Additional file 1: Supplementary Table 1. Antibiotics prescribed based on WHO AWaRe and Antibiotic Classification in China. 

Additional file 1 of Patterns of antibiotic administration in Chinese neonates: results from a multi-center, point prevalence survey

Objective This study investigated the long-term trends in the distribution and antibiograms of ESKAPEEc pathogens in neonatal and pediatric bloodstream infections (BSIs), shifts in minimum inhibitory concentration (MIC) of vancomycin and linezolid in Staphylococcus aureus , along with the changing patterns of antimicrobial resistance phenotypes over time in China. This work provides a reference for the prevention and treatment of pediatric BSIs. Methods A multicenter retrospective surveillance study was carried out from 2016 to 2023 at 12 tertiary pediatric hospitals across nine provinces and autonomous regions in China. The collected data were analyzed using GraphPad Prism 8 and WHONET 5.6. Temporal variations and linear trends were evaluated using chi-square or Fisher’s exact tests. Results A total of 10,051 ESKAPEEc strains accounted for 22.5% (10,051/44,675) of all BSIs, with 32.3% from neonatal BSIs and 67.7% from pediatric BSIs. The detection rate of ESKAPEEc pathogens increased for post the coronavirus disease 2019 (COVID-19) compared to the pre-COVID-19. Carbapenem resistance levels were 5.5% in Escherichia coli , 28.0% in Klebsiella pneumoniae , 16.0% in Enterobacter cloacae , 12.5% in Pseudomonas aeruginosa and 38.5% in Acinetobacter baumannii . Both Staphylococcus aureus and Enterococcus faecium remained fully susceptible to vancomycin and linezolid. Between 2016–2019 and 2020–2023, resistance to ceftazidime and gentamicin decreased in Escherichia coli and Klebsiella pneumoniae while resistance to imipenem and meropenem increased. Acinetobacter baumannii exhibited reduced resistance to most antibiotics except cefotaxime, levofloxacin and amikacin. Staphylococcus aureus displayed a declining resistance to macrolides and aminoglycosides but increasing resistance to fluoroquinolones, whereas Enterococcus faecium exhibited reduced resistance to all tested antibiotics. Compared to neonatal BSIs, Klebsiella pneumoniae from pediatric BSIs exhibited lower resistance to all β-lactams especially carbapenems (32.3% vs. 15.0%) while Acinetobacter baumannii displayed higher resistance to all tested agents. Methicillin-susceptible Staphylococcus aureus (MSSA) strains had lower vancomycin MIC ≥2 μg/mL levels compared to methicillin-resistant Staphylococcus aureus (MRSA) strains. Significant temporal differences were observed in MRSA isolates with linezolid MIC ≥2 μg/mL but not in MSSA isolates. The MIC 50 of vancomycin in MRSA strains was either equal to or higher than in MSSA strains from 2016 to 2022. The most frequently detected bacteria in carbapenem resistance, extended-spectrum cephalosporin resistance, fluoroquinolone resistance and aminoglycoside resistance were Acinetobacter baumannii , Klebsiella pneumoniae , Escherichia coli and Acinetobacter baumannii respectively. Conclusions The incidence of ESKAPEEc in BSIs has increased, and the rising resistance to imipenem and meropenem in Escherichia coli and Klebsiella pneumoniae underscores the need for continued surveillance. Carbapenems remain effective against Gram-negative ESKAPEEc, while vancomycin and linezolid remain effective against Gram-positive ESKAPEEc. Age-stratified strategies are essential to manage carbapenem-resistant Klebsiella pneumoniae in neonatal BSIs and carbapenem-resistant Acinetobacter baumannii in pediatric BSIs. The MIC values for vancomycin in MRSA strains remained stable over time, whereas a decreasing susceptibility trend to vancomycin in MSSA strains and linezolid MIC shifts were not observed. Our findings are expected to provide to treatment of bloodstream infections in children and evidence on best practices and resource sharing for policy consideration to healthcare providers at the local and international levels. 

pdf/covid-19-pandemic-increased-eskapeec-bloodstream-infections-txxr4fzzbrt8.pdf

COVID-19 pandemic increased ESKAPEEc bloodstream infections and amplified carbapenem resistance in Chinese children: a multicenter surveillance study (2016–2023)

