20 July 2026, Volume 26 Issue 4
    

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    Original Article
  • XIE Chunyan, ZHANG Chuancang, WANG Zhaoping, ZHAN Shudi
    Chinese Journal of Infection and Chemotherapy. 2026, 26(4): 327-332. https://doi.org/10.16718/j.1009-7708.2026.04.001
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    Objective To explore the efficacy of N-acetylcysteine (NAC) nebulizer therapy for severe Mycoplasma pneumoniae pneumonia (SMPP) in children. Methods A total of 130 children with SMPP admitted to Navy 971 Hospital were enrolled as study subjects and assigned to NAC-free conventional therapy (65 cases) or NAC add-on therapy (65 cases) group based on a random number table. The patients in the conventional group received conventional antimicrobial treatment plus low-dose methylprednisolone (MTH), while the patients in the NAC add-on therapy group received NAC in addition to the same conventional therapy. The patients in the two groups were compared in terms of efficacy, time to symptom improvement, lung function tests such as forced vital capacity (FVC), maximum mid-expiratory flow (MMEF), forced expiratory volume in one second (FEV1), airway inflammation biomarkers including interleukin (IL)-8, C-reactive protein (CRP), tumor necrosis factor (TNF)-α, immune function tests, and adverse events. Results The overall efficacy rate of NAC add-on therapy was 93.85% , significantly higher than that of the conventional therapy (81.54%) (P< 0.05). NAC add-on therapy was associated with significantly shorter time to the disappearance of cough, lung rales, opacities, and defervescence compared with the conventional therapy (P < 0.05). NAC add-on therapy also resulted in significantly higher levels of FVC, MMEF, FEV1, CD3+, CD4+, and CD4+/CD8+ than the conventional therapy(P < 0.05). However, NAC add-on therapy was associated with significantly lower levels of IL-8, TNF-α, and CRP than the conventional therapy (P < 0.05). The overall incidence of adverse events was 13.85% in NAC add-on therapy group and 12.31% in the conventional therapy group (P > 0.05). Conclusions NAC nebulizer add-on to conventional antimicrobial agents and low-dose MTH has shown good clinical efficacy in treating SMPP in children. NAC add-on therapy can effectively and safely improve the outcomes of patients by shortening the time to the improvement of relevant clinical symptoms, inhibiting the secretion of airway inflammatory biomarkers, alleviating lung damage, improving immune dysfunction, and enhancing lung function recovery.
  • WU Xiancong, KANG De, HUANG Zebin, CAI Zhishi, FANG Wenge, CHENG Xianwei, ZHENG Zhipeng
    Chinese Journal of Infection and Chemotherapy. 2026, 26(4): 333-340. https://doi.org/10.16718/j.1009-7708.2026.04.002
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    Objective To examine the clinical features and prognostic factors of Vibrio vulnificus infection in Zhangzhou area. Methods Clinical data were collected from patients who were diagnosed with Vibrio vulnificus infection at Zhangzhou Hospital Affiliated to Fujian Medical University and The 909th Hospital between March 2020 and September 2025. Patients were assigned to death or cure group based on outcomes. Data were analyzed using Zstats and R version 4.3.3. Statistical significance was defined as P<0.05. Results The 23 patients included 17 males and 6 females. Six patients died and 17 recovered. Significant difference was identified between the two groups in lower extremity infection rates, SOFA scores, and laboratory tests, including C-reactive protein, procalcitonin. Significant difference was also found between the two groups in the timing of first antimicrobial therapy and the rate of incision and drainage within 2 hours. Conclusions Vibrio vulnificus is highly pathogenic in Zhangzhou, affecting a generally susceptible population with severe conditions and high mortality. Poor outcomes are associated with lower extremity infections, high SOFA scores, elevated levels of C-reactive protein, procalcitonin, aspartate aminotransferase, fibrinogen, myoglobin, and troponin, decreased albumin and calcium ion levels, and prolonged prothrombin time, activated partial thromboplastin time, and thrombin time. Early wound drainage and antibiotic treatment can improve success rates.
