Hospital-acquired urinary tract infections are a frequent complication in intensive care units. They are increasingly being associated with multidrug-resistance, especially in low-resource settings. To assess the uropathogenic and antimicrobial resistance patterns and identify patient-related factors associated with multidrug resistance and mortality among patients with hospital-acquired urinary tract infections in Tehran, Islamic Republic of Iran. We analysed secondary data on all patients aged ≥ 18 years who had hospital-acquired urinary tract infections and were admitted to intensive care units of 45 public and private hospitals in Tehran, Islamic Republic of Iran, between 2022 and 2024. We examined the associations between the demographic and clinical variables using prevalence ratios and the outcomes of interest using relative risks. P ≤ 0.05 was considered statistically significant. Of the 2467 patients, 60% were catheterised. A bacterial pathogen was isolated from 77% and Candida spp. from 23%. The most common pathogens were Escherichia coli (26%), Klebsiella spp. (22%) and Candida spp. (23%). Seventy-two percent of 1590 patients assessed exhibited multidrug resistance. Males, catheterised patients and patients with extended catheter use (> 8 days) had higher prevalence of multidrug resistance. Overall mortality rate was 42% and mortality was highest among patients with prolonged catheter use (57%), those admitted in public hospitals (51%) and those infected with Candida spp (60%). The alarmingly high prevalence of multidrug resistance and high mortality rate among patients with hospital-acquired urinary tract infections indicate the need to enhance infection prevention and control practices in Iranian hospitals, and to significantly improve antibiotic susceptibility testing and antimicrobial resistance surveillance.
Pseudomonas aeruginosa is a major opportunistic pathogen whose ability to form biofilms greatly enhances antimicrobial tolerance and contributes to persistent infection. Although increasing attention has been paid to biofilm-mediated drug resistance, the overall knowledge structure and translational development of this field remain unclear. A bibliometric analysis was performed using publications retrieved from the Web of Science Core Collection and Scopus on December 20, 2025. The search covered the period 2014-2025 and focused on P. aeruginosa, antimicrobial resistance, and biofilms, resulting in 6,537 publications for bibliometric analysis. To complement the bibliometric findings, a supplementary narrative review of published clinical studies and a separate registered trial landscape overview were conducted. After screening, 6 published clinical studies and 18 registered interventional trials were included. Global research output on P. aeruginosa biofilm-mediated resistance increased steadily from 2014 to 2025. China, the United States, and India were the most productive countries, while the United States showed the leading role in the international collaboration network. Keyword clustering and temporal analyses indicated three major research directions: multidrug resistance evolution and pathogenic synergy, novel antibacterial interventions and functional materials, and clinical translation and efficacy evaluation. The supplementary clinical component showed growing interest in adjunctive and mechanistically targeted strategies, particularly in chronic airway and wound-associated infections, although mature efficacy data remain limited. Research on P. aeruginosa biofilm-mediated drug resistance is shifting from mechanistic exploration toward translational application. This study provides a data-driven overview of the field's intellectual structure, research hotspots, and emerging trends, and may help guide future anti-biofilm and anti-resistance research.
Klebsiella pneumoniae (K. pneumoniae) is a major cause of urinary tract infections (UTIs) and poses a growing public health concern due to multidrug resistance and virulence potential. This study aimed to characterize antimicrobial resistance, biofilm formation, and virulence gene distribution among urinary K. pneumoniae isolates from North Lebanon and to explore correlations between these factors. A total of 153 non-duplicate isolates from hospital and community settings were analyzed for antibiotic susceptibility, hypermucoviscosity, biofilm formation, and presence of key virulence (fimH, mrkD, magA, rmpA, entB, iucA, iroN, kfu) and β-lactamase (blaTEM, blaSHV, blaCTX-M) genes. Adhesion-associated genes fimH and mrkD were highly prevalent, particularly in hospital-acquired and strong biofilm-producing isolates. Capsular and regulatory genes (magA) was more frequent in putative hypervirulent and community-acquired strains, while siderophore genes entB and iucA were strongly associated with biofilm formation and hospital-acquired infections. A significantly higher resistance to cephalosporins, along with an increased frequency of multidrug-resistant phenotypes, was detected in hospital-acquired, classical, and strong biofilm-forming isolates. ESBL production was significantly more common in hospital-acquired and biofilm-forming isolates. Strong biofilm formation was largely associated with classical K. pneumoniae and hospital-acquired infections, whereas putative hypervirulent strains were primarily weak biofilm producers and community-acquired. These findings highlight the interplay between virulence determinants, biofilm formation, and antibiotic resistance, emphasizing the need for targeted infection control and treatment strategies in North Lebanon.
