Antimicrobial Resistance Trends of the Most Common Causative Pathogens Associated with Community-acquired Respiratory Infections in China: 2009–2018

Figures & data

Figure 1 Geographical location of different cities participating in this study.

Table 1 The Overall Resistance Rate of S. pneumoniae to Different Antibacterial Agents, from 2010 to 2018

Antibiotics	Sensitive %	Intermediate %	Resistant %	MIC50	MIC90	Range	Strain Number
Penicillin oral	41.4	17.8	40.8	0.5	4	0.004 – 64	2015
Penicillin meningitis	41.4	0.0	58.6	0.5	4	0.004 – 64	2015
Penicillin non-meningitis	76.2	22.2	1.6	0.5	4	0.004 – 64	2015
Amoxicillin-clavulanic acid	73.1	8.7	18.3	0.5	8	0.008 – 64	2015
Cefaclor	39.8	5.7	54.5	16	>256	0.016 – >256	2015
Cefuroxime	49.2	3.8	47.0	2	32	0.016 – >256	2015
Ceftriaxone	78.0	6.7	15.3	0.5	4	0.016 – >64	2015
Ceftriaxone meningitis	57.5	20.5	22.0	0.5	4	0.016 – >64	2015
Vancomycin	100.0	0.0	0.0	0.25	0.25	0.016 – 1	2015
Erythromycin	6.0	0.7	93.3	256	>256	0.016 – >256	2015
Azithromycin	7.4	1.2	91.4	>16	>256	0.016 – >256	2015
Clarithromycin	7.8	1.8	90.4	128	>256	0.016 – >256	2015
Tetracycline	7.1	1.4	91.5	32	64	0.032 – >128	2015
Levofloxacin	97.6	0.2	2.2	1	1	0.016 – >32	2015
Moxifloxacin	98.4	1.0	0.6	0.125	0.25	0.016 – >32	2015
Trimethoprim-sulfamethoxazole	25.3	8.0	66.7	4	16	0.016 – 128	2015
Chloramphenicol	87.9	0.0	12.1	4	8	0.016 – 32	2015
Clindamycin	12.2	1.1	86.7	128	256	0.016 – >256	2015

Table 2 The Overall Resistance Rate of PSSP, PISP and PRSP to Different Antibacterial Agents, from 2010 to 2018

Antibiotics	PSSP^a (N=834)						PISP^b (N=359)						PRSP^c (N=822)
	S^d	I^e	R^f	MIC50	MIC90	Range	S	I	R	MIC50	MIC90	Range	S	I	R	MIC50	MIC90	Range
Penicillin oral	100	0	0	0.032	0.064	0.004 – 0.064	0	100	0	0.5	1	0.125 – 1	0	0	100	4	4	2 – 64
Penicillin meningitis	100	0	0	0.032	0.064	0.004 – 0.064	0	0	100	0.5	1	0.125 – 1	0	0	100	4	4	2 – 64
Penicillin non-meningitis	100	0	0	0.032	0.064	0.004 – 0.064	100	0	0	0.5	1	0.125 – 1	41.7	54.4	3.9	4	4	2 – 64
Amoxicillin-clavulanic acid	99.8	0	0.2	0.016	0.032	0.008 – 32	98.6	1.1	0.3	0.5	1	0.008 – 8	34.8	20.8	44.4	4	8	0.016 – 64
Cefaclor	87.9	10.4	1.7	1	2	0.016 – >256	18.9	7.8	73.3	16	>64	0.125 – >256	0	0	100	>256	>256	16 – >256
Cefuroxime	99.5	0.2	0.2	0.032	0.125	0.016 – 16	44	17.8	38.2	2	4	0.032 – >16	0.4	1.2	98.4	8	32	0.125 – >256
Ceftriaxone	99.8	0.1	0.1	0.016	0.064	0.016 – 4	96.1	2.5	1.4	0.5	1	0.016 – >64	47.9	15.2	36.9	2	8	0.125 – >32
Ceftriaxone meningitis	99.6	0.1	0.2	0.016	0.064	0.016 – 4	74.9	21.2	3.9	0.5	1	0.016 – >64	7.1	40.9	52.1	2	8	0.125 – >32
Vancomycin	100	0	0	0.25	0.25	0.064 – 0.5	100	0	0	0.25	0.25	0.016 – 1	100	0	0	0.25	0.25	0.064 – 1
Erythromycin	12.7	1.2	86.2	128	>256	0.016 – >256	5.7	1.7	92.6	128	>256	0.016 – >256	0.3	0	99.7	>128	>256	0.032 – >256
Azithromycin	15.1	2.2	82.7	32	>256	0.016 – >256	5.3	0.8	93.9	>16	>256	0.016 – >256	0.5	0.4	99.1	>256	>256	0.032 – >256
Clarithromycin	15.5	2.4	82.1	>4	>256	0.016 – >256	7.2	3.3	89.4	>4	>256	0.016 – >256	0.4	0.5	99.1	>256	>256	0.032 – >256
Tetracycline	12.2	3	84.8	32	64	0.032 – 128	7.4	1.3	91.3	32	64	0.125 – 256	2.5	0.1	97.3	32	64	0.25 – >128
Levofloxacin	98.3	0.1	1.6	1	1	0.016 – 32	96.7	0.3	3.1	1	1	0.016 – 32	97.2	0.4	2.4	1	1	0.125 – >32
Moxifloxacin	98.9	0.7	0.4	0.125	0.125	0.016 – 16	98.3	0.6	1.1	0.125	0.125	0.016 – 8	97.9	1.5	0.6	0.125	0.25	0.032 – >32
Trimethoprim-sulfamethoxazole	47.4	7.4	45.1	1	8	0.016 – 128	24.3	15.7	60	4	8	0.016 – 128	6.7	5.9	87.4	8	16	0.125 – 128
Chloramphenicol	78.4	0	21.6	4	8	0.016 – 16	89.1	0	10.9	2	8	0.064 – 32	95.6	0	4.4	4	4	0.125 – 16
Clindamycin	25.9	2.3	71.8	64	256	0.016 – >256	12.2	1.4	86.5	64	256	0.016 – >256	1.4	0	98.6	256	256	0.064 – >256

