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Trend of distribution and antimicrobial resistance in uropathogens in China from the CHINET antimicrobial resistance surveillance program, a 7-year retrospective study

One Health Advances volume 2, Article number: 16 (2024) Cite this article

Abstract

Urinary tract infections (UTIs) are common urological diseases that easily relapse and have led to an increasing economic and health burdens. The China Antimicrobial Surveillance Network (CHINET) system is one of the most influential antimicrobial resistance surveillance networks in China. This study analyzed antimicrobial resistance and distribution trends of uropathogens from 2015 to 2021 using the CHINET system. A total of 261,893 non-duplicate strains were collected; Gram-positive bacteria accounted for 23.8% while Gram-negative bacteria accounted for 76.2%. Escherichia coli, Enterococcus faecium, Klebsiella pneumoniae, and Enterococcus faecalis were the most common species. The resistance to vancomycin, linezolid, and teicoplanin in E. faecalis and E. faecium was less than 3%. The prevalence of carbapenem-resistant strains of E. coli, K. pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii was 1.7%, 18.5%, 16.4%, and 40.3%, respectively. The prevalence of carbapenem-resistant A. baumannii increased from 27.6% in 2015 to 43.4% in 2021. The prevalence of methicillin-resistant Staphylococcus aureus decreased from 40.6% in 2015 to 22.9% in 2021. The resistance rates to most β-lactam antimicrobials, aminoglycosides and fluoroquinolones in E. coli, K. pneumoniae, P. aeruginosa and A. baumannii isolated from ICU inpatients were significantly higher than in those isolated from outpatients and non-ICU inpatients. This study indicates that E. coli, Enterococcus, and K. pneumoniae were the most commonly isolated uropathogens in China. The bacterial species isolated and their antimicrobial resistance patterns differed in different patient populations. More attention must be paid uropathogen resistance surveillance to provide data for the rational use of antimicrobial agents.

Introduction

Urinary tract infections (UTIs) are among the most common bacterial infections. Approximately 150 million people worldwide experience UTIs every year, causing severe health problems and socioeconomic burdens [1]. Regular monitoring of the antimicrobial resistance in bacteria isolated from urine specimens is necessary to guide the rational use of antibiotics and reduce bacterial resistance. The China Antimicrobial Surveillance Network (CHINET) was founded in 2004; a total of 21 hospitals (including 19 general hospitals and 2 specialized children's hospitals) participated in the network as of 2015. As of 2021, there are 51 hospitals (including 45 general hospitals and 6 specialized children's hospitals) involved from 29 provinces, municipalities, and autonomous regions across the country. In this study, we analyzed the antimicrobial resistance of bacteria isolated from urine using data from CHINET system from 2015 to 2021. Bacterial species and antimicrobial resistance over seven years were summarized to guide antimicrobial therapy.

Results

Distribution of clinical isolates

A total of 261,893 non-duplicate bacterial strains were isolated from urine, including 62,219 (23.8%) Gram-positive bacteria and 199,674 (76.2%) Gram-negative bacteria (Table 1). The number of isolates continously grew over 7 years as increasing numbers of hospitals participated in the system, but the proportion remained largely consistent. The top ten bacteria isolated were E. coli (46.7%), Klebsiella spp. (11.5%), E. faecium (10.4%), E. faecalis (8.7%), P. mirabilis (3.5%), P. aeruginosa (3.4%), S. agalactiae (2.6%), E. cloacae (2.1%), A. baumannii (1.7%), and S. aureus (1.1%).

Table 1 Distribution of 261,893 bacteria in urine specimens over 7 years
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Among the 261,893 non-duplicate bacterial strains, 161,063 strains (61.5%) were obtained from females, and 100,830 strains (38.5%) were obtained from males. In terms of age distribution, 36,894 strains (14.1%) were collected from patients ≤ 18 years old, 37,819 strains (14.4%) were from patients aged 18–44, 57,705 strains (22.0%) were from patients aged 45–59, and 129,475 strains (49.4%) were from patients ≥ 60 years old.

