Shuangshuang Yang

Plasma microbial cell-free DNA sequencing (mcfDNA-seq) has emerged as a promising diagnostic and prognostic tool for infectious diseases, with early enthusiasm driven by its potential to outperform conventional microbiological assays in detection sensitivity. However, its anticipated clinical superiority has not consistently translated into transformative improvements in infection management, particularly in high-risk populations. Since its inception in 2015, key controversies have persisted regarding the optimal timing of mcfDNA-seq testing, clinical utility of longitudinal quantification, preferred testing modality (plasma mcfDNA-seq vs blood cell DNA sequencing), and integrative analysis of mcfDNA-seq data incorporating host immune biomarkers and antimicrobial resistance (AMR) gene profiling to enhance diagnostic precision. To address these unresolved questions, this review synthesizes the current evidence on the clinical applications of plasma mcfDNA-seq, critically evaluates its performance across diverse infectious disease contexts, and concludes by delineating future challenges and opportunities to optimize its translational utility for clinical practice.

Purpose: This exploratory study aimed to investigate the potential causal relationships between plasma metabolites and dermatomyositis using Mendelian randomization (MR), with the goal of generating hypotheses for future research. Patients and Methods: We screened well-established metabolite GWAS databases and a comprehensive dermatomyositis patient database, starting with 1,400 metabolites. Suitable instrumental variables (IVs) were selected based on genome-wide significance, LD independence (r² < 0.01), and F-statistics > 10 to minimize weak instrument bias and pleiotropy. These IVs were then integrated with dermatomyositis patient data for MR analysis, employing techniques such as inverse-variance weighting (IVW), MR-Egger regression, and weighted median approaches. Sensitivity analyses were conducted to ensure result robustness, and findings were visualized using forest plots, scatter plots, and funnel plots. Results: The IVW method revealed 53 metabolites and metabolic ratios significantly associated with dermatomyositis. Specifically, 20 metabolites and 8 metabolic ratios were linked to a decreased risk, while 17 metabolites and 8 ratios indicated increased risk. However, none of these associations remained statistically significant after false discovery rate (FDR) correction. Notable heterogeneity was observed in Lactosyl-N-palmitoyl-sphingosine levels, and pleiotropy was evident with 3-carboxy-4-methyl-5-pentyl-2-furanpropionate (3-CMPFP). Robustness was confirmed through MR-PRESSO and leave-one-out analyses. Conclusion: This study conducted the first exploratory Mendelian randomization analysis to investigate potential causal links between plasma metabolites and dermatomyositis. Although no statistically significant causal relationships were identified after multiple testing correction, this study provides preliminary evidence and valuable hypotheses for further research into metabolic pathways underlying dermatomyositis.

Background: This study aimed to assess the effect of infection patterns on the outcomes of patients with hematological malignancies (HM) and to identify the determinants of in-hospital mortality. Methods: A case-control study was retrospectively conducted in a tertiary teaching hospital in Chongqing, Southwest China from 2011 to 2020. Clinical characteristics, microbial findings, and outcomes of HM patients with infections were retrieved from the hospital information system. Chi-square or Fisher’s exact test was adopted to test the significance of mortality rate. Kaplan-Meier survival analysis and Log rank test were applied to evaluate and compare the 30-day survival rates of those groups. Binary logistic regression, Cox proportional hazards regression, and receiver operating characteristic curves were used to investigate the determinants of in-hospital mortality. Results: Of 1,570 enrolled participants, 43.63% suffered from acute myeloid leukemia, 69.62% received chemotherapy, and 25.73% had hematopoietic stem cell transplantation (HSCT). Microbial infection was documented in 83.38% of participants. Co-infection and septic shock were reported in 32.87% and 5.67% of participants, respectively. Patients with septic shock suffered a significantly lower 30-day survival rate, while those with distinct types of pathogens or co-infections had a comparable 30-day survival rate. The all-cause in-hospital mortality was 7.01% and higher mortality rate was observed in patients with allo-HSCT (7.20%), co-infection (9.88%), and septic shock (33.71%). Cox proportional hazards regression illustrated that elderly age, septic shock, and elevated procalcitonin (PCT) were independent predictors of in-hospital mortality. A PCT cut-off value of 0.24 ng/mL predicted in-hospital mortality with a sensitivity of 77.45% and a specificity of 59.80% (95% CI = 0.684– 0.779, P< 0.0001). Conclusion: Distinct infectious patterns of HM inpatients were previously unreported in Southwest China. It was the severity of infection, not co-infection, source of infection, or type of causative pathogen that positively related to poor outcome. PCT guided early recognition and treatment of septic shock were advocated.