Abbreviations: ^aPSSP, penicillin-susceptible Streptococcus pneumoniae; ^bPISP, penicillin-intermediate Streptococcus pneumoniae; ^cPRSP, penicillin-resistant Streptococcus pneumoniae; ^dS, Sensitive percentage; ^eI, intermediate percentage; ^fR, resistant percentage.

Table 3 The Differences in Drug Resistance Rates Between Invasive and Noninvasive S. pneumoniae

Antibiotics	Invasive (N=145)						Noninvasive (N = 1870)						P-value
	S%	I%	R%	MIC50	MIC90	Range	S%	I%	R%	MIC50	MIC90	Range
Penicillin oral	44.1	17.2	38.6	0.25	4	0.004 – 8	41.2	17.9	41	0.5	4	0.004 – 64	0.780733
Penicillin meningitis	44.1	0	55.9	0.25	4	0.004 – 8	–	–	–	–	–	–	–
Penicillin nonmeningitis	–	–	–	–	–	–	76.1	22.2	1.7	0.5	4	0.004 – 64	–
Amoxicillin/clavulanic acid	74.5	6.9	18.6	0.25	8	0.008 – 32	72.9	8.8	18.2	0.5	8	0.008 – 64	0.729767
Cefaclor	40.7	6.2	53.1	16	>256	0.016 – >256	39.7	5.7	54.7	16	>256	0.016 – >256	0.922137
Cefuroxime	50.3	3.4	46.2	0.5	32	0.016 – >256	49.1	3.8	47.1	2	32	0.016 – >256	0.946579
Ceftriaxone	79.3	7.6	13.1	0.25	4	0.016 – >32	77.9	6.6	15.5	0.5	4	0.016 – >64	0.695279
Ceftriaxone meningitis	60	19.3	20.7	0.25	4	0.016 – >32	–	–	–	–	–	–	–
Vancomycin	100	0	0	0.25	0.25	0.125 – 0.5	100	0	0	0.25	0.25	0.016 – 1	–
Erythromycin	7.4	0	92.6	256	>256	0.016 – >256	5.8	0.8	93.4	256	>256	0.016 – >256	0.490743
Azithromycin	8.3	0	91.7	>16	>256	0.016 – >256	7.3	1.3	91.4	>16	>256	0.016 – >256	0.363069
Clarithromycin	8.3	2.1	89.7	>128	>256	0.016 – >256	7.8	1.8	90.4	64	>256	0.016 – >256	0.943526
Tetracycline	7.4	2.5	90.1	32	64	0.032 – 128	7	1.3	91.6	32	64	0.032 – >128	0.582572
Levofloxacin	96.6	0	3.4	1	1	0.016 – >32	97.6	0.3	2.1	1	1	0.016 – >32	0.461022
Moxifloxacin	97.2	1.4	1.4	0.125	0.25	0.016 – >32	98.5	1	0.5	0.125	0.25	0.016 – 16	0.392802
Trimethoprim/sulfamethoxazole	28.1	5	66.9	4	16	0.016 – 32	25.1	8.2	66.7	4	16	0.016 – 128	0.388543
Chloramphenicol	86	0	14	4	8	0.016 – 16	88.1	0	11.9	4	8	0.016 – 32	0.592261
Clindamycin	11	1.2	87.8	128	256	0.016 – >256	12.4	1.1	86.6	128	256	0.016 – >256	0.929252

Figure 2 Changes in resistance rates of S. pneumoniae to various drugs in different age groups.

