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Long-Term Continuous Antimicrobial Resistance Surveillance Among Nosocomial Gram-Negative Bacilli in China from 2010 to 2018 (CMSS)

Authors Wang Q, Wang Z, Zhang F, Zhao C, Yang B, Sun Z, Mei Y, Zhao F, Liao K, Guo D, Xu X, Sun H, Hu Z, Chu Y, Li Y, Ji P, Wang H

Received 15 April 2020

Accepted for publication 12 July 2020

Published 28 July 2020 Volume 2020:13 Pages 2617—2629

DOI https://doi.org/10.2147/IDR.S253104

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Eric Nulens


Qi Wang,1 Zhanwei Wang,1 Feifei Zhang,1 Chunjiang Zhao,1 Bin Yang,2 Ziyong Sun,3 Yaning Mei,4 Feng Zhao,5 Kang Liao,6 Dawen Guo,7 Xiuli Xu,8 Hongli Sun,9 Zhidong Hu,10 Yunzhuo Chu,11 Yi Li,12 Ping Ji,13 Hui Wang1

1Department of Clinical Laboratory, Peking University People’s Hospital, Beijing 100044, People’s Republic of China; 2Department of Clinical Laboratory, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, People’s Republic of China; 3Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People’s Republic of China; 4Department of Clinical Laboratory, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, People’s Republic of China; 5Department of Infectious Diseases, Sir Run Shaw Hospital (SRRSH), Affiliated with the Zhejiang University School of Medicine, Hangzhou 310016, People’s Republic of China; 6Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, People’s Republic of China; 7Department of Clinical Laboratory, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, People’s Republic of China; 8Department of Clinical Laboratory, Xijing Hospital of Air Force Military Medical University, Xi’an 100191, People’s Republic of China; 9Department of Clinical Laboratory, Peking Union Medical College Hospital, Beijing 100730, People’s Republic of China; 10Department of Clinical Laboratory, General Hospital of Tianjin Medical University, Tianjin 300052, People’s Republic of China; 11Department of Clinical Laboratory, The First Affiliated Hospital of China Medical University, Shenyang 110001, People’s Republic of China; 12Department of Clinical Laboratory, Henan Provincial People’s Hospital, Zhengzhou 450003, People’s Republic of China; 13Department of Clinical Laboratory, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, People’s Republic of China

Correspondence: Hui Wang
Department of Clinical Laboratory, Peking University People’s Hospital, Beijing 100044, People’s Republic of China
Tel/ Fax +86-10-88326300
Email whuibj@163.com

Purpose: The Chinese Meropenem Surveillance Study (CMSS) was conducted every 2 years from 2010 to 2018 to monitor the antimicrobial activity of commonly used antimicrobial agents against nosocomial gram-negative bacilli in China.
Methods: From 2010 to 2018, 6,537 gram-negative bacilli were collected from 14 teaching hospitals. The minimum inhibitory concentrations (MICs) of meropenem and other antimicrobial agents were determined using the agar dilution and broth microdilution methods.
Results: Continuous surveillance indicated that, except for Klebsiella pneumoniae, the susceptibility of Enterobacterales to carbapenems was relatively stable over time. Carbapenems had the highest activity against the tested isolates, with MIC90 values (MIC for 90% of organisms) ranging from 0.032 mg/L to 8 mg/L. More than 90% of bacteria were susceptible to either meropenem or imipenem; more than 80% were susceptible to ertapenem. The prevalence of extended-spectrum beta-lactamase (ESBL)-producing E. coli, K. pneumoniae, and P. mirabilis each year was 50.4– 64.3%, 18– 41.2%, and 1.9– 33.8%, respectively. The prevalence of carbapenem-resistant K. pneumoniae (CRKP) and carbapenem-resistant Acinetobacter baumannii (CRAB) continued to increase significantly over time, from 7.6% to 21.2% and 64.6% to 69.3%, respectively. The prevalence of CRKP was higher from urinary tract infections (25.4%) than from bloodstream infections (14.2%), intra-abdominal infections (14.5%), and respiratory infections (14.4%). In total, 129 CRKP isolates were evaluated by PCR; of these, 92 (71.3%) carried the blaKPC-2 gene. Colistin maintained very high in vitro antimicrobial activity against P. aeruginosa and A. baumannii (more than 95% of isolates exhibited susceptibility at all timepoints).
Conclusion: The results indicate an increase in K. pneumoniae resistance to carbapenems over time, mainly owing to KPC-type carbapenemase production. A. baumannii was severely resistant to carbapenems in China. Ongoing MIC-based resistance surveillance, like CMSS, provides additional data for clinical anti-infective treatment.

Keywords: CMSS, gram-negative bacilli, antimicrobial susceptibility surveillance, carbapenem-resistant

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