  • ZHANG Yu, CHEN Yuancheng, ZHANG Jing, XU Yuhong, PENG Baowei, WU Xiaojie
    Chinese Journal of Infection and Chemotherapy. 2026, 26(4): 341-352. https://doi.org/10.16718/j.1009-7708.2026.04.003
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    Objective To conduct a population pharmacokinetic (PopPK)/pharmacodynamic (PD) study of MRX-8 for injection, a novel antimicrobial agent against drug-resistant Gram-negative bacterium, in healthy Chinese subjects in order to propose a dosing regimen for use in subsequent clinical trials. Methods A single-center, randomized, double blind, placebo controlled, dose escalation trial design was adopted. Forty healthy adult participants received the investigational drug or placebo at doses ranging from 0.5 to 3 mg/kg. Blood samples were collected after single and multiple doses. Plasma concentrations of MRX-8 were determined using high performance liquid chromatography tandem mass spectrometry (HPLC MS/MS). A PopPK model was developed using the nonlinear mixed effects modeling approach. Combined with in vitro susceptibility data of MRX-8, the probability of target attainment (PTA) and cumulative fraction of response (CFR) were calculated for 15 dosing regimens via Monte Carlo simulation. Results After intravenous infusion of MRX-8 for Injection in healthy Chinese participants, the pharmacokinetics followed a three compartment model. The clearance from the central compartment was 3.36 L/h,while the inter-compartmental clearance was 7.37 L/h between the central and the shallow peripheral compartment, and 0.26 L/h between the central and the deep peripheral compartment. Body weight, direct bilirubin, and alanine aminotransferase were identified as covariates influencing the pharmacokinetics of MRX-8. Model shrinkage, diagnostic plots, visual predictive check, and bootstrap results demonstrated good goodness of fit and stability of the PopPK model. Sensitivity analysis indicated that the covariates had only minor impact on MRX 8 exposure. No dose adjustment was required. The recommended daily dose of MRX-8 for Injection is ≥2.25 mg/kg based primarily on the pharmacokinetic (PK)/PD analysis results of free drug concentrations. The recommended dosing regimen is 1.25 mg/kg q12h. This regimen can achieve satisfactory CFR, ranging from 93% to 100%. Conclusions In subsequent clinical trials, the recommended daily dose of MRX-8 for Injection should be at least 2.25 mg/kg. It is recommended to use MRX-8 for Injection at dose of 1.25 mg/kg q12h via 1.5-hour infusion, which is expected to yield favorable microbiological efficacy.
  • ZHONG Wen, OU Shuangyu, ZHONG Jing
    Chinese Journal of Infection and Chemotherapy. 2026, 26(4): 353-358. https://doi.org/10.16718/j.1009-7708.2026.04.004
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    Objective To understand the clinical characteristics of infective endocarditis caused by Erysipelothrix rhusiopathiae and help raise clinicians’ awareness of such an infection in clinical practice. Methods The clinical manifestations, laboratory test results, treatment, and outcome were reviewed and analyzed in a patient with endocarditis caused by E. rhusiopathiae. PubMed database was searched using search terms “Erysipelothrix rhusiopathiae”and “endocarditis”, retrieving 47 articles published in English from January 1, 1967 to August 1, 2025. Additionally, 5 articles published in Chinese was found in the CNKI, Wanfang, and Weipu databases from 1967 to 2025, using the Chinese search terms meaning “Erysipelothrix rhusiopathiae” and “endocarditis”. The case data of Erysipelothrix rhusiopathiae-induced infective endocarditis were reviewed and summarized. Results The patient in this report was admitted with fever of unknown origin. A history of a snake bite six months ago was reported. Echocardiography indicated a hyper-echoic mass on the mitral valve. Blood cultures confirmed the presence of Erysipelothrix rhusiopathiae. The above evidence suggested infective endocarditis. Treatment with penicillin resulted in the reduction of the mitral valve vegetation and improvement in the patient's condition. A total 36 patients (including this case) were identified, 24 males and 12 females, with an average age of 54.9 ±10.6 years. Most patients worked in animal-related industries or had contact with animals. The primary clinical symptoms included fever and anorexia. All patients had vegetation on the cardiac valves. All patients were treated with β-lactam antibiotics, and 22 received surgery. The outcomes were recovery in 29 cases, death in 3 cases, and unknown in 4 cases. Conclusions Erysipelothrix rhusiopathiae is a zoonotic pathogen associated with occupational exposure. Infective endocarditis caused by this organism is rarely reported in China. The infection is largely latent. Clinicians should collect detailed medical histories and relevant laboratory test results and identify the pathogen against the modified Duke criteria. Effective treatment should be initiated timely once diagnosis is confirmed.
