Spatiotemporal trajectories of antimicrobial resistance in bloodstream infections in China: a nationwide longitudinal surveillance study from 2014 to 2023
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Bloodstream infections (BSIs) impose a substantial global burden, increasingly complicated by antimicrobial resistance (AMR). We aimed to characterise decade-long trends in BSI pathogens and major resistance phenotypes across mainland China. Methods We analysed BSI surveillance data from 72 hospitals across 22 provinces in the Bacterial Resistant Investigation Collaborative System (BRICS) between 2014 and 2023. Isolates were transferred to a central reference laboratory for species identification and standardised antimicrobial susceptibility testing, with raw minimum inhibitory concentration values retrospectively reinterpreted using 2025 CLSI guidelines. Fourteen continuously participating hospitals formed a sentinel cohort. Findings Among 76,211 non-duplicate BSI isolates, Escherichia coli and Klebsiella pneumoniae predominated, with K. pneumoniae increasing by 0.91 percentage points annually (95% CI 0.59–1.23; p < 0.001). Extended-spectrum β-lactamase (ESBL)-producing E. coli decreased from 61.5% to 47.4%, MRSA from 39.0% to 26.2%, and ESBL-producing K. pneumoniae from 30.5% to 21.5% (all p < 0.001). Conversely, carbapenem-resistant K. pneumoniae increased from 7.0% to 14.9%, peaking at 22.5% in 2018, with marked spatial heterogeneity. CRAB remained persistently high (55.2–64.3%). Resistance proportions were higher in intensive care units, older patients and male patients for several phenotypes. Interpretation Major resistance phenotypes declined during a decade of nationwide antimicrobial stewardship, while the contribution of K. pneumoniae to BSIs increased and carbapenem resistance remained a major challenge. Future AMR strategies should integrate antimicrobial stewardship with targeted infection prevention, outbreak control, and genomic surveillance. Funding This study was supported by Prevention and Control of Emerging and Major Infectious Diseases-National Science and technology Major Project (2025ZD01903301), National Key R&D Program of China (2024YFC2311304) and Research Project of Jinan Microecological Biomedicine Shandong Laboratory (JNL-2025004B).
Authors: Yunbo Chen, Zhiying Liu, Jinru Ji, Chaoqun Ying, Hua Zhang, Haisheng Kong, Qing Yang, Ping Shen, Yonghong Xiao, Kunpeng Liang, Peng Zhang, Ying Huang, Jilu Shen, Yinjiao Dong, Zhou Liu, Guoping Lu, Xiusan Xia, Fei Du, Li Sun, Baohua Zhang, Yuanyuan Dai, Fei Li, Lu Wang, Jian Li, Liang Guo, Fenghong Chen, Donghong Huang, Xiaoyan Li, Lan Ma, Shuyan Hu, Dengyan Qiao, Ling Meng, Hai Chen, Guolin Liao, Bo Quan, Pengpeng Tian, Yizheng Zhou, Donghua Liu, Qiuying Zhang, Jiangqin Song, Jinhua Liang, Yanhong Li, Hongxia Hu, Qiang Liu, Lin Zhang, Dahong Wang, Chuandan Wan, Danting Jin, Haiquan Kang, Renjing Hu, Rong Xu, Dan Liu, Yiqun Liao, Jianzhong Wang, Xuefei Hu, Liang Luan, Weiping Liu, Liping Zhang, Xiaoping Yan, Yongyun Liu, Haixin Dong, Sijin Man, Jiliang Wang, Yan Jin, Yanyan Li, Hong He, Chunhua Han, Zhuo Li, Haiying Li, Yan Geng, Jiangbang Kang, Hong Lu, Zhixiang Liao, Baorui Yang, Youdong Yin, Aiyun Li, Dijing Song, Hui Ding, Lin Zheng, Junmin Cao, Xinhua Qiang
Language: English
Subfield: Microbiology (medical)
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,250
Funders: Lanzhou University, Hunan Normal University, Anhui Medical University, Henan University of Science and Technology, Ningbo University, National Health and Family Planning Commission of the People's Republic of China, Nanchang University, Henan University, Zhejiang University, Binzhou Medical University, Shanxi Medical University, Jining Medical University, Southern Medical University, Qingdao University, Xuzhou Medical University, Fujian Medical University, Xi'an Medical University, National Science and Technology Major Project, National Health Commission of the People's Republic of China, Gannan Medical University
OpenAlex ID: W7223208094