Figure 3 Resistance of S. pneumoniae to routine antibiotics in different years.

Table 4 The Overall Resistance Rate of H. influenzae to Different Antibacterial Agents, from 2010 to 2018

Antibiotics	Sensitive %	Intermediate %	Resistant %	MIC50	MIC90	Range	Strain Number
Ampicillin	60.5	7.3	32.2	1	>16	0.016 – >64	1215
Amoxicillin-Clavulanic acid	89.5	0	10.5	0.5	8	0.008 – >32	1215
Cefaclor	65.3	6.7	28	4	>32	0.016 – >32	1215
Cefuroxime	80.2	4.3	15.5	1	32	0.016 – 128	1215
Ceftriaxone	100	0	0	0.032	0.125	0.016 – 0.5	1215
Azithromycin	100	0	0	1	2	0.016 – 4	1215
Clarithromycin	84.8	7.7	7.6	4	16	0.064 – >64	1215
Tetracycline	89.2	2.2	8.6	0.5	4	0.016 – >64	1215
Levofloxacin	100	0	0	0.016	0.5	0.008 – 2	1215
Moxifloxacin	100	0	0	0.032	0.5	0.008 – 1	1215
Trimethoprim-sulfamethoxazole	36.6	9.2	54.2	4	32	0.016 – >32	1215
Chloramphenicol	92.2	1.9	5.9	0.5	2	0.016 – 32	1215

Table 5 The Sensitivities of β-Lactamase Negative and Positive H. influenzae to Different Antibacterial Agents, from 2010 to 2018

Antibiotics	β-Lactamase Negative (N=896)					β-Lactamase Positive (N=319)
	Sensitive %	Resistant %	MIC50	MIC90	Range	Sensitive %	Resistant %	MIC50	MIC90	Range
Ampicillin	81.5	8.8	0.25	2	0.016 – >64	1.6	97.8	>8	>32	0.016 – >64
Amoxicillin-clavulanic acid	93.1	6.9	0.5	4	0.008 – >32	79.3	20.7	1	16	0.016 – 32
Cefaclor	73.3	22	2	>32	0.016 – >32	42.6	44.8	16	>32	0.016 – >32
Cefuroxime	84.2	11.4	0.5	16	0.016 – 128	69.2	27	2	>32	0.016 – >32
Ceftriaxone	100	0	0.016	0.064	0.016 – 0.5	100	0	0.032	0.25	0.016 – 0.5
Azithromycin	100	0	1	2	0.016 – 4	100	0	1	2	0.016 – 4
Clarithromycin	89.5	2.6	4	16	0.25 – >64	71.5	21.5	8	>32	0.064 – >64
Tetracycline	93.8	4.9	0.5	2	0.016 – 32	79	17	1	8	0.064 – >64
Levofloxacin	100	0	0.016	0.5	0.008 – 2	100	0	0.016	0.5	0.008 – 2
Moxifloxacin	100	0	0.016	0.5	0.008 – 1	100	0	0.032	0.5	0.008 – 1
Trimethoprim-sulfamethoxazole	43.4	46.7	2	32	0.016 – >32	21.6	70.9	8	32	0.016 – >32
Chloramphenicol	96.2	2.6	0.5	1	0.016 – 32	83	13.3	0.5	8	0.016 – 32

Figure 4 Resistance of H. influenzae to routine antibiotics in different years.

Table 6 The Overall Resistance Rate of M. catarrhalis to Different Antibacterial Agents, from 2010 to 2018

Antibiotics	Sensitive %	Intermediate %	Resistant %	MIC50	MIC90	Range
Amoxicillin-clavulanic acid	100	0	0	0.125	0.5	0.008 – 4
Cefaclor	85.2	5.4	9.4	2	16	0.016 – >32
Cefuroxime	97.3	1.3	1.3	1	4	0.016 – >32
Ceftriaxone	100	0	0	0.25	1	0.016 – 2
Azithromycin	100	0	0	0.064	0.125	0.016 – 0.25
Clarithromycin	100	0	0	0.25	1	0.016 – 1
Tetracycline	91	0.2	8.8	0.25	1	0.016 – >64
Levofloxacin	100	0	0	0.064	0.125	0.008 – 2
Trimethoprim-sulfamethoxazole	67.7	26.3	6	0.25	2	0.016 – >64
Chloramphenicol	95.6	1.4	3	0.5	0.5	0.016 – 32
Clindamycin	19	48	33	2	64	0.016 – >256

Figure 5 The prevalence of β-lactamase positive M. catarrhalis in different years.