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Carbapenemase-producing Klebsiella pneumoniae has been a major clinical threat worldwide because therapeutic options are limited. Although New Delhi metallo-β-lactamase (NDM) is an important carbapenemase responsible for carbapenem resistance, it is uncommon in carbapenemase-producing K. pneumoniae in China. In this study, we described strain HZW25, an NDM-7-producing K. pneumoniae strain belonging to sequence type 34 (ST34). HZW25 exhibited resistance to all β-lactams tested but was susceptible to aminoglycosides and fluoroquinolones. The whole genome of HZW25 was sequenced with Pacific Biosciences RSII SMRT technology. HZW25 was composed of one chromosomal DNA and four plasmids, and the resistance genes of HZW25 were all located on the chromosome, except blaNDM–7 was located on a conjugative plasmid belonging to type IncX3 designated P4. The results of conjugation and transformation experiments showed that blaNDM–7 could be horizontally transferred successfully from the donor strain, HZW25, to the recipient strains, E. coli J53 and E. coli DH5α. The NDM variant transposable elements of the blaNDM–7-harboring plasmid P4 were the ISL3 and IS3000 families. The upstream region of blaNDM–7 contained ΔISAba125, which was inserted near the IS5 or ΔIS5 sequence. Our study is the first report of metallo-β-lactamase NDM-7 in a carbapenemase-producing K. pneumoniae strain with ST34 in China. The emergence of NDM-producing K. pneumoniae would be troublesome during treatment using ceftazidime-avibactam. Therefore, the rapid and accurate identification of carbapenemase-producing K. pneumoniae is necessary.

Background To discuss the clinical significance of interleukin (IL)-6 in the differential diagnosis of sepsis and its capability of differentiating the sepsis induced by Gram-negative bacteria from that induced by Gram-positive bacteria. Methods A total of 379 children with sepsis were involved in this study to form the case group, and their C-reactive protein (CRP), procalcitonin (PCT) and IL-6 levels before antibiotics and after recovery were checked. Receiver operating characteristic curve was applied to evaluate the significance of CRP, PCT and IL-6 in the differential diagnosis of sepsis and their capability of differentiating the sepsis induced by Gram-negative bacteria from that induced by Gram-positive bacteria. Results When these 3 indicators were applied to the differential diagnosis of sepsis, the area under the curve (AUC) of IL-6, PCT and CRP was 0.881, 0.877 and 0.754, respectively. The combination of IL-6 and PCT presented highest diagnostic efficiency. CRP, PCT and IL-6 levels in children with sepsis induced by Gram-negative bacteria were significantly higher than those in children with sepsis induced by Gram-positive bacteria. Conclusions CRP, IL-6 and PCT are applicable to the differential diagnosis of sepsis and differentiating the sepsis induced by Gram-negative bacteria from Gram-positive bacteria. Appropriate combinations of these indicators are capable of increasing differential diagnosis efficiency. These indicators can be used as markers of antibiotics usage, but whether they can be used as markers to withdraw antibiotics is still needed to be observed.

Carbapenem-resistant Acinetobacter baumannii (CRAB) is a common nosocomial bacterial pathogen with limited treatment options. CRAB outbreaks are disastrous for critically ill patients. This study investigated carbapenemase-produced A. baumannii outbreaks in a tertiary hospital. Although multiple outbreaks were suggested by pulse-field gel electrophoresis, the genetic lineages and evolution between these isolates were not clear. To investigate the genomic epidemiology of these outbreaks and to reveal possible transmission routes, whole genome sequences (WGS) were compared and analyzed. From the WGS data, thirty isolates had the same sequence type (ST208); acquired resistance genes and chromosome resistant genes were detected and were responsible for multidrug resistance. A phylogenetic tree of single-nucleotide polymorphisms (SNPs) compared to the earliest index isolate found that three outbreaks had emerged and disseminated simultaneously. Of these

Bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) strains have been a severe problem with high clinical costs and high mortality rates. The bla KPC-2 -producing CRKP strain XPY20 was collected from the blood of a patient. The genome characteristics and antimicrobial resistance mechanisms were determined using next-generation sequencing.

The aim of this study was to assess insulin-like growth factor-1 (IGF-1) and insulin-like growth factor-binding protein-3 (IGFBP-3) concentrations in children with obstructive sleep apnea-hypopnea syndrome (OSAHS) and to compare the results according to disease severity and duration.Fifty-one children with OSAHS underwent polysomnography and were classified as having mild, moderate, or severe disease. All children underwent bilateral tonsillectomy/adenoidectomy or adenoidectomy. IGF-1 and IGFBP-3 concentrations were assessed before surgery and 3 and 6 months after surgery.Before surgery, IGF-1 and IGFBP-3 concentrations were significantly higher (P.05) in the5-y group (125.20 ± 42.38 μg/L and 2.00 ± 0.54 mg/L) compared with the ≥ 5-y group (61.92 ± 19.07 μg/L and 1.20 ± 0.37 mg/L). After surgery, concentrations significantly increased (P.05) in both groups, but remained lower in the ≥ 5-y group. Before surgery, there were no significant differences in IGF-1 (mild: 93.82 ± 37.52 mg/L; moderate: 109.06 ± 58.42 mg/L; severe: 73.88 ± 28.51 mg/L) and IGFBP-3 (mild: 1.76 ± 0.57 mg/L; moderate: 1.67 ± 0.72 mg/L; severe: 1.33 ± 0.45 mg/L) concentrations by severity. After surgery, concentrations significantly increased (P.05) in both groups, but did not differ by severity. After adjusting for time after surgery, disease duration, apnea-hypopnea index, time spent at SpO290%, and body mass index Z score, IGF-1 and IGFBP-3 concentrations significantly decreased with every year of age.These results suggest that disease duration, but not severity, affects the concentrations of 2 important mediators of growth/development (IGF-1 and IGFBP-3) in children with OSAHS before and after surgery.

BACKGROUND The aim of this study was to investigate the degree of impact of obstructive sleep apnea hypopnea syndrome (OSAHS) severity on pediatric psychological and behavioral abnormalities. MATERIAL AND METHODS Fifty-one children aged 5-12 years with a confirmed diagnosis of OSAHS were divided into 3 groups according to the severity of OSAHS. They underwent bilateral tonsillectomy plus adenoidectomy or adenoidectomy alone. Repeated polysomnography and integrated visual and auditory continuous performance testing (-IVA-CPT) was performed to assess full-scale response control quotient (FRCQ), full-scale attention quotient (FAQ), and hyperactivity (HYP) before surgery and 3 and 6 months after surgery. RESULTS Mean FRCQ, FAQ, and HYP significantly improved over time in the 3 groups (FRCQ, F=292.05; FAQ, F=258.27; HYP, F=295.10, all P