20 September 2026, Volume 26 Issue 5

  

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Original Article
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  Clinical features, risk factors, and prognosis of Klebsiella pneumoniae liver abscess

  ZHU Lijuan, MA Xiaoyan, DENG Xiaoling, MA Xigang

  2026, 26(5): 439-443. https://doi.org/10.16718/j.1009-7708.2026.05.001

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  Objective To investigate the clinical features, risk factors, and prognosis of Klebsiella pneumoniae liver abscess (KP-LA). Methods A retrospective analysis was conducted on the clinical data of 798 patients with liver abscess admitted to the General Hospital of Ningxia Medical University from January 2018 to December 2021. Based on etiological results, the patients were divided into KP-LA group (318 cases) or non-K. pneumoniae liver abscess (NKP-LA) group (480 cases). The general data, underlying diseases, clinical manifestations, etiological characteristics, and prognostic indicators were compared between the two groups. Multivariate logistic regression analysis was used to identify the independent risk factors for K. pneumoniae infection. Results K.pneumoniae was the most predominant pathogen of liver abscess, with an average detection rate of 40.3%. Compared with NKP-LA group, KP-LA group had a higher prevalence of diabetes mellitus but lower prevalence of cholecystitis, cholangitis, history of hepatobiliary surgery, history of liver abscess, and malignancy (all P < 0.05). KP-LA group showed a significantly higher positive rate of pus culture but a lower positive rate of blood culture than the NKP-LA group (P < 0.001). Multivariate analysis revealed that diabetes mellitus was an independent risk factor for KP-LA (OR = 2.391, 95% CI: 1.631-3.503, P < 0.001). Furthermore, cholecystitis, the history of liver abscess, malignancy, and positive blood cultures are more frequently observed in NKP-LA patients. There was no statistically significant difference in disease severity scores between the two groups upon admission. However, the 28-day mortality rate was significantly higher in KP-LA group compared to NKP-LA group (P < 0.05). Conclusions K. pneumoniae is the predominant pathogen of liver abscess, and diabetes mellitus is an important risk factor for incidence of KP-LA. KP-LA patients have higher short-term mortality. Therefore, clinicians should strengthen early identification and intervention for high-risk patients.
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  Analysis of 8 cases of human infection with Streptococcus suis in a Grade A tertiary hospital in Guangdong Province

  ZHU Ruirui, XIE Baocheng, XU Yongxiang

  2026, 26(5): 444-449. https://doi.org/10.16718/j.1009-7708.2026.05.002

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  Objective To retrospectively analyze the clinical characteristics and treatment process of Streptococcus suis infection cases in Dongguan People’s Hospital for better treatment of such patients. Methods The data and treatment process of S. suis infection cases in Dongguan People’s Hospital from January 2021 to October 2025 were retrospectively collected and analyzed. Results A total of 8 cases of S. suis infection were included. All patients were male. The primary symptoms included fever, chills, dizziness, headache, vomiting, and altered mental status. The patients included 1 case of mixed infection, and 7 cases of meningitis. All of the 8 patients received intravenous antibiotics combined with dexamethasone. One patient received additional intrathecal injections of vancomycin and dexamethasone. All of the 8 patients were discharged from the hospital after improvement. 7 patients receiving conventional treatment regimens had complications such as moderate to severe bilateral deafness, while those treated with early intrathecal injection did not have complications such as deafness. Conclusions The combination of corticosteroids and sensitive antibiotics is effective in treating S. suis infection. Early intrathecal administration of vancomycin and dexamethasone may provide a protective effect against hearing loss.
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  Establishment of a UPLC-MS/MS method for therapeutic drug monitoring of ceftazidime-avibactam and its application in clinical sample analysis