There were significant differences in the dominant bacteria among populations of various ages and genders. The proportions of E. coli, E. faecium, K. pneumoniae, P. mirabilis, and S. agalactis isolated from female patients were higher than those isolated from male patients, while the proportions of E. faecalis, P. aeruginosa, E. cloacae, A. baumannii, and S. aureus isolated from female patients were lower. Almost half of the isolates were isolated from people aged ≥ 60 years. Among 6910 strains of S. agalactiae, only 2.8% were isolated from individuals ≤ 18 years, which was significantly different from the distribution trend of other bacteria (Fig. 1).

Fig. 1
figure 1

Distribution of the most common isolates across different ages and genders. Gender distribution is shown as a line chart and age distribution is shown as a stacked bar chart

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The majority of the isolates were from non-ICU inpatients (74.6%), 18.4% were from outpatients, 2.4% were from emergency patients, and 4.6% were from ICU patients. The dominant strains varied among patients from different departments. As shown in Supplementary Table 1, the top five bacteria isolated from outpatients were E. coli, K. pneumoniae, E. faecalis, P. mirabilis, and S. agalactiae; the top five bacteria isolated from emergency patients and non-ICU inpatients were E. coli, E. faecium, K. pneumoniae, E. faecalis, and P. aeruginosa, while they were E. faecium, E. coli, K. pneumoniae, E. faecalis, and P. aeruginosa in ICU inpatients. E. faecium was the most common in ICU inpatients, but it ranked 6th in outpatients.

Antimicrobial resistance in Gram-positive cocci

Enterococcus spp.

A total of 51,436 Enterococcus strains were isolated from urine specimens from 2015 to 2021; E. faecium accounted for 53.2% (27,343), E. faecalis accounted for 44.2% (22,741) and other Enterococcus accounted for 2.6% (1352). Compared with E. faecalis, E. faecium showed higher resistance rates to ampicillin, levofloxacin, high concentrations of gentamicin (GEH), and nitrofurantoin (P < 0.05) (Fig. 2). Less than 2.2% of E. faecalis and E. faecium were resistant to vancomycin, linezolid, and teicoplanin in our study.

Fig. 2
figure 2

Resistance profiles of Enterococcus and Staphylococcus isolated from urine towards common antimicrobial agents. a Resistance rates of E. faecalis and E. faecium for antimicrobial agents; b Resistance rates of S. aureus and S. saprophyticus to antimicrobial agents. MRSA: methicillin-resistant S. aureus; MSSA: methicillin-sensitive S. aureus; MRSAP: methicillin-resistant S. saprophyticus; MSSAP: methicillin-sensitive S. saprophyticus

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Staphylococcus spp.

A total of 3248 strains of Staphylococcus were isolated, including 2964 strains of S. aureus (91.3%) and 284 strains of S. saprophytic (8.7%). No Staphylococcus were found to be resistant to vancomycin and linezolid. The prevalences of methicillin-resistant S. aureus (MRSA) and methicillin-resistant S. saprophyticus (MRSAP) were 27.8% (819/2947) and 59.3% (162/273), respectively. As shown in Fig. 2, the resistance rates of MRSA to gentamicin, erythromycin, clindamycin, levofloxacin and rifampicin were much higher than those of methicillin-sensitive S. aureus (MSSA) (P < 0.05). The resistance rates to gentamicin, erythromycin, levofloxacin, and trimethoprim-sulfamethoxazole (SMZ-TMP) were much higher than that of methicillin-sensitive S. saprophyticus (MSSAP) (P < 0.05).

β-hemolytic Streptococcus

A total of 7412 strains of β-hemolytic Streptococcus were isolated, 93.2% of which were S. agalactiae. All S. agalactiae strains were sensitive to penicillin, ceftriaxone, vancomycin and linezolid. The resistance rates to erythromycin, clindamycin, and levofloxacin were more than 50%.

