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Background  ESKAPEEc contribute to a majority of bloodstream infections (BSIs) and their antibiogram have changed overtime, while data concerning about these alterations are lacking in China. Added that a paucity of studies referred to ESKAPEEc in pediatric BSIs, our study aimed to demonstrate the longitudinal alterations of ESKAPEEc distribution and antibiogram in adult and pediatric BSIs in Southwest China.    Methods  A multicenter retrospective surveillance study was launched from 2012 to 2017. Data of China Antimicrobial Resistance Surveillance System (CARSS) was analyzed by Whonet 5.6 and Graphpad Prism 6 Software.  Chi-square  test or  Fisher’s  exact test was used to examine and compare temporal changes.    Results  A total of 32,259 strains was isolated, with 17.4% from pediatric BSIs. ESKAPEEc contributed to 58.67% (18,924/32,259) of BSIs, with 65.3% of adult BSIs and 27.2% of pediatric BSIs.  Escherichia coli  ( E. coli ) and  Klebsiella pneumoniae  ( K. pneumoniae ) were the two predominant species. Carbapenem resistance was prevalent in 0.76, 4.60, 9.47,13.66, 59.47% of  E. coli ,  K. pneumoniae ,  Enterobacter cloacae ,  Pseudomonas aeruginosa  ( P. aeruginosa ) and  Acinetobacter baumannii  ( A. baumannii ), respectively. The proportions of methicillin-resistant  Staphylococcus aureus  (MRSA) and vancomycin-resistant  Enterococcus faecium  (VREFM) were 28.91% and 2.20%, respectively. Between 2012-2014 and 2015–2017,  E. coli  and  K. pneumonia  showed significantly increased resistance rates to imipenem but decreased to ceftriaxone and ceftazidime, while  A. baumannii  exhibited reduced resistances to almost all the beta-lactams tested. The prevalence of antimicrobial resistance to most of agents against Gram-positive ESKAPEEc did not significantly varied during the same timeframe. In comparison with those from adult BSIs,  K. pneumoniae  from pediatric BSIs exhibited high resistance rates to all the beta-lactams tested, especially to carbapenems (12.79% vs 3.87%), while  A. baumannii  showed low resistance rates to all the agents.    Conclusions  Ongoing burden of ESKAPEEc in BSIs and increasing trend of imipenem resistance in  E. coli  and  K. pneumoniae  call for continued surveillance. Carbapenems are still active against Gram-negative ESKAPEEc, except for  A. baumannii  and vancomycin or linezolid is still effective against Gram-positive ESKAPEEc. Carbapenem-resistant  K. pneumoniae  in children and carbapenem-resistant  A. baumannii  in adults necessitate effective antimicrobial strategies in consideration of age stratification.

Shifting trends and age distribution of ESKAPEEc resistance in bloodstream infection, Southwest China, 2012–2017