  • XIAO Min, ZHANG Xiaoyu, DANG Xiumin, LIN Jiaxin, WU Weixing, ZHANG Li
    Chinese Journal of Infection and Chemotherapy. 2026, 26(4): 359-363. https://doi.org/10.16718/j.1009-7708.2026.04.005
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    Objective To report the diagnosis and treatment of a case of Dialister micraerophilus bloodstream infection and compare the differences in clinical characteristics between this bacterium and Dialister pneumosintes via literature review. The clinical characteristics of Dialister infection was summarized for better understanding of this rare pathogen. Methods The clinical data of a patient with Dialister micraerophilus bloodstream infection were retrospectively analyzed. PubMed, China National Knowledge Infrastructure (CNKI), Wanfang and VIP databases were searched for relevant reports up to November 2025. The search terms were "Dialister" in both English and Chinese. A total of 16 cases (including this case) were included in data analysis. The underlying diseases, sources of infection, treatment options and prognosis were summarized and analyzed. Results The patient responded poorly to the initial antimicrobial therapy, and was cured by piperacillin-tazobactam combined with levofloxacin and surgical drainage. The 16 cases of Dialister infection included Dialister pneumosintes infection in 12 cases and Dialister micraerophilus infection in 4 cases (3 cases of bloodstream infection and 1 case of localized infection of the Bartholin's gland). There were 15 cases of bloodstream infection, most of which originated from oral or genital tract infection. There were 12 cases of Dialister pneumosintes bloodstream infection and 3 cases of Dialister micraerophilus bloodstream infection. The clinical characteristics of the two types of bloodstream infection were different: the sources of Dialister pneumosintes infection were diverse, and both men and women could be affected. Three cases of Dialister micraerophilus bloodstream infection (including this case) were all in females. The source of infection was mainly reproductive tract and/or pelvic cavity. The remaining case of Dialister micraerophilus infection was submandibular gland abscess (from head and neck). The diagnosis in 2 out of 3 cases (66.7%) of Dialister micraerophilus was relied on 16S rRNA sequencing or mass spectrometry, while 8 out of 12 cases (66.7%) of Dialister pneumosintes infection were diagnosed via molecular methods. Localized Dialister infection should be confirmed by mass spectrometry. All reported cases were cured. Conclusions Dialister bloodstream infection is rarely reported. The bacterium is difficult to culture and easily masked by dominant bacteria. When unexplained bloodstream infection is found in a high-risk patient with mucosal barrier destruction, it is necessary to be aware of this bacteria and should be identified by molecular methods even if the local lesion culture is negative.
