Antimicrobial resistance (AMR) is reshaping the treatment landscape for bacterial infections, and nationwide surveillance is essential for seeing where pressure is easing and where new risks are emerging. A 2025 analysis from the China Antimicrobial Surveillance Network (CHINET) tracked 516,309 clinical bacterial isolates from 80 hospitals across China, revealing a mixed picture: resistance declined in some major pathogens, but worrying rebounds appeared in others. Methicillin-resistant Staphylococcus aureus (MRSA) continued to fall, while vancomycin-resistant Enterococcus faecium rose for a fifth consecutive year. Carbapenem resistance also remained a major concern, particularly in Acinetobacter baumannii, underscoring the need for sustained surveillance, antimicrobial stewardship, stronger laboratory capacity, and infection-control measures as resistance patterns continue to shift.
Antibiotics have transformed modern medicine, but their effectiveness is increasingly threatened as bacteria acquire and spread resistance. China faces a particularly complex challenge because antimicrobial use, large patient populations, healthcare-associated transmission, and the circulation of multidrug-resistant organisms can rapidly shift resistance patterns. CHINET, established in 2004, has grown into a national network spanning all 31 provinces, municipalities, and autonomous regions, allowing year-to-year tracking of clinically important bacteria and their drug responses. Yet national averages can mask changing threats, especially when resistance falls in one organism but rises sharply in another, complicating treatment decisions and infection control. Because of these challenges, in-depth surveillance of evolving AMR patterns and their clinical implications is urgently needed.
Researchers from the Institute of Antibiotics at Huashan Hospital, Fudan University, and the Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, conducted the study (DOI: 10.1186/s44280-026-00147-w) , which was published in One Health Advances . Using CHINET data collected from January through December 2025, the team characterized the distribution and antimicrobial susceptibility of bacterial isolates from 80 hospitals and compared important resistance patterns with previous surveillance years, providing an updated national snapshot of clinically relevant AMR and its changing direction across major bacterial pathogens.
The surveillance captured 516,309 isolates, 12.7% more than in 2024; 71.5% were Gram-negative and 28.5% Gram-positive. Escherichia coli was the most common organism, followed by Klebsiella species, Staphylococcus aureus, Enterococcus species, and Pseudomonas aeruginosa. Respiratory specimens, urine, and blood remained the main sources, showing that the bacterial landscape itself was broadly stable even as resistance shifted. Among staphylococci, Methicillin-resistant Staphylococcus aureus (MRSA) declined from 29.2% in 2024 to 28.4% in 2025, while methicillin-resistant Staphylococcus epidermidis and other methicillin-resistant coagulase-negative staphylococci also decreased. In contrast, vancomycin-resistant Enterococcus faecium (VREfm) rose from 1.4% in 2021 to 8.4% in 2025, marking five consecutive years of increase. Carbapenem resistance showed similarly divergent trajectories. In Klebsiella pneumoniae, imipenem and meropenem resistance declined for a second year, reaching 21.9% and 21.0%, respectively. But resistance in Pseudomonas aeruginosa rebounded to 22.6% and 18.8%, while Acinetobacter baumannii climbed sharply to 72.0% and 71.9%. These opposing movements show how aggregate resistance statistics can conceal organism-specific reversals that matter directly for treatment. The study also found that several newer beta-lactam-beta-lactamase inhibitor combinations retained substantial activity against selected carbapenem-resistant organisms, supporting organism- and mechanism-specific susceptibility testing rather than one-size-fits-all antibiotic choices.
The authors said the surveillance shows why progress against AMR cannot be judged by a single national trend. Declining methicillin resistance in staphylococci and lower carbapenem resistance in K. pneumoniae are encouraging, they said, but the continuing rise of vancomycin-resistant E. faecium and the rebound in carbapenem resistance among P. aeruginosa and A. baumannii demand close attention. They added that laboratories need timely susceptibility testing for newly introduced antibiotics, while molecular epidemiology and standardized clinical data will be important for explaining how resistant strains spread, identifying the mechanisms behind changing patterns, and guiding more precise interventions.
The findings can help clinicians choose empirical antibiotics more rationally, laboratories prioritize susceptibility testing, and health authorities focus infection-prevention resources on organisms showing renewed or persistent resistance. The authors recommend stronger longitudinal surveillance, standardized testing for newer antimicrobial agents, and a national reference laboratory for antimicrobial susceptibility testing (AST). They also call for multicenter molecular epidemiology linked to standardized clinical data to clarify transmission pathways and resistance mechanisms. Such work is especially important because the present surveillance is dominated by tertiary hospitals and did not include molecular characterization or reliably distinguish community-acquired from healthcare-associated infections. Together, these steps could make resistance monitoring more actionable, strengthen early warning of emerging threats, and support targeted antimicrobial stewardship and infection-control strategies.
