Skip to main content
SpringerLink
Log in

Microbiological profiles and antimicrobial resistance patterns of pediatric bloodstream pathogens in China, 2016–2018

  • Original Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Objectives

This study aimed to investigate the microbiological profiles and antimicrobial resistance patterns of bloodstream pathogens in Chinese children.

Methods

This retrospective study was conducted at 13 tertiary hospitals in China during 2016–2018. The first bloodstream isolates of the same species from one pediatric patient < 18 years were included to this study for analysis. Antimicrobial susceptibility testing was determined based on minimum inhibitory concentrations or Kirby-Bauer disk diffusion methods according to the 2018 Clinical and Laboratory Standards Institute guidelines.

Results

Overall, 9345 nonduplicate bloodstream isolates were collected. Top 10 pathogens included Coagulase-negative staphylococcus (CoNS) (44.4%), Escherichia coli (10.2%), Klebsiella pneumoniae (5.9%), Staphylococcus aureus (5.0%), Streptococcus pneumoniae (4.9%), Pseudomonas aeruginosa(2.8%), Enterococcus faecium (2.7%), Stenotrophomonas maltophilia (2.4%), Salmonella spp. (2.3%), and Streptococcus agalactiae (2.0%). The commonest pathogens apart from CoNS in age group 0–28 days, 29 days–2 months, 3-11 months, 1–5 years, and ≥ 5 years were Escherichia coli (17.2%), Escherichia coli (14.0%), Escherichia coli (7.9%), Streptococcus pneumoniae (10.7%) ,and Staphylococcus aureus (13.6%), respectively. The overall prevalence of extended-spectrum β-lactamases-producing Enterobacteriaceae, carbapenem-resistant Klebsiella pneumoniae, carbapenem-resistant Acinetobacter baumannii, and carbapenem-resistant Pseudomonas aeruginosa were 41.4, 28.4, 31.7, and 5.6%, respectively. The overall prevalence of methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae and vancomycin-resistant Enterococcus was 38.1, 28.3, and 0.7%, respectively.

Conclusions

The major bacterial pathogens have differences in different age groups, ward types, and regions in Chinese children, and the commonest causing microorganism was the Escherichia coli, especially in neonates and infants. High prevalence of important resistant phenotypes is of a serious concern.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.

Similar content being viewed by others

References

  1. Weiss SL, Fitzgerald JC, Pappachan J, Wheeler D, Jaramillo-Bustamante JC, Salloo A et al (2015) Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study. Am J Respir Crit Care Med 191(10):1147–1157

    Article  Google Scholar 

  2. Aiken AM, Allegranzi B, Scott JA, Mehtar S, Pittet D, Grundmann H (2014) Antibiotic resistance needs global solutions. Lancet Infect Dis 14(7):550–551

    Article  Google Scholar 

  3. Lai CC, Lee K, Xiao Y, Ahmad N, Veeraraghavan B, Thamlikitkul V et al High burden of antimicrobial drug resistance in Asia. J Glob Antimicrob Resist 2(3):141–147

  4. Diekema DJ, Hsueh PR, Mendes RE, Pfaller MA, Rolston KV, Sader HS et al (2019) The Microbiology of Bloodstream Infection: 20-Year Trends from the SENTRY Antimicrobial Surveillance Program. Antimicrob Agents Chemother 63(7)

  5. Tacconelli E, Carrara E, Savoldi A, Harbarth S, Mendelson M, Monnet DL et al (2018) Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis 18(3):318–327

    Article  Google Scholar 

  6. World Health Organization Expert Committees. World Health Organization Model List of Essential Medicines for Children 7th List 2019. https://www.who.int/medicines/publications/essentialmedicines/en/. Accessed 15 Apr 2020

  7. Johnson AP, Davies J, Guy R, Abernethy J, Sheridan E, Pearson A et al (2012) Mandatory surveillance of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in England: the first 10 years. J Antimicrob Chemother 67(4):802–809

    Article  CAS  Google Scholar 

  8. National Health Commission of the People's Republic of China (2018) Status report on antimicrobial adminstration in the People's Republic of China. Beijing, China, p 2018

    Google Scholar 

  9. Chen S, Liu S, Yuan X, Mai H, Lin J, Wen F Etiology, drug sensitivity profiles and clinical outcome of bloodstream infections: A retrospective study of 784 pediatric patients with hematological and neoplastic diseases. Pediatr Hematol Oncol 36(8):482–493

  10. Dong L, Zhang XY, Li CC, Li Z, Xia YQ (2017) Characteristics of epidemiology and antimicrobial resistance of gram-negative bacterial bloodstream infections in children. Zhonghua Er Ke Za Zhi 55(9):683–688

    CAS  PubMed  Google Scholar 

  11. Li S, Guo L, Liu L, Dong F, Liu G (2016) Clinical features and antibiotic resistance of Escherichia coli bloodstream infections in children. Zhonghua Er Ke Za Zhi 54(2):150–153

