The study was approved by the Institutional Review Board. Conflicts of interest: The authors declare that there are no confl icts of interest regarding the publication of this paper. Contributors: MF proposed the study, analyzed the data and wrote the first drafts. All authors contributed to the design and interpretation of the study and to further drafts.

Background In moderate or severe acute cholecystitis, effective antibiotic therapy is important. We aimed to analyze microorganisms isolated from the bile of patients treated with percutaneous transhepatic gallbladder drainage and their antibiotic susceptibility patterns to assess empirical antibiotic therapy in patients with acute cholecystitis. Methods A retrospective descriptive study of clinical data from patients with acute cholecystitis treated with PTGBD at Zhejiang Provincial People's Hospital from January 2020 to December 2022. Results Totally, 127 patients' clinical data were collected. 82 patients yielded positive for bile culture and 16 patients yielded positive for blood bacterial culture for at least 1 organism. A total of 124 microorganisms were isolated 19 bacterial and 1 fungal species. Escherichia coli (31.7%), Klebsiella pneumoniae (24.4%), Enterococcus faecium (8.9%), and Enterococcus faecalis(5.6%) were the most frequently isolated pathogenic organisms. Drug sensitivity studies have shown that Gram-negative bacteria are less susceptible to quinolones and cephalosporins, while Gram-positive bacteria are more resistant to erythromycin, and Streptomycin. Long-term nursing home stays are a risk factor for the generation of drug-resistant bacteria. Conclusions Escherichia coli, Klebsiella pneumoniae, and enterococcus are common causative agents of acute cholecystitis and they are highly resistant to clinically used antibiotics such as quinolones, cephalosporins, erythromycin, and Streptomycin. Empirical antibiotic use should cover both gram-negative and gram-positive bacteria, with triple-cephalosporins in combination with beta-lactamase inhibitors, carbapenem antibiotics such as imipenem and ertapenem preferred, and may be downgraded when the source of infection is controlled. Nursing facility patients should be aware of multi-drug-resistant bacteria.

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

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