High prevalence of ESBL-producing<i>Escherichia coli</i>and<i>Klebsiella pneumoniae</i>in community-onset bloodstream infections in China

Quan, Jingjing; Zhao, Dongdong; Liu, Lilin; Chen, Yan; Zhou, Jiancang; Jiang, Yan; Du, Xiaoxing; Zhou, Zongtan; Akova, Murat; Yu, Yunsong

doi:10.1093/jac/dkw372

Cited by 108 publications

(84 citation statements)

References 37 publications

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“…The region is connected to hotspots of AMR as Asia (12.0% of traffic) characterized by high AMR prevalence in community [e.g., ESBL in China (69), important antibiotic consumption (70), and emergence of new AMR profiles (e.g., NDM-1, mcr-1) (71)]. Screening of travelers, returning from at risk AMR areas, with a history of hospitalization and consumption of antibiotic drugs abroad has been recently proposed (72) and could be relevant for an early emergence detection.…”

Section: Perspectivesmentioning

confidence: 99%

Review of Antibiotic Resistance in the Indian Ocean Commission: A Human and Animal Health Issue

Belmonte

Collard

Halifa³

et al. 2017

Front. Public Health

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Antimicrobial resistance (AMR) is a major threat to human, animal health, and environment worldwide. For human, transmission occurred through a variety of routes both in health-care settings and community. In animals, AMR was reported in livestock, pets, and wildlife; transmission of AMR can be zoonotic with the probably most important route being foodborne transmission. The Indian Ocean Commission (IOC), composed of Comoros, Madagascar, Mauritius, Reunion (France), and Seychelles recognized the surveillance of AMR in both animal and human as a main public health priority for the region. Mayotte, French overseas territory, located in Comoros archipelago, was also included in this review. This review summarized our best epidemiological knowledge regarding AMR in Indian Ocean. We documented the prevalence, and phenotypic and genotypic profiles of prone to resistance Gram-positive and Gram-negative bacteria both in animals and humans. Our review clearly pointed out extended-spectrum β-lactamase and carbapenemase-producing Enterobacteriaceae as main human and animal health issue in IOC. However, publications on AMR are scarce, particularly in Comoros, Mayotte, and Seychelles. Thus, research and surveillance priorities were recommended (i) estimating the volume of antimicrobial drugs used in livestock and human medicine in the different territories [mainly third generation cephalosporin (3GC)]; (ii) developing a “One Health” surveillance approach with epidemiological indicators as zoonotic foodborne pathogen (i.e., couple Escherichia coli resistance to 3GC/carbapenems); (iii) screening travelers with a history of hospitalization and consumption of antibiotic drug returning from at risk areas (e.g., mcr-1 transmission with China or hajj pilgrims) allowing an early warning detection of the emergence for quick control measures implementation in IOC.

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Section: Perspectivesmentioning

confidence: 99%

Review of Antibiotic Resistance in the Indian Ocean Commission: A Human and Animal Health Issue

Belmonte

Collard

Halifa³

et al. 2017

Front. Public Health

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“…Although the sales of carbapenems, a class of last-resort antibiotics, were similar to EU/EEA countries (0.10 DID vs 0.06 DID in 2017, country range: 0.02-0.17), the significant increase of carbapenems sales still cannot be ignored (0.03 DID in 2011 to 0.10 DID in 2018) [25]. Because carbapenems are categorized as highly restricted antibiotics by the National Health Commission and require pre-authorization before use in China, this increase could be partly due to the rise in extended-spectrum β-lactamaseproducing Gram-negative bacteria, which has been identified in epidemiological surveillance studies [18,34]. Alongside the increase of carbapenem sales, the resistance rate of carbapenem-resistant Enterobacteriaceae has also been reported [35].…”

Section: Discussionmentioning

confidence: 99%

Secular trend analysis of antibiotic consumption in China’s hospitals 2011-2018, a retrospective analysis of sales data

