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

Abstract

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 bla _KPC-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; antimicrobial susceptibility surveillance; carbapenem-resistant; gram-negative bacilli.

Figure 1

Cumulative MIC of E. coli, (K) pneumoniae, (P) aeruginosa, and A. baumannii against antimicrobial agents. (A and B) Cumulative MIC of E. coli, K. pneumoniae, P. aeruginosa, and A. baumannii against carbapenems. (C and D) Cumulative MIC of E. coli, K. pneumoniae, P. aeruginosa, and A. baumannii against major cephalosporins including ceftazidime, ceftriaxone, and cefotaxime. (E and F) Cumulative MIC of E. coli, K. pneumoniae, P. aeruginosa, and A. baumannii against quinolones. (G and H) Cumulative MIC of E. coli, K. pneumoniae, P. aeruginosa, and A. baumannii against cefoperazone-sulbactam and piperacillin-tazobactam.