Antimicrobial resistance in Gram-negative bacilli

Enterobacteriaceae

A total of 178,979 strains of Enterobacteriaceae were isolated, including 122,384 strains of E. coli (68.4%), 30,316 strains of Klebsiella spp. (16.9%), and 10,271 strains of Proteus spp. (5.7%). The resistance rates of E. coli to imipenem, piperacillin-tazobactam and tigecycline remained lower than 4% while resistance rates to cefazolin, cefuroxime, and ciprofloxacin were higher (Fig. 3). The resistance rates of E. coli to cefazolin, cefuroxime, cefepime and gentamicin decreased gradually over seven years. Similarly, K. pneumoniae showed relatively high resistance rates to cefazolin, cefuroxime and ciprofloxacin, with resistance rates of 40%–60%. The average resistance frequencies of K. pneumoniae to tigecycline and polymyxin B were 6.9% (1027/14,890) and 3.2% (118/3708), respectively. In the early years of 2015–2021, susceptibility test for polymyxin B were conducted only when carbapenem resistance was identified in some hospitals; because of this, the results of polymyxin B are present for informational purposes only.

Fig. 3
figure 3

Resistance profiles of E. coli, K. pneumoniae, P. aeruginosa, and A. baumannii isolated from urine towards common antimicrobial agents over seven years. a Resistance rates of E. coli for antimicrobial agents; b Resistance rates of K. pneumoniae for antimicrobial agents; c Resistance rates of P. aeruginosa for antimicrobial agents; d Resistance rates of A. baumannii for antimicrobial agents

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Nonfermenting Gram-negative Bacilli

Low average resistance rates were observed toward polymyxin B (0.8%, 15/1899) and amikacin (5.4%, 480/8890) in P. aeruginosa. The resistance rates of P. aeruginosa to imipenem, ceftazidime, cefepime, cefoperazone-sulbactam, and piperacillin-tazobactam ranged from 8 to 17%. In addition, A. baumannii maintained a lower resistance rate to polymyxin B (0.7%, 7/934) and tigecycline (4.4%, 14/3234). More than 40% of the strains were resistant to ceftazidime and ciprofloxacin. Increasing trends were observed in the resistance rates of A. baumannii to amikacin, imipenem, cefepime, ceftazidime, piperacillin-tazobactam, cefoperazone-sulbactam and ciprofloxacin over the 7 years examined (Fig. 3).

Minocycline was the most effective antimicrobial agent in S. maltophilia strains, which had a resistance rate of only 2.2% (23/1050). The resistance rates to levofloxacin and TMP-SMZ of S. maltophilia were 14.4% (178/1234) and 12.9% (155/1202), respectively. Lower resistance rates in B. cepacia were observed against ceftazidime (3.3%, 32/967), meropenem (4.5%, 43/953) and TMP-SMZ (6.9%, 68/981).

Antimicrobial resistance within different populations

As shown in Fig. 4, the resistance rates to ampicillin and GEH in E. faecalis and E. faecium from ICU inpatients were significantly higher than in those from outpatients and other inpatients (P < 0.05).

Fig. 4
figure 4

Comparison of antibiotic resistance of E. faecalis, E. faecium, E. coli, Klebsiella spp., P. aeruginosa, and Acinetobacter spp. between the different populations. a Antibiotic resistance of E. faecalis between different populations; b Antibiotic resistance of E. faecium between different populations; c Antibiotic resistance of E. coli between different populations; d Antibiotic resistance of Klebsiella spp. between different populations; e Antibiotic resistance of P. aeruginosa between different populations; f Antibiotic resistance of Acinetobacter spp. between different populations

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The resistance rates to most β-lactam antimicrobials, aminoglycosides, and fluoroquinolones in E. coli and Klebsiella spp. from ICU inpatients were significantly higher than those from outpatients and other inpatients (P < 0.05). The resistance rates to most β-lactam antimicrobials in E. coli and Klebsiella spp. from pediatric outpatients and inpatients aged < 18 years were higher than those from inpatients aged ≥ 18 years, while the opposite was observed for resistance to aminoglycosides and fluoroquinolones.

Except for tigecycline and polymyxin, the resistance rates to other antimicrobial agents in P. aeruginosa and Acinetobacter spp. from ICU inpatients were significantly higher than those from outpatients and non-ICU inpatients (P < 0.05). Among non-ICU inpatients, the resistance rates to most antimicrobials in isolated from medical inpatients aged ≥ 18 years were higher than in those from surgical inpatients aged ≥ 18 years and inpatients aged < 18 years (P < 0.05). Detailed results are shown in Supplementary Tables 2–4.