Antimicrobial resistance (AMR) constitutes a critical global health challenge with major implications for public health and economic stability, increasing infection- and sepsis-related mortality. Despite growing evidence on its contribution to disease burden, comprehensive assessments of long-term trends at the regional level remain limited in the World Health Organization (WHO) Southeast Asia Region (SEAR) and Western Pacific Region (WPR). We used data from the Global Research on Antimicrobial Resistance (GRAM) Project to evaluate sepsis- and AMR-related deaths and disability-adjusted life-years (DALYs) for 11 infectious syndromes, 22 pathogens, and 84 pathogen-drug combinations across 42 countries and territories in the WHO SEAR and WPR from 1990 to 2021. AMR burden was estimated under two counterfactual scenarios: deaths and DALYs attributable to AMR (representing the burden if drug-resistant infections were replaced by drug-susceptible infections), and deaths and DALYs associated with AMR (representing the burden if infections did not occur at all). We reported numbers, crude rates, and age-standardized rates, and generated forecasts of AMR burden to 2050 using an autoregressive integrated moving average model. In SEAR and WPR, there were 8.36×106 [95% uncertainty interval (UI) 7.93-8.79] sepsis-related deaths in 1990, which decreased to 6.03×106 (95% UI 5.68-6.39) in 2019 before increasing to 8.31×106 (95% UI 7.86-8.76) in 2021. The number of deaths associated with AMR ranged from 2,445,875 (95% UI 2,221,769-2,670,192) in 1990 to 2,358,190 (95% UI 2,173,521-2,545,190) in 2021, while deaths attributable to AMR ranged from 546,479 (95% UI 487,669-605,277) to 587,103 (95% UI 534,165-639,903) over the same period. From 1990 to 2021, deaths attributable to AMR decreased among people <25 years, with a 76.1% [95% confidence interval (CI) 70.6-81.6] reduction occurring among children <5 years, while those among adults aged ≥70 years more than doubled, increasing from 133,013 (95% UI 124,066-141,922) to 298,366 (95% UI 284,023-312,475). The largest increase in the number of deaths attributable to AMR was caused by methicillin-resistant Staphylococcus aureus [from 30,168 (95% UI 24,956-35,351) in 1990 to 66,946 (95% UI 57,544-76,479) in 2021]. In 2021, Kiribati had the highest age-standardized mortality rate (per 100,000 person-years) attributable to AMR [30.9 (95% UI 24.1-37.8)], whereas New Zealand had the lowest [3.2 (95% UI 2.6-3.8)] among the two regions. By 2050, the number of deaths associated with AMR is predicted to reach 3,875,753 (95% UI 1,502,402-9,998,297) in these two regions, of which 952,592 (95% UI 766,353-1,184,090) deaths are attributable to AMR. This study highlights the escalating burden of AMR in SEAR and WPR, emphasizing the urgent need for attention to this persistent and growing crisis. Our analyses underscore the dual challenge of sustaining gains among people <25 years while addressing the alarming increase of AMR in elderly populations. Given the high variability of AMR burden by pathogen, age group, and country, strengthened surveillance and improved laboratory capacity are essential to accurately characterize resistance patterns and guide clinical decision-making.
Acinetobacter baumannii is a major healthcare-associated opportunistic pathogen with exceptional environmental persistence. However, its ecological distribution and potential transmission pathways in veterinary hospital environments remain poorly characterized. Samples were collected from multiple departments and surface types across eight veterinary hospitals in Beijing from September to December 2020. A. baumannii isolates were recovered and subjected to antimicrobial susceptibility testing and whole-genome sequencing. Environmental risk factors were assessed using generalized linear mixed-effects models (GLMMs) with a binomial distribution and logit link, with hospital included as a random intercept and sampling site and department as fixed effects. Genomic analyses included profiling of antimicrobial resistance genes, virulence factors, and biocide/metal resistance genes, as well as Bayesian population structure and cgMLST to infer potential transmission patterns. Among 1,136 environmental samples collected across eight veterinary hospitals in Beijing, 64 A. baumannii isolates were recovered, with an overall isolation rate of 5.63% and hospital-level rates ranging from 0.54% to 15.33%. The X-ray room showed the highest observed department-level isolation rate (16.36%, 9/55) and was significantly associated with increased A. baumannii recovery compared with the clinic room reference category in the multivariable GLMM. Floors (12.40%, 31/250), sinks (9.80%, 10/102), and staff uniforms (9.73%, 11/113) showed the highest surface-level isolation rates and were significantly associated with increased recovery compared with the door reference category (all P < 0.05). Most isolates were susceptible to the tested antimicrobial agents, while ceftriaxone showed the highest non-susceptibility rate (43.8% intermediate, 4.7% resistant). Two isolates were multidrug-resistant, including one carrying a 7,561-bp resistance region with a class 1 integron cassette array (aadA1-cmlA-aadA2-bla PSE-1). Whole-genome analysis revealed a conserved baseline resistome, core virulence determinants related to adhesion, biofilm formation, nutrient acquisition, regulation, and secretion systems, as well as broadly distributed metal tolerance and oxidative-stress