{
  "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_shown": true,
  "affiliations": [
    "State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, 310003, China"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 81,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yunbo Chen"
    },
    {
      "affs": [
        0
      ],
      "name": "Zhiying Liu"
    },
    {
      "affs": [
        0
      ],
      "name": "Jinru Ji"
    },
    {
      "affs": [
        0
      ],
      "name": "Chaoqun Ying"
    },
    {
      "affs": [
        0
      ],
      "name": "Hua Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Haisheng Kong"
    },
    {
      "affs": [
        0
      ],
      "name": "Qing Yang"
    },
    {
      "affs": [
        0
      ],
      "name": "Ping Shen"
    },
    {
      "name": "Yonghong Xiao"
    },
    {
      "name": "Kunpeng Liang"
    },
    {
      "name": "Peng Zhang"
    },
    {
      "name": "Ying Huang"
    },
    {
      "name": "Jilu Shen"
    },
    {
      "name": "Yinjiao Dong"
    },
    {
      "name": "Zhou Liu"
    },
    {
      "name": "Guoping Lu"
    },
    {
      "name": "Xiusan Xia"
    },
    {
      "name": "Fei Du"
    },
    {
      "name": "Li Sun"
    },
    {
      "name": "Baohua Zhang"
    },
    {
      "name": "Yuanyuan Dai"
    },
    {
      "name": "Fei Li"
    },
    {
      "name": "Lu Wang"
    },
    {
      "name": "Jian Li"
    },
    {
      "name": "Liang Guo"
    },
    {
      "name": "Fenghong Chen"
    },
    {
      "name": "Donghong Huang"
    },
    {
      "name": "Xiaoyan Li"
    },
    {
      "name": "Lan Ma"
    },
    {
      "name": "Shuyan Hu"
    },
    {
      "name": "Dengyan Qiao"
    },
    {
      "name": "Ling Meng"
    },
    {
      "name": "Hai Chen"
    },
    {
      "name": "Guolin Liao"
    },
    {
      "name": "Bo Quan"
    },
    {
      "name": "Pengpeng Tian"
    },
    {
      "name": "Yizheng Zhou"
    },
    {
      "name": "Donghua Liu"
    },
    {
      "name": "Qiuying Zhang"
    },
    {
      "name": "Jiangqin Song"
    },
    {
      "name": "Jinhua Liang"
    },
    {
      "name": "Yanhong Li"
    },
    {
      "name": "Hongxia Hu"
    },
    {
      "name": "Qiang Liu"
    },
    {
      "name": "Lin Zhang"
    },
    {
      "name": "Dahong Wang"
    },
    {
      "name": "Chuandan Wan"
    },
    {
      "name": "Danting Jin"
    },
    {
      "name": "Haiquan Kang"
    },
    {
      "name": "Renjing Hu"
    },
    {
      "name": "Rong Xu"
    },
    {
      "name": "Dan Liu"
    },
    {
      "name": "Yiqun Liao"
    },
    {
      "name": "Jianzhong Wang"
    },
    {
      "name": "Xuefei Hu"
    },
    {
      "name": "Liang Luan"
    },
    {
      "name": "Weiping Liu"
    },
    {
      "name": "Liping Zhang"
    },
    {
      "name": "Xiaoping Yan"
    },
    {
      "name": "Yongyun Liu"
    }
  ],
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  "published": "2026-10-01",
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  "title": "Spatiotemporal trajectories of antimicrobial resistance in bloodstream infections in China: a nationwide longitudinal surveillance study from 2014 to 2023",
  "title_text": "Spatiotemporal trajectories of antimicrobial resistance in bloodstream infections in China: a nationwide longitudinal surveillance study from 2014 to 2023",
  "type": "peer-reviewed",
  "updated_at": "2026-11-02T12:22:30Z",
  "url": "https://research.draconitic.com/paper/42kmk31cbah77",
  "venue": "The Lancet Regional Health. Western Pacific",
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