  GU Yang, YUAN Ye, XU Xin, YANG Haotian, BAI Wanjun

  2026, 26(5): 450-459. https://doi.org/10.16718/j.1009-7708.2026.05.003

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  Objective To develop a sensitive and reliable isotope-labeled internal standard ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method for simultaneous quantification of ceftazidime (CAZ) and avibactam (AVI) in human plasma, and to evaluate the impact of renal function on drug exposure, providing a methodological tool for individualized therapeutic drug monitoring (TDM) in special situations such as renal impairment or suboptimal clinical response. Methods Plasma samples were processed by acetonitrile precipitation and separated on an ACQUITY UPLC BEH C18 column with a water-methanol gradient. Quantification was performed in multiple reaction monitoring mode. The method was systematically validated according to the guidelines outlined in Chinese Pharmacopoeia (General Chapter 9012: Guidance for Validation of Quantitative Analytical Methodsfor Biological Samples), covering selectivity, linearity, accuracy, precision, dilution reliability, extraction recovery, matrix effect, stability, and carryover. The established method was subsequently applied to preliminary clinical sample analysis. Results CAZ and AVI showed good linearity in the ranges of 1.0-200.0 mg/L and 1.0-50.0 mg/L, respectively (r > 0.998), with a lower limit of quantification (LLOQ) of 1.0 mg/L for both CAZ and AVI. The within-run and between-run precision (relative standard deviation, RSD) were both <11.0%, and the accuracy ranged from 84.6% to 113.6%. The matrix effect and recovery met the bioanalytical acceptance criteria. Clinically measured trough concentrations of CAZ ranged from 3.5 to 392.0 mg/L, and the trough concentrations of AVI ranged from <LLOQ to 83.9 mg/L (the concentrations were below the LLOQ in five samples), showing significant interindividual variability. Drug exposure was markedly elevated in some patients with renal impairment. Conclusions This method demonstrates high sensitivity and specificity, and rapid analysis speed, making it suitable for TDM studies of CAZ-AVI. The results from clinical sample analysis suggest that renal function has a significant impact on the exposure to CAZ and AVI, providing a reference for individualized dosing adjustment in special situations such as renal impairment or suboptimal clinical response.
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  Antimicrobial resistance of Corynebacterium striatum isolated from sterile body fluids and clinical characteristics of patients infected with Corynebacterium striatum

  YAN Xiaoli, LIN Yuling, QIU Huina, ZHANG Jianming, CHEN Qingqing

  2026, 26(5): 460-466. https://doi.org/10.16718/j.1009-7708.2026.05.004

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  Objective To investigate the antimicrobial resistance profiles of Corynebacterium striatum isolated from sterile body fluids and the clinical characteristics of patients infected with C. striatum. Methods A total of 35 nonduplicate strains of C. striatum isolated from sterile body fluids between December 2022 and November 2025 at Quanzhou First Hospital Affiliated to Fujian Medical University were retrospectively collected. Broth microdilution method was used to determine the susceptibility of the strains to commonly used antibiotics. Clinical data and laboratory test results of the patients were collected for statistical analysis. Results The 35 strains of C. striatum showed multidrug resistance, with resistance rates to antimicrobial agents ranging from 77% to 100%, except for all susceptible to vancomycin, daptomycin, and linezolid. The isolates were primarily isolated from blood (23 strains) and pleural effusion (6 strains). The 34 patients had a mean age of (64.1 ± 13.2) years. Most of the patients were males (73.5%) and admitted to intensive care unit (82.4%). All patients had undergone invasive procedures before infection and had underlying diseases. The key finding was that 52.9% (18/34) of patients had prior isolates of C. striatum from sputum or wound secretions before developing sterile site infection, with a median interval of 5 days. These patients universally received prolonged courses [mean (15.9 ± 10.0) d] of β-lactamase inhibitor combination therapy. Moreover, 38.2% of patients had co-infections. Laboratory test results showed that patients generally had elevated white blood cell count, neutrophil count, C-reactive protein, and procalcitonin levels, along with reduced hemoglobin levels. The overall poor outcome was documented in 70.6% of patients. Conclusions C. striatum strains isolated from sterile body fluids were multidrug-resistant. Infections are predominantly in critically ill patients with complex underlying diseases and polymicrobial co-infections, and are associated with a poor prognosis. Therefore, for elderly ICU patients with underlying conditions, invasive procedures, or prolonged broad-spectrum antibiotic exposure, isolation of C. striatum from non-sterile sites should warrant high vigilance for the risk of subsequent invasive infection.
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  Acute fibrinous and organizing pneumonia associated with pulmonary tuberculosis: a report of three cases and literature review