defense genes. In contrast, accessory ARGs, VFs, and disinfectant- or metal-associated resistance determinants showed lineage- or isolate-specific variability. Bayesian population structure analysis resolved nine BAPS lineages with distinct spatial distribution patterns, including hospital-restricted, locally shared, and spatially dispersed lineages. cgMLST further identified hospital-specific near-clonal subclusters within these lineages, defined by ≤8 allelic differences and 0-3 core-genome SNPs. These subclusters were detected across multiple departments and environmental surfaces within the same hospital, indicating broad within-hospital environmental distribution of highly related isolates. This study demonstrates heterogeneous environmental contamination of A. baumannii in veterinary hospitals, with higher recovery from X-ray rooms, wet sites, staff uniforms, floors, and other shared or frequently contacted surfaces. Although most isolates were not multidrug-resistant, they carried conserved resistance-, virulence-, and environmental survival-associated genomic determinants, suggesting that their ecological risk may be related to surface survival, stress tolerance, and redistribution within hospital environments rather than widespread MDR clone dissemination. Population structure and cgMLST analyses revealed both inter-hospital lineage sharing and hospital-specific near-clonal subclusters, indicating the presence of highly related A. baumannii isolates across multiple departments and environmental surfaces within individual hospitals. These findings highlight the need to incorporate environmental opportunistic bacteria such as A. baumannii into veterinary hospital surveillance and infection prevention and control planning, particularly in high-use functional areas, wet zones, staff uniforms, shared equipment, and high-touch surfaces.
Bone and joint infections (BJIs) are disabling conditions whose global burden is evolving. This study aimed to systematically analyze the disease burden, temporal trends, pathogen spectrum, and resistance profiles of BJIs at the global, regional, and national levels from 1990 to 2021. Based on the Global Research on Antimicrobial Resistance Project, this study extracted data on deaths and disability-adjusted life years (DALYs) attributable to BJIs from 1990 to 2021, stratified by sex, age, region, pathogen, and antimicrobial resistance. Trends and inequalities were analyzed using estimated annual percentage change, the Bayesian age-period-cohort model and health inequality analysis. Between 1990 and 2021, the global number of deaths due to BJIs increased by 228% (from 7,475 to 24,505), and DALYs increased by 291% (from 1,549,957 to 6,054,611), with age-standardized rates showing a consistent upward trend. The disease burden exhibited significant geographical inequality, with East Asia bearing the heaviest and fastest-growing burden. Staphylococcus aureus was the leading pathogen responsible for both mortality and DALYs. Regarding antimicrobial resistance-associated burden, the death toll attributable to antimicrobial resistance increased markedly, with Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae being the most prominent contributors. The global burden of BJIs continues to increase, exhibits significant regional inequalities, and antimicrobial resistance serves as a critical driver of health loss. These findings necessitate strengthened infection prevention and control, prudent antimicrobial use, and the development of novel therapeutic strategies.
The incidence of infections caused by rare pathogens has increased in recent years. This necessitates the development of effective diagnostic and therapeutic approaches. In this study, we report the first documented case of Aspergillus steynii-induced pulmonary infection in humans. We evaluated the morphological and molecular characteristics of this fungus to elucidate its role in human infections. A 47-year-old woman with immunosuppression after bone marrow transplantation developed symptoms of pulmonary infection. The pathogen was identified as A. steynii through culture techniques, microscopy, mass spectrometry, multigene molecular identification, and whole-genome sequencing. Antifungal susceptibility testing was performed, and comparative genomic analysis was conducted to assess the phylogenetic relationship and genomic characteristics of A. steynii and other pathogenic Aspergillus species. Genomic analysis revealed a high degree of similarity with other pathogenic Aspergillus species. Furthermore, we identified 470 unique gene families primarily associated with ABC transporter pathways linked to multidrug resistance. The strain was sensitive to triazoles and echinocandins but exhibited elevated minimum inhibitory concentrations (MICs) for amphotericin B, flucytosine, and fluconazole. In addition, multiple potential drug resistance genes were identified, indicating the potential for multidrug resistance. The emergence of A. steynii in humans poses new clinical challenges and risks, including cross-species transmission and multidrug resistance. The potential for A. steynii infections, particularly in immunosuppressed patients, highlights the importance of early diagnosis and timely intervention to reduce the risk of misdiagnosis or delayed treatment. Thus, our findings have the potential to improve the clinical and differential diagnosis of this infection and facilitate the development of effective therapeutic approaches.
