预约演示

更新于：2026-02-27

Meropenem

美洛培南

更新于：2026-02-27

概要

基本信息

药物类型

小分子化药

别名

Belopenem、Mepem、Meropen

+ [23]

靶点

PBPs

作用方式

抑制剂

作用机制

PBPs抑制剂(细菌青霉素结合蛋白家族抑制剂)

治疗领域

感染神经系统疾病消化系统疾病+ [8]

在研适应症

复杂腹腔感染细菌性脑膜炎（非特异性）化脓性脑膜炎+ [28]

非在研适应症

菌血症血源性感染蜂窝织炎+ [3]

原研机构

Sumitomo Pharma Co., Ltd.

在研机构

Sumitomo Pharma Co., Ltd.

Pfizer Australia Pty Ltd.

Rempex Pharmaceuticals, Inc.

+ [4]

非在研机构

Pfizer Inc.

Matinas BioPharma Holdings, Inc.

Melinta Therapeutics, Inc.

+ [1]

权益机构

上药康德乐（上海）医药有限公司

AstraZeneca PLC

Pfizer Inc.

+ [1]

最高研发阶段批准上市

首次获批日期

日本 (1995-06-30),

附件炎关节炎胆管炎+ [16]

最高研发阶段(中国)批准上市

特殊审评孤儿药 (美国)

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结构/序列

分子式C17H27N3O6S

InChIKeyWCDAAZJSDNCCFU-NACOAMSHSA-N

CAS号119478-56-7

关联

214

项与美洛培南相关的临床试验

NCT07326540

/ Not yet recruiting临床3期

A Phase 3 Prospective, Randomized, Multicenter, Active-controlled Study to Evaluate the Efficacy and Safety of BV100 Plus Low-dose Polymyxin B Compared With Colistin Plus High-dose Ampicillin/Sulbactam in the Treatment of Adult Patients With Hospital-acquired Bacterial Pneumonia and Ventilator-associated Bacterial Pneumonia Caused by Carbapenem-resistant Acinetobacter Baumannii-calcoaceticus Complex

This is a two-part study, with Part A being the randomized, controlled portion of the study in patients with hospital-acquired bacterial pneumonia (HABP) or ventilator-associated bacterial pneumonia (VABP) suspected or confirmed to be due to carbapenem-resistant Acinetobacter baumannii-calcoaceticus complex (CRABC).
Part B is the single-group portion of the study and includes patients with HABP or VABP with CRABC infections that are resistant to or have failed colistin/polymyxin B treatment.

开始日期2026-03-20

申办/合作机构

BioVersys AG

[+1]

CTIS2024-516232-10-00

/ Not yet recruiting临床4期IIT

Defining Antibiotic Levels in Intensive care patients (DALI-2) protocol - A multi-national pharmacokinetic/pharmacodynamic cohort study to determine whether contemporary antibiotic dosing for critically ill patients achieves therapeutic exposures.

开始日期2025-12-01

申办/合作机构

Centre Hospitalier Universitaire de Nimes

IRCT20120731010453N8

/ Recruiting临床3期

Comparison of the Efficacy and Safety of Extended Infusion Versus Intermittent Infusion of Meropenem in Pediatric Patients with Febrile Neutropenia: A Clinical Trial

开始日期2025-11-22

申办/合作机构

Shiraz University of Medical Sciences

100 项与美洛培南相关的临床结果

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100 项与美洛培南相关的转化医学

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100 项与美洛培南相关的专利（医药）

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18,436

项与美洛培南相关的文献（医药）

2026-06-01·Biofilm

Staphylococcal persistence and biofilm resistance in bone-anchored hearing systems: Clinical impact

Article

作者: Hoffman, Maria ; Hultcrantz, Malou ; Ganeyev, Marsel ; Trobos, Margarita ; Thomsen, Peter ; Johansson, Martin L ; Palmquist, Anders ; Morales-Laverde, Liliana

Persistent inflammation and infection, often linked to staphylococcal colonization, affect bone-anchored hearing system (BAHS) outcomes. Although antibiotics are often used to treat skin complications, the roles of biofilms and antimicrobial resistance (AMR) in clinical success remain unclear. This clinical prospective study characterized biofilm formation and antibiotic resistance in Staphylococcus spp. from BAHS patients, and examined associations with inflammation, pain, and hygiene. Adults eligible for BAHS were prospectively enrolled at a tertiary university hospital in Sweden during 2014-2015. Fifteen patients were followed clinically and microbiologically at surgery, 3- and 12- months. Abutment, peri-abutment exudate and soft-tissue samples were cultured. Fifty-seven Staphylococcus spp. isolates underwent biofilm phenotyping (Crystal Violet, Congo Red), antimicrobial susceptibility testing (minimum inhibitory concentration [MIC], minimum biofilm eradication concentration [MBEC]) and whole-genome sequencing (lineage, AMR and virulence genes). Clinical status was scored (Holgers, pain, debris). Individual patients harbored the same staphylococcal clone on abutment, exudate, and tissue for 12 months. S. aureus was more prevalent in patients with inflammation (Holgers score >0), S. epidermidis correlated with pain, and slime production was associated with debris accumulation. Overall, 56 % of isolates showed resistance to fusidic acid, and 11-34 % carried tetracycline resistance genes. S. epidermidis carried multidrug resistance genes (beta-lactams, tetracycline, sulfamethoxazole, fosfomycin), and resistance increased under biofilm conditions (MBEC > MIC). The ica operon was detected in all S. aureus and S. epidermidis ST7, ST297, ST749 and ST278. These findings indicate that staphylococci from BAHS exhibit persistent colonization, diverse clonal lineages, and high biofilm-associated AMR. Early microbial diagnostics and biofilm-targeted strategies, alongside cautious use of topical antibiotics, may improve outcomes.

2026-06-01·JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL ANALYSIS

Development and validation of an UPLC–MS/MS method for simultaneous determination of meropenem and its open-ring metabolite in human serum and cerebrospinal fluid with application to clinical samples

Article

作者: Li, Tongtong ; Fan, Jinwei ; Yang, Lijuan ; Huang, Shenjia ; Zhang, Qian ; Tang, Lian ; Wang, Chengliang ; Xu, Jinhui ; Chen, XiangLong ; Yu, Yanxia

Central nervous system (CNS) infections require adequate drug exposure at the site of action, yet antibiotic meropenem (MER) shows limited cerebrospinal fluid (CSF) penetration and easily undergoes non-enzymatic degradation to an inactive open-ring metabolite (ORM). In this study, we developed a simple, sensitive, and fast liquid chromatography tandem mass spectrometry (LC-MS/MS) method for the simultaneous determination of MER and ORM in human serum and CSF. Chromatographic separation was accomplished on an Agela Venusil MP C18 column, with MER-d6 and ORM-d6 as internal standards. Methanol was found to promote methanolysis, yielding a characteristic product (m/z 416.2). Therefore, acetonitrile was selected as both the organic phase and the protein-precipitation solvent. Method validation was conducted according to the ICH M10 guideline. Follow validation, the method was successfully applied to 57 serum and 16 CSF samples. ORM concentrations in human CSF were reported for the first time. This method provides a valuable tool to support MER monitoring in patients with CNS infections.

2026-05-01·JOURNAL OF ETHNOPHARMACOLOGY

Repurposing an ethnomedicinal herb: Horseradish (Armoracia rusticana) as a source of quorum sensing inhibitors to attenuate Pseudomonas aeruginosa virulence

Article

作者: Stanisavljević, Nemanja S ; Ćurčić, Jovana M ; Vukotić, Goran N ; Pešić, Mirjana B ; Milinčić, Danijel D ; Kostić, Aleksandar Ž ; Miladinović, Jelena ; Malešević, Milka J ; Matijašević, Danka M

ETHNOPHARMACOLOGICAL RELEVANCE:

Horseradish (Armoracia rusticana P. Gaertn., B. Mey. & Scherb) is a traditional ethnomedicinal herb with established antimicrobial properties, yet its potential to disrupt bacterial communication via quorum sensing inhibition (QSI) remains under-explored.

AIM OF THE STUDY:

To evaluate the impact of root processing and extraction methods on the QSI activity of horseradish against a highly recalcitrant multidrug-resistant (MDR) clinical isolate of Pseudomonas aeruginosa.

METHODS:

Fresh and dried roots were extracted using five solvent systems. Phytochemical profiles were determined via UHPLC-Q-ToF-MS and QSI activity was validated using Chromobacterium subtsugae CV026, RT-qPCR of QS genes, and fluorescence microscopy for biofilm architecture. Synergistic effects with antibiotics were assessed via checkerboard assays, complemented by in silico molecular docking against LasR, PqsR, and RhlR.

RESULTS:

Hexane-ethyl acetate extracts of fresh roots exhibited superior QSI, significantly downregulating core QS (lasR, lasI, rhlR, rhlI, mvfR, pqsH) and virulence (lasB, phzM, rhlC, algK, pvdS) genes. The extract prevented cell adhesion and biofilm maturation while showing strong synergy with meropenem and gentamicin. MS analysis identified isothiocyanates (ITCs), nitriles, and phenolics as key bioactive constituents. Docking revealed that while binding energy correlates with alkyl chain length, functional efficacy results from a multi-component synergy between iberin and other ITCs/nitriles.

CONCLUSION:

Horseradish extracts act as potent antivirulence adjuvants, increasing the susceptibility of MDR P. aeruginosa to conventional antibiotics. These findings validate ethnomedicinal use and suggest a low-cost, complementary strategy for managing recalcitrant infections.

