Xiao, Y. H. et al. Epidemiology and characteristics of antimicrobial resistance in China. Drug. Resist. Updat. 14, 236-250

State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
Drug resistance updates: reviews and commentaries in antimicrobial and anticancer chemotherapy (Impact Factor: 9.12). 08/2011; 14(4-5):236-50. DOI: 10.1016/j.drup.2011.07.001
Source: PubMed


A comprehensive surveillance system for bacterial resistance in tertiary hospitals has been established in China that involves tertiary hospitals in distinct regions nationwide, enabling the collection of a large amount of antimicrobial surveillance data. Antimicrobial resistance in China has become a serious healthcare problem, with high resistance rates of most common bacteria to clinically important antimicrobial agents. Methicillin-resistant S. aureus, ESBL-producing Enterobacteriaceae and carbapenem-resistant Acinetobacter baumannii represent more than 50% of microbial isolates. Additionally, bacterial resistance to fluoroquinolones, macrolides and third-generation cephalosporins is of serious concern. The molecular epidemiology and resistance mechanisms of the antimicrobial strains in China exhibited regional specificity, as well as the influence of dissemination of international clonal complexes. The molecular characteristics of MRSA, ESBL- and carbapenemase-producing Enterobacteriaceae, and macrolide-resistant gram-positive Streptococci in China were significantly different from those in other countries and regions, while S. pneumoniae serotypes appear to have been affected by the global spread of prevalent clones in other parts of the world. Moreover, important antimicrobial resistant bacteria such as community-acquired-MRSA, multidrug-resistant P. aeruginosa and extensive-resistant A. baumannii, and the antimicrobial resistance in primary healthcare and outpatient setting should be intensely monitored and investigated in the future.