Wushouer¹,

Zhou²,

Zhang³

et al. 2020

Preprint

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Background: This study was aimed to explore the secular trends of antibiotic sales over an 8-year period. Methods: We retrospectively analysed aggregated monthly surveillance data on antibiotic sales to 586 hospitals from 28 provinces in China from January 2011 to December 2018. Information including generic name, sales amount, dosage form, strength, the route of administration, and geographical data were collected. Population weighted antibiotic sales were expressed in DDD per 1,000 inhabitants per day (DID). WHO’s ‘Access, Watch, Reserve’ categorization was also adopted to analyse antibiotic sales. Results: Between 2011 and 2018, total antibiotic sales in China’s hospitals increased by 39.6% (from 4.8 DID in 2010 to 6.7 DID in 2018). Antibiotic sales were stable or had moderately decreased in 13 provinces, while in the other 15 provinces they had substantially increased. Cephalosporins were the most consumed antibiotics, accounting for 26.9% of the total antibiotic sales (1.8 DID/6.7 DID). In 2018, antibiotics in the Access category comprised 19.4% of the total sales (1.3 DID/6.7 DID), where antibiotics in the Watch category comprised the largest proportion of 71.6% (4.8 DID/6.7 DID). Population-weighted antibiotic sales were greater in secondary hospitals than in tertiary hospitals (7.3 DID vs 6.6 DID). The antibiotics sales of oral form were almost two times the sales of parenteral forms in secondary hospitals, whereas in tertiary hospitals the amounts were about the same. Conclusions: Although efforts were made towards restricting antibiotics in the past decade by the Chinese government, antibiotic sales demonstrated an upward trend during the study period. More efforts are needed to explore whether the antibiotics are prudently used.

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“…Although quinolones were noted by US FDA that should be only used for those have no other treatment options [32], physicians may prefer quinolones and cephalosporins more than penicillins due to the time-consuming skin testing requirement for penicillins prior to administration for allergy assessment in China [33],Although the consumption of carbapenems, a class of last-resort antibiotics, was similar to EU/EEA countries (0.10DID VS 0.06 DID in 2017, country range: 0.02-0.17), the significant increase of carbapenems consumption still cannot be ignored (0.03 DID in 2011 to 0.10 DID in 2018) [25]. Because carbapenems are categorized as highly restricted antibiotics by National Health Commission and requires pre-authorization before use in China, this increase could be partly due to the rise in extended-spectrum β-lactamase-producing Gram-negative bacteria, which has been identified in epidemiological surveillance studies [18,34]. As the increase of carbapenems consumption, the resistance rate of carbapenem-resistant Enterobacteriaceae is also reported [35].…”

Section: Discussionmentioning

confidence: 99%

Secular trend analysis of antibiotic consumption in China’s hospitals 2011-2018, a retrospective analysis of sales data

Wushouer

Zhou

Zhang

et al. 2019

Preprint

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Background: This study was aimed to explore the secular trends of antibiotic consumption over an 8-year period. Methods: We retrospectively analysed aggregated monthly surveillance data on antibiotic sales to 586 hospitals from 28 provinces in China from January 2011 to December 2018. Information including generic name, sales amount, dosage form, strength, the route of administration, and geographical data were collected. Population weighted Antibiotic consumption was expressed in DDD per 1,000 inhabitants per day (DID). WHO’s ‘Access, Watch, Reserve’ categorization was also adopted to analyse antibiotic consumption. Results: Between 2011 and 2018, total antibiotic consumption in China’s hospitals increased by 38.2% (from 4.8 DID in 2010 to 6.7 DID in 2018). Antibiotic consumption was stable or had moderately decreased in 13 provinces, while the other 15 provinces had substantially increased. Cephalosporins were the most consumed antibiotics, accounted for 26.9% of the total antibiotic consumption. In 2018, antibiotics in the Access category comprised 20.0% of total consumption, where antibiotics in the Watch category consumed the most with 72.2%. Population-weighted antibiotic consumption was larger in secondary hospitals than tertiary hospitals (7.3 DID VS 6.6 DID). The antibiotics consumption of oral form was almost two times the consumption of parenteral forms in secondary hospitals, whereas the proportion of tertiary hospitals was about the same. Conclusions: Although efforts were made towards restricting antibiotics in the past decade by Chinese government, antibiotic consumption demonstrated an upward trend during the study period. More efforts are needed to explore the quality of antibiotic usage in terms of rationality.

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High prevalence of ESBL-producingEscherichia coliandKlebsiella pneumoniaein community-onset bloodstream infections in China

Abstract: ESBL producers are highly prevalent in COBSIs in China, especially among cases caused by E. coli. For these resistant pathogens, clinicians should consider adequate empirical therapy, and different risk factors for prediction should be used in this country.

Cited by 108 publications

References 37 publications

Review of Antibiotic Resistance in the Indian Ocean Commission: A Human and Animal Health Issue

Review of Antibiotic Resistance in the Indian Ocean Commission: A Human and Animal Health Issue

Secular trend analysis of antibiotic consumption in China’s hospitals 2011-2018, a retrospective analysis of sales data

Secular trend analysis of antibiotic consumption in China’s hospitals 2011-2018, a retrospective analysis of sales data

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