488

项与美洛培南相关的新闻（医药）

2026-02-26

·北京医学感染与传染研究

临床传染病学 82卷1-2期、增刊1期（2026年2月26日更新）

Clinical Infectious Diseases Volume 82 Issue 1 临床传染病学 82卷1期 https://academic.oup.com/cid/issue/ ID Art Through the Ages（穿越时代的传染病学技艺） 1 Peasants' Revolt, 1381 1381年农民起义 Mary Grizzard and Michael Grizzard Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Page i, https://doi.org/10.1093/cid/ciaf692 In the Literature（文献概览） 2 In the Literature 文献概览 Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages ii–iii, https://doi.org/10.1093/cid/ciaf631 State-of-the-Art Review（最新技术综述） 3 State-of-the-Art Review: Diagnosis and Management of Acute and Chronic Bacterial Prostatitis 最新技术综述：急性和慢性细菌性前列腺炎的诊断与治疗 Prathit A Kulkarni and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 1–13, https://doi.org/10.1093/cid/ciaf483 Clinical Dilemmas in Infectious Diseases（传染病临床难题） 4 “Insisting on Treatment” “坚持治疗” Kevin Andrew Smith and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 14–18, https://doi.org/10.1093/cid/ciaf282 Voices of ID（传染病之声） 5 Martin Arrowsmith and Me 马丁·阿罗史密斯与我 Janet R Gilsdorf Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 19–20, https://doi.org/10.1093/cid/ciaf277 Invited Commentary（特邀述评） 6 The 2025 Centers for Disease Control and Prevention Nonoccupational HIV Postexposure Prophylaxis Guidelines: Updated Regimens and Remaining Questions 2025年美国疾病控制与预防中心非职业性艾滋病毒暴露后预防指南：更新方案及遗留问题 Lao-Tzu Allan-Blitz and Kenneth H Mayer Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 21–24, https://doi.org/10.1093/cid/ciaf567 Antimicrobial Resistance and Stewardship（抗菌药物耐药性与管控） 7 Modeling the Impact and Cost of a Culture-Dependent Molecular Test for Antimicrobial Resistance in Resource-Limited Settings 资源有限环境下，基于培养的分子检测法对抗菌药物耐药性的影响和成本建模 Joshua M Chevalier and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 25–32, https://doi.org/10.1093/cid/ciaf236 8 The Xpert MTB/RIF Cycle Threshold Value Predicts Mycobacterium tuberculosis Transmission to Close Contacts in a Brazilian Prospective Multicenter Cohort 巴西一项前瞻性多中心队列研究中Xpert MTB/RIF循环阈值可预测结核分枝杆菌在密切接触者中的传播 Leandro S Garcia and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 33–41, https://doi.org/10.1093/cid/ciad794 9 Beyond Diagnosis: Xpert Cycle Threshold Values as Predictors of Tuberculosis Transmission 超越诊断：Xpert循环阈值作为结核病传播的预测指标 Lauren Linde and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 42–43, https://doi.org/10.1093/cid/ciad791 10 First Report of Treatment-Emergent Resistance to Cefepime-Zidebactam in Pseudomonas aeruginosa 铜绿假单胞菌在头孢吡肟-齐德巴坦治疗中出现耐药性的首例报告 Ava J Dorazio and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 44–48, https://doi.org/10.1093/cid/ciaf638 Clinical Practice and Policy（临床实践与政策） 11 Sputum and Tongue Swab Molecular Testing for the In-Home Diagnosis of Tuberculosis in Unselected Household Contacts: A Cost and Cost-Effectiveness Analysis 痰液和舌拭子分子检测用于未筛选家庭接触者结核病居家诊断的成本及成本效益分析 Charl Bezuidenhout and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 49–57, https://doi.org/10.1093/cid/ciaf389 12 You’ve Got a Friend in Me: Curbside Questions Infectious Diseases Clinicians Ask Infectious Diseases Pharmacists 我是你的朋友：传染病临床医生向传染病药剂师咨询的即兴问题 Matthew R Davis and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 58–61, https://doi.org/10.1093/cid/ciaf250 13 Home Testing for Contagious Illness: Historical Context and Modern Caveats 传染性疾病居家检测：历史背景与现代注意事项 Abigail Zuger Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 62–66, https://doi.org/10.1093/cid/ciaf623 Fungal Infections（真菌感染） 14 Evaluating the Use of Lower Dose Flucytosine for the Treatment of Cryptococcal Meningitis: A Clinical Trial 评估低剂量氟胞嘧啶治疗隐球菌性脑膜炎的临床试验 Morris K Rutakingirwa and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 67–74, https://doi.org/10.1093/cid/ciaf432 15 Association Between Duration of Candidemia and Clinical and Healthcare Resource Utilization Outcomes Among Hospitalized Adult Patients With Candidemia Who Received Empiric Treatment With an Echinocandin Across United States Hospitals 美国各医院中接受棘白菌素经验性治疗的念珠菌血症成年住院患者中，念珠菌血症持续时间与临床和医疗资源利用结局之间的关联 Thomas P Lodise and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 75–85, https://doi.org/10.1093/cid/ciaf472 16 Aspergillosis-Attributable Mortality in the United States: Analysis of Death Certificate Data 美国隐球菌病导致的死亡率分析：基于死亡证明数据 Thomas J Walsh and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 86–92, https://doi.org/10.1093/cid/ciaf653 HIV/AIDs（人类免疫缺陷病毒/艾滋病） 17 Outcomes of Critical Illness in People With Advanced HIV Disease: 30 Years of Binational Data 晚期艾滋病患者危重症结局：30年的双国数据 Bryan Tan and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 93–99, https://doi.org/10.1093/cid/ciaf362 18 Phase 2 Trial of Long-Acting Cabotegravir and VRC07-523LS for Viral Suppression in Adults With HIV-1: ACTG A5357 长效卡博特韦和VRC07-523LS用于HIV-1感染成人病毒抑制的2期试验：ACTG A5357 Babafemi O Taiwo and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 100–108, https://doi.org/10.1093/cid/ciaf375 19 Therapeutic Drug Monitoring of Long-Acting Cabotegravir and Rilpivirine in a National Cohort of People With HIV-1: First Results From the ANRS-MIE CARLAPOP Study 全国HIV-1感染者队列中长效卡博特韦和利匹韦林的治疗药物监测：ANRS-MIE CARLAPOP研究的首批结果 Nadège Néant and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 109–118, https://doi.org/10.1093/cid/ciaf385 20 Is Therapeutic Drug Monitoring of Long-Acting Cabotegravir and Rilpivirine of Clinical Utility? 长效卡博特韦和利匹韦林的治疗药物监测是否具有临床实用性？ Catia Marzolini Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 119–121, https://doi.org/10.1093/cid/ciaf386 21 Efficacy and Safety of Dual Therapy With Dolutegravir/Lamivudine in Treatment-naive Persons With CD4 Counts <200/mm3: 48-Week Results of the DOLCE Study 多替拉韦/拉米夫定双药治疗在CD4计数<200/mm³的初治患者中的疗效和安全性：DOLCE研究48周结果 Maria Ines Figueroa and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 122–131, https://doi.org/10.1093/cid/ciaf415 22 DOLCE: Sweet Success for Dolutegravir/Lamivudine? DOLCE研究：多替拉韦/拉米夫定双药治疗是否取得完美成功？ Laura J Waters Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 132–133, https://doi.org/10.1093/cid/ciaf416 Infection Control and Hospital Epidemiology（感染控制与医院流行病学） 23 Real-Time Genomic Surveillance for Enhanced Healthcare Outbreak Detection and Control: Clinical and Economic Impact 实时基因组监测用于加强医疗保健机构疫情检测与控制：临床与经济影响 Alexander J Sundermann and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 134–141, https://doi.org/10.1093/cid/ciaf216 24 Patient Perspectives Regarding Different Contact Precaution Policies for Methicillin-resistant Staphylococcus aureus Across Two Hospitals: Patients Are in Favor of Contact Precautions 两家医院患者对耐甲氧西林金黄色葡萄球菌不同接触预防政策的态度：患者支持接触预防措施 Nicholas F Angelino and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 142–144, https://doi.org/10.1093/cid/ciaf330 Photo Quiz（影像问答） 25 The Clue That Wriggled into View 蜿蜒入目的线索 Nitin Gupta and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 145–147, https://doi.org/10.1093/cid/ciaf427 Infection Control and Hospital Epidemiology（感染控制与医院流行病学） 26 Comparing Generative Artificial Intelligence vs Experts for Detection of Catheter-Associated Urinary Tract Infection 比较生成式人工智能与专家在导管相关尿路感染检测中的应用 Shatha Alshanqeeti and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 148–150, https://doi.org/10.1093/cid/ciaf486 Sexually Transmitted Infections（性传播感染） 27 Viability of Chlamydia trachomatis in Different Anatomical Sites—a Systematic Review and Meta-analysis 不同解剖部位沙眼衣原体的存活能力——系统综述和荟萃分析 Arthur Wong and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 151–158, https://doi.org/10.1093/cid/ciae401 Photo Quiz（影像问答） 28 A 46-Year-Old With Persistent Altered Mental Status and Respiratory Failure 一例46岁患者持续出现意识状态改变伴呼吸衰竭 Ann F Yang and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 159–161, https://doi.org/10.1093/cid/ciaf439 Sexually Transmitted Infections（性传播感染） 29 Mpox in People With HIV: Predictors of Diagnosis, Outcomes, and Vaccine Effectiveness in a Multisite Cohort HIV感染者中的猴痘：多站点队列中诊断、预后和疫苗有效性的预测因素 Michalina Montaño and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 162–172, https://doi.org/10.1093/cid/ciae464 30 Development and Evaluation of a Novel Algorithm to Identify Doxycycline Postexposure Prophylaxis Users at a Large Healthcare System in the Bronx, New York 开发和评估一种新型算法，用于识别纽约布朗克斯区一家大型医疗系统中多西环素暴露后预防用药者 Caroline E Mullis and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 173–176, https://doi.org/10.1093/cid/ciaf109 31 Evidence-Informed Provision of Doxycycline Postexposure Prophylaxis for Prevention of Bacterial Sexually Transmitted Infections 为预防细菌性性传播感染提供基于证据的多西环素暴露后预防用药 Julia C Dombrowski and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages 177–184, https://doi.org/10.1093/cid/ciae527 Bacterial Infections（细菌性感染） 32 Long-term Mortality Trends Among Individuals With Tuberculosis: A Retrospective Cohort Study of Individuals Diagnosed With Tuberculosis in Brazil 巴西结核病患者的长期死亡率趋势：一项针对巴西结核病诊断患者的回顾性队列研究 Sun Kim and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e1–e8, https://doi.org/10.1093/cid/ciaf206 33 Clinical and Microbiological Characteristics of Meningococcal Eye Infections: Retrospective National Surveillance in England, 2010–2022 脑膜炎球菌眼部感染的临床和微生物学特征：2010 - 2022年英格兰全国回顾性监测 Stephen A Clark and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e9–e16, https://doi.org/10.1093/cid/ciaf274 34 Does Piperacillin-Tazobactam Increase Mortality Risk Compared With Cefepime? Collider Bias and the Importance of Assumptions in Instrumental Variable Analyses 与头孢吡肟相比，哌拉西林-他唑巴坦是否会增加死亡率风险？