  • LIU Na, PANG Chongjie, YU Haonan, LI Jing, YUAN Shuanglong
    Chinese Journal of Infection and Chemotherapy. 2026, 26(4): 364-368. https://doi.org/10.16718/j.1009-7708.2026.04.006
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    Objective To explore the diagnosis and treatment of Lactobacillus-induced infective endocarditis (IE) associated with probiotic intake, and enhance clinicians' awareness of probi-otic-related risks in high-risk populations. Methods A case of Lactobacillus-induced IE diagnosed at General Hospital of Tianjin Medical University was retrospectively analyzed. Databases in-cluding CNKI and PubMed were searched from 1995 to 2025, using search terms "Lactobacillus" and "endocarditis" to screen definitively diagnosed cases with a history of long-term probiotic intake or excessive yogurt consumption before onset. Results A 66-year-old male with a history of aortic valve replacement 8 months ago was admitted for intermittent fever lasting 20 days, following 1-month probiotic use for constipation. Blood cultures turned positive at 32 hours. Lactobacillus casei was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Transthoracic and transesophageal echocardiography showed valve thickening and perivalvular regurgitation, while 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) confirmed prosthetic valve infection. The patient was cured after 6-week treatment with ampicillin-sulbactam combined with etimicin. Literature review included 15 cases: median age 60 years, male predominance (73%), aortic valve as the most common site of infection, 27% with emboli in other sites, and 73% with valvular heart disease or valve surgery history. The main pathogenic bacteria were Lactobacillus rhamnosus and Lactobacillus casei. The core antimicrobial regimen was β-lactams combined with aminoglycosides. The mortality rate was 7% (1/15). Conclusions Probiotic use should be cautious in patients with valvular heart disease or post-valve replacement. 18F-FDG PET/CT can provide crucial diagnostic evidence for patients highly suspected of IE but echocardiography did not detect valvular vegetation.
  • WANG Shuaishuai
    Chinese Journal of Infection and Chemotherapy. 2026, 26(4): 369-373. https://doi.org/10.16718/j.1009-7708.2026.04.007
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    Objective To explore the clinical manifestations, diagnosis, and treatment methods of patients with bloodstream infections caused by Peptoniphilus harei. Methods The diagnosis and treatment process of Peptoniphilus harei bloodstream infection in a patient were analyzed. Literature published from the establishment of databases to January 2026 was retrieved from PubMed, Google Scholar, ScienceDirect, CNKI, Wanfang and VIP databases using the search term “Peptoniphilus harei”. Results The patient in this case report presented primarily with fever. Blood culture results indicated Peptoniphilus harei. After 10 days of treatment with meropenem 1 g qd, the patient’s condition improved. A total of 8 relevant articles were reviewed, including 8 cases. Finally, 9 cases of Peptoniphilus harei infection were analyzed, including the case in this report. Infections caused by Peptoniphilus harei included 3 cases of systemic infection, 3 cases of breast abscess, 1 case of abdominal cavity infection, 1 case of osteomyelitis, and 1 case of lymphocele. Treatment primarily involved drainage, debridement surgery combined with β-lactam, fluoroquinolone, and nitroimidazole antibiotics. All of the 9 patients were cured. Conclusions Clinical infections caused by Peptoniphilus harei are relatively rare. Effective antimicrobial agents combined with surgical treatment can achieve good outcomes for most patients. Application of matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry for microbial identification can assist in early diagnosis.
  • KUANG Lin, XIAO Ke
    Chinese Journal of Infection and Chemotherapy. 2026, 26(4): 374-378. https://doi.org/10.16718/j.1009-7708.2026.04.008
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    Objective To investigate the clinical features and prognosis of central nervous system (CNS) infection caused by Talaromyces marneffei. Methods A case of disseminated Talaromyces marneffei infection involving the CNS was reported and the relevant literature reports were reviewed. The PubMed database and the Chinese databases of CNKI, Wanfang, and VIP were searched with search terms Talaromyces marneffei OR Penicillium marneffei and central nervous system infection, intracranial infection, meningitis, OR brain abscess. The search period was from January 2016 to December 2025. The clinical data of patients with Talaromyces marneffei CNS infection were screened out and summarized. Results A 45-year-old female presented with fever and headache. CT scan revealed multiple enlarged lymph nodes, lung and liver lesions. Talaromyces marneffei strains were found in lymph node and lung biopsy pathology, blood and cerebrospinal fluid cultures. The patient died after treatment. A total of 41 patients with Talaromyces marneffei CNS infection (including this case) were reviewed. There were 34 males with a median age of 37 years. Four patients had no underlying diseases and 37 patients had immunodeficiency syndrome. The clinical manifestations were mainly nervous system disorders and fever. Brain imaging manifestations were diverse. Forty patients were diagnosed by cerebrospinal fluid and/or brain tissue examination. One patient was diagnosed after effective diagnostic treatment. Of the 41 patients analyzed, 24 patients were improved, 13 died and 4 were cured. Conclusions Talaromyces marneffei CNS infection is more common in immunodeficient patients. Cerebrospinal fluid culture and next-generation sequencing are the main diagnostic methods. The prognosis is poor. Early diagnosis and treatment are the key to improving the prognosis.
