A ten years (2000–2009) surveillance of resistant Enterobacteriaceae in Zhejiang Province, China

Figures & data

Supplementary Table 1. Distribution of clinical isolates in Zhejiang Province from 2000 to 2009

No.	2000	No. of strains	2001	No. of strains	2002	No. of strains	2003	No. of strains	2004	No. of strains
1	S. aureus	773	S. aureus	1996	P. aeruginosa	2156	P. aeruginosa	2201	P. aeruginosa	4388
2	P. aeruginosa	767	P. aeruginosa	1782	S. aureus	1880	S. aureus	2025	S. aureus	2850
3	E. coli	501	E. coli	1084	E. coli	1190	E. coli	1695	E. coli	2594
4	A. baumannii	463	A. baumannii	984	K. pneumoniae	1069	A. baumannii	1585	K. pneumoniae	2466
5	K. pneumoniae	399	K. pneumoniae	941	A. baumannii	1035	K. pneumoniae	1387	A. baumannii	2465
6	S. epidermidis	336	S. epidermidis	770	S. epidermidis	811	S. epidermidis	1386	S. epidermidis	1922
7	E. cloacae	235	E. faecalis	456	E. faecalis	690	E. faecium	1123	S. maltophilia	1377
8	E. faecalis	228	S. maltophilia	428	S. maltophilia	621	S. maltophilia	792	E. faecium	1281
9	S. maltophilia	203	E. faecium	385	F.meningosepticum	500	E. cloacae	506	E. faecalis	769
10	E. faecium	108	E. cloacae	342	E. cloacae	483	E. faecalis	440	E. cloacae	768
No.	2005	No. of strains	2006	No. of strains	2007	No. of strains	2008	No. of strains	2009	No. of strains
1	P. aeruginosa	7225	P. aeruginosa	9502	P. aeruginosa	14667	P. aeruginosa	28049	P. aeruginosa	25897
2	A. baumannii	5875	A. baumannii	7819	A. baumannii	9577	A. baumannii	20892	A. baumannii	24938
3	K. pneumoniae	3438	S. aureus	4305	K. pneumoniae	6161	S. aureus	9234	K. pneumoniae	9472
4	E. coli	3003	K. pneumoniae	4058	S. aureus	5291	K. pneumoniae	8080	S. aureus	8033
5	S. aureus	2829	E. coli	2920	E. coli	3951	E. coli	6926	E. coli	6954
6	S. epidermidis	2394	S. epidermidis	2474	S. epidermidis	2880	S. epidermidis	4271	S. maltophilia	5155
7	E. faecalis	1262	S. maltophilia	1732	S. maltophilia	2344	S. maltophilia	4040	S. epidermidis	5036
8	S. maltophilia	1260	E. faecium	1386	B. cepacia	1942	S. marcescens	3809	S. marcescens	2997
9	E. faecium	1175	B. cepacia	1138	E. faecium	1674	B. cepacia	2193	P. mirabilis	2877
10	B. cepacia	1132	E. faecalis	990	S. marcescens	1339	E faecalis	1962	E. faecium	1798

Fig. 1.  Distribution of clinically isolated Enterobacteriaceae in Zhejiang Province from 2000 to 2009.

Fig. 2.  Annual changes in the detection ratio of Enterobacteriaceae that produced ESBLs from clinically isolated Enterobacteriaceae.

Fig. 3.  Annual changes in the resistance rate of various Enterobacteriaceae species against carbapenem from 2000 to 2009. (A) Imipenem, (B) meropenem.

Supplementary Table 2. Variation of antimicrobial susceptibility of Enterobacteriaceae isolated from 2000 to 2009