工具变量分析中的混杂偏倚和假设的重要性 Fergus Hamilton and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e17–e23, https://doi.org/10.1093/cid/ciaf317 COVID-19 / SARS COV-2（新冠肺炎/严重急性呼吸综合征冠状病毒2型） 35 Efficacy and Safety of Obeldesivir in High-Risk Nonhospitalized Patients With COVID-19 (BIRCH): A Phase 3, Randomized, Double-Blind, Placebo-Controlled Study 奥贝德西韦在高危非住院COVID-19患者（BIRCH研究）中的疗效和安全性：一项3期、随机、双盲、安慰剂对照研究 Anca Streinu-Cercel and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e24–e32, https://doi.org/10.1093/cid/ciaf406 36 Retreatment With Nirmatrelvir/Ritonavir Following Return of COVID-19 Symptoms and SARS-CoV-2 Positivity COVID-19症状复发且SARS-CoV-2检测呈阳性后使用奈玛特韦/利托那韦重新治疗 Wuyan Zhang and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e33–e40, https://doi.org/10.1093/cid/ciaf548 Emerging Infections(新兴感染) 37 “I Didn’t Know Him Before the Pandemic… Now He's on My Speed Dial”: Strengthening Collaboration Between Infectious Diseases Physicians and State and Local Public Health for Future Public Health Emergencies “疫情前我并不认识他……现在他已是我的快速拨号对象”：加强传染病医生与州和地方公共卫生部门在未来突发公共卫生事件中的合作 Diana Valencia and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e41–e46, https://doi.org/10.1093/cid/ciaf179 38 Identification of and Response to Influenza A(H5) in Off-the-Shelf Raw Milk—Santa Clara County, California, November–December 2024 2024年11 - 12月加利福尼亚州圣克拉拉县在现成生牛奶中检出甲型流感（H5）病毒及应对措施 Alessandra Løchen and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e47–e48, https://doi.org/10.1093/cid/ciaf420 39 The Indispensable Value of Small-Molecule Antivirals in Epidemic and Pandemic Preparedness 小分子抗病毒药物在流行病和大流行病防范中的不可或缺价值 Ruxandra Draghia-Akli and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e49–e55, https://doi.org/10.1093/cid/ciaf476 HIV/AIDs（人类免疫缺陷病毒/艾滋病） 40 Increasing HIV Testing During Gonorrhea and Chlamydia Evaluations in Urgent Care and Emergency Departments: A Large Health System Initiative 在紧急护理和急诊科进行淋病和衣原体检测时增加HIV检测：一项大型医疗系统倡议 Allan M Seibert and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e56–e67, https://doi.org/10.1093/cid/ciaf434 41 Clinical Predictors and Incidence of Kaposi Sarcoma Among Males With HIV in the Treat-All Era in the United States and Canada 美国和加拿大“全员治疗”时代男性HIV感染者卡波西肉瘤的临床预测因素和发病率 Sally B Coburn and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e68–e77, https://doi.org/10.1093/cid/ciaf446 42 Integrase Strand Transfer Inhibitors for Treatment-experienced Young Adults With Perinatal HIV in the US: Immunologic, Virologic, and Anthropometric Outcomes 美国接受过治疗的围产期感染HIV的年轻成人使用整合酶链转移抑制剂的免疫学、病毒学和人体测量学结果 Kunjal Patel and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e78–e88, https://doi.org/10.1093/cid/ciaf538 43 Win Ratio Aligns With and Enhances Interpretation of REPRIEVE's Primary Findings Win比值与REPRIEVE研究的主要发现一致并增强了其解释性 Emma Davies Smith and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e89–e92, https://doi.org/10.1093/cid/ciaf477 44 The Critical Importance of Clinical Use Case to Inform Point-of-Care Technology Development: A Case Study of HIV Nucleic Acid Assays in the United States 临床应用案例对于指导即时检测技术开发的重要性：以美国HIV核酸检测为例 Yukari C Manabe and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e93–e99, https://doi.org/10.1093/cid/ciaf510 Mycobacterial Infections（分枝杆菌感染） 45 Body Mass Index and Incident Tuberculosis in Close Tuberculosis Contacts 结核密切接触者中体重指数与新发结核病的关系 María B Arriaga and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e100–e109, https://doi.org/10.1093/cid/ciaf475 46 The Role of Youths in Within-Household Tuberculosis Transmission: A Household Contact Cohort Study 青年在家庭内结核病传播中的作用：一项家庭接触队列研究 Meredith B Brooks and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e110–e118, https://doi.org/10.1093/cid/ciaf490 47 Cost-effectiveness of Targeted Next-Generation Sequencing for Tuberculosis Drug-resistance Testing as an Alternative to the Standard of Care in South Africa 南非以靶向下一代测序作为结核病耐药检测标准护理方案的替代方案的成本效益分析 Alexandra de Nooy and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e119–e125, https://doi.org/10.1093/cid/ciaf495 48 Xpert MTB/RIF Cycle Threshold as a Marker of Tuberculosis (TB) Disease Severity: Implications for TB Treatment Stratification Xpert MTB/RIF循环阈值作为结核病（TB）疾病严重程度的标志物：对结核病治疗分层的启示 Daniel J Grint and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e126–e134, https://doi.org/10.1093/cid/ciaf527 49 The Role of β-Lactam Antibiotics in Treating Mycobacterium abscessus: From Laboratory Insights to Clinical Applications and the Case for Clinical Trials β-内酰胺类抗生素在治疗脓肿分枝杆菌中的作用：从实验室见解到临床应用及开展临床试验的必要性 Khalid M Dousa and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e135–e145, https://doi.org/10.1093/cid/ciaf547 Pediatric and Maternal Infectious Diseases（儿科与孕产妇传染病） 50 Efficacy, Immunogenicity, and Safety of an Investigational Maternal Respiratory Syncytial Virus Prefusion F Protein–Based Vaccine 一种研究性孕产妇呼吸道合胞病毒融合前F蛋白疫苗的疗效、免疫原性和安全性 Peyman Banooni and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e146–e155, https://doi.org/10.1093/cid/ciaf033 51 Hepatotoxicity Among People With HIV and Receiving Isoniazid Preventive Therapy in Pregnancy and Postpartum: The Role of Antiretroviral Regimen and Pharmacogenetics HIV感染者在孕期和产后接受异烟肼预防性治疗时的肝毒性：抗逆转录病毒治疗方案和药物基因组学的作用 Grace Montepiedra and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e156–e164, https://doi.org/10.1093/cid/ciaf198 52 Transplacental Transfer of Lumefantrine, Mefloquine, and Piperaquine: A Comparison of Concentrations in Mothers, Neonates, and Cord Blood 青蒿素、甲氟喹和哌喹的胎盘转运：母亲、新生儿和脐带血中浓度的比较 Makoto Saito and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e165–e173, https://doi.org/10.1093/cid/ciaf552 53 Why Did the Antimalarial Drug Cross the Placenta? 抗疟药为何要穿过胎盘？ Stephen J Rogerson and Holger W Unger Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e174–e175, https://doi.org/10.1093/cid/ciaf553 Viral Infections（病毒性传染病） 54 Kinetics and Predictors of Hepatitis B Surface Antigen Loss After Commencing Hepatitis B Virus (HBV)–Active Antiretroviral Therapy in the Setting of HIV and Chronic HBV Coinfection HIV和慢性乙型肝炎病毒（HBV）共感染患者开始使用HBV活性抗逆转录病毒治疗后乙型肝炎表面抗原消失的动力学和预测因素 Jennifer Audsley and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e176–e184, https://doi.org/10.1093/cid/ciaf281 55 Secondary Pneumococcal Disease in Veterans With Viral Respiratory Infections 患有病毒性呼吸道感染退伍军人的继发性肺炎球菌病 Lauren A Powers and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e185–e190, https://doi.org/10.1093/cid/ciaf285 Correspondence（读者来信） 56 Unveiling Latent Risk Patterns in Antimicrobial-Resistant Bacteremia: A Deeper Look at Pathogen-Specific Mortality 揭示抗菌药物耐药性菌血症中的潜在风险模式：深入探究病原体特异性死亡率 Yuan-Ti Lee and Shiuan-Chih Chen Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Page e191, https://doi.org/10.1093/cid/ciaf493 57 Resistance to Antibiotics With High Empiric Treatment Relevance Explains Attributable Mortality Across 110 Pathogen-antibiotic Combinations 对经验性治疗具有高度相关性的抗生素耐药性可解释110种病原体 - 抗生素组合的归因死亡率 Kevin A Brown and Nick Daneman Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e191–e192, https://doi.org/10.1093/cid/ciaf494 58 Culture Clash: Dual-Pathogen Endocarditis and the Metagenomic Next-Generation Sequencing Studies We Need 文化冲突：双病原体心内膜炎以及我们所需的宏基因组下一代测序研究 Carl Boodman and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e193–e195, https://doi.org/10.1093/cid/ciaf518 59 Metagenomic Next-Generation Sequencing and Cardiovascular Infections: Promise and Pitfalls of Polymicrobial Detection 宏基因组下一代测序与心血管感染：多微生物检测的前景与陷阱 Sarwat Khalil and M Rizwan Sohail Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Page e196, https://doi.org/10.1093/cid/ciaf519 60 It Is Time to Go Beyond the Association Between Colistin and Meropenem for Invasive Carbapenem-Resistant Acinetobacter baumannii Infections 是时候超越多粘菌素和美罗培南联合治疗侵袭性碳青霉烯耐药鲍曼不动杆菌感染了 Alberto Enrico Maraolo and Giancarlo Ceccarelli Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e197–e198, https://doi.org/10.1093/cid/ciaf533 61 Actually, It May be Time to Return to Colistin and Meropenem in Some Patients Infected With Carbapenem-resistant Acinetobacter baumannii (CRAB) 实际上，对于某些感染碳青霉烯耐药鲍曼不动杆菌（CRAB）的患者，或许是时候重新使用多粘菌素和美罗培南了 Jason M Pogue and Keith S Kaye Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e198–e199, https://doi.org/10.1093/cid/ciaf534 62 COVID-19 and Bacterial Pneumonia: Protective Effect or Diagnostic Bias? COVID-19和细菌性肺炎：保护作用还是诊断偏差？ Duygu Aydın and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Page e200, https://doi.org/10.1093/cid/ciaf539 63 Secondary Pneumococcal Disease in Veterans With Viral Respiratory Infections: A Follow Up 患有病毒性呼吸道感染退伍军人的继发性肺炎球菌病：后续研究 John C Hu and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e200–e201, https://doi.org/10.1093/cid/ciaf540 64 Long-Acting Cabotegravir/Rilpivirine in Viremic People With HIV: Bumpy Road to Perfection 长效卡博特韦/利匹韦林用于病毒载量阳性的HIV感染者：通往完美的坎坷之路 Beatrice Barda and Marco Bongiovanni Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e201–e202, https://doi.org/10.1093/cid/ciaf482 65 Beyond the Sequence: Operationalizing Whole-Genome Sequencing for Real-time Infection Control in Low- and Middle-Income-Country Healthcare Settings Healthcare Settings 超越序列：在中低收入国家医疗环境中实际应用全基因组测序进行实时感染控制 Schawanya Kaewpitoon Rattanapitoon and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e202–e203, https://doi.org/10.1093/cid/ciaf535 66 Reassessing Adherence Trajectories in Multidrug-Resistant Tuberculosis: Recovery Advantage and Hidden Biases 重新评估耐多药结核病的依从性轨迹：康复优势和隐藏偏差 Shiuan-Chih Chen and Chun-Chieh Chen Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e203–e204, https://doi.org/10.1093/cid/ciaf536 67 Metagenomic Sequencing of Blood Culture Broth for Diagnosing Fastidious Endocarditis 血培养肉汤宏基因组测序用于诊断苛养性心内膜炎 Po-Hsiu Huang and others Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Pages e204–e205, https://doi.org/10.1093/cid/ciaf554 Corrections（更正） 68 Correction to: Secondary Pneumococcal Disease in Veterans With Viral Respiratory Infections 《患有病毒性呼吸道感染退伍军人的继发性肺炎球菌病》更正 Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Page e206, https://doi.org/10.1093/cid/ciaf572 69 Correction to: Treatment Outcomes With an Oral Short Course Regimen for Rifampicin-resistant Tuberculosis in a High HIV Prevalence, Programmatic Setting in South Africa 《南非高HIV流行率、项目化环境中口服短程利福平耐药结核病治疗方案的治疗结果》更正 Clinical Infectious Diseases, Volume 82, Issue 1, 15 January 2026, Page e207, https://doi.org/10.1093/cid/ciaf711 Clinical Infectious Diseases Volume 82 Issue Supplement_1 临床传染病学 82卷增刊1期 https://academic.oup.com/cid/issue/82/Supplement_1 SUPPLEMENT（增刊） Laboratory and Point-of-care Testing to Detect Chlamydia trachomatis and Neisseria gonorrhoeae: Review of the Available Evidence 实验室及即时检测技术用于检测沙眼衣原体和淋病奈瑟菌：现有证据综述 SUPPLEMENT ARTICLES（增刊论著） 1 Evidence Review for Centers for Disease Control and Prevention Guidance Development on the Detection of Chlamydia trachomatis and Neisseria gonorrhoeae 美国疾病控制与预防中心沙眼衣原体和淋病奈瑟菌检测指南制定证据综述 Amanda C Smith and Ellen N Kersh Clinical Infectious Diseases, Volume 82, Issue Supplement_1, 15 February 2026, Pages S1–S5, https://doi.org/10.1093/cid/ciaf665 2 Narrative Review of Chlamydia trachomatis Culture, Viability Testing, and Sequencing Methods 沙眼衣原体培养、活性检测及测序方法的叙述性综述 Alana K Sterkel and others Clinical Infectious Diseases, Volume 82, Issue Supplement_1, 15 February 2026, Pages S6–S12, https://doi.org/10.1093/cid/ciaf697 3 Culture and Identification of Neisseria gonorrhoeae: A Narrative Review of Current Laboratory Methods 淋病奈瑟菌培养与鉴定：当前实验室方法叙述性综述 Olusegun O Soge and others Clinical Infectious Diseases, Volume 82, Issue Supplement_1, 15 February 2026, Pages S13–S18, https://doi.org/10.1093/cid/ciaf698 4 Review of the Performance of Laboratory-Based Molecular Diagnostics for Chlamydia trachomatis and Neisseria gonorrhoeae 实验室分子诊断技术检测沙眼衣原体和淋病奈瑟菌的性能综述 Megan Crumpler and others Clinical Infectious Diseases, Volume 82, Issue Supplement_1, 15 February 2026, Pages S19–S35, https://doi.org/10.1093/cid/ciaf696 5 Review of Methods for Detecting Antimicrobial Resistance of Neisseria gonorrhoeae 淋病奈瑟菌抗菌药物耐药性检测方法综述 Kara K Mitchell and others Clinical Infectious Diseases, Volume 82, Issue Supplement_1, 15 February 2026, Pages S36–S42, https://doi.org/10.1093/cid/ciaf706 6 Point-of-care Tests for Chlamydia trachomatis and Neisseria gonorrhoeae: Review of the Literature 沙眼衣原体和淋病奈瑟菌即时检测技术文献综述 Yukari C Manabe and others Clinical Infectious Diseases, Volume 82, Issue Supplement_1, 15 February 2026, Pages S43–S51, https://doi.org/10.1093/cid/ciaf699 Clinical Infectious Diseases Volume 82 Issue 2 临床传染病学 82卷 2期 https://academic.oup.com/cid/issue/ ID Art Through the Ages（穿越时代的传染病技艺） 1 Interior of the Old Jersey Prison Ship in the Revolutionary War 美国革命战争中老泽西监狱船的内部景象 Mary Grizzard and Michael Grizzard Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Page i, https://doi.org/10.1093/cid/ciaf693 In the Literature（本期精选） 2 In the Literature 本期精选 Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages ii–v, https://doi.org/10.1093/cid/ciag011 IDSA 2025 Collections Editorial（美国传染病学会2025年专题合集社论） 3 2025 Content Collections from the IDSA Journals IDSA期刊2025年内容合集 Roger Bedimo and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 185–186, https://doi.org/10.1093/cid/ciag041 State-of-the-Art Review（前沿综述） 4 State-of-the-Art Review: Chagas Disease—an Enduring Challenge 前沿综述：恰加斯病——一个持续存在的挑战 Nelson Iván Agudelo Higuita and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 187–205, https://doi.org/10.1093/cid/ciaf654 IDSA Features（美国传染病学会特色内容） 5 Policy Recommendations to Support Equitable Access to Long-Acting Injectables for HIV Prevention and Treatment: A Policy Paper of the Infectious Diseases Society of America and the HIV Medicine Association 支持公平获取用于艾滋病毒预防和治疗的长效注射剂的政策建议：美国传染病学会与艾滋病毒医学协会的政策文件 Julia L Marcus and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 206–211, https://doi.org/10.1093/cid/ciae648 Voices of ID（传染病之声） 6 A “Terminal Infection” “绝症感染” Jennifer Furin Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 212–214, https://doi.org/10.1093/cid/ciaf332 Invited Commentary（特邀评论） 7 A Rapid Test to Differentiate Viral From Bacterial Infections: Searching for the Holy Grail 区分病毒与细菌感染的快速检测：寻找“圣杯” Lao-Tzu Allan-Blitz and Jeffrey D Klausner Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 215–218, https://doi.org/10.1093/cid/ciaf585 Bacterial Infections（细菌感染） 8 Nonoperative Versus Neurosurgical Treatment of Brain Abscess: An Emulated Trial Nested Within a Nationwide, Population-Based Cohort 脑脓肿的非手术治疗与神经外科治疗：一项基于全国人群队列的模拟试验 Emilie Marie Eriksen and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 219–227, https://doi.org/10.1093/cid/ciaf304 9 What Is the Impact of Anti-Enterococcal Empirical Therapy on Survival of Patients With Enterococcal Bloodstream Infections? 抗肠球菌经验性治疗对肠球菌血流感染患者生存率的影响是什么？ Linda Bussini and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 228–237, https://doi.org/10.1093/cid/ciaf323 10 Adjunctive Fosfomycin for the Treatment of Staphylococcus aureus Bacteremia: A Pooled Post Hoc Analysis of Individual Participant Data From 2 Randomized Trials 辅助使用磷霉素治疗金黄色葡萄球菌菌血症：两项随机试验个体参与者数据的汇总事后分析 Francesc Escrihuela-Vidal and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 238–245, https://doi.org/10.1093/cid/ciaf387 HIV/AIDs（人类免疫缺陷病毒/艾滋病） 11 Kinetics of Non-nucleoside Reverse Transcriptase Inhibitor Resistance-associated Mutations in HIV-1 Proviral Cellular Reservoirs in Non-nucleoside Reverse Transcriptase Inhibitor-experienced Persons 在接受过非核苷类逆转录酶抑制剂治疗的HIV-1感染者中，非核苷类逆转录酶抑制剂耐药相关突变在HIV-1前病毒细胞储存库中的动力学 Thomas Drumel and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 246–251, https://doi.org/10.1093/cid/ciaf430 12 Impact of Different Integrase Strand Transfer Inhibitors on Body Mass Index Among People With HIV Who Newly Started Antiretroviral Therapy in Shenzhen, China: A Real-World Data Analysis 中国深圳新开始抗逆转录病毒治疗的HIV感染者使用不同整合酶链转移抑制剂对体重指数的影响：一项现实数据分析 Lukun Zhang and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 252–261, https://doi.org/10.1093/cid/ciaf466 13 Consequences of Stopping Antiretroviral Treatment in a Persistently Seronegative Individual with HIV-1 HIV-1持续血清阴性个体停止抗逆转录病毒治疗的后果 Marc Wirden and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 262–264, https://doi.org/10.1093/cid/ciaf422 14 Approaches to the Management of Virologic Failure on Dolutegravir-Based Antiretroviral Therapy in the 50 Countries With the Highest Adult HIV Prevalence 在成人HIV患病率最高的50个国家中，多替拉韦为基础的抗逆转录病毒治疗出现病毒学失败的治疗方法 Cameron T Nutt and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 265–273, https://doi.org/10.1093/cid/ciaf444 Mycobacterial Infections（结核分枝杆菌感染） 15 Retrospective Cohort Analysis for Identification of Discordant Rifampicin-resistant Xpert MTB/RIF Assay Results in South Kivu, Eastern Democratic Republic of the Congo, a High Burden Tuberculosis Setting 刚果民主共和国东部南基伍这一结核病高负荷地区，识别利福平耐药不一致的Xpert MTB/RIF检测结果的回顾性队列分析 Bertin C Bisimwa and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 274–281, https://doi.org/10.1093/cid/ciaf451 16 Prevention of Tuberculosis in Patients Treated With Biological Therapies: 20 Years' Experience in a Specialized Tuberculosis Clinic in a Low-prevalence Country 生物疗法治疗患者中结核病的预防：某低流行国家一个专科结核病诊所20年的经验 Sandra Pérez-Recio and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 282–290, https://doi.org/10.1093/cid/ciaf491 17 Reducing Household Tuberculosis Transmission: A Pilot Cluster-Randomized Controlled Trial 减少家庭内结核病传播：一项试点整群随机对照试验 Cinthya Ruiz-Tagle and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 291–298, https://doi.org/10.1093/cid/ciaf526 18 (Un)masking Tuberculosis （揭开）结核病的“面具” Joseph N Burzynski and Neil W Schluger Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 299–300, https://doi.org/10.1093/cid/ciaf528 19 Estimating the Accuracy and Additionality of TB-LAM to Diagnose TB in Children Without HIV (AccuLAM) 评估TB-LAM在无HIV儿童中诊断结核病的准确性和额外价值（AccuLAM） Lucía CarratalàCastro and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 301–303, https://doi.org/10.1093/cid/ciaf525 Sexually Transmitted Infections（性传播感染） 20 Potential Impact of Doxycycline Post-exposure Prophylaxis Prescribing Strategies on Incidence of Bacterial Sexually Transmitted Infections 多西环素暴露后预防用药策略对细菌性性传播感染发病率的影响 Michael W Traeger and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 304–311, https://doi.org/10.1093/cid/ciad488 21 Filling in the Gaps: Updates on Doxycycline Prophylaxis for Bacterial Sexually Transmitted Infections 填补空白：多西环素预防细菌性性传播感染的最新进展 Aniruddha Hazra and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 312–320, https://doi.org/10.1093/cid/ciae062 22 Reported Neurologic Manifestations Among Persons With Syphilis by Stage of Infection—12 States, 2019–2022 2019-2022年12个州按感染阶段划分的梅毒患者报告的神经系统表现 Sarah B Wondmeneh and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 321–325, https://doi.org/10.1093/cid/ciaf015 Viral Infections（病毒性感染） 23 Investigating the Role of Cytomegalovirus as a Cause of Stillbirths and Child Deaths in Low- and Middle-Income Countries Through Postmortem Minimally Invasive Tissue Sampling 通过死后微创组织采样，调查巨细胞病毒在低收入和中等收入国家死胎和儿童死亡原因中的作用 Sithembiso Velaphi and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 326–336, https://doi.org/10.1093/cid/ciaf098 Photo Quiz（影像问答） 24 Bursting at the Seams “撑破” Maxwell Olenski and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 337–340, https://doi.org/10.1093/cid/ciaf488 Viral Infections（病毒性感染） 25 Clinical and Epidemiological Investigation of Vaccine-Derived Poliovirus Type 2 Outbreak in Pakistan During 2019–2021 2019-2021年巴基斯坦2型疫苗衍生脊髓灰质炎病毒疫情的临床和流行病学调查 Nayab Mehmood and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 341–351, https://doi.org/10.1093/cid/ciaf151 26 Inactivated Polio Vaccine Must Be an Essential Part of Polio Eradication 灭活脊髓灰质炎疫苗必须是根除脊髓灰质炎的重要组成部分 Konstantin Chumakov and Stanley A Plotkin Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 352–353, https://doi.org/10.1093/cid/ciaf215 Photo Quiz（影像问答） 27 Intracranial Lesion in a Patient With Chronic Myeloid Leukemia 慢性髓性白血病患者颅内病变 Mohammed Shakeel Sillat and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 354–357, https://doi.org/10.1093/cid/ciaf441 Viral Infections（病毒性感染） 28 Respiratory Syncytial Virus Co-Detection With Other Respiratory Viruses Is Not Significantly Associated With Worse Clinical Outcomes Among Children Aged <2 Years: New Vaccine Surveillance Network, 2016–2020 在<2岁的婴幼儿中，呼吸道合胞病毒与其他呼吸道病毒共同检测与临床预后恶化无显著关联：2016-2020年新疫苗监测网络数据 Justin Z Amarin and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 358–365, https://doi.org/10.1093/cid/ciaf194 29 Transfer of Herpes Simplex Virus Type 1 (HSV-1) Specific T Cells in a Pediatric Patient Post-HSCT With Severe, Acyclovir-resistant HSV-1 Infection 一例异基因造血干细胞移植后严重、阿昔洛韦耐药的单纯疱疹病毒1型（HSV-1）感染患儿的HSV-1特异性T细胞的输注 Astrid Wintering and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages 366–369, https://doi.org/10.1093/cid/ciaf125 Clinical Trials（临床实验） 30 Interferon-α Nasal Spray Prophylaxis Reduces COVID-19 in Cancer Patients: A Randomized, Double-Blinded, Placebo-Controlled Trial 干扰素-α鼻喷雾剂预防可降低癌症患者新冠病毒感染率：一项随机、双盲、安慰剂对照试验 Michelle K Yong and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e208–e216, https://doi.org/10.1093/cid/ciaf409 31 A Phase 3, Randomized Trial Investigating the Safety, Tolerability, and Immunogenicity of V116, an Adult-Specific Pneumococcal Conjugate Vaccine, in Pneumococcal Vaccine-Naïve Adults 18–64 Years of Age at Increased Risk of Pneumococcal Disease, STRIDE-8 一项3期随机试验，调查V116（一种成人特异性肺炎球菌结合疫苗）在未接种过肺炎球菌疫苗且患肺炎球菌疾病风险增加的18-64岁年龄段成人中的安全性、耐受性和免疫原性，STRIDE-8试验 Paul T Scott and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e217–e226, https://doi.org/10.1093/cid/ciaf604 32 Effect of Direct-from-blood Bacterial Testing on Antibiotics Administration in Adults Presenting With Acute Infection: A Randomized Trial 直接从血液进行细菌检测对急性感染成年患者抗生素给药的影响：一项随机试验 David C Gaston