To characterize pathogen distribution and antimicrobial resistance among neonates with bloodstream infections at a Grade-A tertiary medical center in China. This retrospective study reviewed clinical data, culture results, and antimicrobial resistance information from neonates admitted between January 2021 and December 2024. Clinical specimens were collected in accordance with standard protocols for culture. Antimicrobial susceptibility testing was performed using an automated microbial identification system, with results interpreted according to the CLSI standards of the corresponding testing year. Of 652 neonates admitted within 3 days of life, 283 had blood-culture-proven bloodstream infection; blood-culture positivity was 22.65%. Common bloodstream isolates included Staphylococcus epidermidis and Klebsiella pneumoniae. Staphylococcus epidermidis showed high resistance to penicillin, oxacillin, cefoxitin, and erythromycin, whereas Klebsiella pneumoniae was frequently resistant to cefepime and piperacillin-tazobactam. Among 290 blood-culture isolates, 161 (55.52%) were Gram-positive bacteria, including 109 MDR isolates (67.70%), and 122 (42.07%) were Gram-negative bacteria, including 32 MDR isolates (26.23%). Preterm infants, low-birth-weight infants, and late-onset bloodstream infections accounted for large proportions of the cases. Local surveillance of pathogen distribution and resistance patterns can support antimicrobial stewardship and infection prevention in neonatal care.
Macrococcus caseolyticus is a Gram-positive bacterium mainly isolated from dairy products and animal skin and is usually associated with animal infections. M. caseolyticus comprises two subspecies, M. caseolyticus subsp. caseolyticus and M. caseolyticus subsp. hominis. Here, we report a fatal bloodstream infection caused by M. caseolyticus subsp. caseolyticus in China and characterize the clinical isolate by genomic and phenotypic analyses. Strain WH712 was isolated from the blood culture of a 91-year-old male patient and identified by matrix-assisted laser desorption ionization/time-of-flight mass spectrometry. Whole-genome sequencing was performed using the Illumina HiSeq platform. Antimicrobial susceptibility testing was conducted using the AutoMic-i600 system, and biofilm-forming capacity was evaluated using a 96-well microtiter plate assay. WH712 was initially identified as M. caseolyticus by MALDI-TOF MS and confirmed as M. caseolyticus subsp. caseolyticus by whole-genome analysis. Homology-based genomic analysis identified putative homologs of bopD, ami, srtE, and pfbA, which have been associated in other bacteria with biofilm-related regulation, adhesion, and cell-surface functions. These findings suggest that WH712 may harbor genomic features relevant to host colonization and persistence. The isolate was phenotypically susceptible to most tested antibiotics but showed intermediate resistance to clindamycin, possibly associated with a vgaB homolog and efflux-related homologs, including macB and sdrM. Phenotypic testing demonstrated that WH712 had strong biofilm-forming capacity, comparable to that of Staphylococcus aureus ATCC 29213, which may have contributed to bacterial persistence and the poor clinical outcome. This study reports a fatal human bloodstream infection associated with M. caseolyticus subsp. caseolyticus in China. Whole-genome analysis and phenotypic testing showed that this clinical isolate had a strong biofilm-forming phenotype, which may have contributed to bacterial persistence. However, the poor clinical outcome should be interpreted primarily in the context of the patient's advanced age, severe comorbidities, and impaired host defenses.
Escherichia coli (E. coli) bloodstream infections (BSIs) are a significant public health concern. This study aimed to examine the clinical characteristics, laboratory indicators, outcomes, and antimicrobial resistance patterns of E. coli BSIs in neonatal populations. A retrospective analysis was conducted from January 2017 to December 2023 at Guangxi Children's Hospital in China. We compared neonatal and non-neonatal patient groups, analyzing clinical parameters, lab results, and antimicrobial susceptibility patterns. Using multivariable regression analysis, we identified specific laboratory markers as prognostic indicators for ICU admission in newborns with E. coli BSIs. Diagnostic efficacy was assessed using ROC curves, sensitivity, and specificity. The study analyzed 179 hospitalized patients with E. coli BSIs, including 91 neonates (0-28 days) and 88 older pediatric cases. Among the neonates, 52 (57%) required ICU admission, while the remaining 39 (43%) were managed in general pediatric wards. In neonates, the highest resistance rate was observed for ampicillin (83.52%), followed by sulfamethoxazole (51.65%) and cefazolin (46.15%). Non-neonates exhibited higher resistance to ceftazidime (P=0.022), imipenem (P=0.021), meropenem (P=0.023), and other antibiotics. Multivariate analysis showed that decreased albumin (ALB) and total bile acid (TBA) levels, along with increased direct bilirubin (DBIL), were independent risk factors for ICU admission. Findings indicated that when ALB <33.06 g/L, TBA <8.2 μmol/L, and DBIL >14.64 μmol/L, the risk of ICU admission for neonates increased. E. coli BSIs in neonates and non-neonates exhibit distinct clinical features and resistance profiles. Low ALB and TBA, and high DBIL were found to be important predictors of ICU admission in neonates. Close monitoring of these markers can improve outcomes for high-risk neonates with E. coli BSIs.