  • YE Liya, PAN Julong, YU Gang, YAN Hanfei, ZHANG Hanxue, SHEN Jing, CAI Hui
    Chinese Journal of Infection and Chemotherapy. 2026, 26(4): 379-385. https://doi.org/10.16718/j.1009-7708.2026.04.009
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    Objective To investigate the intestinal carriage, serotypes, and antimicrobial resistance profiles of Salmonella isolates among catering staff in the southern region of Wujiang District, Suzhou City, from January to December 2024 for better prevention and control of foodborne diseases and rational clinical drug use in this area. Methods A retrospective analysis was conducted on 26 531 fecal samples collected from catering staff during health checkup at 10 medical consortium facilities in the region. Salmonella was isolated using real-time fluorescent PCR (RT-PCR) preliminary screening combined with traditional culture methods. The isolates were serotyped, and antimicrobial resistance of the isolates were analyzed. Results A total of 179 non-typhoidal Salmonella strains were detected. The overall prevalence was 0.7%. The prevalence of Salmonella strains showed seasonal fluctuations, peaking in August and September (both 1.6%) and reaching the lowest levels in January, February, and April (all 0.2%). Thirty-three serotypes were identified. The predominant serotype was S. typhimurium (21.2%), followed by S. choleraesuis, S. kunzendorf, S. stanley, and S. derby (6.7% each), indicating high genetic diversity. The strains demonstrated the highest resistance rates to doxycycline (70.4%), tetracycline (67.0%), and moxifloxacin (58.1%), but still highly susceptible to carbapenems (meropenem and imipenem, only 1.1% resistant). Nine resistance patterns were identified. Multidrug-resistant strains (resistant to three or more drug classes) accounted for 8.9%. Conclusions In 2024, asymptomatic Salmonella carriage was observed among some catering staff in the southern region of Wujiang District, Suzhou City. The prevalence of Salmonella carriage peaks in summer and autumn. The strains showed diverse serotypes and significant resistance to commonly used antibiotics but remained highly susceptible to carbapenems. It is recommended to enhance surveillance during summer and autumn, standardize antibiotic use, and strengthen food safety education for better prevention and control of foodborne diseases.