    PubMed  Google Scholar 

  12. Zhang F, Li Y, Lv Y, Zheng B, Xue F (2019) Bacterial susceptibility in bloodstream infections: Results from China Antimicrobial Resistance Surveillance Trial (CARST) Program, 2015-2016. J Glob Antimicrob Resist 17:276–282

    Article  Google Scholar 

  13. World Health Organization (2020). Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report. https://www.who.int/glass/resources/publications/GLASS_report_2020_launch_webinar_v_25May2020_FINAL.pdf?ua=1. Accessed 27 Sept 2020

  14. Hu F, Guo Y, Yang Y, Zheng Y, Wu S, Jiang X et al (2019) Resistance reported from China antimicrobial surveillance network (CHINET) in 2018. Eur J Clin Microbiol Infect Dis 38(12):2275–2281

    Article  CAS  Google Scholar 

  15. Esposito S, Principi N (2015) Impacts of the 13-Valent Pneumococcal Conjugate Vaccine in Children. J Immunol Res 2015:591580

    PubMed  PubMed Central  Google Scholar 

  16. Bielicki JA, Lundin R, Sharland M (2015) Antibiotic Resistance Prevalence in Routine Bloodstream Isolates from Children's Hospitals Varies Substantially from Adult Surveillance Data in Europe. Pediatr Infect Dis J 34(7):734–741

    Article  Google Scholar 

  17. Droz N, Hsia Y, Ellis S, Dramowski A, Sharland M, Basmaci R (2019) Bacterial pathogens and resistance causing community acquired paediatric bloodstream infections in low- and middle-income countries: a systematic review and meta-analysis. Antimicrob Resist Infect Control 8:207

    Article  Google Scholar 

  18. Dramowski A, Cotton MF, Rabie H, Whitelaw A (2015) Trends in paediatric bloodstream infections at a South African referral hospital. BMC Pediatr 15:33

    Article  Google Scholar 

  19. Maham S, Fallah F, Gholinejad Z, Seifi A, Hoseini-Alfatemi SM (2018) Bacterial etiology and antibiotic resistance pattern of pediatric bloodstream infections: A multicenter based study in Tehran, Iran. Ann Ig 30(4):337–345

    CAS  PubMed  Google Scholar 

  20. Obeng-Nkrumah N, Labi AK, Addison NO, Labi JE, Awuah-Mensah G (2016) Trends in paediatric and adult bloodstream infections at a Ghanaian referral hospital: a retrospective study. Ann Clin Microbiol Antimicrob 15(1):49

    Article  Google Scholar 

  21. Spaulding AB, Watson D, Dreyfus J, Heaton P, Grapentine S, Bendel-Stenzel E et al (2019) Epidemiology of Bloodstream Infections in Hospitalized Children in the United States, 2009-2016. Clin Infect Dis 69(6):995–1002

    Article  Google Scholar 

  22. Cailes B, Kortsalioudaki C, Buttery J, Pattnayak S, Greenough A, Matthes J et al (2018) Epidemiology of UK neonatal infections: the neonIN infection surveillance network. Arch Dis Child Fetal Neonatal Ed 103(6):F547–F553

    Article  Google Scholar 

  23. Chou CH, Lai YR, Chi CY, Ho MW, Chen CL, Liao WC et al (2020) Long-Term Surveillance of Antibiotic Prescriptions and the Prevalence of Antimicrobial Resistance in Non-Fermenting Gram-Negative Bacilli. Microorganisms. 8(3)

  24. Olesen SW, Barnett ML, MacFadden DR, Brownstein JS, Hernández-Díaz S, Lipsitch M et al (2018) The distribution of antibiotic use and its association with antibiotic resistance. Elife.:7

  25. Tammer I, Geginat G, Lange S, Kropf S, Lodes U, Schlüter D et al (2016) Antibiotic Consumption and the Development of Antibiotic Resistance in Surgical Units. Zentralbl Chir 141(1):53–61

    CAS  PubMed  Google Scholar 

  26. Carrara E, Pfeffer I, Zusman O, Leibovici L, Paul M (2018) Determinants of inappropriate empirical antibiotic treatment: systematic review and meta-analysis. Int J Antimicrob Agents 51(4):548–553

    Article  CAS  Google Scholar 

  27. Tacconelli E, Cataldo MA, Mutters NT, Carrara E, Bartoloni A, Raglio A et al (2019) Role of place of acquisition and inappropriate empirical antibiotic therapy on the outcome of extended-spectrum β-lactamase-producing Enterobacteriaceae infections. Int J Antimicrob Agents 54(1):49–54

