Patients with liver cirrhosis are highly susceptible to various infectious complications due to impaired liver function, immune dysregulation and disruption of the intestinal barrier. Secondary infections not only precipitate the acute decompensation of liver function, but may also lead to severe outcomes such as acute-on-chronic liver failure, hepatorenal syndrome and sepsis, representing a major determinant of poor prognosis. In recent years, the increasing prevalence of antimicrobial-resistant pathogens and advances in diagnostic and therapeutic strategies have posed new challenges in the management of infections in patients with liver cirrhosis. Based on the latest guidelines from China and abroad, expert consensus statements, evidence-based medicine, and the clinical characteristics of patients with liver cirrhosis in China, this consensus provides recommendations on the diagnosis, antimicrobial therapy, adjunctive treatment, management of special clinical situations, preventive measures, monitoring and follow-up of secondary infections in liver cirrhosis. It aims to provide a reference for standardized clinical management, thereby further improve the infection prevention, control and enhance the patients’ clinical outcomes and long-term prognosis.

Liver transplantation is the most effective curative treatment for end-stage liver disease. In recent years, with the advancements in surgical techniques, immunosuppressive regimens and perioperative management, patient survival rates have significantly improved. However, postoperative infection remains a major complication affecting graft function and long-term survival of recipient. Bacterial infections are the most common among them. Epidemiological studies showed that approximately 55% of liver transplant recipients develop infections within one year post-operation, and the one-year survival rate of infected recipients is significantly reduced. Therefore, it is crucial to strengthen the prevention, early diagnosis, and standardized treatment of bacterial infections after liver transplantation. Based on the latest domestic and international evidence-based medical evidence and clinical practice, this consensus aims to provide the guidance for the comprehensive, whole-course and refined management of bacterial infections following liver transplantation.

Viral liver failure is a group of clinical syndromes caused by various hepatotropic viruses (such as hepatitis A, B, C, D and E virus), characterized by massive hepatocyte necrosis as the main pathological basis, and manifested by jaundice, coagulation dysfunction, hepatorenal syndrome, hepatic encephalopathy and ascites, etc. The 28-day mortality rate is as high as 40%. Liver failure caused by hepatitis B virus is mainly acute-on-chronic liver failure (ACLF). Patients with viral liver failure have severely impaired immune function and are extremely prone to secondary infections, which may lead to deterioration of the patient’s condition, multiple organ failure, even death. Timely and accurate diagnosis and treatment of secondary infections are crucial to improving the prognosis of patients. This consensus elaborates on the diagnosis and treatment measures related to secondary infections for viral liver failure from four aspects: the definition and classification of viral liver failure, diagnosis and treatment of secondary infections in viral liver failure, and providing a reliable theoretical basis for their diagnosis and treatment.

To analyze the pathogen distribution, antimicrobial resistance and antibiotic usage in adult patients with influenza pneumonia who developed secondary pulmonary bacterial infections in the intensive care unit (ICU), and to provide evidence for optimizing anti-infection treatment strategies and rational use of antibiotics in this population.

Clinical data of 117 adult patients with influenza pneumonia admitted to ICU of Beijing Ditan Hospital, Capital Medical University, from January 2009 to March 2025 were analyzed by a single-center retrospective study. Bacterial cultures were performed on deep respiratory tract specimens (sputum or bronchoalveolar lavage fluid). Species identification was carried out using the fully automated microbial mass spectrometry detection system VITEK-2 identification cards, and in vitro antimicrobial susceptibility testing was performed using the corresponding VITEK-2 susceptibility cards and the Kirby-Bauer (K-B) disc diffusion method. Toal of 117 patients were divided into infection group (53 cases) and non-infection group (64 cases) based on the presence of secondary pulmonary bacterial infection. The independent risk factors for secondary pulmonary bacterial infection were identified by Logistic regression analysis.