To clarify the molecular epidemiology, resistance gene profiles, virulence characteristics, and clinical prognosis-related factors of Carbapenem-Resistant Enterobacterales (CRE) isolated from sterile body fluids. This study provides microbiological evidence for clinical management and infection control surveillance. 62 non-duplicate sterile fluid CRE strains from 2016-2025 were retrospectively analyzed. VITEK-2 Compact detected MICs per CLSI M100. Illumina NovaSeq whole-genome sequencing was assembled via ABySS and GapCloser. Databases analyzed resistance, virulence, plasmid and MLST profiles. SNP phylogenetic analysis identified clonal clusters and strain genetic relationships. Among the 62 CRE isolates, Klebsiella pneumoniae was the predominant species (77.4%, 48/62), followed by Escherichia coli (12.9%, 8/62) and Enterobacter cloacae complex (6.5%, 4/62). Additionally, single isolates of Klebsiella aerogenes and Citrobacter freundii were recovered. A total of 6 sequence types (STs) were identified, with ST11 being the most prevalent (87.5%, 42/48) among K. pneumoniae isolates. Carbapenemase genes were detected in 91.7% (44/48) of K. pneumoniae strains, with blaKPC-2 (85.4%, 41/48) and blaNDM-1 (10.4%, 5/48) as the main types. Three strains co-harbored blaKPC-2 and blaNDM-1, and one strain carried blaNDM-5 alone. These strains also carried class C β-lactamase (AmpC), extended-spectrum β-lactamases (ESBLs), and aminoglycoside/quinolone resistance genes. The rmpA2 virulence gene was detected in 75.0% (36/48) of K. pneumoniae isolates. Among E. coli, blaNDM-5 (4/8) and blaNDM-13 (2/8) were predominant. One ST155 isolate exhibited ertapenem resistance potentially mediated by AmpC promoter mutations and porin loss based on genomic prediction. Additionally, mcr-1.1 was detected in one ST361 isolate. All four E. cloacae complex belonged to ST171 and harboured blaNDM-1; one co-carried mcr-9.1. Clonal analysis revealed five major clusters within ST11 (Clade A-E), with Clade B comprising genetically related dual-carbapenemase isolates from multiple wards (8-10 SNPs). Twelve patients (19.4%) died. Intensive Care Unit (ICU) admission was significantly associated with mortality (83.3% vs. 30.0%, P=0.002). CRE from sterile body fluids were dominated by ST11 K. pneumoniae carrying blaKPC-2, with complex multidrug resistance and frequent carriage of rmpA2 and other virulence-associated genes. Continuous molecular surveillance of dominant clones and monitoring of high-risk patient populations may inform strategies to reduce CRE burden.
The global prevalence of multidrug-resistant (MDR) Gram-negative bacterial infections has posed a severe threat to public health security. As the "last line of defense" antibiotic against such infections, polymyxin B is severely limited in clinical application by dose-dependent nephrotoxicity (25-50% incidence), neurotoxicity, and the global spread of mcr-mediated resistance. Nanotechnology overcomes these limitations through three key mechanisms: (1) targeted enrichment at infection sites to reduce systemic exposure; (2) controlled drug release to minimize peak concentration-related toxicity; and (3) synergistic co-delivery to reverse bacterial resistance. This review systematically summarizes the design principles and research progress of polymyxin B nanopreparations, focuses on analyzing the core issues encountered in their clinical translation, including insufficient biosafety verification, limited targeted delivery efficiency, immature large-scale production technology, and lack of drug resistance prevention and control systems. However, these nanopreparations still face critical translational challenges including unclear long-term toxicity mechanisms, poor biofilm penetration, and lack of standardized quality control. Combined with the latest research findings, targeted solutions are proposed, including optimization of carrier material biocompatibility, construction of intelligent responsive targeting systems, establishment of standardized production processes, and development of multi-dimensional drug resistance monitoring strategies. This review aims to provide theoretical support and technical guidance for the clinical translation of polymyxin B nanopreparations, promote their clinical application in the treatment of MDR bacterial infections, and offer a reference paradigm for the development of novel antibacterial preparations.
