The emergence and spread of drug-resistant bacteria have always been a public concern. With the increase of resistance to available antimicrobial agents and the emergence of multi-drug resistant bacteria, antimicrobial resistance has caused serious threats to public health in the world (Livermore 2012; Rossolini et al. 2014; Yang et al. 2017). It can cause damage to human health and, at the same time, it can lead to a situation where there is no cure. The research reported that antimicrobial resistance causes about 700 000 deaths worldwide each year, and if no effective action is taken, it is expected to cause 10 million deaths a year by 2050 (Hoffman et al. 2015).
Simultaneously, antibiotics that become ineffective against bacteria have been reported (Liu et al. 2016). The bacterial resistance crisis has been greatly attributed to the overuse and misuse of these antibiotics (Pathak et al. 2013; Michael et al. 2014; Tang et al. 2018). Monitoring of the epidemiology of resistance provides useful information for prevention and helps clinicians prescribe the effective antibiotic therapy (Ventola 2015), as well as optimize the use of antibiotics, which has become one of the most important parts of drug resistance control (Lafaurie et al. 2012; Wang et al. 2018). In this study, the significant changes and trends in antibiotic resistance of clinically important pathogens isolated from a general hospital in Zhengzhou, Henan Province, China, from 2011 to 2016 were described to provide a more complete picture of bacterial infections and to help clinicians and decision-making departments undertake the proper decisions for patients and antibiotic use.
Based on the data from a general hospital in Zhengzhou, Henan province, China from 2011 to 2016, five dominant bacteria (
From 2011 to 2016, a total of 19 260 bacterial isolates were obtained, with five dominant bacteria being
Distribution of bacterial isolates in relation to years and type of samples.
Category | No. isolates | Total | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | n | % | n | % | ||
Year | |||||||||||||
2011 | 1429 | 276 | 19.31 | 213 | 14.91 | 96 | 6.72 | 108 | 7.56 | 68 | 4.76 | 761 | 53.25 |
2012 | 3350 | 524 | 15.64 | 531 | 15.85 | 248 | 7.40 | 236 | 7.04 | 114 | 3.40 | 1653 | 49.34 |
2013 | 3143 | 486 | 15.46 | 493 | 15.89 | 219 | 6.98 | 168 | 5.35 | 114 | 3.63 | 1480 | 47.09 |
2014 | 3073 | 605 | 19.69 | 477 | 15.52 | 213 | 6.93 | 248 | 8.07 | 224 | 7.29 | 1767 | 57.50 |
2015 | 3750 | 781 | 20.83 | 522 | 13.92 | 254 | 6.77 | 259 | 6.91 | 292 | 7.89 | 2108 | 56.21 |
2016 | 4515 | 739 | 16.37 | 548 | 12.18 | 400 | 8.86 | 259 | 5.74 | 296 | 6.56 | 2242 | 49.66 |
