Abstract:Transmission of antimicrobial-resistant organisms(AROs) is a serious threat to human health, currently, the problem of antimicrobial resistance is becoming more and more serious, causing a great burden on medical and health care. Strengthening the prevention, control, diagnosis and treatment of AROs infection is an important part of the prevention and control of AROs infection in medical institutions. This consensus analyzes the current situation of epidemiology, antimicrobial resistance mechanism and laboratory detection of clinically important AROs, and puts forward expert recommendations on the prevention and control of transmission of AROs infection, aiming to improve the awareness of prevention and control, standardize the prevention and control strategy of transmission of clinically important AROs infection, and clarify the prevention and control process.

Abstract:Objective To understand the distribution and antimicrobial resistance of common pathogens in clinical specimens in China from 2014 to 2019, provide scientific basis for the rational clinical antimicrobial use as well as the formulation and evaluation of management policies for antimicrobial clinical use. Methods According to China Antimicrobial Resistance Surveillance System(CARSS) technical program, antimicrobial resistance of all isolated bacteria reported by CARSS in 2014-2019 were analyzed with WHONET 5.6 software. Results From 2014 to 2019, the top 5 isolated Gram-positive bacteria were Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Streptococcus pneumoniae, and Enterococcus faecium, the top 5 isolated Gram-negative bacteria were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacter cloacae. In the past 6 years, isolation rates of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase negative Staphylococcus (MRCNS) decreased from 36.0% to 30.2% and 79.8% to 75.4% respectively. Isolation rates of vancomycin-resistant Enterococcus faecalis and Enterococcus faecium showed a downward trend (from 0.8% to 0.2% and from 2.9% to 1.1% respectively). Isolation rate of penicillin-resistant Streptococcus pneumoniae (PRSP) also decreased from 4.3% to 1.6%. Isolation rates of imipenem-resistant Pseudomonas aeru-ginosa changed little (18.2%-21.0%). Antimicrobial resistance rate of Acinetobacter baumannii was more than 50%. Resistance rates of Escherichia coli and Klebsiella pneumoniae to cefotaxime decreased gradually, resistance rates of Escherichia coli to imipenem didn’t change much, and were all lower than 1.5%. Resistance rate of Klebsiella pneumoniae to imipenem increased from 4.8% to 10.5%. Resistance rates of Haemophilus influenzae to all kinds of antimicrobial agents increased, resistance rate to ampicillin increased from 48.1% to 69.0%. Conclusion Isolation rates of MRSA, MRCNS and vancomycin-resistant Enterococcus decreased. Isolation rate of imipenem-resistant Klebsiella pneumoniae showed an upward trend, resistance of Acinetobacter baumannii to all kinds of antimicrobial agents is serious, resistance rates of Haemophilus influenzae to all kinds of antimicrobial agents increased. Management of rational use of antimicrobial agents as well as prevention and control of healthcare-associated infection should be strengthened continuously, antimicrobial resistance surveillance should be conducted well.

Abstract:Objective To surveil the distribution and antimicrobial susceptibility of clinically isolated bacteria from outpatients in China from 2014 to 2019. Methods According to China Antimicrobial Resistance Surveillance System (CARSS) program, clinically isolated bacteria and antimicrobial susceptibility testing results of outpatients reported by all CARSS member hospitals in 2014-2019 were analyzed by WHONET 5.6 software. Results The total number of bacteria isolated from outpatients in 2014-2019 were 53 243-91 692 strains, Gram-negative bacteria accounted for 75.3%, 57.3%, 58.3%, 58.5%, 60.5% and 60.9% respectively, Gram-positive bacteria accounted for 24.7%, 42.7%, 41.7%, 41.5%, 39.5% and 39.1% respectively. Isolation rates of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase negative Staphylococcus (MRCNS) were 25.1%-27.8% and 68.3%-72.4% respectively. Resistance rates of MRSA and MRCNS to most antimicrobial agents were higher than those of methicillin susceptible strains, vancomycin-, teicoplanin- and linezolid-resistant strains were not found. Resistance rates of Enterococcus faecalis to most tested antimicrobial agents were lower than those of Enterococcus faecium, and both had a few vancomycin-resistant strains. Resistance rate of Streptococcus pneumoniae isolated from non-cerebrospinal fluid specimens to penicillin were 1.0%-2.3%. Resistance rates of Pseu-domonas aeruginosa and Acinetobacter baumannii to imipenem were 10.7%-15.2% and 38.5%-49.4% respectively; resistance rates of Escherichia coli to cefotaxime and imipenem were 48.0%-55.6% and 0.6%-0.8% respectively; resistance rates of Klebsiella pneumoniae to cefotaxime and imipenem were 31.0%-38.3% and 3.9%-6.3% respectively. Resistance rates of Haemophilus influenzae to ampicillin were 37.5%-55.6%. Conclusion Antimicrobial resistance of clinically isolated bacteria from outpatients is still serious, especially carba-penem-resistant Gram-negative bacilli and methicillin-resistant Staphylococcus.

