Shangmin Yang,1,2 Mengyuan Wang,1,2 Shifu Wang1,2 On behalf of Shandong Provincial Microbiome Research Center Children Bacterial and fungal Resistance Monitoring Research Network

1Department of Clinical Microbiology, Children’s Hospital affiliated to Shandong University, Jinan, Shandong, People’s Republic of China; 2Shandong Provincial Clinical Research Center for Children’s Health and Disease, Jinan, Shandong, People’s Republic of China

Correspondence: Shifu Wang, Children’s Hospital affiliated to Shandong University, Jinan, Shandong, 250022, People’s Republic of China, Email wshfu709@163.com

Introduction: Bacterial antimicrobial resistance is becoming increasingly serious, but there are very limited studies in children. Shandong Province Pediatric bacterial & fungal Antimicrobial Resistance Surveillance System (SPARSS) program was established in 2017 to monitor and analyze the trends of bacterial epidemiology and antimicrobial resistance in children. Clinical bacterial isolates were collected from 59 tertiary hospital in Shandong Province China during 2017 to 2022.
Methods: We conducted a retrospective analysis of bacterial distribution and resistance patterns, utilizing data from the SPARSS network and analyzed with WHONET 5.6 software.
Results: A total of 185,274 isolates were collected, and the top 5 bacteria were Staphylococcus aureus (19.0%), Escherichia coli (12.8%), Streptococcus pneumoniae (12.3%), Haemophilus influenzae (11.0%) and Klebsiella pneumoniae (7.1%). In the composition of strain specimens, most of the strains came from the respiratory tract (59.8%), followed by pus (11.4%). The resistance rate of Staphylococcus spp. to penicillins remains high at 90%, while the resistance rate to linezolid is low but shows an upward trend. Vancomycin-resistant strains have emerged in Enterococcus spp. which due to its complex genetic structure, possesses inherent resistance to most drugs. The resistance rate of Enterobacter spp. to meropenem remains low, although it exhibits a high resistance rate to β-lactams. Notably, carbapenem-resistant Salmonella spp. has been identified since from 2022. Acinetobacter baumannii and Pseudomonas aeruginosa demonstrate high drug resistance to most antibiotics. H. influenzae and Moraxella catarrhalis, primarily isolated from respiratory tract samples, show an increasing trend in β-lactamase-producing strains annually. The detection rates of multi-drug-resistant bacteria, including MRSA, CREO, CRKP, CRPA, and CRAB, have been decreasing annually, with their distribution varying among children of different ages. The resistance rate of Candida tropicalis to fluconazole was 43.6%, which was much higher than the detection rate of adults in China and Europe.
Discussion: Despite restrictions on antibiotic use in China, the situation of bacterial drug resistance remains critical, particularly in children. Therefore, long-term monitoring of bacterial drug resistance in this population is essential to develop effective strategies for the early and accurate treatment of childhood infections.

Keywords: bacteria, antimicrobial resistance, children, China, Multi-Drug-Resistant Organisms, MDROs