and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e227–e235, https://doi.org/10.1093/cid/ciaf677 33 The Tantalizing Pursuit for a Perfect Diagnostic Test: Balancing Innovation With Stewardship 对完美诊断检测的诱人追求：平衡创新与管理 K C Coffey and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e236–e238, https://doi.org/10.1093/cid/ciaf674 Global Health and Neglected Tropical Diseases（全球健康与被忽视的热带病） 34 Diagnostic Accuracy of Tuberculosis Screening Tests in a Prospective Multinational Cohort: Chest Radiography With Computer-Aided Detection, Xpert Tuberculosis Host Response, and C-Reactive Protein 在一项前瞻性多国队列研究中，结核病筛查试验的诊断准确性：计算机辅助检测的胸部X光片、Xpert结核宿主反应检测和C反应蛋白 Rebecca Crowder and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e239–e247, https://doi.org/10.1093/cid/ciae549 HIV/AIDs（人类免疫缺陷病毒/艾滋病） 35 Risk Assessment in a Global CVD Prevention Cohort of People With HIV by PCE, PREVENT, and SCORE2 通过PCE、PREVENT和SCORE2对全球心血管疾病预防队列中艾滋病毒感染者进行风险评估 Steven K Grinspoon and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e248–e257, https://doi.org/10.1093/cid/ciaf542 36 REPRIEVE Analysis of New Cardiovascular Risk Calculators in HIV: Underpredicting Risk Means Preventing Fewer Heart Attacks HIV新心血管风险计算器的REPRIEVE分析：低估风险意味着预防的心脏病发作更少 Matthew S Durstenfeld Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e258–e261, https://doi.org/10.1093/cid/ciaf543 37 Comparable Inflammatory and Metabolic Outcomes After Switching to Bictegravir/Emtricitabine/Tenofovir Alafenamide Versus Continuing Dolutegravir/Lamivudine in Virologically Suppressed Adults With HIV (INSTINCT/GESIDA10918 Study) 在病毒学抑制的HIV感染成人中，转换为比克替拉韦/恩曲他滨/丙酚替诺福韦与继续使用多替拉韦/拉米夫定后的炎症和代谢结局相当（INSTINCT/GESIDA10918研究） Sergio Serrano-Villar and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e262–e274, https://doi.org/10.1093/cid/ciaf565 38 Tenofovir Alafenamide and Body Weight: Have We Finally Tipped the Scale? 丙酚替诺福韦与体重：我们最终是否打破了平衡？ John R Koethe Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e275–e277, https://doi.org/10.1093/cid/ciaf566 39 Long-Term Clinical, Immunologic, and Viral Reservoir Outcomes in Children Treated With VRC01LS and 10-1074 Monoclonal Antibodies in the Tatelo Study 在Tatelo研究中，接受VRC01LS和10-1074单克隆抗体治疗的儿童的长期临床、免疫学和病毒储存库结局 Gbolahan Ajibola and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e278–e285, https://doi.org/10.1093/cid/ciaf568 40 Trends in Persons Prescribed HIV Postexposure Prophylaxis in the United States, 2015–2023 2015-2023年美国开具HIV暴露后预防处方的患者趋势 John N Le and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e286–e295, https://doi.org/10.1093/cid/ciaf581 Immunocompromised Hosts（免疫功能低下宿主） 41 Epidemiology, Risk Factors, and Outcomes of Neutropenic Enterocolitis in Onco-Hematological Patients According to Chemotherapy Regimen 根据化疗方案分析肿瘤血液学患者中性粒细胞减少性肠结肠炎的流行病学、危险因素和预后 Anne-Sophie Brunel and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e296–e307, https://doi.org/10.1093/cid/ciaf134 42 An Analysis of Cytomegalovirus-Specific Cell-Mediated Immunity in a Phase 3, Randomized, Placebo-Controlled Trial of Letermovir Prophylaxis in Cytomegalovirus-Seropositive Recipients of an Allogeneic Hematopoietic Cell Transplant 在一项3期随机、安慰剂对照试验中，分析来特莫韦预防对巨细胞病毒血清阳性异基因造血细胞移植受者巨细胞病毒特异性细胞介导免疫的影响 Genovefa A Papanicolaou and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e308–e315, https://doi.org/10.1093/cid/ciaf646 43 Cytomegalovirus (CMV)-Specific Cell-Mediated Immunity for Prediction of Postprophylaxis CMV Disease in a Phase 3 Trial of Letermovir Versus Valganciclovir Prophylaxis in Donor CMV-Seropositive/Recipient CMV-Seronegative Kidney Transplant Recipients 在供体巨细胞病毒血清阳性/受体巨细胞病毒血清阴性的肾移植受者中，来特莫韦与缬更昔洛韦预防的3期试验中，巨细胞病毒（CMV）特异性细胞介导免疫对预防后CMV疾病的预测作用 Ajit P Limaye and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e316–e324, https://doi.org/10.1093/cid/ciaf632 44 The Role of Cytomegalovirus-Specific Cellular Immunity in Transplant Recipients with Letermovir Prophylaxis: To be Determined 来特莫韦预防移植受者中巨细胞病毒特异性细胞免疫的作用：有待确定 Yoichiro Natori and Martina Sester Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e325–e327, https://doi.org/10.1093/cid/ciaf633 45 IL12RB1 Deficiency Appearing in North America: Expanding the Clinical Phenotypes 北美出现的IL12RB1缺陷：拓展临床表型 Chen Wang and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e328–e331, https://doi.org/10.1093/cid/ciaf637 Vaccines（疫苗） 46 A Phase IV, Open-label, Single-Arm, Multicentric Clinical Trial for Evaluation of Human Papillomavirus 9vHPV Vaccine Immunogenicity in Men Who Have Sex With Men With HIV: GeSIDA Study 10 017 一项评估人乳头瘤病毒9vHPV疫苗在感染HIV的男男性行为者中免疫原性的IV期、开放标签、单臂、多中心临床试验：GeSIDA 10 017研究 Raquel Ron and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e332–e342, https://doi.org/10.1093/cid/ciaf435 47 Immunogenicity and Safety of the COVID-19 Messenger RNA Vaccine Coadministered With Influenza and 23-valent Pneumococcal Polysaccharide Vaccines 与流感疫苗和23价肺炎球菌多糖疫苗同时接种的COVID-19信使核糖核酸疫苗的免疫原性和安全性 Omid Rezahosseini and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e343–e351, https://doi.org/10.1093/cid/ciaf455 48 Intestinal Mucosal Immune Responses to Novel Oral Poliovirus Vaccine Type 2 in Healthy Newborns 健康新生儿对新型2型口服脊髓灰质炎疫苗的肠道黏膜免疫反应 Audrey Godin and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e352–e360, https://doi.org/10.1093/cid/ciaf484 49 Estimated Vaccine Effectiveness for Respiratory Syncytial Virus–Related Acute Respiratory Illness in Older Adults: Findings From the First Postlicensure Season 老年人呼吸道合胞病毒相关急性呼吸道疾病的估计疫苗有效性：首个上市后季节的研究结果 Sara Y Tartof and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e361–e370, https://doi.org/10.1093/cid/ciaf496 Sexually Transmitted Infections（性传播感染） 50 Systematic Review and Meta-analysis of the Association Between Mycoplasma genitalium and Pelvic Inflammatory Disease (PID) 生殖支原体与盆腔炎性疾病（PID）关联的系统综述和荟萃分析 Kay Htaik and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e371–e379, https://doi.org/10.1093/cid/ciae295 51 Sexually Transmitted Infection (STI)/HIV Testing, STIs, and HIV Pre-exposure Prophylaxis Use Among Men Who Have Sex With Men and Men Who Have Sex With Men and Women in the United States, 2019–2022 2019-2022年美国男男性行为者以及男男性行为者和女性性行为者中性传播感染（STI）/HIV检测、性传播感染和HIV暴露前预防用药情况 Guoyu Tao and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e380–e386, https://doi.org/10.1093/cid/ciae314 52 Cabotegravir Maintains Protective Efficacy in the Setting of Bacterial Sexually Transmitted Infections: A Secondary Analysis of HPTN 083 卡博特韦在细菌性性传播感染情况下维持保护效力：HPTN 083的二次分析 Meredith E Clement and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e387–e395, https://doi.org/10.1093/cid/ciae572 Viral Infections（病毒性感染） 53 Comprehensive Analysis of Cardiovascular Events and Risk Factors in Patients Hospitalized With Respiratory Syncytial Virus 对因呼吸道合胞病毒感染住院患者的心血管事件和危险因素的综合分析 Paulina Sudnik and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e396–e403, https://doi.org/10.1093/cid/ciaf310 54 In Critical Condition: The Urgent Need to Support Mpox Therapeutic and Diagnostic Pipelines 处于危急状况：迫切需要支持猴痘治疗和诊断管线 Carmen Perez Casas and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e404–e408, https://doi.org/10.1093/cid/ciaf529 Correspondence（读者来信） 55 Caution in Interpreting INSTIs and Weight in Observational Studies 在观察性研究中解读整合酶抑制剂与体重关系时需谨慎 Esteban Martínez Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Page e409, https://doi.org/10.1093/cid/ciaf569 56 Weight Trajectories With Integrase Inhibitors: Unaddressed Insights and Limitations in a Chinese Cohort 整合酶抑制剂与体重变化轨迹：中国队列中未解决的见解和局限性 Yuan-Ti Lee and Shiuan-Chih Chen Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e409–e410, https://doi.org/10.1093/cid/ciaf570 57 Real-World Evidence as a Complement to Randomized Trials in Interpreting Weight Gain on Modern INSTI Regimens 现实证据作为随机试验的补充，用于解读现代整合酶抑制剂方案导致的体重增加 Xinsheng Wu and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e410–e411, https://doi.org/10.1093/cid/ciaf571 58 C-reactive Protein in TB Meningitis: Signal, Surrogate, or Saboteur? 结核性脑膜炎中的C反应蛋白：信号、替代指标还是破坏因素？ Patrick K Moonan and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e411–e412, https://doi.org/10.1093/cid/ciaf575 59 C-Reactive Protein in Tuberculous Meningitis: A Viable Biomarker for Individualized Care 结核性脑膜炎中的C反应蛋白：个体化护理的可行生物标志物 Lillian Tugume and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e412–e413, https://doi.org/10.1093/cid/ciaf576 60 The Win Ratio Should Be Complemented by Other Win Statistics to Provide a Comprehensive Picture of Relative and Absolute Treatment Effects: The Case Study of the REPRIEVE Trial 胜利比率应与其他胜利统计数据相结合，以全面呈现相对和绝对治疗效果：REPRIEVE试验案例研究 Melissa J Hardy and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e413–e414, https://doi.org/10.1093/cid/ciaf587 61 Small Effects, Big Impact: Multiple Win Measures Aid Interpretation, But Do Not Forget the Bigger Picture 效应虽小，影响重大：多种胜利衡量指标有助于解读，但不要忘记整体情况 Emma Davies Smith and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e414–e416, https://doi.org/10.1093/cid/ciaf588 62 Does Oral Antibiotic Switching Therapy Show Similar Efficacy to Intravenous Administration for Treating Infective Endocarditis? 口服抗生素转换疗法治疗感染性心内膜炎的疗效是否与静脉给药相似？ Jun Suzuki and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e416–e417, https://doi.org/10.1093/cid/ciaf598 63 Toward a Wider Use of Oral Antibiotic Switch in Infective Endocarditis 朝着更广泛地使用感染性心内膜炎口服抗生素转换疗法迈进 Romane Pouy and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e417–e418, https://doi.org/10.1093/cid/ciaf599 64 Operationalizing Sepsis Definitions With Artificial Intelligence: Toward Smarter Antibiotic Use 利用人工智能实现败血症定义的落地应用：迈向更明智的抗生素使用 James S Ford and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e418–e419, https://doi.org/10.1093/cid/ciaf601 65 Balancing Innovation in Artificial Intelligence With Practical Sepsis Definitions 平衡人工智能创新与实用的败血症定义 Chanu Rhee and Michael Klompas Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e419–e420, https://doi.org/10.1093/cid/ciaf602 66 Precision Prevention of Tuberculosis in Biologic Therapy: Lessons Beyond Screening Strategies 生物疗法中结核病的精准预防：筛查策略之外的启示 Shiuan-Chih Chen and Yuan-Ti Lee Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e420–e421, https://doi.org/10.1093/cid/ciaf559 67 Recalibrating COVID-19 Booster Policy: Lessons From Hybrid Immunity and Global Equity Gaps 重新调整COVID-19加强针政策：从混合免疫和全球公平差距中吸取教训 Nathkapach K Rattanapitoon and others Clinical Infectious Diseases, Volume 82, Issue 2, 15 February 2026, Pages e421–e422, https://doi.org/10.1093/cid/ciaf605