Among the 117 patients with influenza pneumonia, 53 (45.3%) were diagnosed with secondary pulmonary bacterial infection, from whom 90 bacterial strains were isolated, with an isolation rate of 76.9%. Gram-negative bacteria predominated (70 strains, 77.8%), with Acinetobacter baumannii (25 strains, 27.8%), Stenotrophomonas maltophilia (11 strains, 12.2%) and Pseudomonas aeruginosa (10 strains, 11.1%) being the top three. Total of 20 Gram-positive strains (22.2%) were isolated, mainly Staphylococcus aureus (6 strains, 6.7%), but no Streptococcus pneumoniae was detected. All patients received early empirical antibiotic therapy upon admission, with β-lactamase inhibitor combinations (30.8%, 36 cases), quinolones (28.2%, 33 cases) and carbapenems (17.9%, 21 cases) being the main choices. Compared with the non-infection group, patients in infection group had significantly higher rates of use of reserved-grade antibiotics (χ²=4.584, P=0.032), neutrophil percentage (NEUT%) (U=－2.207, P=0.027), C-reactive protein (CRP) level (U=－2.360, P=0.018), incidence of respiratory failure (χ²=11.069, P=0.001), acute kidney injury (χ²=6.612, P=0.010), shock (χ²=23.553, P=0.001) and rate of invasive mechanical ventilation (χ²=14.913, P=0.001), as well as longer durations of invasive mechanical ventilation (U=－2.925, P=0.003), ICU duration (U=－6.890, P=0.001) and total hospital duration (U=－6.747, P=0.001), all with significant differences. Multivariate Logistic regression analysis showed that invasive mechanical ventilation (OR=3.278, 95%CI: 1.275-8.430, P=0.014), shock (OR=5.372, 95%CI: 1.568-18.197, P=0.007) and neutrophil-to-lymphocyte ratio (NLR) (OR=1.075, 95%CI: 1.011-1.144, P=0.022) were all independent risk factors for secondary pulmonary bacterial infection.

Secondary bacterial infection in ICU adult patients with influenza pneumonia significantly increases the incidence of respiratory failure and prolongs total hospital and ICU duration. The predominant pathogens are Gram-negative bacilli. Clinically, early identification and monitoring of high-risk patients with invasive mechanical ventilation, shock and elevated NLR should be strengthened. In initial empirical anti-infection therapy, unnecessary use of reserved-grade antibiotics should be avoided, and individualized and rational antibiotic use should be pursued as much as possible.

To investigate the clinical characteristics of community-acquired Legionella pneumonia and the factors associated with disease severity.

A retrospective analysis was performed among 26 patients with community-acquired Legionella pneumophila pneumonia and 1 patient with community-acquired Legionella longbeachae pneumonia diagnosed by metagenomic next-generation sequencing of bronchoalveolar lavage fluid in the Department of Respiratory and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, from April 2024 to January 2026. Clinical data, laboratory results, imaging features and treatment regimens were analyzed. According to the disease severity, the patients were divided into severe group (14 cases) and non-severe group (13 cases). The clinical data between the two groups were compared by independent-samples t test, Mann-Whitney U test and Fisher’s exact test. The factors associated with pneumonia severity were analyzed by Univariate Logistic regression, and the diagnostic efficacy of the corresponding indicators for severe disease stratification was evaluated by the receiver operating characteristic (ROC) curve.