Multidrug resistance (MDR) and special antimicrobial resistance

MDR was defined as resistantance to at least one antimicrobial agents from three or more different antimicrobial classes. The prevalence of MDR in E. coli, K. pneumoniae, E. faecium and E. faecalis was 72.0% (88,105/122,384), 62.1% (15,929/25,642), 77.0% (21,063/27,343), and 23.4% (5312/22,741), respectively. The prevalence of MDR E. coli and K. pneumoniae in male patients was higher than that in female patients while the prevalence of MDR E. faecalis in male patients was lower than that in female patients (P < 0.05). The prevalence of MDR was significantly higher in isolates from ICU inpatients than in non-ICU inpatients, emergency patients, and outpatients (P < 0.05). Further details are available in the Supplementary Table 5.

The prevalence of carbapenem-resistant A. baumannii (CRABA) increased from 27.6% in 2015 to 43.4% in 2021. The prevalence of carbapenem-resistant E. coli (CRECO) was relatively stable from 1.4% to 2.9% during the same period, while the prevalences of carbapenem-resistant K. pneumoniae (CRKPN) and carbapenem-resistant P. aeruginosa (CRPAE) fluctuated between 14.7% and 20.5%. A significant decrease in the prevalence of methicillin-resistant S. aureus (MRSA) was observed, from 40.6% in 2015 to 22.9% in 2021. The average prevalence of vancomycin-resistant E. faecalis and E. faecium were 0.1% and 1.3%, respectively, and those of linezolid-resistant E. faecalis and E. faecium were 2.2% and 0.3%, respectively (Fig. 5).

Fig. 5
figure 5

Prevalence of MRSA, CRECO, CRKPN, CRPAE, CRABA and VRE. MRSA: methicillin-resistant S. aureus; CRECO: carbapenem-resistant E. coli; CRKPN: carbapenem-resistant K. pneumoniae; CRPAE: carbapenem-resistant P. aeruginosa; CRABA: carbapenem-resistant A. baumannii; VRE: vancomycin-resistant Enterococcus

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Compared with female patients, the prevalence of CRECO, CRKPN and CRABA in male patients was significantly higher; the prevalence of CRECO and CRKPN was nearly two times greater in man than in women. The prevalence of CRECO, CRKPN, CRPAE and CRABA in ICU inpatients was higher than other patients (Supplementary Table 6).

Discussion

This is the first summary of antimicrobial resistance trends in uropathogens from CHINET system. The surveillance results showed that 76.2% of the bacteria isolated from urinary tract specimens were Gram-negative bacteria; E. coli, E. faecalis, E. faecium and K. pneumoniae were predominantly identified isolates. The dominant bacteria differed among populations of various ages and genders. The resistance patterns varied among different bacteria, and there were also differences in their changes over time.

Most of the strains were isolated from hospitalized patients. Uropathogens were more common in females and half were isolated from people > 60 years of age. E. coli, E. faecium, K. pneumoniae, P. mirabilis and S. agalactis were more frequently isolated from urine specimens from female patients, while E. faecalis, P. aeruginosa, E. cloacae, A. baumannii and S. aureus were more common in male patients. The proximity of the urethral orifice to the anus and short urethra in females may be the reason for a greater susceptibility to infection by intestinal bacteria [2, 3]. P. aeruginosa and A. baumannii, as common pathogens causing hospital-acquired infections [4, 5], were more common in male patients. It is worth further analysis to determine whether UTIs are hospital acquired or community acquired.