2026-02-23

·基层神经外科周医生

颅内感染的诊断与治疗：从传统方法到精准医学的演进

摘要颅内感染是神经科危急重症，涵盖脑膜炎、脑脓肿、硬膜下积脓等多种类型，其病原谱广泛包括细菌、病毒、真菌及寄生虫。近年来，随着耐药菌株的涌现、新型病原体的出现以及诊断技术的革新，颅内感染的诊疗模式正经历深刻变革。本文系统综述颅内感染的流行病学特征与病原谱演变，重点阐述诊断技术的进展，包括传统实验室检查的局限性、多重PCR与宏基因组二代测序等分子诊断技术的突破，以及新型生物标志物和人工智能辅助诊断的应用前景。在治疗方面，本文讨论经验性抗感染策略、针对耐药菌的联合用药方案（尤其鞘内/脑室内给药途径）、外科干预指征与时机，以及聚焦超声等创新治疗技术的探索。此外，本文还关注特殊类型颅内感染（如术后感染、罕见病原体感染）的个体化管理策略。研究表明，以mNGS为代表的分子诊断技术显著提高了病原体检出率，而针对多重耐药菌的局部给药方案改善了难治性感染的预后。未来，颅内感染的诊疗将朝着快速精准诊断、个体化抗感染治疗和微创外科干预的方向发展。关键词：颅内感染；宏基因组二代测序；多重耐药菌；鞘内注射；脑脓肿1 引言颅内感染是指病原微生物侵入脑实质、脑膜或脑室系统引起的炎症性疾病，其临床表现多样，病情进展迅速，病死率和致残率居高不下。根据解剖部位，颅内感染可分为脑膜炎、脑脓肿、硬膜外脓肿、硬膜下积脓、脑室炎等类型【1】。病原体可通过血行播散、邻近感染灶直接蔓延、外伤或手术直接接种等途径侵入中枢神经系统。近年来，颅内感染的流行病学特征发生显著变化：一方面，器官移植、免疫抑制剂使用和HIV感染的增加导致机会性病原体感染增多；另一方面，神经外科手术量的增长使得术后颅内感染成为临床重要挑战，其发生率约为0.8%-7%【2】。更值得关注的是，多重耐药菌如耐甲氧西林金黄色葡萄球菌（MRSA）、碳青霉烯类耐药肠杆菌（CRE）和多重耐药鲍曼不动杆菌的流行，使传统抗感染方案面临失效风险【2】。与此同时，诊断技术领域取得了突破性进展。宏基因组二代测序（mNGS）技术的临床应用使得无偏倚检测脑脊液中病原体核酸成为可能，显著提高了罕见病原体和难培养病原体的检出率【1】【2】。CRISPR-based检测平台、代谢组学分析等新型技术也展现出良好的应用前景【2】。治疗方面，针对血脑屏障穿透性差的药物，鞘内/脑室内给药策略在多药耐药菌感染中显示出显著优势【6】。本文旨在系统梳理颅内感染诊断与治疗的最新研究进展，分析不同技术的临床价值与局限性，为临床决策提供参考，并展望未来发展方向。2 流行病学与病原谱2.1 发病率与危险因素颅内感染的发病率因地域、人群和感染类型而异。社区获得性脑膜炎在发达国家年发病率约为2-5/10万，而在资源有限地区更高。脑脓肿约占颅内占位性病变的8%在发展中国家，发达国家则为1-2%【8】。术后颅内感染的发生率与手术类型密切相关，清洁切口颅脑手术后感染率为0.8%-7%，复杂神经外科手术（如肿瘤切除、动脉瘤夹闭）可超过5%【2】。危险因素可分为患者相关因素和医疗相关因素。患者相关因素包括：免疫功能低下（糖尿病、长期糖皮质激素使用、HIV感染）、营养不良、高龄、慢性肝肾疾病【2】。医疗相关因素包括：手术时间延长、重复开颅手术、植入物（引流管、钛网）使用、术后脑脊液漏等【2】。2.2 病原体分布颅内感染的病原体谱因感染途径和宿主状态而异：血源性感染：常为单发或多发脓肿，病原体以链球菌属（尤其是咽峡炎链球菌）、金黄色葡萄球菌和厌氧菌为主【4】。先天性心脏病右向左分流患者易发生脑脓肿，病原体多为口腔厌氧菌。邻近感染灶蔓延：鼻窦炎相关颅内感染病原体包括厌氧菌、链球菌和葡萄球菌；中耳炎和乳突炎可导致颞叶或小脑脓肿，病原体多为拟杆菌属、肠杆菌科和链球菌【4】。外伤或术后感染：金黄色葡萄球菌（包括MRSA）和凝固酶阴性葡萄球菌是主要病原体【2】。近年来，鲍曼不动杆菌、肺炎克雷伯菌等革兰阴性菌所致术后感染比例上升，且多呈现多重耐药性【6】。免疫缺陷宿主：易发生弓形虫、隐球菌、巨细胞病毒、诺卡菌等机会性感染【4】。一项针对原发性脑室内脓肿的系统综述显示，链球菌占23.1%，葡萄球菌占15.4%，革兰阴性菌（大肠埃希菌、肺炎克雷伯菌）占30.8%，结核分枝杆菌和真菌各占7.7%【8】。这一分布反映了罕见部位感染的特殊病原谱。2.3 耐药性演变多重耐药菌在颅内感染中的检出率逐年上升。鲍曼不动杆菌颅内感染多为碳青霉烯耐药菌株（CRAB），治疗选择极为有限【6】。金黄色葡萄球菌中MRSA比例居高不下，其耐药机制涉及mecA基因介导的β-内酰胺类抗生素靶点改变【2】。肠杆菌科细菌中产KPC型碳青霉烯酶的CRE菌株播散迅速，导致头孢菌素类和碳青霉烯类失效。值得警惕的是，耳念珠菌（Candida auris）作为一种多重耐药酵母菌，近年来被报道可引起颅内感染，尤其在存在神经外科植入物的患者中【5】。该菌对氟康唑普遍耐药，部分菌株对两性霉素B和棘白菌素也呈现耐药，给治疗带来严峻挑战。3 诊断技术进展3.1 传统诊断方法的局限性脑脊液常规与生化检查仍是颅内感染诊断的基础，但其敏感性和特异性存在明显局限。细菌性脑膜炎典型表现为脑脊液白细胞增高（以中性粒细胞为主）、蛋白升高、糖降低。然而，在免疫抑制患者中，细胞反应可不典型；部分真菌感染（如隐球菌脑膜炎）脑脊液改变轻微【2】。结核性脑膜炎早期脑脊液改变可不明显，延误诊断常见。病原体培养是诊断金标准，但阳性率低、周期长。脑脓肿脓液培养阳性率约70%，但术前使用抗生素可降至30%以下【4】。术后感染中，细菌生物被膜形成使常规培养假阴性率增高。培养周期通常需48-72小时，真菌和分枝杆菌需数周，无法满足早期诊断需求。神经影像学：增强MRI是诊断脑脓肿的首选方法，典型表现为环形强化伴弥散加权成像（DWI）高信号。但早期脓肿（脑炎期）可无环形强化，需与肿瘤、脱髓鞘病变鉴别【2】。CT对早期感染敏感性低，术后改变与感染鉴别困难【2】。生物标志物：血降钙素原（PCT）对细菌感染有一定特异性，但术后或全身炎症反应时可升高【2】。C反应蛋白（CRP）敏感但缺乏特异性。脑脊液乳酸在细菌性脑膜炎中升高，但抗生素使用后结果判读受影响【1】。3.2 分子诊断技术的革新多重PCR可同时检测多种常见病原体，2-4小时内出具结果。目前商业化的脑膜炎/脑炎多重PCR panel可检测14种常见病原体（细菌、病毒、真菌），敏感性和特异性均超过90%【9】。其主要优势在于快速排除或确认常见病原体，指导早期经验性治疗调整。局限性在于无法检测panel以外的病原体，且不能提供药敏信息。宏基因组二代测序（mNGS）是近年来颅内感染诊断领域最重要的突破【1】【2】。其原理是对脑脊液中所有核酸进行无偏倚测序，通过与数据库比对鉴定病原体。临床研究显示，mNGS可将病原体检出率提高15%-30%，尤其对罕见病原体（如诺卡菌、非结核分枝杆菌、病毒、寄生虫）和混合感染具有独特价值【2】。mNGS还可提供耐药基因信息（如mecA、KPC），辅助用药决策。但该技术成本较高，操作流程复杂，存在环境微生物污染可能，结果判读需结合临床。数字PCR（ddPCR）可实现病原体核酸的绝对定量，比传统定量PCR更敏感，适合脑脊液中微量病原体检测【2】。在结核性脑膜炎诊断中，ddPCR敏感性优于涂片和培养，且可监测治疗反应。CRISPR-based检测平台利用CRISPR-Cas系统的特异性核酸剪切功能，结合等温扩增技术，可在1小时内完成检测，无需复杂设备【2】。该技术在资源有限地区的床旁快速检测中具有巨大潜力。3.3 新型生物标志物与组学技术代谢组学通过分析脑脊液中小分子代谢物谱，识别感染特异性代谢指纹。初步研究显示，细菌性脑膜炎与病毒性脑膜炎的代谢谱存在差异，有望成为辅助鉴别诊断工具。宿主免疫反应标志物：检测脑脊液中细胞因子（如IL-6、IL-8、TNF-α）水平可反映中枢神经系统炎症状态【3】。部分研究探索利用宿主基因表达谱区分感染病因，但仍处于研究阶段【9】。噬菌体免疫沉淀测序（PhIP-seq）可检测血清或脑脊液中针对多种病原体的抗体谱，适用于病原体已清除但免疫印记存在的病例，或病原体核酸已降解的后期诊断【9】。3.4 影像学新技术高分辨磁共振成像：弥散张量成像（DTI）、磁共振波谱（MRS）和磁敏感加权成像（SWI）可提供脓肿与肿瘤鉴别的附加信息【2】。MRS可检测脓肿内特定代谢物（如乙酸盐、琥珀酸盐），有助于鉴别。分子影像：新型示踪剂标记的白细胞显像或病原体特异性示踪剂正处于临床转化阶段，有望实现感染灶的精准定位【2】。3.5 人工智能辅助诊断AI算法可整合临床资料、影像特征和实验室数据，辅助早期诊断和预后预测【2】。机器学习模型已被用于预测术后颅内感染风险、鉴别感染与非感染性脑膜炎、识别耐药菌株。随着多中心大数据的积累，AI在颅内感染诊疗中的应用前景广阔。4 治疗策略4.1 经验性抗感染治疗颅内感染病情凶险，病原学结果获取前需尽早启动经验性治疗。药物选择需兼顾：①对最常见病原体有效；②具有良好的血脑屏障穿透性；③考虑当地耐药流行病学。社区获得性细菌性脑膜炎：推荐第三代头孢菌素（头孢曲松或头孢噻肟）联合万古霉素，覆盖肺炎链球菌（包括耐药株）、脑膜炎奈瑟菌和流感嗜血杆菌【1】。老年患者或免疫功能低下者需加用氨苄西林覆盖单核细胞增生李斯特菌。脑脓肿经验性治疗：需覆盖链球菌、厌氧菌和葡萄球菌。推荐头孢曲松联合甲硝唑为基础方案，怀疑葡萄球菌时加用万古霉素【4】。术后颅内感染：需重点考虑葡萄球菌（包括MRSA）和革兰阴性杆菌（包括耐药菌）。万古霉素联合抗假单胞菌β-内酰胺类（头孢他啶、头孢吡肟或美罗培南）是常用选择【2】。抗真菌经验治疗：高危患者（如神经外科术后、免疫抑制）出现颅内感染征象，需考虑隐球菌、曲霉或念珠菌感染。脂质体两性霉素B联合氟胞嘧啶是隐球菌脑膜炎首选；伏立康唑适用于曲霉感染【5】。4.2 靶向治疗与耐药菌处理获得病原学及药敏结果后，应降阶梯为靶向治疗。MRSA颅内感染：万古霉素是主要选择，但需监测脑脊液药物浓度。利奈唑胺口服生物利用度高、脑脊液穿透性好，可作为替代【4】。达托霉素不宜用于中枢神经系统感染，因在脑脊液中失活。多重耐药革兰阴性菌：碳青霉烯类耐药鲍曼不动杆菌（CRAB）颅内感染治疗极为困难。多粘菌素类（多粘菌素B、多粘菌素E）是主要选择，但静脉给药脑脊液浓度低。鞘内/脑室内注射多粘菌素B可显著提高脑室液药物浓度，临床研究显示联合给药组治愈率45.2%，显著高于单用静脉组15.4%，30天死亡率从50.0%降至19.4%【6】。替加环素脑脊液穿透性差，一般不推荐单用。CRE颅内感染：头孢他啶/阿维巴坦对产KPC菌株有效，脑脊液浓度可达治疗水平。美罗培南/法硼巴坦是另一选择。对于全耐药菌株，需考虑联合用药和鞘内给药。耳念珠菌颅内感染：脂质体两性霉素B联合氟胞嘧啶是基础方案【5】。棘白菌素类（卡泊芬净、米卡芬净）脑脊液穿透性差，常规剂量无效，但有病例报告采用鞘内注射米卡芬净联合全身氟胞嘧啶成功治愈【5】。伏立康唑联合米卡芬净也显示出一定疗效。4.3 鞘内/脑室内给药对于血脑屏障穿透性差的药物（多粘菌素、氨基糖苷类、部分抗真菌药），鞘内注射（IT）或脑室内注射（IVT）可绕过血脑屏障，直接将药物注入脑脊液，显著提高局部药物浓度【2】【6】。适应症包括：①多重耐药菌感染，常规静脉治疗失败；②药物脑脊液穿透性差；③脑室炎或植入物相关感染。临床证据主要来自回顾性研究。一项纳入57例鲍曼不动杆菌颅内感染的研究显示，静脉联合鞘内/脑室内注射多粘菌素B组治愈率显著高于单用静脉组（45.2% vs 15.4%），30天死亡率更低（19.4% vs 50.0%）【6】。多因素回归分析显示，未使用鞘内/脑室内给药是30天死亡的独立危险因素（P=0.043）。鞘内给药安全性总体可接受，常见不良反应包括化学性脑膜炎、神经根刺激症状、癫痫等。操作需严格无菌，避免引入外源感染【6】。4.4 外科治疗脑脓肿：直径>2.5cm的脓肿、占位效应明显、药物治疗无效或需明确病原者，应行手术干预【4】。立体定向穿刺引流是主流术式，创伤小、可重复。开颅切除适用于表浅脓肿、多房脓肿或需同时清除异物时【8】。对于直径<2.5cm、多发性或深部脓肿，可尝试单纯药物治疗，但需密切影像随访【4】。脑室内脓肿：罕见但预后差，需积极干预。治疗包括脑室外引流（EVD）、脓肿穿刺引流、脑室灌洗及全身抗感染【8】。多数患者因合并脑积水需行脑室-腹腔分流。硬膜下积脓/硬膜外脓肿：多需手术引流，可选用钻孔引流或开颅清除【7】。感染源（如鼻窦炎、中耳炎）需同期处理。植入物相关感染：脑室-腹腔分流感染、Ommaya囊感染等，通常需移除植入物，置入EVD临时引流脑脊液，抗感染治疗稳定后择期重置分流【5】。4.5 辅助治疗与新兴技术糖皮质激素：在细菌性脑膜炎中的作用存在争议。儿童流感嗜血杆菌脑膜炎使用地塞米松可降低听力损害发生率。成人肺炎链球菌脑膜炎可能获益，但需在首剂抗生素前或同时使用。脑脓肿伴明显脑水肿、占位效应时，可短期使用减轻颅内高压【4】。抗癫痫治疗：幕上病变（包括脑脓肿）有癫痫风险，可预防性使用抗癫痫药物，但不推荐常规长期使用【4】。聚焦超声（FUS）：临床前研究显示，聚焦超声可暂时开放血脑屏障，调节局部免疫反应，促进炎症细胞浸润和病原体清除。在脑脓肿动物模型中，FUS治疗使脓肿体积缩小50%，神经元损伤减轻【3】。该技术尚处早期探索阶段，有望成为辅助药物递送和免疫调节的新工具。5 特殊类型颅内感染5.1 术后颅内感染术后颅内感染是神经外科重要并发症，诊断难点在于术后非感染性炎症与感染的鉴别【2】。临床表现为术后发热、意识水平下降、颈抵抗，但亦可缺如。脑脊液检查可见细胞数增高，但术后本身可致无菌性炎症。脑脊液培养阳性是确诊依据，但敏感度低。治疗原则：①经验性覆盖葡萄球菌和革兰阴性杆菌；②根据培养和药敏结果降阶梯；③植入物感染需考虑移除；④耐药菌感染可联合鞘内给药【2】【6】。5.2 耐药真菌颅内感染耳念珠菌颅内感染近年被报道，多见于存在脑室-腹腔分流或EVD的患者【5】。临床表现无特异性，脑脊液检查符合真菌性脑膜炎特征。诊断依靠培养和分子鉴定（MALDI-TOF或测序）。治疗挑战在于：①多数菌株对氟康唑耐药；②棘白菌素脑脊液穿透性差；③植入物相关感染需综合处理【5】。个案报告汇总显示，11例耳念珠菌颅内感染中8例预后良好，采用脂质体两性霉素B联合氟胞嘧啶或联合鞘内棘白菌素的方案成功率较高【5】。5.3 原发性脑室内脓肿原发性脑室内脓肿罕见，指脓肿局限于脑室内形成包膜，而非脑实质脓肿破入脑室【8】。常见症状为发热（69.2%）、头痛（53.8%），61.5%患者合并脑积水。病原体以链球菌、葡萄球菌和革兰阴性菌为主。治疗需手术干预（立体定向穿刺、脑室外引流或开颅切除）联合靶向抗感染，病死率15.4%【8】。6 挑战与展望6.1 当前面临的主要挑战诊断困境：mNGS等技术虽提高病原体检出率，但结果判读缺乏统一标准，区分感染与污染、定植与致病仍依赖临床判断【2】。技术成本高，基层推广受限。耐药问题：多重耐药菌在颅内感染中比例上升，新药研发滞后于耐药进化。部分耐药菌（如全耐药鲍曼不动杆菌）面临无药可用困境【6】。治疗药物选择有限：许多新抗生素血脑屏障穿透数据缺乏，剂量方案多源于经验。特殊人群（儿童、孕妇、肾功能不全）用药缺乏循证依据。临床研究困难：颅内感染病种多、单病种病例少，开展RCT困难。多数指南基于专家共识和回顾性研究，证据级别不高。6.2 未来发展方向精准诊断体系：建立mNGS本地化检测流程，开发快速耐药基因检测技术，整合病原体与宿主反应标志物，实现感染与非感染的准确鉴别【9】。AI辅助诊断模型有望整合多维数据，提高早期诊断准确性【2】。个体化抗感染治疗：基于治疗药物监测（TDM）优化给药方案，根据药代动力学/药效动力学（PK/PD）目标调整剂量。开发新型药物递送系统（如聚焦超声辅助血脑屏障开放），提高药物脑内浓度【3】。新型抗菌药物研发：针对多重耐药革兰阴性菌的新型β-内酰胺酶抑制剂复合制剂、新型多粘菌素衍生物、抗菌肽等进入临床研究阶段。多中心协作网络：建立罕见颅内感染登记系统，开展多中心真实世界研究，积累高质量临床证据，推动指南更新【5】。7 结论颅内感染的诊断与治疗正经历从经验医学向精准医学的深刻转型。以mNGS为代表的分子诊断技术显著提高了病原体检出率，缩短了诊断时间，为靶向治疗创造了条件。针对多重耐药菌的鞘内/脑室内给药策略为难治性感染提供了有效解决方案，改善了患者预后。外科治疗趋向微创和精准，立体定向穿刺引流成为脑脓肿主流术式。然而，耐药菌的持续演变、新药研发的相对滞后、诊断技术的可及性差异，仍是临床面临的现实挑战。未来，需要进一步推动快速诊断技术的临床转化与普及，完善耐药监测网络，开展高质量临床研究积累循证依据。多学科协作（神经外科、感染科、微生物科、药学）是实现颅内感染个体化诊疗的关键保障。参考文献【1】Trujillo-Gómez J, et al. Acute infections of the central nervous system in children and adults: diagnosis and management. Minerva Med, 2024, 115(4): 476-502. 【2】Recent advances in diagnostic technologies for postoperative central nervous system infections: a review. Neurol Sci, 2025, 46(9): 4279-4291. 【3】Modulation of the immune response by focused ultrasound suppressed brain abscess formation. Drug Deliv Transl Res, 2026, 16: 1007-1019. 【4】Klein RS. Brain Abscess. MSD Manual Professional Edition, 2024. 【5】Jelkin G, et al. Intracranial Candida Auris Infection: A Case Report and Scoping Review. World Neurosurg, 2026, 124775. 【6】Comparative efficacy of intravenous versus intravenous combined with intrathecal/intracerebral ventricle injection of polymyxin B for Acinetobacter baumannii intracranial infection: A retrospective study. Int J Infect Dis, 2025, 106. 【7】颅内硬膜外脓肿和硬膜下积脓. 《默沙东诊疗手册大众版》, 2024. 【8】 Primary intraventricular brain abscess: a systematic review of risk factors, etiology, and management. Egypt J Neurosurg, 2025, 40: 101. 【9】Alam AM, Houlihan CF, Bharucha T. Novel techniques for the diagnosis of neurological infections. Curr Opin Neurol, 2025, 38(4): 414-421.