Most enrolled patients occurred fever, accompanied by multilobar lung lesions and multisystem laboratory abnormalities. Omadacycline and quinolones were the main anti-infection agents, with a favorable overall prognosis. Compared with the non-severe cases, severe patients had significantly advanced age and higher levels of systemic inflammatory indicators, accompanied by myocardial injury, hyponatremia, hypochloremia, reduced platelet and eosinophil counts. Among the 27 patients with Legionella pneumonia, 14 cases (51.9%) were classified as severe pneumonia and 13 cases (48.1%) as non-severe pneumonia. Compared with the non-severe group, the patients with severe disease were significantly older (t=2.130, P=0.043), and had higher proportion of fever (Fisher’s exact test: P=0.041), higher CURB-65 scores (Z=－3.469, P=0.001), alveolar-arterial oxygen gradients (t=3.975, P<0.001), procalcitonin (PCT) (Z=－3.240, P=0.001), serum troponin (Z=－2.666, P=0.008) and serum myoglobin (Z=－2.578, P=0.010) levels, and lower platelet counts (t=－2.943, P=0.010), serum sodium (t=－3.326, P=0.003) and chloride levels (t=－2.079, P=0.048), and peripheral blood eosinophil counts (Z=－2.397, P=0.017), with significant differences. Univariate Logistic regression analysis showed that troponin (OR=1.183, 95%CI: 1.026-1.365, P=0.021), alveolar-arterial oxygen gradient (OR=1.137, 95%CI: 1.030-1.256, P=0.011) and CURB-65 score (OR=13.693, 95%CI: 1.760-106.557, P=0.012) were associated with severe Legionella pneumonia. ROC curve analysis showed that the area under the curve (AUC) of the combined indicator based on these three variables for identifying severe Legionella pneumonia was 0.936, with a sensitivity of 83.3% and specificity of 100.0%.

The clinical manifestations of community-acquired Legionella pneumonia are nonspecific. Severe cases are often accompanied by a marked inflammatory response, impaired oxygenation and multisystem involvement. Troponin, alveolar-arterial oxygen gradient and CURB-65 score may be associated with severity stratification, and the combined indicator of these three variables may provide a useful reference for early identification of severe Legionella pneumonia. Further validation in studies with larger sample size is still required.

To investigate the correlation between the severity of liver cirrhosis in chronic hepatitis B (CHB) and C-reactive protein-albumin-lymphocyte (CALLY) index, and to identify the influencing factors of adverse prognosis.

Total of 112 patients with CHB-related cirrhosis admitted in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January 1st, 2023 to January 1st, 2024 were enrolled, retrospectively. According to the median CALLY index at admission (1.35), patients were divided into high-CALLY group and low-CALLY group, with 56 cases in each group. Baseline characteristics were compared between the two groups. The correlation between CALLY index and Child-Pugh grades were assessed by Spearman rank correlation analysis. The prognostic performance of CALLY index was evaluated by receiver operating characteristic (ROC) curve analysis. The overall survival between the two groups were compared by Kaplan-Meier analysis and Log-rank test, and the influencing factors of prognosis in patients with CHB-related cirrhosis were identifed by Cox proportional hazards regression.

The levels of C-reactive protein (Z=4.106, P＜0.001), serum free cortisol (t=－2.140, P=0.035), copeptin (t=－3.873, P＜0.001), neutrophil count (t=－3.606, P＜0.001), albumin (t=－7.917, P<0.001), serum total bilirubin (t=4.923, P＜0.001), prolongation of prothrombin time (t=8.120, P<0.001) and Child-Pugh grade (Z=－1.994, P=0.046) were significantly different between patients with CHB-related liver cirrhosis in high-CALLY group and low-CALLY group. The area under the ROC curve (AUC) of the CALLY index for predicting 2-year all-cause mortality was 0.714 (95%CI: 0.581-0.834), with an optimal cutoff value of 1.23, the sensitivity and specificity were 71.4% and 62.6%, respectively. The CALLY index was negatively correlated with Child-Pugh grade (r=－0.610, P＜0.001). The 2-year overall survival rates were 91.1% and 71.4% in high-CALLY and low-CALLY groups, respectively, with significant difference (Log-rank χ²=7.323, P=0.007). Multivariable Cox regression analysis showed that monocyte count (HR=1.18, 95%CI: 1.03-1.36, P=0.018) and Child-Pugh grade (HR=2.17, 95%CI: 1.07-4.40, P=0.032) were both risk factors for poor prognosis of CHB-related liver cirrhosis, whereas the standardized CALLY score was not an independent influencing factor of all-cause mortality (HR=0.69, 95%CI: 0.30-1.60, P=0.386).