  WU Xuexue, LI Xiaoyuan, JIANG Lili

  2026, 26(5): 467-473. https://doi.org/10.16718/j.1009-7708.2026.05.005

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  Objective To investigate the clinicopathological features and therapeutic strategies of pulmonary tuberculosis-associated acute fibrinous and organizing pneumonia (AFOP), for better understanding of this rare condition. Methods We retrospectively analyzed three patients with tuberculosis who showed granulomatous inflammation accompanied by AFOP changes at West China Hospital of Sichuan University. Relevant literature reports were identified from PubMed, Web of Science, Wanfang Data, VIP and CNKI using the search terms “acute fibrinous and organizing pneumonia” or “AFOP” and “pulmonary tuberculosis”. The clinicopathological features, treatments, and outcomes of the 3 patients and the reported cases were summarized. Results All of the three patients presented with respiratory symptoms such as chest tightness or shortness of breath, while typical tuberculous toxic symptoms were inconspicuous. Imaging revealed mediastinal lymphadenopathy and pleural effusion in two cases. Laboratory tests demonstrated significantly elevated inflammatory markers but normal or only mildly elevated white blood cell counts. Diagnosis relied on an integrated clinical-imaging-pathological assessment. The coexistence of granulomatous inflammation and AFOP served as the crucial pathological clue. All patients received standard anti-tuberculosis therapy. Two patients showed rapid improvement, while one exhibited initial radiological progression that resolved upon the short-term addition of low-dose glucocorticoids in addition to effective anti-tuberculosis coverage. Among the four patients from the literature reports, two were diagnosed by autopsy and two by a second biopsy. Ultimately, two patients died and two survived. The surviving patients all initially received glucocorticoid therapy but experienced disease relapse. After a second biopsy confirmed the diagnosis of tuberculosis, anti-tuberculosis therapy was initiated, leading to significant clinical improvement. Conclusions The clinical presentation of pulmonary tuberculosis-associated AFOP is often atypical. Imaging findings, laboratory tests, and characteristic pathological manifestations provide important diagnostic clues. Management should be based on anti-tuberculosis therapy as the cornerstone. However, if paradoxical progression occurs despite adequate anti-tuberculosis treatment, the presence of AFOP may provide a pathological rationale for the short-term and cautious addition of low-dose glucocorticoids, although its definitive efficacy requires further validation in prospective clinical trails.
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  Characterization of human bocavirus 1 infection in children: a targeted next-generation sequencing based study

  YANG Mei, XIE Pengfei, GAO Fangfang, WANG Tiantian, ZHAO Renbing

  2026, 26(5): 474-480. https://doi.org/10.16718/j.1009-7708.2026.05.006

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  Objective This retrospective study aimed to characterize the demographic features, season prevalence, clinical manifestations, co-infection profiles, complications and their relationship between the viral load of HBoV1 infection among pediatric inpatients at Zibo Maternal and Child Health Hospital, to elucidate the clinical significance of HBoV1. Methods Enrolled all hospitalized children (aged 0-14 years old) who tested positive for HBoV1 by targeted next-generation sequencing (tNGS) of nasopharyngeal swabs or sputum specimens from November 2023 to November 2025 were enrolled. Results Among 3 815 pediatric patients, acute HBoV1 infection was confirmed in 91 cases, with a median age of 26 months. Among these cases, there were 24(26.4%) cases of single infection and 67(73.6%) cases of mixed infection, rhinovirus was the most frequently detected pathogen among the mixed infection cases. The majority of infections occurred during the autumn season (September-November, 56.0% of cases). 17 cases required transfer to the ICU, and patients in the severe infection group were younger with more pronounced wheezing symptoms. Conclusion The results of this study demonstrate HBoV1 infection can lead to respiratory symptoms ranging from mild to severe in infants and young children.
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  Effects of LncRNA KCNQ1OT1 on acute lung injury in septic mice by targeting the miR-34a/SIRT1 axis

