Blood bacterial resistant investigation collaborative system (BRICS) report: a national surveillance in China from 2014 to 2019
Yunbo Chen, Jinru Ji, Chaoqun Ying, Zhiying Liu, Qing Yang, Haishen Kong, Yonghong Xiao, Blood Bacterial Resistant Investigation Collaborative System (BRICS) Study Group, Hui Ding, Yongyun Liu, Haifeng Mao, Ying Huang, Zhenghai Yang, Yuanyuan Dai, Guolin Liao, Lisha Zhu, Liping Zhang, Yanhong Li, Hongyun Xu, Junmin Cao, Baohua Zhang, Liang Guo, Haixin Dong, Shuyan Hu, Sijin Man, Lu Wang, Zhixiang Liao, Rong Xu, Dan Liu, Yan Jin, Yizheng Zhou, Yiqun Liao, Fenghong Chen, Beiqing Gu, Jiliang Wang, Jinhua Liang, Lin Zheng, Aiyun Li, Jilu Shen, Yinqiao Dong, Lixia Zhang, Hongxia Hu, Bo Quan, Wencheng Zhu, Kunpeng Liang, Qiang Liu, Shifu Wang, Xiaoping Yan, Jiangbang Kang, Xiusan Xia, Lan Ma, Li Sun, Liang Luan, Jianzhong Wang, Li Zhuo, Dengyan Qiao, Lin Zhang, Chuandan Wan, Xiaoyan Qi, Fei Du
Abstract
BACKGROUND: In this first national bloodstream infection (BSI) surveillance program in China, we assessed the composition of pathogenic bacteria and the trends for antimicrobial susceptibility over a 6-year period in China. METHODS: Blood bacterial isolates from patients at hospitals participating in the Blood Bacterial Resistant Investigation Collaborative System (BRICS) were collected from January 2014 to December 2019. Only the first isolate of a species per patient was eligible over the full study period. Antibiotic-susceptibility testing was conducted by agar-dilution or broth-dilution methods as recommended by the Clinical and Laboratory Standards Institute (CLSI). WHONET 5.6 was used to analyze data. RESULTS: During the study period, 27,899 bacterial strains were collected. Gram-positive organisms accounted for 29.5% (8244) of the species identified and Gram-negative organisms accounted for 70.5% (19,655). The most-commonly isolated organisms in blood cultures were Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, coagulase-negative Staphylococci, and Acinetobacter baumannii. The prevalence of multidrug-resistant organisms, such as E. coli, K. pneumoniae, A. baumannii was higher in tertiary hospitals, whereas extended-spectrum, β-lactamase-producing E. coli (ESBL-E. coli), carbapenem-resistant A. baumannii were more prevalent in economically-developing areas. The prevalence of methicillin-resistant S. aureus declined from 39.0% (73/187) in 2014 to 25.9% (230/889) in 2019 (p < 0.05). The prevalence of ESBL-E. coli dropped from 61.2% (412/673) to 51.0% (1878/3,683) over time (p < 0.05), and carbapenem-resistant E. coli remained low prevalence (< 2%; 145/9944; p = 0.397). In contrast, carbapenem-resistant K. pneumoniae increased markedly from 7.0% (16/229) in 2014 to 19.6% (325/1,655) in 2019 (p < 0.05). CONCLUSION: E. coli and K. pneumoniae were the leading causes of BSI during the 6-year study period. The major resistant pathogens declined or remained stable, whereas carbapenem-resistant K. pneumoniae continued to increase, which poses a great therapeutic challenge for BSIs.