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    • "It suggests that a substantial amount of antimicrobials are used in pig farming for growth promotion, prophylactic or therapeutic purposes. A high prevalence of multiple antimicrobial resistance in pig isolates was also found in another province (Shanxi) (Wang et al., 2012), and an abundance of diverse antibiotic resistance genes (ARGs) have been found on Chinese pig farms (Zhu et al., 2013); in contrast, most MSSA in Chinese hospitals have maintained a high degree of susceptibility to most antimicrobial agents, mainly exhibiting erythromycin and clindamycin resistance (Xiao et al., 2011). No doubt, there remains a potential threat to human health that resistant strains or resistance genes that have emerged in pigs (Zhu et al., 2013) are introduced into human health care institutions. "
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    ABSTRACT: To describe the prevalence and population structure of Staphylococcus aureus bacteria that colonize pigsat slaughterhouses in northeastern China, nose swabs were collected from pigs in two slaughterhouses inHarbin, Heilongjiang Province, China in 2009. S. aureus isolates were characterized by multilocus sequencetyping (MLST), spa typing, SCCmec typing, antimicrobial susceptibility testing and pvl gene detection. Atotal of 200 S. aureus isolates were collected from 590 pigs (33.9%, 200/590), of which 162 (81%, 162/200)were methicillin-susceptible S. aureus (MSSA) and 38 (19%, 38/200) were methicillin-resistant S. aureus(MRSA). Ninety-nine of the MSSA isolates (99/162, 61.1%) were ST398, which represented the dominantsequence type overall. Eighty-seven isolates were ST9 (87/200, 43.5%), and all MRSA belonged to thatsequence type which consisted of the spa types t899 and t2922. Among the MSSA strains, t034, t899 andt4358 were the most dominant spa types (139/162, 85.8%). All MRSA isolates harbored SCCmec type IVb.The pvl gene was only detected in 3 ST7/t2119 MSSA isolates. All MRSA but more importantly also 82.7%(134/162) of the MSSA isolates were resistant to six or more antibiotics. Moreover, a novel resistancedeterminant-lsa(E) was identified among 22% (44/200) of all isolates. In conclusion, pigs in northeastChina are frequently colonized with ST398 MSSA. MRSA with this sequence type, typically associatedwith pigs in Europe, was not found. High levels of multiple antibiotic resistance among MRSA isolates aswell as MSSA isolates are a public health concern.
    Full-text · Dataset · Dec 2014
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    • "The recent emergence and rapid worldwide dissemination of E. coli resistant to extended-spectrum cephalosporins due to the production of extended-spectrum b-lactamases (ESBLs) has clearly shown that E. coli antibiotic resistance is currently a real public health concern (Mukherjee et al., 2013; Khanna et al., 2012; Vaidya, 2011; Xiao et al., 2011; Zhang et al., 2012). To our knowledge, no epidemiological surveillance studies in Palestine have investigated the molecular nature of E. coli strains circulating in the healthcare settings. "
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    ABSTRACT: Antibiotic resistance of uropathogenic E. coli (UPEC) in urinary tract infections (UTIs) is increasing worldwide. A total of 41 UPEC isolates were isolated from urine samples from hospitalized patients with UTI during the period of March and June 2011 from three hospitals in the Northern districts of the West Bank, Palestine. Resistance rates were: Erythromycin (95%), sulfamethoxazole-trimethoprim (59%), ciprofloxacin (56%), gentamicin (27%), aoxycillin (93%), amoxyclave (32%), ceftazidime (66%), and cefotaxime (71%). Among the 41 isolates, phylogenetic group B2 was observed in 13 isolates, group D in 12 isolates, group A in 11 isolates, and B1 in 5 isolates. Twenty-five of the isolates were positive for an ESBL phenotype. The PCR assay of ESBL genes showed that all the ESBL producers harboured CTX-M, 8 harboured TEM, whereas none of the isolates contained the SHV gene. Transformation experiments indicated that some of the ESBL-encoding genes (i.e. CTX-M and TEM) with co-resistance to erythromycin and gentamicin was observed. Apart from this, ERIC-PCR revealed that the 41 isolates were genetically diverse and comprised a heterogeneous population with 11 ERIC profiles at a 60% similarity level.
    Full-text · Article · Nov 2013 · Journal of Medical Microbiology
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    • "Since the ESBL SHV-2 was first reported in China in the 1990s, ESBL-producing Enterobacteriaceae have spread rapidly, particularly after 2000. The prevalence of ESBL-producing E. coli strains varies across different regions of China, with the lowest incidence in Uramuq (28.5%, Northwest), and the highest in Wuhan (78%, Central-South) in 2008 [30]. The increased importance of ESBL resistance in Enterobacteriaceae has necessitated the use of ESBL stable β-lactams like carbapenems in China. "
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    ABSTRACT: This retrospective study evaluated trends and association between resistance of Pseudomonas aeruginosa isolated from patients with hospital-acquired infections (HAIs) and hospital antimicrobial usage from 2003 through 2011 in a tertiary care hospital in northeast China. HAI was defined as occurrence of infection after hospital admission, without evidence that infection was present or incubating (≦48 h) on admission. In vitro susceptibilities were determined by disk diffusion test and susceptibility profiles were determined using zone diameter interpretive criteria, as recommended by Clinical and Laboratory Standards Institute (CLSI). Data on usage of various antimicrobial agents, expressed as defined daily dose (DDD) per 1,000 patients-days developed by WHO Anatomical Therapeutical Chemical (ATC)/DDD index 2011, were collected from hospital pharmacy computer database. Most of 747 strains of P. aeruginosa were collected from respiratory samples (201 isolates, 26.9%), blood (179, 24.0%), secretions and pus (145, 19.4%) over the years. Time series analysis demonstrated a significant increase in resistance rates of P. aeruginosa to ticarcillin/clavulanic acid, piperacillin/tazobactam, cefoperazone/sulbactam, piperacillin, imipenem, meropenem, ceftazidime, cefepime, ciprofloxacin, and levofloxacin except aminoglycosides over time in the hospital (P<0.001). The rates of carbapenem-resistant P. aeruginosa (CRPA) isolated from patients with HAIs were 14.3%, 17.1%, 21.1%, 24.6%, 37.0%, 48.8%, 56.4%, 51.2%, and 54.1% over time. A significant increase in usage of anti-pseudomonal carbapenems (P<0.001) was seen. ARIMA models demonstrated that anti-pseudomonal carbapenems usage was strongly correlated with the prevalence of imipenem and meropenem-resistant P. aeruginosa (P<0.001). Increasing of quarterly CRPA was strongly correlated at one time lag with quarterly use of anti-pseudomonal carbapenems (P<0.001). Our data demonstrated positive correlation between anti-pseudomonal antimicrobial usage and P. aeruginosa resistance to several classes of antibiotics, but not all antimicrobial agents in the hospital.
    Preview · Article · Nov 2013 · PLoS ONE
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