Trends in Antibiotic Consumption and Antimicrobial Resistance in China: An Ecological Analysis from 2016 to 2022

To examine national trends in antibiotic consumption and antimicrobial resistance (AMR) among six WHO-priority bacterial pathogens in China from 2016 to 2022.

This ecological study analyzed national and provincial data from the China Antibacterial Resistance Surveillance System (CARSS) and the National Hospital Information Network. Beta regression models assessed temporal trends, and hierarchical models evaluated associations between antibiotic use and resistance.

From 2016 to 2022, carbapenem resistance in Acinetobacter baumannii and Pseudomonas aeruginosa, and vancomycin resistance in Enterococcus faecium and E. faecalis significantly declined ( β < 0, P < 0.010), while carbapenem-resistant Klebsiella pneumoniae increased ( β = 0.081, P < 0.001). Nationwide antibiotic consumption rose across 10 major classes. Positive associations were found between carbapenem use and resistance in A. baumannii ( z = 2.719, P = 0.007) and P. aeruginosa ( z = 3.241, P = 0.001), and between vancomycin use and resistance in E. faecium ( z = 4.510, P = 0.001) and E. faecalis ( z = 3.210, P = 0.001).

Carbapenem-resistant K. pneumoniae increased significantly in China, while other resistant pathogens declined. Resistance patterns were linked to the use of multiple antibiotic classes, underscoring the need for strengthened antibiotic stewardship and surveillance.