  ZENG Haiwen, XU Jisong, SU Wanting, CHEN Yazheng

  2026, 26(5): 481-489. https://doi.org/10.16718/j.1009-7708.2026.05.007

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  Objective To examine the impact of LncRNA KCNQ1OT1 on acute lung injury (ALI) in septic mice by targeting the miR-34a/SIRT1 axis. Methods The HSAEC cells were assigned to the control group or LPS group (treated with 10 mg/L LPS for 24 hours). RT-qPCR was used to detect the levels of LncRNA KCNQ1OT1, miR-34a and SIRT1 mRNA in the cells. The dual luciferase reporter assay and RNA pull-down assay were used to detect the targeting relationship between LncRNA KCNQ1OT1/SIRT1 and miR-34a. The experimental mice were randomly assigned to the control group, model group, NC group, KCNQ1OT1 group, KCNQ1OT1 + NC group, and KCNQ1OT1 + miR-34a group. Except for the control group, all the mice in other groups were induced to develop sepsis-induced ALI models by intraperitoneal injection of 10 mg/kg LPS. RT-qPCR was used to detect the levels of LncRNA KCNQ1OT1, miR-34a, SIRT1 mRNA, TNF-α mRNA, IL-6 mRNA, IL-1β mRNA, caspase-3 mRNA and Bax mRNA in lung tissue. ELISA was used to measure the levels of inflammatory factors in lung tissue. The lung wet/dry weight ratio (W/D ratio) was measured in each group of mice. HE staining was used to observe the pathological changes of the lung tissue. TUNEL staining was used to observe the apoptosis of lung tissue cells. Western blot was used to detect the level of apoptosis-related proteins. Results Cell experiments revealed that compared with the control group, the levels of LncRNA KCNQ1OT1 and SIRT1 mRNA decreased, while the level of miR-34a increased significantly in LPS group (P < 0.05). The dual luciferase reporter assay and RNA pull-down experiment revealed that there were targeting relationships between LncRNA KCNQ1OT1/SIRT1 and miR-34a. Animal experiments revealed that compared with the control group, the alveoli of mice collapsed, the number of alveoli decreased, and the alveoli and pulmonary interstitium were congested and edematous in the model group. The alveoli were infiltrated by a large number of inflammatory cells, associated with punctate or patchy hemorrhagic foci. The levels of LncRNA KCNQ1OT1 and SIRT1 mRNA decreased, while the level of miR-34a, mRNA levels of TNF-α, IL-6, and IL-1β, protein level of TNF-α, IL-6, and IL-1β, mRNA and protein levels of caspase-3 and Bax, W/D ratio, apoptosis rate and protein level of C-caspase-3 increased significantly (P < 0.05). Compared with the NC group, the pathological damage of lung tissue in the KCNQ1OT1 group improved significantly. The levels of LncRNA KCNQ1OT1 and SIRT1 mRNA increased, while the level of miR-34a, mRNA levels of TNF-α, IL-6, and IL-1β, protein level of TNF-α, IL-6, and IL-1β, mRNA and protein levels of caspase-3 and Bax, W/D ratio, apoptosis rate and protein level of C-caspase-3 decreased significantly (P < 0.05). Compared with the KCNQ1OT1 + NC group, the pathological damage of lung tissue was more severe in the KCNQ1OT1 + miR-34a group. The SIRT1 mRNA level was lower, and the level of miR-34a, mRNA and protein levels of TNF-α, IL-6, and IL-1β, mRNA and protein levels of caspase-3 and Bax, W/D ratio, apoptosis rate and protein level of C-caspase-3 all increased significantly (P < 0.05). Conclusions LncRNA KCNQ10T1 can improve ALI in septic mice, probably by targeted inhibition of the miR-34a/SIRT1 axis.
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  Distribution and antimicrobial resistance profiles of clinical isolates in a Grade A tertiary hospital in Henan Province, 2024

  CHANG Qingli, CUI Feifei, LIU Jingshuo, YANG Shangyue, ZENG Tao, ZHONG Hua

  2026, 26(5): 490-497. https://doi.org/10.16718/j.1009-7708.2026.05.008

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  Objective To monitor the susceptibility of bacteria isolated from clinical specimens in the First Affiliated Hospital of Henan Medical University to antimicrobial agents in 2024. Methods Antimicrobial susceptibility tests were conducted using an automated susceptibility analyzer or the disk diffusion method in accordance with the technical protocol of the China Antimicrobial Resistance Surveillance System (2024). Results were interpreted based on the breakpoints released by the Clinical and Laboratory Standards Institute (CLSI) in 2024. Results A total of 7 517 bacterial isolates were identified. Gram-positive and Gram-negative bacteria accounted for 29.1% and 70.9%, respectively. The proprotion of methicillin-resistant strains among Staphylococcus aureus and coagulase-negative Staphylococcus was 37.8% and 69.7%, respectively. Methicillin-resistant strains showed significantly higher resistance rates to most antibiotics than methicillin-sensitive strains. However, MRSA showed significantly lower resistance rate to trimethoprim-sulfamethoxazole (6.7%) than other staphylococci. Enterococcus faecium was the predominant species among Enterococcus genus (60.9%). E. faecium strains demonstrated higher resistance rates to all the antibiotics tested except linezolid and minocycline than Enterococcus faecalis. A few vancomycin-, teicoplanin-, or linezolid-resistant strains were detected among E. faecium. E. faecalis showed higher resistance rate to linezolid than E. faecium. No penicillin-resistant strains were identified among Streptococcus pneumoniae and β-hemolytic Streptococcus, while 1.4% of the Streptococcus viridans strains were resistant to penicillin. The prevalence of carbapenem-resistant Klebsiella ranged from 25.5% to 26.3%, and the prevalence of imipenem-resistant Morganella was 20.7%. The prevalence of carbapenem-resustant strains among other genera of Enterobacterales was all below 14.8%. The prevalence of imipenem-resistant and meropenem-resistant strains was 18.7% and 16.4% among Pseudomonas aeruginosa, but up to 75.3% and 75.6% among Acinetobacter species. Conclusions The antimicrobial resistance of clinical isolates still poses a serious challenge for clinicians. The detection rate of P. aeruginosa showed an increasing trend, and the prevalence of other important multidrug-resistant bacteria remains high. These findings suggest that ongoing antimicrobial ressitance surveillance should be carried out. The rational use of antimicrobial should be strengthened. Multiple strategies should be combined to address the emergence of antimicrobial resistance.
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  Changing distribution and antimicrobial resistance profiles of bacterial isolates in bronchoalveolar lavage fluid in Shandong Province during the SARS-CoV-2 pandemic

  KOU Linna, WANG Shifu

  2026, 26(5): 498-506. https://doi.org/10.16718/j.1009-7708.2026.05.009

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  Objective To explore the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on the composition and antimicrobial resistance rates of the bacterial strains isolated from bronchoalveolar lavage fluid (BALF) specimens in Shandong region for the early empirical and precise treatment of pneumonia in clinical practice. Methods The WHONET 5.6 software was used to retrospectively analyze the composition of the bacterial isolates from BALF specimens and antimicrobial susceptibility testing results. The data were collected from the member hospitals of the Shandong Pediatric Antimicrobial Resistance Surveillance System Network from 2017 to 2024. The bacterial strains were isolated from both children and adult populations. Results From 2017 to 2024, a total of 31 882 strains of bacteria were isolated from BALF samples. Among them, Gram-negative bacteria accounted for the highest proportion, reaching 76.6% (24 409/31 882). Gram-positive bacteria accounted for 17.2% (5 478/31 882), while fungi accounted for 6.2% (1 995/31 882). Among the bacterial strains isolated from BALF of children, Gram-negative bacteria and Gram-positive bacteria accounted for 51.1% and 45.1%, respectively. The top three bacteria were Streptococcus pneumoniae (23.1%), Staphylococcus aureus (20.4%), and Haemophilus influenzae (15.3%). The bacterial strains isolated from alveolar lavage fluid of adults were mainly Gram-negative bacteria (81.7%). The top three bacteria were Pseudomonas aeruginosa (20.3%), Klebsiella pneumoniae (18.5%), and Acinetobacter baumannii (15.4%). During the three periods of the SARS-CoV-2 pandemic, the bacteria mentioned above were the predominant ones for all groups of people. Among the bacterial isolates from children, the prevalence of penicillin-insensitive S. pneumoniae (PNSP = PRSP + PISP) was 3.4%. The prevalence of methicillin-resistant S. aureus (MRSA) was 26.3%. Vancomycin- or linezolid-resistant strains were rarely identified in S. pneumoniae and S. aureus. The prevalence of β-lactamase was 83.1% in H. influenzae. Few H. influenzae strains were found nonsusceptible to meropenem or cefotaxime. H. influenzae strains showed increasing resistance rates to ampicillin, amoxicillin-clavulanic acid, cefuroxime, and trimethoprim-sulfamethoxazole. The isolates from adults showed that the top three bacteria had relatively high resistance rates to most commonly used antibacterial drugs. The prevalence of carbapenem-resistant strains were 21.0% in P. aeruginosa, 12.0% in K. pneumoniae, and 85.5% in A. baumannii. The prevalence of carbapenem-resistant P. aeruginosa, K. pneumoniae, and A. baumannii showed an increasing trend, especially carbapenem-resistant K. pneumoniae, during the pandemic. Conclusions The SARS-CoV-2 pandemic had a significant impact on the composition and resistance rates of the bacterial strains isolated from BALF in Shandong region. We need to continuously and dynamically monitor the epidemic trends and antimicrobial resistance of the bacteria for improving rational antibiotic use and antimicrobial treatment.
Case Report
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  Mixed infection caused by Bacteroides pyogenes and Escherichia coli in the lower limb following an animal bite: a case report

  WU Jing, CUI Hairong, LI Jixia, LIU Xiaofei, XUE Lian

  2026, 26(5): 507-510. https://doi.org/10.16718/j.1009-7708.2026.05.010

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  Severe empyema caused by Porphyromonas endodontalis in a patient with chronic obstructive pulmonary disease

  WANG Lu, HU Fuying, SONG Jiangqin

  2026, 26(5): 511-514. https://doi.org/10.16718/j.1009-7708.2026.05.011

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  Spinal Mycobacterium intracellulare infection following allogeneic hematopoietic stem cell transplantation: a case report

  SHI Hongyue, ZHAO Xinyu, LÜ Xin

  2026, 26(5): 515-518. https://doi.org/10.16718/j.1009-7708.2026.05.012

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  Acute suppurative cholecystitis and liver abscess induced by dapagliflozin: a case report

  JIANG Hui, CAO Zhenxue, DING Yanmin, YAO Yasai, LÜ Shengrong

  2026, 26(5): 519-522. https://doi.org/10.16718/j.1009-7708.2026.05.013

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  AIDS complicated with Listeria monocytogenes meningoencephalitis: a case report

  QIAN Juan, LI Mingjun, HUANG Rui, CAO Qi, ZHANG Jing, HE Kun, LIU Qinghua

  2026, 26(5): 523-526. https://doi.org/10.16718/j.1009-7708.2026.05.014

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  Clinical analysis of 5 cases of Clostridioides difficile infection secondary to anti-tuberculosis treatment

  LIU Yang, YAN Chenyu

  2026, 26(5): 527-530. https://doi.org/10.16718/j.1009-7708.2026.05.015

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Review
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  Research progress on the current status and applicability of model-informed precision dosing software for antimicrobial agents

  FAN Yaxin, YANG Wanqiu, YAN Ming, CHEN Mengting, ZHANG Jing

  2026, 26(5): 531-538. https://doi.org/10.16718/j.1009-7708.2026.05.016

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  Latest advances in clinical cure of HBeAg-positive patients with low-level HBsAg

  LI Panpan, ZHAO Zhen

  2026, 26(5): 539-545. https://doi.org/10.16718/j.1009-7708.2026.05.017

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  Infections and treatment of drug-resistant Acinetobacter baumannii

  WANG Yue, YANG Fan

  2026, 26(5): 546-550. https://doi.org/10.16718/j.1009-7708.2026.05.018

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