Spatiotemporal trajectories of antimicrobial resistance in bloodstream infections in China: a nationwide longitudinal surveillance study from 2014 to 2023
In brief
ESBL-producing E. coli fell from 62% to 47% in China's bloodstream infections
In surveillance of 76,211 bloodstream infection isolates from 72 hospitals, several resistance patterns declined from 2014 to 2023: ESBL-producing E. coli fell from 61.5% to 47.4%, and MRSA from 39.0% to 26.2%. Carbapenem-resistant Klebsiella pneumoniae more than doubled to 14.9%, while resistance varied by location; stewardship gains have not removed the need for targeted infection control.
- Journal
- The Lancet regional health. Western Pacific (Q1)
- Published
- 22 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Yunbo Chen, Zhiying Liu, Jinru Ji, Chaoqun Ying, Hua Zhang, Haisheng Kong, et al.
- PMID
- 42959813
- DOI
- 10.1016/j.lanwpc.2026.102010
Why clinicians should know about it
- Picked for Internal Medicine (paper of the day, 2 November 2026): Longitudinal bloodstream infection resistance trends inform antimicrobial choices
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).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.