To analyze the etiological and epidemiological characteristics of acute lower respiratory infection (ALRI) in hospitalized children in Northeast China (Shenyang, Liaoning Province) following the lifting of non-pharmaceutical interventions (NPIs). Clinical data and test results for 12 respiratory pathogens from 26,721 hospitalized children with ALRI admitted to two hospitals in Shenyang between January 2023 and December 2025 were retrospectively analyzed. Pathogen detection was performed using polymerase chain reaction (PCR) or serological methods. To control for diagnostic heterogeneity, analyses were stratified by PCR and serology as follows: chi-square test for age, gender, and seasonal distributions; multivariate logistic regression for independent factors associated with pathogen positivity; and Spearman's rank correlation test for associations between meteorological factors and monthly positivity rates. PCR testing showed that rhinovirus (RV) had the highest positivity rate (13.80%), followed by influenza A virus (IAV) and respiratory syncytial virus (RSV). RSV was most common in infants aged <1 year, while RV and IAV were more common in children aged 3-<6 years. The positivity rate of RV was higher in males than in females (P < 0.001). IAV and RSV peaked in winter and spring, whereas RV peaked in summer. Serological testing showed that Mycoplasma pneumoniae (MP) had the highest positivity rate (37.64%), followed by RSV and adenovirus (ADV). The detection peaks of MP and ADV were concentrated in children aged 6-14 years. The positivity rates of Epstein-Barr virus (EBV), MP, and Chlamydia pneumoniae (Cpn) were lower in males than in females (all P < 0.05). MP peaked in autumn and winter, while IAV peaked in winter. The age and seasonal distribution patterns of RSV were consistent with those from PCR testing. Age, season, and gender were independent influencing factors for pathogen infection. Meteorological factors were significantly correlated with monthly positivity rates of specific pathogens (P < 0.05). Following the lifting of NPIs, the pathogen spectrum of childhood ALRI in Shenyang presented distinct seasonal, age, and gender differences. Age, season, and gender were independent influencing factors for pathogen infection. Although methodological differences exist between PCR and serological testing, comparisons within the same detection method are generally reliable.
Chronic and recalcitrant dermatophytosis has become increasingly problematic in dermatology practice, largely due to emerging antifungal resistance, affecting not only terbinafine but also azoles. Among the causative agents, Trichophyton indotineae has emerged as a key pathogen associated with treatment failure, extensive disease, and frequent relapse, even in immunocompetent patients. This study aimed to evaluate and compare two rapid molecular diagnostic approaches: A commercial multiplex qPCR assay (DermaGenius Resistance Multiplex PCR, DermaGenius RMP) and a T. indotineae-specific in-house qPCR assay, focusing on their practical value for early detection of recalcitrant dermatophyte infections and terbinafine resistance in routine dermatology practice. Sixty-four dermatophyte isolates obtained from patients with chronic or treatment-resistant dermatophytosis in Türkiye wereanalysed. Species identification and detection of squalene epoxidase (SQLE) gene mutations associated with terbinafine resistance were performed using DermaGenius RMP and the in-house T. indotineae-specific qPCR assay, with confirmatory ITS/SQLE sequencing and CLSI microbroth dilution antifungal susceptibility testing. Overall concordance between the two qPCR methods was 93.8% (κ = 0.74, z = 5.99, p < 0.001) for T. indotineae identification. Most recalcitrant cases were caused by T. indotineae, and SQLE mutations were detected in > 90% of these isolates, consistent with the observed clinical resistance. DermaGenius RMP enabled rapid, standardised detection of terbinafine resistance-associated mutations suitable for routine diagnostics, whereas the in-house qPCR provided highly specific identification of T. indotineae. Notably, 10 T. indotineae isolates harboured the SQLE F397L substitution despite terbinafine susceptibility. Rapid molecular diagnostics, particularly qPCR-based assays, provide actionable information early in the course of infection. In this study, both assays showed comparable performance for T. indotineae detection. Prompt identification of T. indotineae and associated resistance mutations may help avoid ineffective antifungal therapy, reduce chronicity, and support rational treatment decisions in routine clinical practice.
Candidemia is a life-threatening invasive fungal infection, particularly in patients admitted to intensive care units (ICUs). Epidemiology of candidemia and antifungal resistance have been significantly affected in COVID-19 pandemic. We analysed candidemia cases in neonatal, paediatric, and adult ICUs at Hippokration General Hospital in Thessaloniki, Greece (site 1) and Kayseri City Training and Research Hospital in Kayseri, Türkiye (site 2) from January 2020 to December 2023. Epidemiology, species distribution, and antifungal susceptibility of cases were compared. A total of 388 patients from site 1 and 379 patients from site 2 were included. A significant increase in the incidence of candidemia was observed in both hospitals during the COVID-19 pandemic. Candida parapsilosis was the most common species in all ICUs at Site 1, while Candida albicans was predominant at Site 2. C. parapsilosis became the most frequent species at Site 2 after 2021. C. glabrata was isolated more frequently in Site 1, whereas C. tropicalis was more frequently isolated in Site 2. A total of 14 C. auris strains were isolated, 13 of which were at the site 1. Over 90% of C. albicans strains were fluconazole-sensitive, but resistance was high in C. parapsilosis strains (47% at the site 1 and 40% at the site 2). C. parapsilosis and C. albicans remained the most common species, but their distributions varied between the two locations and over time. The high fluconazole resistance in C. parapsilosis causes a significant challenge for treatment. These findings highlight the necessity of continuous epidemiological surveillance to ensure appropriate antifungal treatment in different geographical regions.