	Resistance rate (%)
Antimicrobial agents	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009
Escherichia coli
Total number of isolates	501	1084	1190	1695	2594	3003	2920	3951	6926	6954
Aztreonam	23.5	15.3	25.0	21.0	35.0	46.1	48.5	56.2	57.5	51.4
Cefepime	10.3	12.1	32.8	19.7	35.3	46.7	47.0	52.7	52.1	49.4
Cefoperazone-sulbactam	–	–	–	2.4	4.8	10.3	8.3	4.8	9.4	9.0
Cefotaxime	26.0	23.1	36.5	36.3	50.1	56.8	57.0	64.1	63.6	61.7
Cefoxitin	14.3	22.8	24.4	11.9	11.9	20.6	18.1	22.1	14.3	16.9
Ceftazidime	5.5	14.8	23.6	14.0	26.7	34.8	38.5	46.3	50.0	45.3
Imipenem	0	0	0.7	0.9	0.2	0.5	0.4	0.7	1.7	2.3
Meropenem	–	–	–	0	0	0.4	1.0	1.8	1.2	2.4
Piperacillin-tazobactam	–	–	–	7.7	12.6	10.5	10.0	15.0	8.7	12.6
Klebsiella pneumoniae
Total number of isolates	399	941	1069	1387	2466	3438	4058	6161	8080	9472
Aztreonam	24.1	47.5	56.2	49.0	45.0	61.6	65.5	74.2	64.2	61.7
Cefepime	8.6	26.8	51.5	21.0	27.9	45.8	61.4	65.3	57.9	58.1
Cefoperazone-sulbactam	–	–	–	9.9	13.4	31.5	23.8	18.8	24.8	37.0
Cefotaxime	33.0	38.0	56.0	45.8	49.7	67.8	69.8	74.4	70.7	63.0
Cefoxitin	22.2	27.6	35.8	20.0	17.0	26.6	33.9	32.4	27.5	32.0
Ceftazidime	23.9	27.3	46.9	34.6	42.9	54.2	58.7	69.3	60.1	58.4
Imipenem	0	0	1.3	1.8	0.6	1.4	4.7	7.3	8.5	23.3
Meropenem	–	–	–	1.3	1.6	2.2	2.4	8.7	8.4	20.8
Piperacillin-tazobactam	–	–	–	28.1	40.8	43.7	47.0	46.1	38.6	49.0
Enterobacter cloacae
Total number of isolates	235	342	483	506	768	803	943	1096	1358	1598
Aztreonam	62.5	58.6	53.2	60.3	55.2	66.1	57.6	51.6	50.7	48.8
Cefepime	24.5	27.5	44.2	29.8	32.6	41.4	31.3	33.2	27.1	25.1
Cefoperazone-sulbactam	–	–	–	6.1	12.4	25.3	18.5	9.4	18.7	13.6
Cefotaxime	57.4	65.0	65.5	43.5	57.9	66.9	51.9	53.9	49.3	46.8
Cefoxitin	–	92.7	95.9	89.3	83.9	89.4	95.5	94.8	96.0	94.5
Ceftazidime	47.9	53.9	51.7	56.0	53.7	58.0	48.8	44.9	48.5	49.5
Imipenem	0	0	2.9	0	2.4	5.0	4.4	4.6	4.4	9.8
Meropenem	–	–	–	0	0	2	3.6	7.0	4.7	5.1
Piperacillin-tazobactam	–	–		31.3	34.7	42.2	31.2	26.6	26.4	21.8
Serratia marcescens
Total number of isolates	19	33	59	44	187	551	1057	1674	3809	2997
Aztreonam	–	–	–	–	2.3	50.9	52.5	66.9	48.1	53.7
Cefepime	–	–	–	–	–	25.4	30.6	31.9	26.7	48.0
Cefoperazone-sulbactam	0	0	0		0	0	26.1	11.3	21.5	16.7
Cefotaxime	0	0	0	0	0	44.3	45.9	60.0	48.2	49.6
Cefoxitin	–	10.0	50.0	28.6	43.5	61.9	60.2	60.1	67.8	62.9
Ceftazidime	0	0	0	0	0	4.2	15.6	7.9	12.0	26.4
Imipenem	–	0	0	0	0	48.7	54.9	34.2	24.1	18.3
Meropenem	–	–	–	–	–	59.3	40.7	28.2	20.2	10.4
Piperacillin-tazobactam	0	0	0		2.3	27.6	35.2	33.7	30.3	25.1
Citrobacter freundii
Total number of isolates	29	52	90	118	245	142	93	136	231	447
Aztreonam	0	33.3	43.5	25.0	28.6	34.3	31.6	56.0	48.3	50.0
Cefepime	0	20.0	22.7	25.0	13.0	28.6	27.8	36.0	37.9	31.8
Cefoperazone-sulbactam	–	–	–	–	13.0	10.0	6.4	19.1	20.0	15.9
Cefotaxime	28.7	25.0	37.5	33.3	46.0	35.7	36.4	42.1	35.3	56.5
Cefoxitin	–	–	85.7	78.5	69.6	86.4	83.3	88.9	91.2	93.8
Ceftazidime	30.0	35.7	41.4	25.0	32.8	25.0	36.9	48.0	41.4	45.7
Imipenem	0	0	4.2	0	1.9	2.9	5.3	4.2	0	13.6
Meropenem	–	–	–	0	0	0	0	6.7	0	13.1
Piperacillin-tazobactam	–	–	–	–	21.8	24.3	31.6	40.0	20.7	39.1

Fig. 4.  Prevalence of carbapenem-resistant Enterobacteriaceae from 10 areas in Zhejiang Province from 2000 to 2009. The year shown inside the area indicated the year when the first carbapenem-resistant Enterobacteriaceae was identified from this area. The sign of different color shown in the area indicates the different carbapenem-resistant Enterobacteriaceae so far have been identified from this area.

Table 1. Detection of carbapenem-resistant Enterobacteriaceae in different districts of Zhejiang Province

District	Year of the earliest appeared carbapenem-resistant Enterobacteriaceae	Number of existing species of bacteria	Existing species of bacteria
Hangzhou district	In 2002, E. coli	8	E. coli, K. pneumoniae, E. cloacae, P. mirabilis, C. freundii, S. marcescens, E. aerogenes, K. oxytoca
Jiaxing district	In 2007, K. pneumoniae	4	E. coli, K. pneumoniae, E. cloacae, S. marcescens
Ningbo district	In 2008, K. pneumoniae	6	E. coli, K. pneumoniae, K. oxytoca, E. cloacae, S. marcescens, P. mirabilis
Shaoxing district	In 2007, K. pneumoniae	3	E. coli, E. cloacae, K. pneumoniae, S. marcescens, C. freundii, P. mirabilis
Huzhou district	In 2008, E. coli	2	E. coli, E. cloacae
Taizhou district	In 2007, K. pneumoniae	4	E. coli, E. cloacae, K. pneumoniae, S. marcescens
Lishui district	In 2008, E. cloacae	1	E. cloacae
Wenzhou district	In 2007, K. pneumoniae	3	E. coli, K. pneumoniae, K. oxytoca
Jinhua District	In 2007, K. pneumoniae	3	E. coli, K. pneumoniae, E. cloacae
Quzhou district	In 2007, E. cloacae	1	E. cloacae
Zhoushan district	In 2008, K. pneumoniae	3	K. pneumoniae, E. coli, S. marcescens

Fig. 5.  Resistant rates of E. coli (Panel A) and K. pneumoniae (Panel B) isolated from different areas of the province against imipenem (open bars) and meropenem (filled bars).