The most common Gram-negative bacilli isolated from urine samples were E. coli and K. pneumoniae, accounting for 46.7% and 9.8% of isolates, respectively, with high resistance rates to cefazolin, cefuroxime, and ciprofloxacin. The resistance rates to tigecycline, amikacin and imipenem were relatively low, which was consistent with the CHINET antimicrobial resistance monitoring results from other types of samples [6]. Fluoroquinolones cannot be easily catabolized in vivo and are mainly excreted in urine in a prototype form, so they are often used as empirical drugs for UTIs. Monitoring showed that the resistance rates to fluoroquinolones in E. coli and K. pneumoniae ranged from 50% to 70%. This is lower than that reported in the literature [7], where it was found that the resistance rate of E. coli from the urine of diabetes patients in Somalia to ciprofloxacin was 77.8%. Cai et al. reported that the resistance rates to ciprofloxacin were 29.9% and 52.4% in E. coli and Klebsiella spp. isolated from female outpatients affected by uncomplicated cystitis at three hospitals in Italy [8]. This indicates that the resistance rate varies among different populations in different regions. We found that the resistance rate to fluoroquinolones was lower in patients ≤ 18 years of age. In the analysis of the etiology of UTIs and antibiotic resistance of isolated strains at a pediatric hospital in Warsaw, the resistance rates of E. coli and Klebsiella spp. to ciprofloxacin were 11.9% and 31.1%, respectively. This suggests that the individualized treatment for UTIs should depend on host factors, severity of illness, and risk for multidrug resistance [3].

The prevalence of nosocomial infections caused by MDR pathogens is increasing and has attracted widespread attention, with complex treatment and high mortality rates [9]. In this 7-year retrospective study, the prevalence of MDR in E. coli, K. pneumoniae, E. faecium, and E. faecalis was 72.0%, 62.1%, 77.0%, and 23.4%, respectively, higher than that reported in the Jiaxing Region [10]. Although in this study, the prevalence of MRSA constantly decreased from 40.6% in 2015 to 22.9% in 2021, it was still relatively high compared with that in some European countries [11, 12]. MRSA bacteria often carries both aminoglycoside and quinolone resistantance genes and exhibits different degrees of resistance to β-lactams, aminoglycosides, quinolones, and other antibiotics [13]. Based on this study, in terms of medication selection for UTIs caused by MRSA, rifampicin, vancomycin or linezolid can be considered for UTIs caused by MRSA. The widespread use of carbapenems has led to a notable increase in the resistance rate, and carbapenem-resistance organisms (CROs) have emerged as a critical priority antibiotic-resistant pathogens worldwide [14, 15]. In this study we found a continuous increase in the prevalence of CRABA that was higher in male patients than in females; it even exceeded 80% in ICU inpatients. Clinicians should rationally select antibacterial drugs based on the results of bacterial culture and drug susceptibility testing, and closely monitor the treatment of CRO infection.

Carbapenem-resistant Enterobacteriaceae (CRE) have increased gradually and caused widespread concern and attention [16]. In this study, the prevalence of CRKPN isolated from urine was 18.5%, slowly increasing from 2015 to 2021; this trends was slightly lower than that from all specimens monitored in CHINET during the same period [17]. Tigecycline and polymyxin are relatively effective antimicrobials in in vitro drug sensitivity assays of CRE strains, but as their concentrations are low in urine and cannot reach effective therapeutic concentrations, they are not recommended for the treatment of UTIs caused by CRE. The Infectious Diseases Society of America [18] recommends ciprofloxacin, levofloxacin, trimethoprim-sulfamethoxazole, nitrofurantoin, or a single dose of an aminoglycoside are preferred treatment options; ceftazidime-avibactam, meropenem-vaborbactam, imipenem-cilastatin-relebactam, or cefiderocol are alternative options for UTIs caused by CRE.

The predominant Gram-positive cocci isolated from urine samples were E. faecalis and E. faecium (10.4% and 8.7%, respectively). According to monitoring results, E. faecalis was more prevalent than E. faecium in outpatients, E. faecium was more prevalent than E. faecalis in inpatients, and E. faecium accounted for nearly 80% of Gram-positive isolates in ICU inpatients. This is was consistent with the reports on antibiotic resistance patterns in uropathogens from selected hospitals in China and Poland [19, 20]. The resistance rates of E. faecalis to ampicillin and nitrofurantoin were less than 10%, while those of E. faecium to ampicillin and levofloxacin exceeded 90%. Empiric antibiotic therapy should be used with different priorities for UTIs caused by Enterococcus in different populations. Enterococcus is sensitive to vancomycin, linezolid, and teicoplanin, which are the most effective antimicrobial drugs against UTIs caused by this genera; however, some Enterococcus have developed resistance to vancomycin, linezolid, and teicoplanin in recent years, complicating the treatment of Enterococcus infections. In this study, the prevalences of vancomycin-resistant E. faecalis and E. faecium were 0.1% and 1.3%, respectively, while the prevalences of linezolid-resistant E. faecalis and E. faecium were 2.2% and 0.3%, respectively. The prevalence of VRE was lower than that in Europe and America [21,22,23], however, it should still be monitored with greater vigilance.