  • LUO Guolan, LI Mengwei, ZENG Jianchao, ZHANG Yingjie, WANG Haixia, WEI Liuhua, LUO Xuebin
    Chinese Journal of Infection and Chemotherapy. 2026, 26(4): 386-392. https://doi.org/10.16718/j.1009-7708.2026.04.010
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    Objective To analyze the susceptibility profiles of carbapenem-resistant Enterobacterales (CRE) to commonly used antibiotics and the types of carbapenemases produced for individualized and precise clinical treatment. Methods A total of 144 non-duplicate CRE strains isolated from clinical samples in Liuzhou Workers' Hospital from January 2022 to December 2024 were tested for antimicrobial susceptibility. The phenotypes and genotypes of carbapenemases were detected using the carbapenemase inhibitor enhancement test and colloidal gold immunochromatography. Results The most common CRE strains were Klebsiella pneumoniae (88.2%), followed by Escherichia coli (3.5%), Klebsiella oxytoca (2.8%), Serratia marcescens (2.1%), Citrobacter freundii (2.1%), Enterobacter cloacae (0.7%), and Morganella morganii (0.7%). Overall, 100% of the 144 CRE strains were susceptible to tigecycline. All of K. pneumoniae strains and 40.0% of E. coli strains were susceptible to ceftazidime-avibactam (CAZ-AVI) while 10.2% of K. pneumoniae strains and 100% of E. coli strains were susceptible to amikacin. The phenotyping of carbapenemases showed that 90.3% of the 144 CRE strains produced only class A serine enzymes, 9.0% produced only class B metalloenzymes, and 0.7% did not produce class A serine enzymes or class B metalloenzymes. The genotyping of carbapenemases showed that 90.3% of the CRE strains produced KPC, while 9.0% produced NDM, and 0.7% of the strains did not produce carbapenemase. The coincidence rate of the two carbapenemase detection methods was 100%. All (100%, 130/130) of the KPC-producing strains and 7.7% (1/13) of the NDM-producing strains were susceptible to CAZ-AVI. For 23 strains with CAZ-AVI inhibition zones of 20-22 mm, broth microdilution method (BMD) was used to confirm the sensitivity to CAZ-AVI. The results showed that the category agreement, major error, and very major error between Kirby-Bauer method and BMD were 78.3% (18/23), 21.7% (5/23), and 0 (0/23), respectively. Five CRE strains had CAZ-AVI inhibition zones of 20 mm (resistant), but were susceptible to CAZ-AVI when confirmed by BMD and E-test. Conclusions The production of KPC and NDM enzymes is the main mechanism of resistance to carbapenem antibiotics in CRE strains. Antimicrobial susceptibility testing and carbapenemase detection methods should be standardized for CRE strains to guide individualized and precise treatment of CRE infections in clinical practice.
  • Case Report
  • WANG Chongzhen, JI Dingwen, XU Lixia, FU Juxiu, CHEN Dongke, ZHONG Shan
    Chinese Journal of Infection and Chemotherapy. 2026, 26(4): 393-394. https://doi.org/10.16718/j.1009-7708.2026.04.011
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  • ZHAI Mengmeng, ZANG Ke, LI Guotao
    Chinese Journal of Infection and Chemotherapy. 2026, 26(4): 395-397. https://doi.org/10.16718/j.1009-7708.2026.04.012
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  • TANG Yingxian, WEN Weihong, CHEN Lingjuan, XU Lingqing
    Chinese Journal of Infection and Chemotherapy. 2026, 26(4): 398-401. https://doi.org/10.16718/j.1009-7708.2026.04.013
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  • HE Kaiju, BAI Meirong, TAN Zhen
    Chinese Journal of Infection and Chemotherapy. 2026, 26(4): 402-406. https://doi.org/10.16718/j.1009-7708.2026.04.014
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  • Review
  • YE Huijing, WU Xiaojie, QI Chunye, DAI Yangyi, WU Junzhen, ZHANG Jing
    Chinese Journal of Infection and Chemotherapy. 2026, 26(4): 407-411. https://doi.org/10.16718/j.1009-7708.2026.04.015
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  • JI Xiang, SHI Jingyi, KANG Xiaojing
    Chinese Journal of Infection and Chemotherapy. 2026, 26(4): 412-417. https://doi.org/10.16718/j.1009-7708.2026.04.016
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  • YUAN Shuanglong, ZHANG Hong, LIU Yue, PANG Chongjie
    Chinese Journal of Infection and Chemotherapy. 2026, 26(4): 418-425. https://doi.org/10.16718/j.1009-7708.2026.04.017
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  • LI Hong, HU Huan, FENG Wentao, YUE Ruiming, WU Jingzhi, SHEN Jun, HUANG Xiaobo, PAN Chun, PAN Ling’ai
    Chinese Journal of Infection and Chemotherapy. 2026, 26(4): 426-432. https://doi.org/10.16718/j.1009-7708.2026.04.018
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  • HONG Wenfei, WANG Lingwei
    Chinese Journal of Infection and Chemotherapy. 2026, 26(4): 433-438. https://doi.org/10.16718/j.1009-7708.2026.04.019
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