Total | 19260 | 3411 | 17.71 | 2784 | 14.45 | 1430 | 7.42 | 1278 | 6.64 | 1108 | 5.75 | 10011 | 51.98 |
1.5767 | −4.7904 | 2.5513 | −1.7311 | 7.8954 | 1.9893 | ||||||||
0.1149 | < 0.0001 | 0.0107 | 0.0834 | < 0.0001 | 0.0467 | ||||||||
Samples | |||||||||||||
Sputum | 2741 | 80.36 | 493 | 17.71 | 81 | 5.66 | 1023 | 80.05 | 910 | 82.13 | 5248 | 27.25 | |
Urine | 382 | 11.2 | 1565 | 56.21 | 249 | 17.41 | 110 | 8.61 | 87 | 7.85 | 2393 | 12.42 | |
Blood | 104 | 3.05 | 265 | 9.52 | 275 | 19.23 | 30 | 2.35 | 24 | 2.17 | 698 | 3.62 | |
Secretion | 92 | 2.7 | 217 | 7.79 | 620 | 43.36 | 65 | 5.09 | 41 | 3.70 | 1035 | 5.37 | |
Throat swabs | 27 | 0.79 | 8 | 0.29 | 6 | 0.42 | 3 | 0.23 | 3 | 0.27 | 47 | 0.24 | |
Others | 65 | 1.91 | 236 | 8.48 | 199 | 13.92 | 47 | 3.68 | 43 | 3.88 | 590 | 3.06 |
During the study period, the detection rate of
The resistance rates of
Antimicrobial agent | MIC breakpoints | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | Total | ||
---|---|---|---|---|---|---|---|---|---|---|
I (μg/ml) | n = 276 | n = 524 | n = 486 | n = 605 | n = 781 | n = 739 | n = 3411 | |||
Ampicillin | 16 | 97.1 | 99.05 | 98.97 | 99.5 | 100 | 100 | 99.38 | 5.2285 | < 0.0001 |
Cefotaxime | 2 | 52.17 | 54.39 | 45.27 | 56.86 | 100 | 100 | 73.67 | 26.9374 | < 0.0001 |
Nitrofurantoin | 64 | 76.81 | 65.84 | 49.59 | 56.36 | 54.16 | 58.59 | 58.49 | −4.711 | < 0.0001 |
Trimethoprim-sulfamethoxazole | 4/76 | 71.38 | 70.61 | 52.06 | 35.7 | 37 | 55.07 | 50.78 | −9.1411 | < 0.0001 |
Ampicillin-sulbactam | 16/8 | 52.54 | 49.81 | 46.09 | 40.17 | 47.25 | 47.9 | 46.79 | −1.1923 | 0.2332 |
Cefuroxime | 16 | 50.72 | 49.81 | 43.21 | 42.64 | 47.76 | 51.01 | 47.46 | 0.51 | 0.6101 |
Ceftriaxone | 2 | 48.91 | 53.24 | 43.21 | 37.52 | 46.09 | 48.71 | 46.06 | −0.9744 | 0.3299 |
Gentamicin | 8 | 44.93 | 43.7 | 33.74 | 31.74 | 40.46 | 40.46 | 38.82 | −0.8754 | 0.3813 |
Cefoxitin | 16 | 40.58 | 43.51 | 34.77 | 31.9 | 39.44 | 39.51 | 38.17 | −0.6514 | 0.5148 |
Levofloxacin | 4 | 34.42 | 33.21 | 22.02 | 26.12 | 37.26 | 35.05 | 31.78 | 2.3291 | 0.0199 |
Cefepime | 16 | 23.91 | 33.59 | 22.84 | 26.28 | 35.47 | 34.91 | 30.69 | 3.7816 | 0.0002 |
Piperacillin-tazobactam | 32/4–64/4 | 21.74 | 24.81 | 18.93 | 23.64 | 32.01 | 30.58 | 26.41 | 4.7683 | < 0.0001 |
Amikacin | 32 | 26.09 | 26.53 | 16.05 | 18.02 | 28.55 | 23 | 23.19 | 0.376 | 0.7069 |
Meropenem | 2 | 0 | 0 | 0 | 0.99 | 10.12 | 11.37 | 4.95 | 12.3843 | < 0.0001 |
Imipenem | 2 | 0 | 0 | 0 | 1.49 | 9.22 | 7.98 | 4.1 | 10.4364 | < 0.0001 |
During the study period, the detection rates of
The resistance rates of
Antimicrobial agent | MIC breakpoints | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | Total | ||
---|---|---|---|---|---|---|---|---|---|---|