Additional file 1: Appendix. Table A1. Specific questionnaire items. Table A2. (a)Association between socio-demographic characteristics and parents’ skills for antibiotic identification and antibiotic use among parents who self-medicated their children(N=1944). (b)Association between sociodemographic characteristics and parents’ skills for antibiotic identification and antibiotic use among parents whose children visited hospital(N=2478). Table A3. Correlation analysis between skills for antibiotic identification and skills for antibiotic use among parents who self-medicated their children(N=1944). Table A4. Correlation analysis between skills for antibiotic identification and skills for antibiotic use among parents whose children visited hospital(N=2478). Table A5. Sensitivity analysis. (a) Parents who self-medicated their children(N=1944) (b) Parents whose children visited hospital(N=2478). 

Additional file 1 of The moderating effect of parental skills for antibiotic identification on the link between parental skills for antibiotic use and inappropriate antibiotic use for children in China

Additional file 1: Table S1. Antimicrobial resistance ratios of different MRSA genotypes (%). 

Additional file 1 of Clinical and molecular characteristics of methicillin-resistant Staphylococcus aureus in bone and joint infection among children

The Infectious Disease Surveillance of Pediatrics (ISPED) program was established in 2015 to monitor and analyze the trends of bacterial epidemiology and antimicrobial resistance (AMR) in children. Clinical bacterial isolates were collected from 11 tertiary care children's hospitals in China in 2016 to 2020. Antimicrobial susceptibility testing was carried out using the Kirby-Bauer method or automated systems, with interpretation according to the Clinical and Laboratory Standards Institute 2019 breakpoints. A total of 288,377 isolates were collected, and the top 10 predominant bacteria were Escherichia coli, Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Streptococcus pyogenes, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Acinetobacter baumannii. In 2020, the coronavirus disease 2019 (COVID-19) pandemic year, we observed a significant reduction in the proportion of respiratory tract samples (from 56.9% to 44.0%). A comparable reduction was also seen in the primary bacteria mainly isolated from respiratory tract samples, including S. pneumoniae, H. influenzae, and S. pyogenes. Multidrug-resistant organisms (MDROs) in children were commonly observed and presented higher rates of drug resistance than sensitive strains. The proportions of carbapenem-resistant K. pneumoniae (CRKP), carbapenem-resistant A. baumannii (CRAB), carbapenem-resistant P. aeruginosa (CRPA), and methicillin-resistant S. aureus (MRSA) strains were 19.7%, 46.4%%, 12.8%, and 35.0%, respectively. The proportions of CRKP, CRAB, and CRPA strains all showed decreasing trends between 2015 and 2020. Carbapenem-resistant Enterobacteriaceae (CRE) and CRPA gradually decreased with age, while CRAB showed the opposite trend with age. Both CRE and CRPA pose potential threats to neonates. MDROs show very high levels of AMR and have become an urgent threat to children, suggesting that effective monitoring of AMR and antimicrobial stewardship among children in China are required. IMPORTANCE AMR, especially that involving multidrug-resistant organisms (MDROs), is recognized as a global threat to human health; AMR renders infections increasingly difficult to treat, constituting an enormous economic burden and producing tremendous negative impacts on patient morbidity and mortality rates. There are many surveillance programs in the world to address AMR profiles and MDRO prevalence in humans. However, published studies evaluating the overall AMR rates or MDRO distributions in children are very limited or are of mixed quality. In this study, we showed the bacterial epidemiology and resistance profiles of primary pathogens in Chinese children from 2016 to 2020 for the first time, analyzed MDRO distributions with time and with age, and described MDROs' potential threats to children, especially low-immunity neonates. Our study will be very useful to guide antiinfection therapy in Chinese children, as well as worldwide pediatric patients.

Bacterial Epidemiology and Antimicrobial Resistance Profiles in Children Reported by the ISPED Program in China, 2016 to 2020.

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Bacterial Epidemiology and Antimicrobial Resistance Profiles in Children Reported by the ISPED Program in China, 2016 to 2020.