The CALLY index exhibits a certain association with the severity of liver cirrhosis and survival outcomes; it can serve as an auxiliary risk stratification parameter complementing conventional clinical indicators, although its independent prognostic value still requires further validation.

To investigate the 24 months immune persistence after rapid immunization with 60 μg recombinant hepatitis B vaccine (Saccharomyces cerevisiae) (abbreviated as 60 μg hepatitis B vaccine) in adult recipients.

This observational study included adults enrolled in the accelerated hepatitis B vaccination program in Dayao County Center for Disease Control and Prevention,Yunnan Province, from March 2021 to April 2022, who received at least one dose of the 60 μg hepatitis B vaccine. Hepatitis B virus surface antigen (HBsAg), hepatitis B virus surface antibody (HBsAb) and geometric mean concentration (GMC) were detected to evaluate the 24 months immunological persistence of the vaccine. The 305 recipients were divided into four groups based on their HBsAb levels at 1 month post-immunization: group with HBsAb 10-＜100 mIU/ml, group with HBsAb 100-＜1 000 mIU/ml, group with HBsAb 1 000-＜10 000 mIU/ml and group with HBsAb≥10 000 mIU/ml. HBsAb positivity rates and HBsAb GMC of patients among different groups were analyzed by Chi-square test and variance analysis (ANOVA), respectively.

Among the 305 enrolled subjects, 249 had HBsAb≥ 10 mIU/ml at 24 months after full-course immunization, with a positive rate of 81.64%, and the HBsAb GMC was 121.97 mIU/ml (95%CI: 98.41-151.16). After 24-month follow-up, the positive rates of HBsAb subgroups 10-＜100 mIU/ml, 100-＜1 000 mIU/ml, 1 000-＜10 000 mIU/ml and≥10 000 mIU/ml were 49.25% (33/67), 86.49% (128/148), 96.92% (63/65) and 100.00% (25/25), respectively; their corresponding GMC values were 39.26 mIU/ml (95%CI: 23.41-65.84), 75.71 mIU/ml (95%CI: 57.91-98.97), 214.80 mIU/ml (95%CI: 169.38-272.41) and 1 503.74 mIU/ml (95%CI: 772.98-2 925.35).

The 60 μg hepatitis B vaccine demonstrates excellent immunogenicity persistence when administered in the adult rapid immunization program.

To investigate the clinical characteristics, diagnostic challenges and antimicrobial therapeutic strategies of vertebral infection caused by Janibacter terrae, so as to provide evidence for the diagnosis and management of rare bacterial vertebral infections.

The clinical data of one adolescent patient with Janibacter-induced vertebral infection who was admitted to Shandong Provincial Hospital Affiliated to Shandong First Medical University on December 11st, 2024 were analyzed, retrospectively. Relevant literature on Janibacter terrae infections published from database establishment to April 29th, 2025 was retrieved from CNKI, Wanfang and PubMed databases to summarize the clinical manifestations and anti-infection regimens of Janibacter terrae infection.

The 15-year-old male patient had no underlying diseases, and the chief complaint was chest and waist pain. Laboratory tests revealed elevated inflammatory biomarkers, C-reactive protein: 83.32 mg/L, serum amyloid A: 348.26 mg/L, procalcitonin: 0.31 ng/ml, interleukin-6: 99.96 pg/ml and erythrocyte sedimentation rate: 48.00 mm/h. Computed tomography (CT) and magnetic resonance imaging (MRI) showed abnormal lesions at the T5 vertebral body. Pathogen identification of Janibacter terrae was confirmed via metagenomic next-generation sequencing (mNGS) of bone tissue. Combined antimicrobial therapy with linezolid (600 mg every 12 hours) plus amikacin (400 mg once daily) achieved favorable therapeutic efficacy. The patient recovered well during the half-year follow-up.

Vertebral infection induced by Janibacter terrae is rare. mNGS facilitates rapid etiological confirmation. Timely administration of susceptible antibiotics with excellent bone tissue penetration is recommended once definite diagnosis is confirmed.