基因疗法微生物疗法

2026-02-21

·腾讯网

年度进展丨呼吸感染性疾病诊治：抗感染药物有何令人鼓舞之处？诊断技术的持续发展方向？

摘要2025年肺部感染性疾病依旧对全球公共卫生构成重要威胁，呼吸感染性疾病的诊治充满挑战，细菌耐药形势持续严峻，病毒流行呈现新形势，全球结核病负担仍处高位，疫情导致的“滞后诊断效应”尚未完全消除。过去一年，呼吸感染诊断技术持续向精准化发展，新型抗感染药物和疫苗的研究及临床应用成果丰硕。本文就呼吸感染性疾病领域主要的研究进展进行回顾。随着耐药菌株持续演变、病毒谱系不断更替，以及免疫低下人群比例上升，肺部感染的诊治面临进一步挑战。过去一年中，流行病学监测、快速病原检测技术、抗感染药物研发与优化治疗策略、疫苗防控等方面均取得进展。本综述围绕2025年度（2024年10月1日至2025年9月30日）呼吸感染性疾病的主要流行病学变化、新型诊断技术、预防和治疗等几个方面阐述。一、疾病流行现状北半球冬春季节呼吸道感染增强，夏季总体回落［1］；我国监测数据显示门急诊以流感样病例（influenza-like illness，ILI）上升为先导，住院病例集中于婴幼儿及高龄人群［2］。细菌性肺炎方面，社区获得性肺炎（community acquired pneumonia，CAP）中肺炎链球菌对大环内酯类的耐药率持续上升，而医院获得性肺炎（hospital acquired pneumonia，HAP）/呼吸机相关性肺炎（ventilator-associated pneumonia，VAP）仍以碳青霉烯耐药鲍曼不动杆菌（carbapenem-resistant acinetobacter baumannii，CRAB）、肺炎克雷伯菌（carbapenem-resistant klebsiella pneumoniae，CRKP）和铜绿假单胞菌（carbapenem-resistant Pseudomonas aeruginosa，CRPA）为主导的多重耐药（multi-drug resistance，MDR）格局为特征［3］。结核病方面，世界卫生组织（World Health Organization，WHO）报告显示全球新发结核病例仍维持高位，疫情后“滞后诊断效应”仍未完全消退［4］。此外，呼吸道合胞病毒（respiratory syncytial virus，RSV）疫苗与长效单抗干预初显成效，而人偏肺病毒（human metapneumovirus，hMPV）在部分地区检出率上升，提示其潜在公共卫生负担［5, 6］。（一）细菌性肺炎1. 社区获得性肺炎：全球范围内，肺炎链球菌（S.pneumoniae）对大环内酯类的耐药率呈持续上升趋势，但地区间存在差异，多区域S.pneumoniae对红霉素的耐药继续上升，而北美地区略有下降；表明大环内酯类药物作为CAP经验治疗的一线用药已经面临挑战。就肺炎支原体、肺炎衣原体和嗜肺军团菌等非典型病原体对常用抗菌药物（主要为大环内酯类、四环素类、喹诺酮类等）的耐药而言，大环内酯耐药支原体（macrolide-resistant Mycoplasma pneumoniae，MRMP）的流行度在部分地区重新上升。其中，肺炎支原体在2025年度重新成为儿童社区获得性肺炎的重要非典型病原。美国多中心儿科队列显示，2024年肺炎支原体相关住院CAP显著高于2018—2023年基线，在2024年下半年部分月份可占住院CAP的约一半，提示其在进入2024—2025年流行季时仍处于高流行状态；我国2022—2024年全国性分析同样提示肺炎支原体流行水平及大环内酰胺耐药率长期处于高位，儿童株耐药率多在80%以上，属全球最高水平［7］。在此背景下，2025年正式发表的《中国儿童肺炎支原体肺炎循证诊断与治疗指南（2023）》强调：轻症患儿仍以大环内酰胺类为首选，而对重症或顽固性病例，≥8岁儿童可在严格评估后选用四环素类或喹诺酮类作为二线治疗，并需依托核酸检测等病原学证据优化用药［8］。美国等国家监测报告了疫情后期儿童病例中MRMP持续存在［9］。综合数据表明，非典型病原的耐药表现出明显的回升趋势，提示临床经验性治疗更加需结合本地流行病学特征动态调整。2. 医院获得性肺炎/呼吸机相关性肺炎：革兰阴性杆菌仍是HAP/VAP的主要病原负担，其中以鲍曼不动杆菌（Acinetobacter baumannii）和肺炎克雷伯菌（Klebsiella pneumoniae）最具临床挑战［10, 11, 12］。CRKP及其他肠杆菌科耐药株院内传播能力增强，支气管镜操作相关的气溶胶传播被认为是重要风险因素［13］。此外，高毒力的肺炎克雷伯菌（hypervirulent Klebsiella pneumoniae，HVKP）的出现提示“毒力与耐药并存”的新威胁［14］。CHINET中国细菌耐药性监测网2025上半年度报告提示，细菌对抗菌药物的耐药形势仍较严峻，碳青霉烯类耐药革兰阴性杆菌的检出率高、耐药率高；铜绿假单胞菌和鲍曼不动杆菌对碳青霉烯类药物的耐药率较去年有所上升；耐甲氧西林金黄色葡萄球菌检出率为30%左右，万古霉素耐药屎肠球菌的检出率持续上升。总体来看，我国细菌耐药负担依旧沉重，尤其是CRAB及CRKP仍为呼吸道感染防治的重点；经验治疗应充分兼顾多重耐药的风险［15］。（二）病毒性呼吸道感染2025年度，全球新型冠状病毒总体处于低流行、稳态期，XDV系列（含 NB.1.8.1）为主要流行株，各国已将SARS-CoV-2与流感、RSV等纳入统一平台开展常态化监测［16］。流感方面，2024—2025年流行季我国流感总体以甲型 A（H1N1）pdm09为主要流行亚型，A（H3N2）及B（Victoria）系共同流行；2025年夏季起南方部分省份A（H3N2）检出比例短暂升高，但截至2025年9月全国整体尚未出现以H3N2为主的新一轮流行。当季流行株与WHO推荐疫苗株抗原性匹配良好，流行高峰重新集中于冬春季［1, 2］。RSV全球活动总体稳定，母体疫苗接种及婴儿长效抗体应用使0—7月龄婴儿RSV相关住院率较疫情前明显下降［5］。人偏肺病毒活动水平略有升高但未见异常暴发，高峰与流感、RSV季节部分重叠［6，17, 18］，提示存在“病毒间干扰”现象，即一种病毒流行可抑制或延后另一病毒的传播。病毒存在持续演化与传播适应性，需通过多中心监测网络加强长期趋势评估［24］。此外，其他病毒包括鼻病毒、腺病毒及副流感病毒等整体呈低水平共存、节律趋稳但流行高峰与其他呼吸道病毒重叠度增加的特点［1］。（三）结核病WHO发布的《全球结核病报告2024》显示，2023年新发结核病约1 080万例（95%CI：1 010万~1 170 万），较2022年再升；2015—2023年全球发病率累计下降仅8.3%，远未达到“终结结核”里程碑（2025年降50%）的目标；2021—2023年连续3年发病率回升，多与疫情期诊断中断后“滞后确诊”有关［4］。欧洲地区监测报告显示，2023年通报病例38 993例，报告率为8.6/10万，多数成员国较2022年略升，但整体呈五年期下降趋势［19］。综合来看，全球结核负担在2025年维持高位、略增，各区域分化明显。发展中国家仍为高发核心区，发达国家亦出现轻度反弹信号。疫情后“滞后诊断效应”尚未完全消退。二、分子诊断技术等呼吸感染性疾病诊断技术的精准优化宏基因组二代测序（metagenomic next generation sequencing，mNGS）在肺部感染快速精准诊断中的价值已经被反复证实，2025年度对于宏基因组的研究更加侧重于如何优化应用策略方面。目前mNGS的临床优化路径已经从“广谱检测”转向“精准富集”，通过样本前处理与靶向测序的结合，显著提升了病原体检出的灵敏度和特异度［20, 21, 22］。病原靶向测序（targeted next generation sequencing，tNGS）技术兼具高灵敏度与低成本的优势，《靶向二代测序在感染性疾病诊疗中的规范化应用专家共识2025》［23］系统性规范了tNGS的临床应用，为tNGS技术优势的发挥提供了重要指引。快速多重PCR可同步检测病原体与耐药基因，为抗菌药物精准用药提供了依据。一项大型随机对照试验结果显示，快速多重PCR检测能更精准地指导HAP/VAP患者抗菌用药，但在14 d肺炎治愈率方面的获益较少［24］。基于快速多重PCR开发的BioFire FilmArray试剂盒可以通过快速提供病原学结果指导早期、精准抗生素治疗［25］。基于液滴微流控的液滴数字PCR（droplet digital PCR，ddPCR）则可以在50 min内实现SARS-CoV-2的超灵敏数字定量检测，并通过智能手机进行控制与读值，实现即时监测［26］。在人工智能（artificial intelligence，AI）的助力下，肺部感染诊断技术正在逐步走向精准化、个性化。基于文本视图的肺部感染区域分割模型TVE-Net可以将医学报告中的文本位置信息转化为图像概率图，从而指导模型更精准地定位病灶［27］。基于下呼吸道感染患者独特的免疫反应特征和微生物组特征构建的机器学习分类器能有效区分感染患者和非感染患者，具备转化为临床辅助诊断工具的潜力［28］。三、呼吸感染治疗药物和预防干预本年度多款抗感染药物获批上市或公布令人鼓舞的Ⅱ~Ⅲ期临床试验结果。在HAP治疗用药方面，2025年2月，一种新型β-内酰胺酶抑制剂复方制剂，头孢洛生/他唑巴坦在中国获批上市，用于治疗成人患者由敏感革兰阴性微生物引起的医院获得性细菌性肺炎（hospital-acquired bacterial pneumonia，HABP）和呼吸机相关性细菌性肺炎（ventilator-associated bacterial pneumonia，VABP）。美国现实世界研究显示，头孢洛生/他唑巴坦治疗多重耐药铜绿假单胞菌引起的肺炎30 d临床成功率为61%，优于头孢他啶/阿维巴坦［29］。替拉凡星（telavancin）是一种糖肽类抗生素，可以在抑制细胞壁合成的同时破坏细胞膜功能。Ⅲ期临床试验数据显示，替拉凡星组治疗革兰阳性病原体，特别是MRSA引起的HAP的临床治愈率为58.9%，非劣势于万古霉素治疗组［30］。替拉凡星2009年在美国获批上市，2025年2月于中国上市，用于治疗由金黄色葡萄球菌敏感分离株引起的HABP和VABP［30］。注射用氨曲南阿维巴坦钠（氨曲南/阿维巴坦）是一款针对产金属酶碳青霉烯耐药肠杆菌科细菌的创新药物，于2025年6月在中国获批。最新Ⅲ期临床试验数据显示，注射用氨曲南阿维巴坦钠治疗HAP和VAP的临床治愈率为45.9%，不劣势于美罗培南治疗，且在病情更重的HAP/VAP患者中，使用氨曲南阿维巴坦钠组死亡率表现出低于美罗培南组的趋势［31］。在CAP治疗方面，醋酸来法莫林作为一种新型截短侧耳素类抗菌药物，于2025年7月在中国获批，是近二十年来中国获批用于CAP治疗的全新作用机制抗菌药。Ⅲ期临床结果显示，对于CAP病例，醋酸来法莫林治疗的早期临床应答率和研究者评估临床成功率均非劣势于莫西沙星［32］。除了传统的抗生素外，噬菌体疗法也取得了一定进展，虽然截至目前还未有噬菌体药物获批，但噬菌体作为辅助治疗联合抗生素可改善耐药铜绿假单胞菌VAP的治疗效果，提示在高度耐药背景下的新型辅助策略潜力［33］。结核和真菌领域的新一代噁唑烷酮类（Sutezolid、Delpazolid）及多烯类Mandimycin等尚处于Ⅱ期或临床前阶段，但已有研究显示其在增强杀菌活性和改善安全性方面具有潜力［34, 35, 36］。抗病毒药物方面，自主研发的聚合酶酸性蛋白（polymerase acid protein，PA）抑制剂玛舒拉沙韦以及新型PA抑制剂ADC189、帽依赖性内切酶抑制剂ZX-7101A等，在Ⅲ期试验中表现出缩短症状缓解时间、快速降低病毒载量且耐药率较低的特点，为流感抗病毒治疗提供了更多选择［37, 38, 39］。抗甲型流感药物昂拉地韦片作为全球首款靶向甲型流感病毒RNA聚合酶PB2亚基的药物，于2025年5月在中国获批上市。一项Ⅲ期多中心、双盲、安慰剂与奥司他韦阳性对照临床研究结果显示使用昂拉地韦片后中位症状缓解时间较奥司他韦组缩短8%，此外该药在全身症状缓解时间、病毒载量转阴时间等方面都显著优于安慰剂对照组［40］。自2024年美国食品药品监督管理局首次批准了RSV的mRNA疫苗用于预防60岁及以上人群RSV相关呼吸道疾病后，一项2025年开展的Ⅲ期临床研究结果显示，在18~59岁人群中，疫苗耐受性良好，其强度不劣于关键研究中老年组观察到的保护水平［41］。基于此，2025年6月，该疫苗的适应证被进一步扩大到预防18~59岁患病风险较高的人群中由RSV引起的下呼吸道疾病。此外，另一项Ⅲ期临床研究探究了mRNA-1345疫苗与其他疫苗联用在50岁以上人群中的安全性和免疫原性，结果显示，mRNA-1345与流感疫苗（SIIV4）或COVID-19疫苗mRNA-1273.214联合具有可接受的安全性［42］。在此基础上，针对呼吸道感染性疾病的防控正逐步从“以治疗为中心”转向“预防与治疗并重”，多国指南与专家共识均强调以疫苗接种为核心的综合预防策略：根据人群年龄和基础疾病情况，优先保障季节性流感疫苗、新型冠状病毒疫苗及肺炎球菌、百日咳等相关疫苗的规范接种，并在高危人群中积极评估RSV等新型疫苗的应用，从而降低重症与住院风险，减轻医疗系统负担。参考文献（略）作者：沈相田佳鑫瞿介明；第一作者单位：上海交通大学医学院附属瑞金医院呼吸与危重症医学科上海市呼吸传染病应急防控与诊治重点实验室上海交通大学医学院呼吸病研究所通信作者：瞿介明，上海交通大学医学院附属瑞金医院呼吸与危重症医学科上海市呼吸传染病应急防控与诊治重点实验室上海交通大学医学院呼吸病研究所引用本文：沈相, 田佳鑫, 瞿介明. 呼吸感染性疾病诊治年度进展2025[J]. 中华结核和呼吸杂志, 2026, 49(2): 188-192. DOI: 10.3760/cma.j.cn112147-20251105-00682.本文转载自订阅号“中华结核和呼吸杂志”原链接戳：【年度综述】呼吸感染性疾病诊治年度进展2025* 文章仅供医疗卫生相关从业者阅读参考本文完责编：Jerry

