Trends in antimicrobial resistance of Escherichia coli and Klebsiella pneumoniae from 2016 to 2021 in Shanghai, China

Abstract Objectives We sought to analyze the antimicrobial resistance trends of Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) isolated from patients. Methods Twelve commonly used antibiotics from E. coli and K. pneumoniae isolated every year from 2016 to 2021 were analyzed to identify trends in antimicrobial resistance over time using univariate tests of trend and multivariate regression models to account for the effects of patient demographics. Results The numbers of E. coli and K. pneumoniae strains increased, while the rates of E. coli and K. pneumoniae remained stable. The number and rate of extended-spectrum beta-lactamase (ESBL)-producing E. coli and K. pneumoniae increased. Statistically significant increases in the proportions of E. coli and ESBL-producing E. coli isolates resistant to meropenem, cefepime, cefoperazone-sulbactam, piperacillin-tazobactam, cotrimoxazole, amikacin, ciprofloxacin, and fosfomycin were observed, and increases in the non-ESBL-producing E. coli resistance rates to cefepime, ceftazidime, and piperacillin-tazobactam were observed. Similarly, the proportions of K. pneumoniae and ESBL-producing K. pneumoniae resistant to imipenem, meropenem, cefoxitin, cefepime, ceftazidime, cefoperazone-sulbactam, piperacillin-tazobactam, ciprofloxacin, and fosfomycin increased during the study, while the non-ESBL-producing K. pneumoniae resistance rates to cefazolin and fosfomycin increased. Conclusions Increases in ESBL-producing E. coli and K. pneumoniae resistance to multiple classes of antimicrobials and the marked increase in carbapenem-resistant K. pneumoniae were the most remarkable changes observed from 2016 to 2021. This paper provides important information for governments and clinicians to track antimicrobial resistance and will provide insights into antimicrobial strategies.