Abstract:Objective To investigate the change in distribution and antimicrobial resistance of bacteria isolated from cerebrospinal fluid (CSF) specimens in China. Methods According to China Antimicrobial Resistance Surveillance System(CARSS) technical program, data of bacteria isolated from CSF specimens and antimicrobial susceptibility testing results reported by CARSS member hospitals in 2014-2019 were analyzed with WHONET 5.6 software. Results From 2014 to 2019, a total of 99 741 strains of bacteria were isolated from CSF, the top 5 were coagulase negative Staphylococcus (49 902 strains, 50.0%), Acinetobacter baumannii (7 692 strains, 7.7%), Escherichia coli (5 561 strains, 5.6%), Klebsiella pneumoniae (4 653 strains, 4.7%), and Staphylococcus aureus (4 295 strains, 4.3%). Isolation rate of methicillin-resistant Staphylococcus aureus (MRSA) decreased from 48.2% in 2014 to 39.9% in 2019; isolation rates of penicillin-resistant Streptococcus pneumoniae (PRSP) maintained above 70%; resistance rates of Enterococcus faecium to most tested antimicrobial agents were higher than Enterococcus faecalis; resistance rates of most Escherichia coli strains to ceftriaxone were >60%, to carbapenems were low, but with an upward trend: resistance rates to meropenem and imipenem increased from 2.6% to 4.6% and from 1.7% to 4.5% respectively; resistance rate of Klebsiella pneumoniae to ceftriaxone was>50%, and to carbapenems increased rapidly: resistance rates to meropenem and imipenem increased from 13.1% to 30.9% and from 12.6% to 30.4% respectively. Resistance rates of Acinetobacter baumannii and Pseudomonas aeruginosa to meropenem had decreased tendency, from 74.2% to 71.7% and 32.6% to 27.8% respectively. Conclusion Antimicrobial resistance of clinical isolates of CSF is still high, surveillance on antimicrobial resistance is very important for the effective treatment of central nervous system infection.

Abstract:Objective To investigate the change in distribution and antimicrobial resistance of bacteria isolated from urine specimens in China. Methods According to the technical program of China Antimicrobial Resistance Surveillance System (CARSS), data of bacteria isolated from urine specimens and antimicrobial susceptibility testing results reported by all CARSS member hospitals from 2014 to 2019 were analyzed by WHONET5.6 software. Results The top 5 bacteria isolated from urine specimens of male patients were Escherichia coli (33.1%-34.6%), Enterococcus faecalis (9.2%-10.2%), Klebsiella pneumoniae (9.0%-9.4%), Enterococcus faecium (7.8%-10.2%) and Pseudomonas aeruginosa (5.6%-6.9%), the top 5 bacteria isolated from urine specimens of female patients were Escherichia coli (57.0%-57.4%), Klebsiella pneumoniae (7.5%-8.3%), Enterococcus faecium (6.8%-8.7%), Enterococcus faecalis (5.5%-6.0%) and Proteus mirabilis (3.3%-3.5%). Resis-tance rates of Enterococcus faecalis from urine specimens of male and female patients to ampicillin and nitrofurantoin were <12% and 7% respectively, to vancomycin was <3%; resistance rates of Enterococcus faecium to ampicillin and levofloxacin were both about 90%, to vancomycin were <4%. Resistance rates of Escherichia coli to ceftria-xone were>47%, to cefoperazone/sulbactam, piperacillin/tazobactam, and nitrofurantoin were all ≤8%, resis-tance rate to β-lactams in male patients was higher than in female patients, resistance rate to ceftriaxone was about 12 percentage higher. Resistance rates of Klebsiella pneumoniae isolated from male and female patients to ceftria-xone were about 58% and about 45% respectively. Resistance rates of Pseudomonas aeruginosa isolated from urine specimens of male and female patients to cefoperazone/sulbactam and piperacillin/tazobactam were both <14%, resistance rates to carbapenems were about 15%. Resistance rates of Acinetobacter baumannii to cefoperazone/sulbactam and minocycline were <27% and <22% respectively, resistance rates to carbapenems were 31.7%-47.7% in males and 26.5%-41.2% in females. Conclusion Constituent of bacteria isolated from urine specimens is different in different genders, antimicrobial resistance rates of partial Enterobacteriaceae are different among different genders, resistance rates of partial bacteria also changed in different years. Surveillance on antimicrobial resistance of bacteria isolated from urine specimens can provide reference data for the rational use of antimicrobial agents in urinary tract infection.