The resistance rates of Enterobacteriaceae and other bacteria from inpatients to most antimicrobial drugs were higher than those of isolates from outpatients and emergency patients. The resistance rates to most antimicrobial agents in ICU inpatients were significantly higher than those in non-ICU inpatients, outpatients and emergency patients; this may be because hospitalized patients are more likely to have a history of antibacterial drug use, which has a screening effect on antibiotic-resistant bacteria. ICU patients usually have a longer length of hospitalization and a higher risk of exposure to immunosuppressants, chemotherapy drugs and antibiotics [24, 25]. The incidence of multidrug-resistant bacterial infections in ICU inpatients is rising [26], making it essential to implement antimicrobial stewardship interventions in the ICU setting.

In summary, we analyzed the distribution trend and antimicrobial resistance of uropathogens in China through a 7-year retrospective study using the CHINET antimicrobial resistance surveillance program. Data were collected from 51 hospitals in different provinces and cities in China from 2015 to 2021, making the results extensively representative, though there were some limitations in our analysis. Firstly, this study was retrospective, meaning selection bias and incomplete data (such as that for polymyxin B resistance) may have been present. Secondly, we did not distinguish the differences in bacterial species and drug sensitivity among different urine collection methods such as catheter urine, and midstream urine, cystocentesis urine, etc. Lastly, we did not obtain more detailed information to associate the severity and duration of UTIs with bacterial species and drug resistance to provide more reference value for clinical treatment. Despite this, the findings provide a valuable reference for empiric treatment of UTIs.

Conclusions

E. coli, Enterococcus, and K. pneumoniae were the most common pathogens causing UTIs in China. The bacterial species and antimicrobial resistance in different patient populations are different. Strengthening of monitoring and surveillance of bacterial resistance in urine samples is needed to minimize the further spread and evolution of multidrug-resistant superbugs such as CRE and VRE.

Materials and methods

Bacterial strains and species identification

All aerobic bacteria isolated from urine specimens of outpatients and inpatients were obtained from the CHINET surveillance system for seven years between 2015 and 2021. Duplicate strains from the same patient were eliminated. Species identification was performed by a commercialized automated system at each participating site and confirmed by matrix-assisted laser desorption ionization-time of flight mass spectrometry at the central laboratory. The quality control strains were S. aureus ATCC25923, E. coli ATCC25922, P. aeruginosa ATCC27853, and E. faecalis ATCC29212.

Antimicrobial susceptibility testing

According to a CHINET uniform protocol, the broth microdilution method was used for minimum inhibitory concentration (MIC) testing by an automated antimicrobial susceptibility system, and the Kirby-Bauer disk diffusion method was used to supplement some antimicrobial agents that were not available in automated systems. Throughout the seven-year sampling period, the methodology remained unchanged in every participating hospital.

All results were interpreted by using breakpoints for susceptibility and resistance according to the Clinical and Laboratory Standards Institute (CLSI) 2022 M100-32 guidelines [27], except for tigecycline and polymyxin B. The MICs of tigecycline were interpreted following the breakpoint established by US Food and Drug Administration [28], while the The MICs of polymyxin B were interpreted following the European Committee on Antimicrobial Susceptibility Testing (EUCAST) MIC interpretive breakpoints for colistin [29].

Data analysis 

Statistical analysis was conducted using WHONET5.6 software. Pearson’s χ2 test or Fisher’s exact test were used for comparisons between two groups. Statistical significance was set at P < 0.05 (two-tailed).

Availability of data and materials

The datasets used or analyzed during the current study are available in CHINET, www.chinets.com.