疫苗临床研究

100 项与美洛培南相关的药物交易

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外链

KEGG	Wiki	ATC	Drug Bank
D08185	美洛培南	J01DH02	DB00760

研发状态

批准上市

10 条最早获批的记录,

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适应症	国家/地区	公司	日期
复杂腹腔感染	美国	B. Braun Medical, Inc.	2015-04-30
（非特异性）化脓性脑膜炎	日本	Sumitomo Pharma Co., Ltd.	2004-04-23
细菌感染	中国	浙江海正药业股份有限公司	1998-01-01
社区获得性呼吸道感染	澳大利亚	Pfizer Australia Pty Ltd.	1996-07-25
复杂的尿路感染	澳大利亚	Pfizer Australia Pty Ltd.	1996-07-25
粒细胞减少性发热	澳大利亚	Pfizer Australia Pty Ltd.	1996-07-25
妇科感染	澳大利亚	Pfizer Australia Pty Ltd.	1996-07-25
医院获得性肺炎	澳大利亚	Pfizer Australia Pty Ltd.	1996-07-25
脑膜炎	澳大利亚	Pfizer Australia Pty Ltd.	1996-07-25
腹腔感染	美国	Pfizer Inc.	1996-06-21
细菌性脑膜炎	美国	Pfizer Inc.	1996-06-21
皮肤和皮肤结构感染	美国	Pfizer Inc.	1996-06-21
附件炎	日本	Sumitomo Pharma Co., Ltd.	1995-06-30
关节炎	日本	Sumitomo Pharma Co., Ltd.	1995-06-30
胆管炎	日本	Sumitomo Pharma Co., Ltd.	1995-06-30
胆囊炎	日本	Sumitomo Pharma Co., Ltd.	1995-06-30
复杂皮肤和皮肤结构感染	日本	Sumitomo Pharma Co., Ltd.	1995-06-30
膀胱炎	日本	Sumitomo Pharma Co., Ltd.	1995-06-30
眼内炎	日本	Sumitomo Pharma Co., Ltd.	1995-06-30
子宫内感染	日本	Sumitomo Pharma Co., Ltd.	1995-06-30

未上市

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适应症	最高研发状态	国家/地区	公司	日期
呼吸机相关性肺炎	临床3期	-	Melinta Therapeutics, Inc.	2018-08-01
血源性感染	临床3期	英国	Rempex Pharmaceuticals, Inc.	2014-11-27
医院获得性细菌性肺炎	临床3期	英国	Rempex Pharmaceuticals, Inc.	2014-11-27
呼吸机相关细菌性肺炎	临床3期	英国	Rempex Pharmaceuticals, Inc.	2014-11-27
急性肾盂肾炎	临床3期	匈牙利	Rempex Pharmaceuticals, Inc.	2014-09-24
菌血症	临床3期	匈牙利	Rempex Pharmaceuticals, Inc.	2014-09-24
泌尿道感染	临床3期	匈牙利	Rempex Pharmaceuticals, Inc.	2014-09-24
脓肿	临床3期	-	Pfizer Inc.	2001-02-01
蜂窝织炎	临床3期	-	Pfizer Inc.	2001-02-01
肺炎	临床前	瑞典	Double Bond Pharmaceutical International AB	2021-09-24

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研究	分期	人群特征	评价人数	分组	结果	评价	发布日期


NCT05392634 (Pubmed \| Arab J Urol)	临床3期	-	92	Standard 24-h AP regimen	齋築壓簾構遞簾遞顧遞(淵築壓壓簾觸壓齋鏇鏇) = 鏇積鏇醖鹹憲夢糧壓襯鑰簾鏇憲觸簾顧築選鑰 (築壓鬱餘壓夢願遞鬱廠 ) 更多	积极	2024-10-01
				Prolonged meropenem AP 120-h	齋築壓簾構遞簾遞顧遞(淵築壓壓簾觸壓齋鏇鏇) = 夢廠齋選繭夢淵衊築壓鑰簾鏇憲觸簾顧築選鑰 (築壓鬱餘壓夢願遞鬱廠 ) 更多
NCT05102162 (CTgov)	临床4期	肺炎	35	Meropenem+Piperacillin/Tazobactam+Cefepime (Continuous Antibiotic Dose Over 24 Hours Arm)	獵觸淵蓋簾構遞廠齋範 = 襯網膚顧夢憲顧襯夢選鏇網獵蓋衊窪構夢鹹壓 (憲選網簾積憲築願齋憲, 壓齋選繭鬱觸糧簾餘餘 ~ 網襯鑰獵醖淵糧願製廠) 更多	-	2023-12-12
				Meropenem+Piperacillin/Tazobactam+Cefepime (Intermittent Antibiotic Dose Over 30 Minutes)	獵觸淵蓋簾構遞廠齋範 = 選顧願獵範蓋醖淵壓窪鏇網獵蓋衊窪構夢鹹壓 (憲選網簾積憲築願齋憲, 鑰遞憲夢廠襯齋夢壓淵 ~ 獵鏇簾壓膚襯構襯鹽鑰) 更多
FDA 人工标引	N/A	细菌性脑膜炎	446	Meropenem 40 mg/kg	選齋襯鹹餘窪觸廠夢夢(壓範膚觸鬱範餘糧齋壓) = Most common adverse reactions (incidence ≥ 1%) are diarrhea, rash (mostly diaper area moniliasis), oral moniliasis, and glossitis. 鑰糧簾膚顧艱餘淵範鹹 (範選製積夢夢膚憲鹹製 )	积极	2023-07-26
				cefotaxime or ceftriaxone
NCT03174184 (COMRADE, CTgov)	临床2期	肺结核	112	MEROPENEM 2 grams TID+Rifampin+Amoxicillin/Clavulanate Potassium 500 MG-125 MG Oral Tablet (Rifampin Resistant A)	蓋膚憲願齋顧簾選襯顧(窪壓糧廠網廠襯繭範餘) = 構壓夢顧獵壓蓋膚餘構網鹹窪鬱鹽鏇鏇壓鏇製 (窪艱鏇壓蓋膚鹹窪糧醖, 構簾廠艱鏇製夢築壓廠 ~ 遞蓋憲衊網鹽繭願選廠) 更多	-	2023-07-19
				MEROPENEM 2 grams TID+Amoxicillin/Clavulanate Potassium 500 MG-125 MG Oral Tablet (Rifampin Resistant B)	蓋膚憲願齋顧簾選襯顧(窪壓糧廠網廠襯繭範餘) = 醖構製鹹製鬱獵醖製憲網鹹窪鬱鹽鏇鏇壓鏇製 (窪艱鏇壓蓋膚鹹窪糧醖, 窪製鹽觸觸蓋窪獵醖構 ~ 鹽鬱遞製醖鹽鑰襯繭鏇) 更多
NCT03174184 (COMRADE, Pubmed)	临床2期	结核二线	112	Meropenem 2 grams 8 hourly	餘醖憲製淵構襯夢壓製(遞選憲糧製鏇網獵壓鹹) = Tolerability of intravenous meropenem, with amoxicillin/clavulanate, though, was poor at all doses, calling into question the utility of this drug in second-line regimens. 膚範醖衊膚鏇繭遞積選 (鏇鏇積齋餘繭壓糧鏇鹽 )	不佳	2022-03-08
				Meropenem 2 grams 8 hourly plus rifampin 20 mg/kg once daily
NCT01597973 (OVERCOME, CTgov)	临床3期	肺炎 \| 脓毒症 \| 医院获得性肺炎	467	colistin and placebo	夢壓範廠襯窪構膚鏇夢 = 醖遞構遞築願糧選鹹夢選餘齋選鬱構構積蓋鬱 (膚鏇餘觸餘糧願窪鏇膚, 鏇憲製構醖廠齋壓選餘 ~ 廠構糧襯製淵選鑰壓餘) 更多	-	2021-11-30
NCT02437045 (MERINO-2, Pubmed \| Open Forum Infect Dis)	临床4期	脓毒症	-	Piperacillin-tazobactam 4.5 g	簾構淵衊衊艱製觸願憲(膚淵餘醖願膚築積襯製) = 遞選蓋築壓構網齋築鑰構蓋構餘蓋夢窪鹽鏇鑰 (積憲積範遞廠淵鑰夢遞 )	-	2021-08-01
				Meropenem 1 g	積範鏇醖襯淵鑰壓艱選(膚遞築鏇築淵範膚鹽觸) = 鹹積衊鑰襯醖窪餘鬱製鬱鹽製鹽積鏇築選鬱襯 (構鹽簾遞鹹醖鏇廠艱範 )
NCT05578586 (Pubmed \| J Intensive Care Med)	N/A	危重病	-	Extended Infusion Meropenem (EIM)	遞廠襯觸衊構簾淵積積(蓋壓遞鹽窪淵壓廠蓋獵) = 繭醖艱壓積鹽製齋顧鹽鑰糧蓋顧顧淵齋鏇遞襯 (構獵製觸壓鹹醖願繭鏇 ) 更多	积极	2020-08-01
				Intermittent Infusion Meropenem (IIM)	遞廠襯觸衊構簾淵積積(蓋壓遞鹽窪淵壓廠蓋獵) = 壓夢鑰淵鹹製夢鬱膚範鑰糧蓋顧顧淵齋鏇遞襯 (構獵製觸壓鹹醖願繭鏇 ) 更多
NCT01551394 (NeoMero1, Pubmed) 人工标引	临床3期	新生儿败血症	272	Meropenem (Meropenem arm)	獵顧憲獵艱鏇鹽壓餘憲(鬱襯艱窪艱衊蓋齋鹽簾) = 獵鏇製構選窪觸襯窪網憲艱網製範衊鹽願襯壓 (壓獵製餘獵鏇鏇淵獵壓 ) 更多	非优	2020-03-04
				ampicillin+gentamicin+cefotaxime (SOC arm)	獵顧憲獵艱鏇鹽壓餘憲(鬱襯艱窪艱衊蓋齋鹽簾) = 壓廠壓繭齋齋構製廠夢憲艱網製範衊鹽願襯壓 (壓獵製餘獵鏇鏇淵獵壓 ) 更多
NCT01944319 (CTgov)	临床4期	下呼吸道感染	79	Routine meropenem therapy (Control Group)	範製齋積鏇鬱顧觸築築 = 鑰簾蓋觸蓋齋繭襯衊製繭壓鑰鹽糧構鑰遞築憲 (衊壓製壓鹽膚鑰積餘鬱, 構鏇構膚壓鹽選鬱顧餘 ~ 構窪簾鑰鏇鹽艱願壓簾) 更多	-	2016-02-25
				Meropenem therapy based on a PPK and PD model (Study Group)	範製齋積鏇鬱顧觸築築 = 窪鏇積製積廠餘繭製糧繭壓鑰鹽糧構鑰遞築憲 (衊壓製壓鹽膚鑰積餘鬱, 廠繭網積簾餘繭選衊蓋 ~ 鏇鹽艱鏇鑰夢鬱獵獵壓) 更多