Changing antimicrobial resistance profile of Enterobacter spp. isolates in hospitals across China: a seven-year analysis from the CHINET antimicrobial resistance surveillance program (2015–2021)
Authors: Yan Shaozhen , Sun Ziyong , Yang Yang , Zhu Demei , Chen Zhongju ,   on behalf of the China Antimicrobial Surveillance Network (CHINET) Study Group, Hu Fupin , Xie Yi , Kang Mei , Zhang Fengbo , Ji Ping , Hu Zhidong , Li Jin , Guo Sufang , Shen Han , Zhou Wanqing , Xu Yingchun , Zhang Xiaojiang , Xu Xuesong , Yan Chao , Wang Chuanqing , Fu Pan , Jia Wei , Li Gang , Xu Yuanhong , Huang Ying , Guo Dawen , Zhao Jinying , Liu Wenen , Li Yanming , Yu Hua , Huang Xiangning , Shan Bin , Du Yan , Wang Shanmei , Chu Yafei , Ni Yuxing , Sun Jingyong , Yu Yunsong , Lin Jie , Zhuo Chao , Su Danhong , Wei Lianhua , Zou Fengmei , Jin Yan , Shao Chunhong , Li Jihong , Zhang Lixia , Ma Juan , Chu Yunzhuo , Tian Sufei , Duan Jinju , Kang Jianbang , Wang Ruizhong , Fang Hua , Hu Fangfang , Hu Yunjian , Ai Xiaoman , Dong Fang , Lv Zhiyong , Zhang Hong , Wang Chun , Zhao Yong , Gong Ping , Zhu Lei , Meng Jinhua , Ma Xiaobo , Zheng Yanping , Wu Jinsong , Lu Yuemei , Guo Ruyi , Zhu Yan , Wen Kaizhen , Zhang Yirong , Yue Chunlei , Liu Jiangshan , Huang Wenhui , Xue Shunhong , Hu Xuefei , Gu Hongqin , Feng Jiao , Zhou Shuping , Zhou Yan , Chen Yunsheng , Meng Qing , Yu Bixia , Shen Jilu , Dou Rui , Wang Shifu , He Wen , Liao Longfeng , Jiang Lin 
Published: April 2024

Antimicrobial resistance poses a global threat to human health. Analyzing monitoring data on antimicrobial resistance can assist clinicians in making strategic decisions and promptly identifying outbreaks of antimicrobial-resistant organisms. The China Antimicrobial Surveillance Network (CHINET) was established in 2004 to monitor the trends in bacterial epidemiology and antimicrobial resistance. In this study, we analyzed the distribution and changing antimicrobial resistance profiles of Enterobacter spp. isolated from 53 hospitals across China between 2015 and 2021 using the CHINET data. Over the seven-year period, a total of 37,966 clinical isolates of Enterobacter spp. were obtained, accounted for 2.5% of all isolates and 5.7% of Enterobacteriaceae isolates. Among those isolates, Enterobacter cloacae was the most prevalent, comprising 93.7% (35,571/37,966). The majority of strains were isolated from respiratory tract samples (44.6%), followed by secretion, pus (16.4%), and urine samples (16.0%). As for patient composition, 37,966 Enterobacter spp. strains were predominantly isolated from inpatients (92.9%), whereas 7.1% were isolated from outpatients and emergency patients. Among inpatients, isolates from patients in surgical ward accounted for the highest percentage (24.4%). E. cloacae exhibited the lowest rates of resistance to amikacin, tigecycline, polymyxin B, imipenem, and meropenem (resistance rates < 8%). However, the percentage of carbapenem-resistant Enterobacter spp. was 10.0%, presenting a rising tendency over the 7-year study period. Antimicrobial resistance profiles of Enterobacter spp. isolates varied according to the department of isolation and patient age (adult or child), with the intensive care unit having the highest proportion of carbapenem-resistant Enterobacter spp. isolates.