    Article  CAS  Google Scholar 

  28. Yang CJ, Chung YC, Chen TC, Chang HL, Tsai YM, Huang MS et al (2013) The impact of inappropriate antibiotics on bacteremia patients in a community hospital in Taiwan: an emphasis on the impact of referral information for cases from a hospital affiliated nursing home. BMC Infect Dis 13:500

    Article  CAS  Google Scholar 

  29. Nabarro L, Shankar C, Pragasam AK, Mathew G, Jeyaseelan V, Veeraraghavan B et al (2017) Clinical and Bacterial Risk Factors for Mortality in Children With Carbapenem-resistant Enterobacteriaceae Bloodstream Infections in India. Pediatr Infect Dis J 36(6):e161–e166

    Article  Google Scholar 

  30. Guan X, He L, Hu B, Hu J, Huang X, Lai G et al (2016) Laboratory diagnosis, clinical management and infection control of the infections caused by extensively drug-resistant Gram-negative bacilli: a Chinese consensus statement. Clin Microbiol Infect 22(Suppl 1):S15–S25

    Article  Google Scholar 

Download references

Acknowledgment

We sincerely thank Prof. Hong Zhao, the secretary of China Society of Infectious Diseases, for her help with the program initiation. We thank the members of the collaborative working group of pediatric subgroups of China Society of Infectious Diseases for their collecting the data for this study. We sincerely thanks Dr. Benedikt D. Huttner, who is an infectious diseases specialist of Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, for his valuable suggestion on this study protocol before the initiation of this study.

Author information

Author notes

  1. Yue Qiu, Junwen Yang and Yiping Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Infectious Diseases, Children’s Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China

    Yue Qiu & Mei Zeng

  2. Department of Microbiology Laboratory, Children’s Hospital Affiliated to Zhengzhou University (Henan Children’s Hospital), Zhengzhou, China

    Junwen Yang

  3. Department of Pediatrics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China

    Yiping Chen

  4. Department of Microbiology Laboratory, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China

    Jinhong Yang

  5. Department of Infection Diseases, Children’s hospital of Jiangxi Province, Nanchang, China

    Qingxiong Zhu & Chunhui Zhu

  6. Department of Hepatology, Hunan Children’s Hospital, Changsha, China

    Shuangjie Li

  7. Department of Infection Diseases, Hunan Children’s Hospital, Changsha, China

    Jing Liu

  8. Department of Pediatrics, Sichuan University West China Second Hospital, Chengdu, China

    Chaomin Wan & Yu Zhu

  9. Department of Infections Disease, Guangzhou Women and Children’s Medical Center, Guangzhou, China

    Minxia Chen & Yi Xu

  10. Department of Pediatric, Gastroenterology and Infectious Diseases, Qingdao Women and Children’s Hospital, Qingdao, China

    Jianning Tong & Rui Li

  11. Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China

    Qingwen Shan

  12. Department of infectious diseases, Hainan Women and Children’s Medical Center, Haikou, China

    Daojiong Lin & Shouye Wu

  13. Department of infectious diseases, Xiamen Children’s Hospital, Xiamen, China

    Zhiqiang Zhuo & Caihong Wang

  14. Department of Infectious Diseases, Hangzhou Children’s Hospital, Hangzhou, China

    Shiyong Zhao & Zhenghong Qi

  15. Department of Infectious Diseases, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China

    Xiaofeng Sun & Bieerding Maihebuba

  16. Department of Pharmacy, The fourth Hospital of Baotou, Baotou, China

    Chunmei Jia & Huiling Gao

  17. Department of Emergency, Henan Children’s Hospital Affiliated to Zhengzhou University, 33, Longhu Outer Ring East Road, Zhengzhou, 450018, China

    Yibing Cheng

Authors
  1. Yue Qiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Junwen Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yiping Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jinhong Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Qingxiong Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chunhui Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shuangjie Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jing Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Chaomin Wan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yu Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Minxia Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yi Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Jianning Tong
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Rui Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Qingwen Shan
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Daojiong Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Shouye Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Zhiqiang Zhuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Caihong Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Shiyong Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Zhenghong Qi
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Xiaofeng Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Bieerding Maihebuba
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Chunmei Jia
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Huiling Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Yibing Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. Mei Zeng
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

On behalf of the Collaborative Working Group of the Pediatric Subgroup of the China Society of Infectious Diseases

Corresponding authors

Correspondence to Yibing Cheng or Mei Zeng.

Ethics declarations

Conflict of interest

All authors declared no potential conflicts of interest to disclose.

Ethical approval

This study was reviewed and informed consent from patients was not required by the ethics committee because there was no contact with patients and all data were de-identified.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Qiu, Y., Yang, J., Chen, Y. et al. Microbiological profiles and antimicrobial resistance patterns of pediatric bloodstream pathogens in China, 2016–2018. Eur J Clin Microbiol Infect Dis 40, 739–749 (2021). https://doi.org/10.1007/s10096-020-04069-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-020-04069-2

Keywords

Search

Navigation