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Acknowledgements

We would like to express our thanks to members of CHINET for their contribution in the collection of the isolates in this study, including the following: Yang Yang, Fupin Hu, and Demei Zhu from the Institute of Antibiotics, Huashan Hospital, Fudan University; Yingchun Xu and Xiaojiang Zhang from Peking Union Medical College Hospital; Fengbo Zhang and Ping Ji from the First Afliated Hospital of Xinjiang Medical University; Yi Xie and Mei Kang from West China Hospital, Sichuan University; Chuanqing Wang and Pan Fu from Children’s Hospital of Fudan University; Yuanhong Xu and Ying Huang from the First Afliated Hospital of Anhui Medical University; Zhongju Chen and Ziyong Sun from Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology; Yuxing Ni and Jingyong Sun from Ruijin Hospital, Shanghai Jiaotong University School of Medicine; Yunzhuo Chu and Sufei Tian from the First Afliated Hospital of China Medical University; Zhidong Hu and Jin Li from Tianjin Medical University General Hospital; Yunsong Yu and Jie Lin from Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; Bin Shan and Yan Du from the First Afliated Hospital of Kunming Medical University; Sufang Guo and Yanyan Wang from the First Afliated Hospital of Inner Mongolia Medical University; Lianhua Wei and Fengmei Zou from Gansu Provincial Hospital; Hong Zhang and Chun Wang from Children’s Hospital of Shanghai; Yunjian Hu and Xiaoman Ai from Beijing Hospital; Chao Zhuo and Danhong Su from the First Afliated Hospital of Guangzhou Medical University; Dawen Guo and Jinying Zhao from the First Afliated Hospital of Harbin Medical University; Xiangning Huang and Hua Yu from Sichuan Provincial People’s Hospital; Yan Jin and Chunhong Shao from Shandong Provincial Hospital; Xuesong Xu and Chao Yan from China-Japan Union Hospital, Jilin University; Shanmei Wang and Yafei Chu from Henan Provincial People’s Hospital; Lixia Zhang and Juan Ma from Shaanxi Provincial People’s Hospital; Shuping Zhou and Yan Zhou from Jiangxi Provincial Children’s Hospital; Lei Zhu and Jinhua Meng from Children’s Hospital of Shanxi; Fang Dong and Zhiyong Lu from Beijing Children's Hospital affiliated to Capital Medical University; Fangfang Hu from Guizhou Provincial People’s Hospital; Han Shen and Wanqing Zhou from Nanjing Drum Tower Hospital, Afliated Hospital of Nanjing; Gang Li and Wei Jia from General Hospital of Ningxia Medical University; Jinsong Wu and Yuemei Lu from Shenzhen People’s Hospital; Jihong Li from the Second Hospital of Hebei Medical University; Jinju Duan and Jianbang Kang from the Second Hospital of Shanxi Medical University; Xiaobo Ma and Yanping Zheng from The First Afliated Hospital of Xiamen University; Ruyi Guo and Yan Zhu from Quanzhou First Hospital, Fujian; Yunsheng Chen and Qing Meng from Shenzhen Children’s Hospital; Shifu Wang from Qilu Children's Hospital of Shandong University; Xuefei Hu from the First Affiliated Hospital of Nanchang University; Jilu Shen from the Fourth Affiliated Hospital of Anhui Medical University; Ruizhong Wang and Hua Fang from Pudong New Area People’s Hospital; Bixia Yu from Zhejiang Ningbo Zhenhai Longsai Hospital; Ping Gong and Yong Zhao from the People’s Hospital of Zigui, Hubei Province; Kaizhen Weng and Yirong Zhang from Jinjiang Municipal Hospital; Jiangshan Liu from Jinchang Hospital of Integrated Traditional Chinese and Western Medicine; Longfeng Liao from the People’s Hospital of Ganxian; Hongqin Gu from Guangrao County People’s Hospital; Lin Jiang from the People’s Hospital of Huixian, Henan Province; Wen He from Central Hospital of Yingkou Development Zone, Liaoning Province; Shunhong Xue from Huzhu County People’s Hospital, Qinghai Province; Jiao Feng from the People’s Hospital of Linshui, Sichuan Province and Chunlei Yue from Jiutai People’s Hospital.

