Spatiotemporal trajectories of antimicrobial resistance in bloodstream infections in China: a nationwide longitudinal surveillance study from 2014 to 2023
- 1State 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
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).
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BibTeX
@article{chen2026spatiotemporal,
title = {{Spatiotemporal trajectories of antimicrobial resistance in bloodstream infections in China: a nationwide longitudinal surveillance study from 2014 to 2023}},
author = {Yunbo Chen and Zhiying Liu and Jinru Ji and Chaoqun Ying and Hua Zhang and Haisheng Kong and Qing Yang and Ping Shen and Yonghong Xiao and Kunpeng Liang and Peng Zhang and Ying Huang and Jilu Shen and Yinjiao Dong and Zhou Liu and Guoping Lu and Xiusan Xia and Fei Du and Li Sun and Baohua Zhang and Yuanyuan Dai and Fei Li and Lu Wang and Jian Li and Liang Guo and Fenghong Chen and Donghong Huang and Xiaoyan Li and Lan Ma and Shuyan Hu and Dengyan Qiao and Ling Meng and Hai Chen and Guolin Liao and Bo Quan and Pengpeng Tian and Yizheng Zhou and Donghua Liu and Qiuying Zhang and Jiangqin Song and Jinhua Liang and Yanhong Li and Hongxia Hu and Qiang Liu and Lin Zhang and Dahong Wang and Chuandan Wan and Danting Jin and Haiquan Kang and Renjing Hu and Rong Xu and Dan Liu and Yiqun Liao and Jianzhong Wang and Xuefei Hu and Liang Luan and Weiping Liu and Liping Zhang and Xiaoping Yan and Yongyun Liu},
journal = {The Lancet Regional Health. Western Pacific},
year = {2026},
month = oct,
doi = {10.1016/j.lanwpc.2026.102010},
url = {https://doi.org/10.1016/j.lanwpc.2026.102010},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Spatiotemporal trajectories of antimicrobial resistance in bloodstream infections in China: a nationwide longitudinal surveillance study from 2014 to 2023
AU - Yunbo Chen
AU - Zhiying Liu
AU - Jinru Ji
AU - Chaoqun Ying
AU - Hua Zhang
AU - Haisheng Kong
AU - Qing Yang
AU - Ping Shen
AU - Yonghong Xiao
AU - Kunpeng Liang
AU - Peng Zhang
AU - Ying Huang
AU - Jilu Shen
AU - Yinjiao Dong
AU - Zhou Liu
AU - Guoping Lu
AU - Xiusan Xia
AU - Fei Du
AU - Li Sun
AU - Baohua Zhang
AU - Yuanyuan Dai
AU - Fei Li
AU - Lu Wang
AU - Jian Li
AU - Liang Guo
AU - Fenghong Chen
AU - Donghong Huang
AU - Xiaoyan Li
AU - Lan Ma
AU - Shuyan Hu
AU - Dengyan Qiao
AU - Ling Meng
AU - Hai Chen
AU - Guolin Liao
AU - Bo Quan
AU - Pengpeng Tian
AU - Yizheng Zhou
AU - Donghua Liu
AU - Qiuying Zhang
AU - Jiangqin Song
AU - Jinhua Liang
AU - Yanhong Li
AU - Hongxia Hu
AU - Qiang Liu
AU - Lin Zhang
AU - Dahong Wang
AU - Chuandan Wan
AU - Danting Jin
AU - Haiquan Kang
AU - Renjing Hu
AU - Rong Xu
AU - Dan Liu
AU - Yiqun Liao
AU - Jianzhong Wang
AU - Xuefei Hu
AU - Liang Luan
AU - Weiping Liu
AU - Liping Zhang
AU - Xiaoping Yan
AU - Yongyun Liu
PY - 2026
DA - 2026/10/01
JO - The Lancet Regional Health. Western Pacific
DO - 10.1016/j.lanwpc.2026.102010
UR - https://doi.org/10.1016/j.lanwpc.2026.102010
AB - 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).
SN - 2666-6065
ER -