This study aimed to systematically delineate the clinical characteristics and identify the key risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) infections in burn patients, thereby informing targeted preventive measures and therapeutic strategies. This retrospective study included 270 burn patients with Staphylococcus aureus (S. aureus) infections at a Chinese centre (2019-2022), comprising 127 MRSA and 143 methicillin-susceptible S. aureus (MSSA) cases. Clinical data were analysed to assess infection profiles, resistance patterns and MRSA risk factors. Amongst the infections, 68.1% (184/270) were caused by multi-drug resistant S. aureus, specifically 47.0% (127/270) by MRSA and 21.1% (57/270) by MSSA. The predominant resistance pattern (penicillin, oxacillin, gentamicin, clindamycin, erythromycin, ciprofloxacin, levofloxacin, tetracycline) accounted for 23.9% (44/184) of multidrug-resistant cases. The overall MRSA detection rate was 47.0% (127/270). Univariate analysis identified multiple factors significantly associated with MRSA infection (p < 0.05). Multivariate analysis identified the use of ≥ 3 types of antibiotics as an independent risk factor for MRSA infection in burn wounds. The detection rate of multi-drug resistant S. aureus (including MRSA) infections in burn wounds is relatively high. A number of variables are the influencing factors for MRSA infections. Medical personnel should adopt infection control measures to block the transmission of multi-drug resistant bacteria (including MRSA).
Candida auris, recently renamed Candidozyma auris, is an invasive fungal pathogen that is on the priority list on the World Health Organization (WHO) for future research. Infection poses major diagnostic and treatment challenges due to its phenotypic similarity to other Candida spp. and multiple antifungal resistance. Despite its emergence in Vietnam, the level of understanding among healthcare professionals is unknown. This study explores the knowledge, attitudes, and practices toward C. auris of registered physicians and nurses in a Vietnamese hospital intensive care unit (ICU). A mixed-methods study was conducted in an international standards-accredited Hanoi private general hospital. It comprised a self-administered cross-sectional survey containing 46 questions distributed to the ICU staff, followed by an in-depth semi-structured interview of selected participants. The survey covered demographic, knowledge, attitudes, and practices domains and utilized Likert-type and ranking scales. Descriptive and analytical statistics were applied to quantitative data and thematic analysis to qualitative insights. A total of 32 ICU staff completed the survey, but only 11 (34.38%) scored above 50%. Knowledge was associated weakly with age and work experience but not gender or profession. Most participants recognized C. auris as an important ICU pathogen and expressed a positive attitude to institutional preparedness but revealed confusion about the site of infection, means of diagnosis, most effective agents for treatment, and best PPE practices to prevent infections. Of the 12 participants selected for in-depth interview, only two were familiar with the WHO guidelines on C. auris. The concerns centered on access to treatment, especially for immunocompromised patients. The opinions on outbreak likelihood varied, with some staff citing poor infection control in public hospitals as a risk, while others considered an outbreak unlikely due to low prevalence and the restricted mode of transmission. For multiple reasons, the private sector was perceived as better prepared than the public sector. This study reveals a knowledge gap regarding C. auris among ICU physicians and nurses in Hanoi caring for high-risk patient populations. The findings underscore a need for targeted continuing medical education, enhanced antifungal stewardship strategies, and revised infection control protocols to combat this clinically important emerging pathogen in Vietnamese hospitals.
Pseudomonas aeruginosa is a major opportunistic pathogen associated with high morbidity in hospitalized patients due to its intrinsic and acquired resistance mechanisms. Carbapenem resistance, often mediated by the production of carbapenemase, poses a critical therapeutic challenge worldwide. This study investigated the genomic organization, molecular diversity, and plasmid-mediated dissemination of carbapenemase genes in P. aeruginosa isolates from hospitals in Paraná and Santa Catarina, Brazil, and explored their correlation with phenotypic resistance profiles. Eight isolates (80%) were classified as extensively drug-resistant (XDR), showing broad resistance to β-lactams, carbapenems, and β-lactam/β-lactamase inhibitor combinations. Multi-Locus Sequence Typing revealed a heterogeneous clonal structure, with ST1560 being the predominant type (30%). Multiple β-lactamase genes were identified, including chromosomal blaPDC variants, blaOXA-50, and carbapenemase genes blaSPM-1, blaIMP-16, blaIMP-1, blaVIM-2, blaKPC-2, and blaNDM-1. Notably, 40% of isolates carried plasmid-borne carbapenemase genes, indicating a potential for horizontal gene transfer. Isolate 20,783 exhibited high resistance despite lacking additional carbapenemase genes, suggesting alternative mechanisms such as efflux or porin loss. The predominance of XDR P. aeruginosa,which harbors diverse carbapenemases, including plasmid-mediated determinants, underscores the complexity of antimicrobial resistance in Brazilian hospitals. The coexistence of multiple resistance mechanisms, coupled with clonal heterogeneity, highlights the urgent need for integrated genomic surveillance and targeted infection control strategies to mitigate the spread of multidrug-resistant P. aeruginosa in clinical settings.