Abstract:Objective To investigate the changes of antimicrobial resistance of bacteria from bronchoalveolar lavage fluid (BALF) specimens in China. Methods Data of BALF specimens were extracted from China Antimicrobial Resistance Surveillance System (CARSS) surveillance report in 2014-2019, antimicrobial resistance was analyzed by WHONET 5.6 software. Results From 2014 to 2019, a total of 140 321 strains of bacteria were isolated from BALF specimens, the top 5 bacteria were Pseudomonas aeruginosa (19.1%), Acinetobacter baumannii (16.6%), Klebsiella pneumoniae (16.6%), Staphylococcus aureus (7.8%) and Streptococcus pneumoniae (6.2%). Antimicrobial susceptibility data of 6 years showed that isolation rates of methicillin-resistant Staphylococcus aureus (MRSA) were 52.3%, 55.5%, 51.4%, 42.8%, 40.6% and 37.9% respectively, vancomycin-, teicoplanin- and line-zolid-resistant Staphylococcus aureus were not found. The overall resistance rates of Streptococcus pneumoniae to penicillin were 1.0%-4.4%, penicillin-nonsusceptible Streptococcus pneumonia (PNSP) showed a downward trend year by year; except for compound sulfamethoxazole, resistance of Klebsiella pneumoniae to other antimicrobial agents increased year by year, especially for carbapenems, resistance was significantly higher than that of Esche-richia coli and Enterobacter cloacae. Among non-fermentative bacteria, resistance rates of Pseudomonas aeruginosa were relatively low, most were below 30%; resistance rates of Acinetobacter baumannii to all tested antimicrobial agents didn’t change much generally, but its resistance rates to most antimicrobial agents were relatively high, most were more than 50%. Conclusion Gram-negative bacilli are the main pathogens isolated from BALF specimens in China, and antimicrobial resistance is serious. It is suggested that high-quality BALF specimens should be sent for clinical examination, pathogen detection should be paid attention to, and antimicrobial agents should be used rationa-lly according to the corresponding antimicrobial resistance surveillance data.

Abstract:Objective To understand the change in antimicrobial resistance of clinical non-fermentative Gram-negative bacilli in China. Methods Surveillance on antimicrobial resistance was carried out according to the requirements of China Antimicrobial Resistance Surveillance System(CARSS), referring to Clinical & Laboratory Stan-dards Institute(CLSI) standard, clinical data of non-fermentative Gram-negative bacilli reported to CARSS by more than 1 000 hospitals in China from 2014 to 2019 were summarized and analyzed. Results Non-fermentative Gram-negative bacilli were mainly isolated from respiratory tract specimens(sputum and bronchoalveolar lavage fluid), urine, pus, and blood, accounting for 83.6%, 6.5%, 4.0% and 3.6% respectively. Isolation rates of Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia, and Burkholderia cepacia were 8.8%, 7.3%, 2.1% and 0.5% respectively. Susceptibility rates of Pseudomonas aeruginosa to polymyxin B, amikacin and gentamicin were 96.9%-98.2%, 89.1%-94.0% and 80.1%-86.4% respectively; susceptibility rates to piperacillin and aztreonam were 66.7%-72.8% and 58.8%-62.4% respectively; susceptibility rates to other antimicrobial agents were 70.4%-81.7%. Susceptibility rates of Acinetobacter baumannii to polymyxin B, amikacin and minocycline were 96.2%-98.0%, 51.0%-58.0% and 59.4%-63.4% respectively, to other antimicrobial agents were 35.8%-50.0%. Susceptibility rates of Stenotrophomonas maltophilia to minocycline, sulfamethoxazole and levofloxacin were 93.0%-95.3%, 89.3%-91.4% and 85.0%-86.6% respectively, susceptibility rates to ticarcillin/clavulanic acid and chloramphenicol were 37.4%-50.3% and 46.6%-51.1% respectively. Susceptibility rates of Burkholderia cepacia to ticarcillin/clavulanic acid and chloramphenicol were 18.5%-37.0% and 54.4%-62.2% respectively, susceptibility rates to other antimicrobial agents maintained 64.7%-86.8%. Isolation rate of carbapenem-resistant Pseudomonas aeruginosa decreased, while isolation rate of carbapenem-resis-tant Acinetobacter baumannii increased first and then decreased. Conclusion There is no significant change in susceptibility of non-fermentative Gram-negative bacilli to commonly used antimicrobial agents, isolation rates of carbapenem-resistant Pseudomonas aeruginosa and carbapenem-resistant Acinetobacter baumannii showed a downward trend.

