title: A ten years (2000-2009) surveillance of resistant Enterobacteriaceae in Zhejiang Province, China.
abstract: OBJECTIVE
  In Zhejiang Province, there are several highly developed cities near the coast and several relatively under-developed mountain areas. Analysis of the composition of bacteria isolated from patients as well as their antibiotic resistance profile from various areas of this province, and tracing of such data year-by-year, will help to delineate the bacterial resistance profile of these areas and to understand how the stage of socio-economical development impacts on the composition of clinical micro-flora and their resistance profile.
  
  
  METHODS
  In order to investigate variation in resistance rates and isolation rates of Enterobacteriaceae, from 2000 to 2009 in Zhejiang Province, China, Enterobacteriaceae isolated from 15 hospitals located in different regions of the province were surveyed.
  
  
  RESULTS
  The total numbers of the Enterobacteriaceae isolated increased more than 20-fold from 2000 to 2009. Among the Enterobacteriaceae, Escherichia coli and Klebsiella pneumoniae were the dominant isolates. The percentage of E. coli and K. pneumoniae that produced detectable extended-spectrum β-lactamases (ESBLs) increased from 2000 to 2007, and then declined slightly in 2008 and 2009. The percentages of K. pneumoniae and E. coli that were resistant to ceftazidime increased sharply from 2000 to 2009. There were remarkable increases in the carbapenem resistant rates during the decade, but they were much higher for the isolates from the developed cities than from the rural areas. In 2002, carbapenem-resistant E. coli was first found in Hangzhou, one of the highly developed cities in Zhejiang Province. By 2009, carbapenem-resistant bacteria were found for all species of Enterobacteriaceae surveyed in almost all areas of the province, although they were more frequently identified in developed areas than in rural areas.
  
  
  CONCLUSIONS
  Much restrictive actions have to be taken in terms of rational use of antibiotics and nosocomial control to prevent the further spread of the drug-resistant pathogens.
authors.affiliation: Second Affiliated Hospital of Zhejiang University, Zhejiang University, Hangzhou, China ; Graduate School of Pharmaceutical Sciences, Osaka University, Osaka, Japan.
authors.forename: Rong
authors.initials: R
authors.lastname: Zhang
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ichijo
authors.forename: Yan-Yan
authors.initials: YY
authors.lastname: Hu
authors.forename: Hong-Wei
authors.initials: HW
authors.lastname: Zhou
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Yamaguchi
authors.forename: Masao
authors.initials: M
authors.lastname: Nasu
authors.forename: Gong-Xiang
authors.initials: GX
authors.lastname: Chen
keywords: Enterobacteriaceae; area distribution; carbapenems; long-term resistant surveillance