I (μg/ml) | n = 213 | n = 531 | n = 493 | n = 477 | n = 522 | n = 548 | n = 2784 | |||
Ampicillin | 16 | 92.49 | 93.03 | 90.06 | 86.37 | 87.16 | 88.87 | 89.4 | −3.0413 | 0.0024 |
Cefotaxime | 2 | 69.01 | 72.88 | 71.4 | 73.17 | 100 | 100 | 82.79 | 16.5655 | < 0.0001 |
Trimethoprim-sulfamethoxazole | 4/76 | 93.9 | 93.03 | 81.74 | 77.99 | 70.69 | 69.16 | 79.63 | −11.9199 | < 0.0001 |
Ampicillin-sulbactam | 16/8 | 76.06 | 73.63 | 80.53 | 67.92 | 60.15 | 62.96 | 69.43 | −6.7117 | < 0.0001 |
Cefuroxime | 16 | 70.42 | 73.45 | 71.81 | 67.51 | 60.92 | 62.59 | 67.42 | −4.8433 | < 0.0001 |
Levofloxacin | 4 | 73.71 | 71.56 | 67.95 | 65.62 | 66.67 | 61.13 | 67.1 | −4.0714 | < 0.0001 |
Ceftriaxone | 2 | 69.01 | 72.5 | 68.97 | 64.36 | 60.15 | 62.23 | 65.88 | −4.3853 | < 0.0001 |
Gentamicin | 8 | 74.18 | 65.73 | 60.45 | 59.75 | 51.34 | 52.92 | 59.2 | −6.7725 | < 0.0001 |
Cefepime | 16 | 49.77 | 54.24 | 46.25 | 38.36 | 30.65 | 38.32 | 42.21 | −7.1678 | < 0.0001 |
Ceftazidime | 8 | 17.84 | 1.32 | 48.48 | 43.61 | 34.29 | 36.31 | 31.25 | 9.9654 | < 0.0001 |
Cefoxitin | 16 | 30.52 | 29.57 | 29.41 | 21.17 | 12.07 | 10.77 | 21.19 | −10.1704 | < 0.0001 |
Nitrofurantoin | 64 | 28.17 | 27.31 | 16.02 | 14.47 | 10.73 | 11.13 | 16.88 | −8.6556 | < 0.0001 |
Piperacillin-tazobactam | 32/4-64/4 | 14.55 | 18.64 | 13.18 | 13.63 | 6.7 | 10.77 | 12.72 | −4.6131 | < 0.0001 |
Amikacin | 32 | 18.31 | 15.25 | 10.75 | 8.39 | 8.24 | 8.03 | 10.78 | −5.3067 | < 0.0001 |
Imipenem | 2 | 0.94 | 1.51 | 2.43 | 1.26 | 1.15 | 1.64 | 1.54 | −0.1060 | 0.9156 |
Meropenem | 2 | 0 | 0.56 | 0.2 | 1.05 | 0.96 | 2.01 | 0.9 | 3.1604 | 0.0016 |
During the study period, the detection rate of
The resistance rates of
Antimicrobial agent | MIC breakpoints | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | Total | ||
---|---|---|---|---|---|---|---|---|---|---|
I (|ig/ml) | n = 96 | n = 248 | n = 219 | n = 213 | n = 254 | n = 400 | n = 1430 | |||
Penicillin | 0.25 | 92.71 | 93.55 | 94.06 | 95.77 | 88.19 | 89.00 | 91.68 | −2.759 | 0.0058 |
Erythromycin | 1–4 | 95.83 | 87.10 | 80.82 | 80.28 | 82.28 | 81.00 | 83.15 | −3.0012 | 0.0027 |
Azithromycin | 4 | 90.63 | 86.29 | 80.37 | 81.22 | 77.95 | 76.50 | 80.70 | −3.8879 | 0.0001 |
Clarithromycin | 4 | 90.63 | 83.87 | 79.45 | 79.81 | 70.08 | 69.00 | 76.43 | −6.0151 | < 0.0001 |
Trimethoprim-sulfamethoxazole | 4/76 | 85.42 | 91.13 | 62.56 | 69.95 | 73.62 | 51.25 | 68.95 | −9.9209 | < 0.0001 |
Clindamycin | 1-2 | 67.71 | 65.73 | 59.36 | 56.34 | 55.12 | 58.25 | 59.51 | −2.4495 | 0.0143 |
Cefoxitin | 8 | 69.79 | 72.18 | 71.23 | 58.69 | 44.49 | 41.50 | 56.36 | −9.6125 | < 0.0001 |
Norfloxacin | 8 | 70.83 | 64.11 | 63.01 | 59.62 | 52.36 | 43.75 | 55.94 | −6.6063 | < 0.0001 |
