPA. Sequence type (ST) 463 was the most prevalent clone in both patient and environmental samples. Spatiotemporal distribution and genomic data revealed sporadic patients-related transmission before COVID-19 upsurge period, while high-risk ST463 clone transmission was detected during COVID-19 upsurge period. However, there was no strong evidence to show that antibiotic consumption significantly influenced CRPA transmission in this study. Additionally, the evolution events of blaKPC (from blaKPC-2 to blaKPC-71) were observed, resulting in multi-sites CRPA colonization in one patient. Conclusion: Our prospective study demonstrates that COVID-19 upsurge is associated with increased P. aeruginosa transmission. These findings provide valuable insights into nosocomial infection management during future public health crisis. We also reported carbapenemase mutation from blaKPC-2 to blaKPC-71 in P. aeruginosa, which provides reference for further antibiotic usage.

Background: Ulcerative colitis (UC), a chronic and relapsing inflammatory bowel disease, has long depended on physician-led objective evaluations for clinical management. However, physicians' assessments of symptoms often differ from patients' subjective experiences, creating a cognitive gap that may influence treatment decisions and overall disease outcomes. Objective: This study aimed to compare the cognitive discrepancy between UC patients and gastroenterologists throughout the diagnosis and treatment process. Design: Multicenter retrospective study. Methods: A nationwide survey was conducted across 39 Inflammatory Bowel Disease centers in China using a convenience sampling method, enrolling 457 UC patients and 170 gastroenterologists. A two-way questionnaire survey was administered to both groups to assess perceptions of disease status, treatment goals, medication use, follow-up preferences, economic burden, and decision-making models. Results: This multicenter study identified significant cognitive gaps between UC patients and gastroenterologists across key domains of disease management. Physicians prioritized objective clinical indicators such as hematochezia (51.18% vs 41.58%, p = 0.031), whereas patients emphasized subjective symptoms like rectal urgency (19.69% vs 4.12%, p < 0.001). Treatment goals also differed: patients valued quality-of-life improvement most, while physicians ranked endoscopic mucosal healing highest. Discrepancies extended to follow-up, with physicians favoring bi-monthly visits and patients preferring intervals exceeding 6 months. In decision-making, although 47.06% of physicians supported shared decision-making, only 10.72% of patients endorsed this model (p < 0.001). Notably, patients' willingness to allocate >50% of household income to treatment (21.44%) substantially surpassed physicians' expectations (5.29%, p < 0.001). Conclusion: These findings indicate a clear disconnect between current clinical management approaches and the lived experience of patients with UC in China. To bridge this gap, practice must shift toward models that actively integrate patient priorities into treatment plans.