Background: Co-evolution of host and aeromonads has diversified their spectrums of diseases and antibiograms, while a paucity of data was concerning about this diversity in China. To fill this gap, this study was aimed to investigate and compare antimicrobial resistance (AMR) patterns of clinically important Aeromonas spp. from various clinical sources. Methods: A multicenter retrospective surveillance study was conducted in Chongqing from 2011 to 2017. Data of strains were retrieved from the database of China Antimicrobial Resistance Surveillance System (CARSS). Whonet 5.6 and Graphpad Prism 6 Software were adopted to determine and compare distribution and AMR patterns. Results: Among 1135 Aeromonas strains, Aeromonas hydrophila complex (65.6%, 745/1135) was the most predominant species, followed by Aeromonas veronii complex (16.7%, 190/1135) and Aeromonas caviae complex (15.3%, 174/1135). Sputum was the most frequent source of strains (27.7%), followed by wound (20.8%), bloodstream (10.8%) and urine (8.8%). Urinary strains demonstrated the highest resistance rates to ceftriaxone (65.6%), ceftazidime (52.1%), cefepime (38.3%), ciprofloxacin (47.7%) and trimethoprim-sulfamethoxazole (56.6%). Similar AMR pattern was observed in intestinal strains, with corresponding resistance rates of 29.4%, 28.9%, 22.2%, 27.3% and 45%, respectively. However, respiratory, bloodstream and skin strains exhibited resistance rates of less than 20% to most of the antimicrobials tested. In terms of species, approximately 30% of Aeromonas hydrophila complex and Aeromonas caviae complex strains were resistant to ceftriaxone and trimethoprim-sulfamethoxazole, while Aeromonas veronii complex strains harbored resistance rates of less than 20% to all tested antimicrobials. Although antibiograms of these species were distinct, they remained constant from 2011 to 2017. Conclusions: Distinct AMR patterns between species and sources highlighted the predominance of Aeromonas hydrophila complex and high resistance of strains in urine and intestine to extended-spectrum cephalosporins, ciprofloxacin and trimethoprim-sulfamethoxazole in Southwest China. Temporally constant AMR patterns should not relax the vigilance of antimicrobial resistance in clinically important Aeromonas species.

[This corrects the article DOI: 10.1155/2018/3150965.].

ESKAPEEc contribute to a majority of bloodstream infections (BSIs) and their antibiogram have changed overtime, while data concerning about these alterations are lacking in China. Added that a paucity of studies referred to ESKAPEEc in pediatric BSIs, our study aimed to demonstrate the longitudinal alterations of ESKAPEEc distribution and antibiogram in adult and pediatric BSIs in Southwest China. A multicenter retrospective surveillance study was launched from 2012 to 2017. Data of China Antimicrobial Resistance Surveillance System (CARSS) was analyzed by Whonet 5.6 and Graphpad Prism 6 Software. Chi-square test or Fisher’s exact test was used to examine and compare temporal changes. A total of 32,259 strains was isolated, with 17.4% from pediatric BSIs. ESKAPEEc contributed to 58.67% (18,924/32,259) of BSIs, with 65.3% of adult BSIs and 27.2% of pediatric BSIs. Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) were the two predominant species. Carbapenem resistance was prevalent in 0.76, 4.60, 9.47,13.66, 59.47% of E. coli, K. pneumoniae, Enterobacter cloacae, Pseudomonas aeruginosa (P. aeruginosa) and Acinetobacter baumannii (A. baumannii), respectively. The proportions of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium (VREFM) were 28.91% and 2.20%, respectively. Between 2012-2014 and 2015–2017, E. coli and K. pneumonia showed significantly increased resistance rates to imipenem but decreased to ceftriaxone and ceftazidime, while A. baumannii exhibited reduced resistances to almost all the beta-lactams tested. The prevalence of antimicrobial resistance to most of agents against Gram-positive ESKAPEEc did not significantly varied during the same timeframe. In comparison with those from adult BSIs, K. pneumoniae from pediatric BSIs exhibited high resistance rates to all the beta-lactams tested, especially to carbapenems (12.79% vs 3.87%), while A. baumannii showed low resistance rates to all the agents. Ongoing burden of ESKAPEEc in BSIs and increasing trend of imipenem resistance in E. coli and K. pneumoniae call for continued surveillance. Carbapenems are still active against Gram-negative ESKAPEEc, except for A. baumannii and vancomycin or linezolid is still effective against Gram-positive ESKAPEEc. Carbapenem-resistant K. pneumoniae in children and carbapenem-resistant A. baumannii in adults necessitate effective antimicrobial strategies in consideration of age stratification.

To investigate novel potential biomarkers for antidiastole of tuberculous pleural effusion (TPE) from malignant pleural effusion (MPE). iTRAQTM-coupled LC-MS/MS were applied to analyze the proteome of TPE and MPE samples. The candidate proteins were verified by enzyme-linked immunosorbent assay. A total of 432 differential proteins were identified. Enzyme-linked immunosorbent assay revealed significantly higher levels of fibronectin (FN) and cathepsin G (CTSG) in MPE than in TPE, but lower levels of leukotriene-A4 hydrolase (LTA4H). The receiver operator characteristic values were 0.285 for FN, 0.64 for LTA4H, 0.337 for CTSG and 0.793 for a combination of these candidate markers. FN, LTA4H and CTSG were identified as potential biomarkers to differentiate TPE from MPE and their combination exhibited higher diagnostic capacity.