Levofloxacin | 2 | 67.71 | 61.29 | 57.99 | 56.34 | 48.43 | 36.25 | 51.19 | −7.6331 | < 0.0001 |
Moxifloxacin | 1 | 63.54 | 56.45 | 52.51 | 53.99 | 48.03 | 34.50 | 48.32 | −6.5328 | < 0.0001 |
Gentamicin | 8 | 64.58 | 64.11 | 46.12 | 45.54 | 35.83 | 35.00 | 45.45 | −8.242 | < 0.0001 |
Tetracycline | 8 | 58.33 | 57.26 | 47.49 | 47.42 | 38.98 | 37.00 | 45.45 | −5.9025 | < 0.0001 |
Oxacillin | 4 | 53.13 | 42.74 | 33.79 | 43.66 | 45.67 | 42.25 | 42.59 | −0.6128 | 0.8283 |
Rifampicin | 2 | 40.63 | 30.65 | 25.57 | 21.60 | 17.32 | 10.00 | 21.19 | −8.1147 | < 0.0001 |
Nitrofurantoin | 64 | 26.04 | 15.73 | 16.44 | 9.86 | 5.91 | 8.00 | 11.75 | −5.7483 | < 0.0001 |
Teicoplanin | 16 | 11.46 | 12.10 | 5.02 | 4.23 | 0.79 | 1.75 | 4.90 | −6.6928 | < 0.0001 |
Linezolid | 8 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||
Vancomycin | 4–8 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
During the study period, the detection rate of
The resistance rates of
Antimicrobial agent | MIC breakpoints | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | Total | ||
---|---|---|---|---|---|---|---|---|---|---|
I (μg/ml) | n = 108 | n = 236 | n = 168 | n = 248 | n = 259 | n = 259 | n = 1278 | |||
Ticarcillin | 32-64 | 70.37 | 74.58 | 76.79 | 76.21 | 75.29 | 76.45 | 75.35 | 0.9182 | 0.3585 |
Piperacillin | 32-64 | 57.41 | 63.14 | 54.76 | 56.45 | 61.00 | 61.39 | 59.47 | 0.3942 | 0.6934 |
Imipenem | 4 | 50.00 | 52.97 | 60.71 | 53.63 | 62.16 | 57.92 | 56.73 | 1.8507 | 0.0642 |
Aztreonam | 16 | 50.93 | 48.31 | 54.76 | 50.00 | 52.90 | 54.83 | 51.96 | 1.1464 | 0.2516 |
Gentamicin | 8 | 52.78 | 61.02 | 55.36 | 43.95 | 49.42 | 50.58 | 51.80 | −2.2516 | 0.0243 |
Ceftazidime | 16 | 43.52 | 52.54 | 54.76 | 49.19 | 51.74 | 53.28 | 51.41 | 0.8686 | 0.3851 |
Tobramycin | 8 | 53.70 | 58.90 | 52.38 | 39.11 | 49.81 | 44.40 | 48.98 | −3.0892 | 0.0020 |
Piperacillin-tazobactam | 32/4–64/4 | 43.52 | 51.27 | 42.86 | 41.94 | 52.90 | 53.28 | 48.44 | 1.6789 | 0.0932 |
Norfloxacin | 8 | 50.93 | 54.24 | 47.02 | 39.92 | 48.26 | 48.26 | 47.81 | −1.2309 | 0.2183 |
Meropenem | 4 | 44.44 | 41.95 | 45.24 | 45.16 | 54.44 | 49.81 | 47.34 | 2.4052 | 0.0162 |
Cefepime | 16 | 42.59 | 46.19 | 50.60 | 37.90 | 49.81 | 51.74 | 46.71 | 1.5010 | 0.1334 |
Ciprofloxacin | 2 | 48.15 | 52.97 | 45.83 | 41.53 | 45.56 | 44.02 | 46.09 | −1.7609 | 0.0783 |
Levofloxacin | 4 | 45.37 | 47.88 | 40.48 | 37.90 | 45.95 | 45.95 | 43.97 | −0.0615 | 0.9510 |
Amikacin | 32 | 36.11 | 40.68 | 37.50 | 29.03 | 35.52 | 36.29 | 35.68 | −0.9114 | 0.3621 |
Polymyxin B | 4 | 20.37 | 19.49 | 14.29 | 9.68 | 13.51 | 6.56 | 13.15 | −4.5199 | < 0.0001 |
During the study period, the detection rate of
The resistance rates of
Antimicrobial agent | MIC breakpoints | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | Total | ||