Abstract:Objective To understand the distribution and antimicrobial resistance of bacteria in biliary tract infection in China, and provide reference for clinical antimicrobial choice. Methods According to China Antimicrobial Resistance Surveillance System(CARSS) technical program, data of bacteria isolated from bile specimen and antimicrobial susceptibility testing results reported by CARSS member hospitals in 2014-2019 were analyzed with WHONET 5.6 software, the same bacteria from the same patient was only adopted the first strain. Results A total of 268 016 bacterial strains were analyzed, the top 8 were Escherichia coli (30.9%), Klebsiella pneumoniae (12.7%), Enterococcus faecium (10.1%), Enterococcus faecalis (8.6%), Pseudomonas aeruginosa (4.9%), Enterobacter cloacae (4.5%), Acinetobacter baumannii (2.2%), and Citrobacter freundii (1.8%). Antimicrobial susceptibility testing results of 6 years showed that resistance rates of Escherichia coli and Klebsiella pneumoniae to third-generation cephalosporins were 33.7%-65.6% and 23.6%-43.5% respectively, to quinolones were 48.9%-56.6% and 22.0%-28.5% respectively, to carbapenems were 1.1%-3.7% and 3.5%-7.6% respectively; resistant rates of Pseudomonas aeruginosa and Acinetobacter baumannii to cefoperazone/sulbactam were 13.4%-19.0% and 29.3%-42.7% respectively, to carbapenems were 18.0%-28.0% and 44.5%-59.9% respectively; resistance rates of Enterococcus faecium and Enterococcus faecalis to vancomycin were 0.6%-1.7% and 0.3%-0.7% respectively. Conclusion Gram-negative bacilli are predominant pathogens in biliary tract infection in China, the mjor bacteria were Enterobacteriaceae; pathogens are resistant to multiple antimicrobial agents, clinical antimicrobial choice should refer to antimicrobial resistance surveillance results.

Abstract:Objective To understand the diagnosis, treatment and infection route of a case of severe fever with thrombocytopenia syndrome(SFTS), provide basis for formulating its prevention and control strategy. Methods The case was performed field epidemiological and seroepidemiological investigation. Results Patient was diagnosed with SFTS according to epidemiological history, clinical manifestations, and laboratory examination results. Prior to the illness onset, patient had a history of fluid contact with confirmed case of SFTS in Hubei Province, no tick was found in epidemic regions, and no other cases were found through case search. Conclusion The patient is the first confirmed case of SFTS in Guangdong Province, and the source of infection is from Hubei Province.

Abstract:Emerging infectious diseases (EIDs) are infectious diseases newly emerged or newly recognized among population, as well as infectious diseases that have been recognized in the past, but incidence or geographical area of diseases has increased or will increase rapidly, usually refer to the infectious diseases found since the 1970s. Due to the lack of background information, it is difficult to give early warning and response in time, EIDs pose a huge threat to human health. Hospital is the main battlefield to deal with EIDs, in recent years, hospitals revealed the problems of low early warning ability, insufficient preparation, and weak disposal capacity in the face against EID events. Strengthening the ability of monitoring, early warning and response to EIDs is of great significance to improve the overall level of disease prevention and control in China. In this paper, advances in EID symptom monitoring, early warning and disposal capacity of hospitals at home and abroad are reviewed.