Spatiotemporal variation of the increased detection rate of vancomycin-resistant Enterococcus faecium in Guangdong Province,2019-2023
Objective To analyze the spatiotemporal distribution of clinically isolated vancomycin-resistant Entero-coccus faecium(VR-Efm)in Guangdong Province in recent years,and explore the causes for the increase in VR-Efm detection rate.Methods A retrospective analysis was conducted on the data about the detection,patients'de-mographic characteristics,as well as departments and specimens distribution of VR-Efm reported to Guangdong Province Antimicrobial Resistance Surveillance System by 38 medical institutions in 4 regions of Guangdong Province(Pearl River Delta,East Guangdong,West Guangdong,and North Guangdong)in 2019-2023.The detection of 5 other antimicrobial-resistant ESKAPE(Enterococcus f aecium,Staphylococcus aureus,Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa,Enterobacter species)concerned by World Health Organization was analyzed synchronously.Results The detection rate of VR-Efm in Guangdong Province increased from 1.4％(63/4 543)in 2019 to 21.3％(1 351/6 345)in 2023,showing a significant upward trend.In 2023,44.7％(n=17)medical institutions had a VR-Efm detection rate of＞20％;the detection rate of VR-Efm in 4 regions of Guangdong Province has generally increased,with a radiation increase from the Pearl River Delta region to the surrounding areas.The overall ESKAPE increased from 10.1％in 2019 to 10.8％in 2023.Among the other 5 pathogens,the de-tection rate of carbapenem-resistant Klebsiella pneumoniae increased from 8.0％in 2019 to 15.0％in 2023.The detection rates of carbapenem-resistant Acinetobacter baumannii,methicillin-resistant Staphylococcus aureus,car-bapenem-resistant Pseudomonas aeruginosa,and carbapenem-resistant Enterobacter spp.decreased from 61.6％,34.4％,21.2％,and 7.9％in 2019 to 58.2％,31.9％,21.0％,and 7.6％in 2023,respectively,all showed var-ying degrees of decline.The detection rate of VR-Efm in intensive care unit(ICU)(12.2％)was higher than that in non-ICU departments such as outpatient and emergency department(9.4％),internal medicine department(9.2％)and surgery department(7.0％)(all P＜0.05).The specimens with higher detection rates of VR-Efm were urine(9.8％)and blood(9.1％),while the detection rates of other specimens ranged from 6.9％to 9.6％.The detec-tion rate of VR-Efm from adolescent patients was lower than that of middle-aged and elderly patients(4.4％vs＞9.4％,P＜0.05).Conclusion In the past 5 years,the detection rate of VR-Efm in Guangdong Province has significantly increased,which may be related to the transmission of dominant clone acquired from communities and hospitals.Medical institutions with favorable condition should conduct VR-Efm screening for hospitalized patients,take effec-tive prevention and control measures for patients with VR-Efm,so as to curb the increase in detection rate of VR-Efm in the region.
vancomycin-resistant Enterococcus faeciumEnterococcus faeciumantimicrobial resistancesurvei-llance of bacterial antimicrobial resistancechange in antimicrobial resistance
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