Funding

This work was funded by the China Antimicrobial Surveillance Network (independent medical grants from Pfizer, 2020QD049) and the Innovative R&D Project Subsidy Program of the Hunan Provincial Development and Reform Commission (Project No. 2019875).

Author information

Authors and Affiliations

  1. Department of Clinical Laboratory, Xiangya Hospital, Central South University, Hunan Province, Changsha, 410008, China

    Yanming Li, Mingxiang Zou, Qun Yan, Jingzhong Liao & Wenen Liu

  2. National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Hunan Province, Changsha, China

    Wenen Liu

Authors
  1. Yanming Li
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  2. Mingxiang Zou
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  3. Qun Yan
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  4. Jingzhong Liao
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  5. Wenen Liu
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Consortia

on behalf of the China Antimicrobial Surveillance Network (CHINET) Study Group

  • Yang Yang
  • , Fupin Hu
  • , Demei Zhu
  • , Yingchun Xu
  • , Xiaojiang Zhang
  • , Fengbo Zhang
  • , Ping Ji
  • , Yi Xie
  • , Mei Kang
  • , Chuanqing Wang
  • , Pan Fu
  • , Yuanhong Xu
  • , Ying Huang
  • , Zhongju Chen
  • , Ziyong Sun
  • , Yuxing Ni
  • , Jingyong Sun
  • , Yunzhuo Chu
  • , Sufei Tian
  • , Zhidong Hu
  • , Jin Li
  • , Yunsong Yu
  • , Jie Lin
  • , Bin Shan
  • , Yan Du
  • , Sufang Guo
  • , Yanyan Wang
  • , Lianhua Wei
  • , Fengmei Zou
  • , Hong Zhang
  • , Chun Wang
  • , Yunjian Hu
  • , Xiaoman Ai
  • , Chao Zhuo
  • , Danhong Su
  • , Dawen Guo
  • , Jinying Zhao
  • , Xiangning Huang
  • , Hua Yu
  • , Yan Jin
  • , Chunhong Shao
  • , Xuesong Xu
  • , Chao Yan
  • , Shanmei Wang
  • , Yafei Chu
  • , Lixia Zhang
  • , Juan Ma
  • , Shuping Zhou
  • , Yan Zhou
  • , Lei Zhu
  • , Jinhua Meng
  • , Fang Dong
  • , Zhiyong Lu
  • , Fangfang Hu
  • , Han Shen
  • , Wanqing Zhou
  • , Gang Li
  • , Wei Jia
  • , Jinsong Wu
  • , Yuemei Lu
  • , Jihong Li
  • , Jinju Duan
  • , Jianbang Kang
  • , Xiaobo Ma
  • , Yanping Zheng
  • , Ruyi Guo
  • , Yan Zhu
  • , Yunsheng Chen
  • , Qing Meng
  • , Shifu Wang
  • , Xuefei Hu
  • , Jilu Shen
  • , Ruizhong Wang
  • , Hua Fang
  • , Bixia Yu
  • , Ping Gong
  • , Yong Zhao
  • , Kaizhen Weng
  • , Yirong Zhang
  • , Jiangshan Liu
  • , Longfeng Liao
  • , Hongqin Gu
  • , Lin Jiang
  • , Wen He
  • , Shunhong Xue
  • , Jiao Feng
  •  & Chunlei Yue

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Y.L. and J.L. The first draft of the manuscript was written by Y.L. and the final review was done by W.L. and Q.Y.. All authors contributed to the article and approved the submitted version.

Corresponding authors

Correspondence to Jingzhong Liao or Wenen Liu.

Ethics declarations

Ethics approval and consent to participate

The study protocol was approved by the Institutional Review Board of Huashan Hospital, Fudan University (no. 2019–460).

Consent for publication

Not applicable.

Competing interests

The authors report no conflicts of interest in this work.

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Li, Y., Zou, M., Yan, Q. et al. Trend of distribution and antimicrobial resistance in uropathogens in China from the CHINET antimicrobial resistance surveillance program, a 7-year retrospective study. One Health Adv. 2, 16 (2024). https://doi.org/10.1186/s44280-024-00045-z

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  • DOI: https://doi.org/10.1186/s44280-024-00045-z

Keywords

One Health Advances

ISSN: 2731-9970

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