title: Results from the Survey of Antibiotic Resistance (SOAR) 2009-11 and 2013-14 in China.
abstract: OBJECTIVE
  To compare antibiotic susceptibility of community-acquired respiratory bacteria in China during 2009-11 and 2013-14.
  
  
  METHODS
  Susceptibility was determined by Etest(®) (bioMérieux) or disc diffusion according to CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints, except for azithromycin where Etest(®) breakpoints (in CO2 incubation) were used in place of standard CLSI breakpoints. Statistical significance of differences in susceptibility across time periods was evaluated using Fisher's exact test.
  
  
  RESULTS
  During 2009-11, 434 Streptococcus pneumoniae, 307 Haemophilus influenzae and 140 Moraxella catarrhalis were collected from eight centres and during 2013-14, 208 S. pneumoniae, 185 H. influenzae and 80 M. catarrhalis were collected from five centres. Penicillin-non-susceptible isolates remained stable at ∼66% over both time periods but susceptibility decreased significantly for amoxicillin/clavulanic acid (or amoxicillin) and cefaclor. For H. influenzae, the proportion of β-lactamase-positive isolates and β-lactamase-negative ampicillin-resistant strains (CLSI definition) was higher in 2013-14 (25.4% and 7.0%, respectively) than in 2009-11 (16.3% and 3.6%, respectively), with decreased ampicillin and cephalosporin susceptibility. By 2009-11 and 2013-14, only amoxicillin/clavulanic acid (amoxicillin), levofloxacin, penicillin (intravenously) and chloramphenicol inhibited >70% of S. pneumoniae. During 2013-14, M. catarrhalis showed increasing resistance, with cefaclor and levofloxacin susceptibility decreasing significantly. However, amoxicillin/clavulanic acid, cefuroxime and levofloxacin continued to inhibit >90% of isolates.
  
  
  CONCLUSIONS
  On the whole, antimicrobial susceptibility decreased in China between 2009-11 and 2013-14. In 2013-14, amoxicillin/clavulanic acid, levofloxacin and chloramphenicol were the most active antibacterial agents tested against community-acquired respiratory pathogens when assessed by CLSI, EUCAST or PK/PD breakpoints. Resistance to other antibacterials in China was generally high. Our data demonstrate the need to harmonize breakpoints for these pathogens.
authors.affiliation: Institute of Antibiotics, Huashan Hospital, Fudan University, Building No. 6, 12 Middle Urumqi Road, Shanghai, China Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Building No. 6, 12 Middle Urumqi Road, Shanghai, China.
authors.forename: F
authors.initials: F
authors.lastname: Hu
authors.affiliation: Institute of Antibiotics, Huashan Hospital, Fudan University, Building No. 6, 12 Middle Urumqi Road, Shanghai, China Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Building No. 6, 12 Middle Urumqi Road, Shanghai, China.
authors.forename: D
authors.initials: D
authors.lastname: Zhu
authors.affiliation: Institute of Antibiotics, Huashan Hospital, Fudan University, Building No. 6, 12 Middle Urumqi Road, Shanghai, China Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Building No. 6, 12 Middle Urumqi Road, Shanghai, China.
authors.forename: F
authors.initials: F
authors.lastname: Wang
authors.affiliation: IHMA Europe Sàrl, 9A route de la Corniche, Epalinges 1066, Switzerland.
authors.forename: I
authors.initials: I
authors.lastname: Morrissey
authors.affiliation: GlaxoSmithKline, The Headquarters Building, No. 168 Middle Tibet Road, Shanghai 200001, China.
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.affiliation: GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK didem.x.torumkuney@gsk.com.
authors.forename: D
authors.initials: D
authors.lastname: Torumkuney
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D062665:Epidemiological Monitoring; D006193:Haemophilus influenzae / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D001936:Moraxella catarrhalis / Q000187:drug effects* / Q000302:isolation & purification; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000382:microbiology*; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents