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May 5, 2018 - 32.000. 16.000–64.000. 98.9. 32.000. 32.000. 16.000–64.000. Cefoperazone/ sulbactam. 50.0. 32.000. 128.000. 16.000–128.000. 70.6. 64.000.

Original Article

Multi-level analysis of bacteria isolated from inpatients in respiratory departments in China Xiang Tang1, Meng Xiao2, Chao Zhuo1, Yingchun Xu2, Nanshan Zhong1 1

State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510230, China;

2

Department of Clinical Laboratory, Peking Union Medical College Hospital, Beijing 100000, China

Contributions: (I) Conception and design: C Zhuo; (II) Administrative support: N Zhong; (III) Provision of study materials or patients: Y Xu; (IV) Collection and assembly of data: M Xiao; (V) Data analysis and interpretation: X Tang; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Chao Zhuo. 151 Yanjiang Road, Guangzhou 510230, China. Email: [email protected]

Background: With the different situation for clinical antibiotic usage and its management in different regions and medical institutions, the antimicrobial resistance varied in different level. However, the epidemiological data of multi-drug resistant (MDR) strains from the department of respiration is limited. Thus, this study aims to investigate the epidemiology of bacteria isolated from inpatients of respiratory departments, and analyze the distribution variation of major multi-drug resistant bacteria in China. Methods: Based on data from China Antimicrobial Resistance Surveillance System (CARSS) in 2015, 50,417 non-duplicate isolates obtained from inpatients of respiratory departments from 91 general hospitals in seven regions of China were enrolled in the study. The distribution of methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Escherichia coli (CREC) and Klebsiella pneumoniae (CRKP), carbapenem-resistant Pseudomonas aeruginosa (CRPA) and Acinetobacter baumannii (CRAB), extendedspectrum β-lactamases-producing E. coli (ESBL-EC) and K. pneumoniae (ESBL-KP), were further analyzed by geographic regions, age groups, wards and specimen types. Results: The major specimens type were sputum (81.6%, 41,131/50,417), followed by blood (5.3%, 2,649/50,417), urine (4.5%, 2,249/50,417) and bronchoalveolar lavage fluid (BALF) (3.2%, 1,620/50,417). The top four bacteria species isolated from sputum and BALF were similar: K. pneumonia (18.9% and 14.8%, respectively), P. aeruginosa (13.6% and 22.2%, respectively), A. baumannii (11.3% and 11.9%, respectively) and S. pneumonia (11.1% and 9.6%, respectively). The four most common bacteria species were K. pneumonia (17.2%), P. aeruginosa (12.1%), A. baumannii (10.4%) and S. pneumonia (10.1%) in tertiary hospitals but K. pneumonia (20.8%), P. aeruginosa (16.3%), E. coli (11.3%) and A. baumannii (6.9%) in secondary hospitals. The top four bacteria species in respiratory intensive care unit (RICU) were A. baumannii (25.8%), P. aeruginosa (13.1%), K. pneumonia (12.2%) and S. aureus (9.2%). The prevalence of CRKP, CRPA and CRAB in tertiary hospitals was significantly higher than that in secondary hospitals (5.2% vs. 2.5%, 23.8% vs. 12.8% and 53.5% vs. 33.9%, respectively) (all P