---|---|---|---|---|---|---|---|---|---|---|
I (μg/ml) | n = 68 | n = 114 | n = 114 | n = 224 | n = 292 | n = 296 | n = 1108 | |||
Ceftriaxone | 16–32 | 32.35 | 64.04 | 72.81 | 72.77 | 79.11 | 80.74 | 73.19 | 7.4412 | < 0.0001 |
Ampicillin-sulbactam | 16/8 | 41.18 | 64.91 | 81.58 | 76.79 | 73.63 | 64.53 | 69.77 | 1.5591 | 0.1190 |
Gentamicin | 8 | 44.12 | 67.54 | 64.04 | 74.55 | 68.15 | 75.68 | 69.49 | 4.0867 | < 0.0001 |
Ciprofloxacin | 2 | 39.71 | 57.89 | 64.04 | 73.66 | 69.52 | 75.34 | 68.32 | 5.6165 | < 0.0001 |
Ceftazidime | 16 | 39.71 | 52.63 | 64.04 | 66.07 | 62.67 | 72.64 | 63.72 | 5.0871 | < 0.0001 |
Trimethoprim-sulfamethoxazole | 4/76 | 39.71 | 63.16 | 60.53 | 60.27 | 66.78 | 64.86 | 62.27 | 3.0414 | 0.0024 |
Cefepime | 16 | 35.29 | 50.00 | 56.14 | 62.05 | 61.99 | 70.95 | 60.92 | 5.8829 | < 0.0001 |
Levofloxacin | 4 | 41.18 | 53.51 | 64.04 | 65.18 | 59.93 | 64.53 | 60.83 | 2.9341 | 0.0033 |
Piperacillin-tazobactam | 32/4–64/4 | 29.41 | 50.00 | 57.02 | 58.04 | 64.38 | 68.24 | 59.75 | 6.0938 | < 0.0001 |
Amikacin | 32 | 33.82 | 60.53 | 56.14 | 62.50 | 57.53 | 62.84 | 58.66 | 2.8410 | 0.0045 |
Meropenem | 4 | 19.12 | 46.49 | 57.89 | 54.02 | 47.95 | 47.64 | 48.19 | 1.9045 | 0.0568 |
Imipenem | 4 | 20.59 | 48.25 | 61.40 | 59.38 | 45.55 | 37.16 | 46.48 | −1.0354 | 0.3005 |
Polymyxin B | 4 | 10.29 | 21.93 | 15.79 | 19.64 | 13.63 | 18.24 | 16.88 | 0.0504 | 0.9598 |
This study provided data about detection rates and resistance patterns of five dominant bacteria isolated in a general hospital in Zhengzhou, Henan province, China, between 2011 and 2016. Overall, the detection rates of these bacteria showed a slowly increasing trend. In addition, Gram-negative bacteria seemed to be the main cause of infection. The possible explanation of these phenomena could be the overrepresentation of some types of the samples (sputum and urine), or a double-membrane structure and the occurrence of efficient efflux pumps in Gram-negative bacteria (Blair et al. 2014). Several studies have reported similar findings. The data from CHINET surveillance between 2005 and 2014 showed that the five selected species, including
During the study period, the situation with these multi-resistant isolates was complicated. For
Overall, among the Enterobacteriaceae, 14.34% of
Although the resistance rate of
In this study, besides polymyxin B,
A similar trend was observed for
In conclusion, Gram-negative bacteria appeared to be the main cause of infection in this study. The resistance rates of five species of the bacteria to most antibiotics were decreasing, but the isolates showed high levels of resistance and multiple-drug resistance, especially