Trichophyton indotineae is an emerging dermatophyte responsible for widespread, chronic, and treatment-refractory dermatophytosis worldwide; however, data from China remain limited. This study aimed to characterize the clinical manifestations, antifungal resistance, and management challenges of T. indotineae infections in Chinese patients. Three patients with disseminated dermatophytosis were evaluated clinically. Fungal isolates were identified using multilocus sequence typing and phylogenetic analysis. Antifungal susceptibility testing and sequencing of the squalene epoxidase gene were performed to assess resistance. All patients presented with extensive dermatophytosis accompanied by severe pruritus, and two had a history of residence or work in Malaysia, suggesting imported infection. Elevated serum IgE levels were observed in two cases. Molecular analyses confirmed all isolates as T. indotineae. Antifungal susceptibility testing revealed reduced susceptibility to terbinafine, with two isolates harboring the SQLE F397L mutation and one carrying the F415C mutation. Clinically, all patients showed poor response to standard antifungal regimens. High-dose itraconazole achieved partial improvement; however, relapse occurred after treatment discontinuation in all cases. These findings indicate that T. indotineae infection is characterized by chronicity, extensive involvement, and difficulty in achieving sustained remission. Antifungal resistance, particularly terbinafine resistance, together with host-related factors, may contribute to disease persistence. This study highlights the importance of accurate species identification and resistance-guided therapy, and underscores the need for optimized management strategies for this emerging dermatophyte infection.
To investigate the antimicrobial resistance patterns of Escherichia coli isolates from infants younger than 90 days and analyze their relationships with age, infection site, and isolation time. A retrospective study was performed by collecting Escherichia coli strains isolated from hospitalized infants aged ≤90 days in the neonatal ward of Capital Center for Children's Health, Capital Medical University from June 2020 to December 2023. Antimicrobial susceptibility testing was conducted. Relevant clinical information including age, infection site, and isolation time was collected to characterize the antimicrobial resistance of Escherichia coli from multiple perspectives. A total of 384 infants were included, among whom 253(65.9%) were in the neonatal group (age ≤28 days) and 131(34.1%) in the young infant group (29-90 days). The overall resistance rate of Escherichia coli was 72.4%, with a multidrug resistance rate of 21.0%. The neonatal group was more susceptible to invasive infections, whereas the young infant group exhibited higher antimicrobial resistance rates, with statistically significant differences observed in resistance rates to multiple antibiotics (P<0.05). Intestinal isolates showed higher resistance rates to β‑lactams, tetracyclines, and quinolones compared to the overall average, but lower resistance to sulfonamides. Blood isolates demonstrated higher resistance to β‑lactams. An increasing trend was observed in resistance to quinolones and tetracyclines over time. Among infants with multi-site infections, 72.9% had isolates with consistent antimicrobial susceptibility patterns, indicating clonal homology. Escherichia coli isolates from infants aged 29-90 days exhibit relatively high antimicrobial resistance rates. In infants younger than 90 days, resistance patterns differ by age group and infection site, highlighting the need for rational antibiotic selection based on these factors. 目的: 探讨90 d内小婴儿大肠埃希菌的耐药特点及其与日龄、感染部位及分离时间的关系。方法: 回顾性收集2020年6月—2023年12月首都医科大学附属首都儿童医学中心新生儿病房日龄在90 d内的住院患儿分离培养获得的大肠埃希菌菌株，进行药敏试验。收集日龄、感染部位、分离时间等信息，从不同角度描述大肠埃希菌的耐药特点。结果: 共纳入384例患儿，其中新生儿组（发病日龄≤28 d）253例（65.9%），小婴儿组（发病日龄29~90 d）131例（34.1%）。大肠埃希菌总体耐药率为72.4%，多重耐药率为21.0%。新生儿组更易发生侵袭性感染，而小婴儿组耐药率更高，两组多种药物耐药率差异有统计学意义（P<0.05）。肠道内菌株对β‑内酰胺类、四环素类、喹诺酮类等多类药物耐药率高于平均水平，而对磺胺类药物的耐药率较低;血液分离株对β‑内酰胺类的耐药率较高。喹诺酮类、四环素类等抗菌药物的耐药率随时间呈上升趋势，且72.9%的多部位感染患儿存在药敏模式一致的菌株，提示菌株同源。结论: 小婴儿组大肠埃希菌耐药率较高;在90 d内小婴儿中，不同日龄和感染部位的大肠埃希菌耐药情况不同，应根据日龄和感染部位科学选择抗菌药物。.