Bacterial Distribution and Antimicrobial Resistance in Intra-Abdominal Infections: A Five- Year Study in Jiaxing, China

Bacterial Distribution and Antimicrobial Resistance in Intra-Abdominal Infections: A Five- Year Study in Jiaxing, China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Bacterial Distribution and Antimicrobial Resistance in Intra-Abdominal Infections: A Five- Year Study in Jiaxing, China Binbin Lu, Xiaoqin Niu, Qinlong Yu, Junhua Tian, Xiaochun Tan, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7626254/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Intra-abdominal infections (IAIs) represent a common and serious clinical condition, often caused by polymicrobial pathogens. The increasing prevalence of antimicrobial resistance among these pathogens poses a growing challenge to effective treatment and public health. Objective To investigate the distribution of bacterial isolates from IAIs patients and their antimicrobial resistance patterns, providing a basis for empirical anti-infective therapy and rational antimicrobial use in clinical practice. Methods Clinical data, pathogen distribution, and antimicrobial resistance profiles were collected from specimens of IAI patients submitted to the Jiaxing First Hospital between 2019 and 2023. Statistical and retrospective analyses of clinical and microbiological characteristics were conducted using WHONET 5.6 and SPSS 25.0. Results A total of 3,154 bacterial isolates were identified, with Escherichia coli and Klebsiella pneumoniae being the predominant Gram-negative pathogens (64.4%). Escherichia coli showed high resistance to ampicillin (> 60%) and moderate resistance to cephalosporins and fluoroquinolones, but remained highly susceptible to carbapenems and tigecycline. Klebsiella pneumoniae had similar trends with slightly lower resistance overall. Pseudomonas aeruginosa and Acinetobacter baumannii were the main non-fermenters; the former was sensitive to aminoglycosides and carbapenems, while the latter showed extensive resistance. Gram-positive isolates (35.6%) were mainly Enterococcus faecium and Enterococcus faecalis , with the former showing high resistance to several agents. Most infections occurred in elderly males, especially during summer. Conclusion The most commonly isolated pathogens in intra-abdominal infections were Escherichia coli , Klebsiella pneumoniae , Pseudomonas aeruginosa , Acinetobacter baumannii , Enterococcus faecium , and Enterococcus faecalis . High resistance rates to multiple antimicrobial agents were observed among these pathogens. Antimicrobial resistance monitoring should guide empirical antibiotic therapy to ensure effective treatment of intra-abdominal infections. Intra-abdominal infections Clinical distribution Pathogens Antimicrobial resistance Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1. Introduction Intra-abdominal infections (IAIs) are common acute and severe infectious diseases primarily caused by bacterial invasion of the abdominal cavity, retroperitoneal space, or associated organs. These infections often occur secondary to surgical conditions such as gastrointestinal perforation, acute appendicitis, biliary tract infections, or pancreatitis. According to a study by the World Society of Emergency Surgery (WSES) on the complexity scoring of IAIs, the overall mortality rate among patients aged 18 years and older with IAIs was 9.2% [ 1 ]. IAIs impose a significant healthcare burden worldwide [ 2 ]. In recent years, advancements in diagnostic techniques, antibiotic application, and surgical procedures have significantly reduced the mortality rate of intra-abdominal infections. However, due to variations in the infection site, pathogenic microorganisms involved, and underlying conditions of patients, mortality rates still exhibit considerable heterogeneity [ 3 , 4 ]. A multicenter observational epidemiological study revealed that secondary peritonitis is the most common type of intra-abdominal infection, followed by biliary tract infections, intra-abdominal abscesses, and pancreatic infections, Elderly individuals and those with comorbidities such as cancer, diabetes, or chronic pulmonary diseases are at higher risk of developing IAIs [ 5 ]. According to pathophysiology, intra-abdominal infections can be classified into uncomplicated intra-abdominal infections and complicated intra-abdominal infections [ 6 ]. Complex intra-abdominal infections (cIAIs) typically require comprehensive treatment, including antimicrobial therapy and organ function support, even after source control has been achieved. The predominant pathogens include Enterobacteriaceae , Enterococci , and Bacteroides species, with their distribution and resistance profiles varying by region and time. Based on the source of infection, IAIs can be classified as community-acquired or healthcare-associated. Community-acquired IAIs are commonly associated with conditions such as appendicitis, with pathogens predominantly comprising anaerobes and Gram-negative bacteria that exhibit relatively low resistance. In contrast, healthcare-associated IAIs are often related to postoperative complications or severe trauma, involving highly resistant pathogens and frequently accompanied by multi-organ dysfunction [ 7 ]. The treatment of intra-abdominal infections requires an appropriate empirical antimicrobial regimen, guided by the spectrum of pathogens and resistance patterns. Both the Surgical Infection Society (SIS) and the Infectious Diseases Society of America (IDSA) emphasize that timely and effective antimicrobial therapy not only improves cure rates but also reduces hospital stay and healthcare costs [ 8 , 9 ]. However, studies on the distribution and antimicrobial resistance patterns of pathogens causing IAIs in the Jiaxing region are limited, particularly regarding long-term trends. This research gap constrains the optimization of clinical management strategies. Strengthening such studies would not only aid in guiding the rational use of antibiotics and reducing the emergence of resistant bacteria but also improve patient outcomes and lower the mortality rate associated with IAIs. 2. Materials and Methods 2.1 Source of Strains A total of 3,154 pathogenic strains were isolated from specimens submitted by intra-abdominal infections patients at our hospital between January 2019 and December 2023. Duplicate strains from the same site in the same patient were excluded. This study was approved by the Medical Ethics Committee of the hospital (Ethics Approval No.: 2025-LP-042). 2.2 Bacterial Identification Bacterial isolates were identified using the MALDI-TOF MS system (BioMérieux, France), following the manufacturer’s instructions. 2.3 Antimicrobial Susceptibility Testing Antimicrobial susceptibility testing (AST) was performed using the VITEK-2 Compact automated system (BioMérieux, France). For antibiotics not included in the automated panel, the disk diffusion method (Oxoid, UK) was applied. AST results were interpreted according to Clinical and Laboratory Standards Institute (CLSI) guidelines for the corresponding year (CLSI 2023). Quality control was performed using the following standard strains: Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922 and ATCC 8739, Klebsiella pneumoniae ATCC 700603, and Klebsiella oxytoca ATCC 13048 (supplied by the Clinical Laboratory Center of the National Health Commission). 2.4 Statistical Analysis Descriptive analysis of bacterial distribution across clinical departments and antimicrobial susceptibility test results was performed using WHONET 5.6 software. Statistical analyses were conducted using SPSS 25.0 software. All visualizations were generated using R software (version 4.3.0). Categorical variables were expressed as frequencies or percentages, and the chi-square test (χ² test) was used for comparisons. P < 0.05 was considered statistically significant. 3. Results 3.1 Epidemiological Profile of Patients with Intra-Abdominal Infections Among the 3,154 patients with confirmed intra-abdominal infections, 58% were male and 42% were female, indicating a significantly higher prevalence in males (χ² = 77.373, P < 0.001). The patients ranged in age from 1 month to 99 years. Elderly individuals aged 60 years and above accounted for the majority of cases (72%), while those aged 18–59 and under 18 represented 27% and 1%, respectively. The difference in age distribution was statistically significant (χ² = 2,533.621, P < 0.001), suggesting that advanced age is a major risk factor for intra-abdominal infections. Seasonal analysis revealed that infections were most frequently reported in summer (27%) and autumn (26%), followed by spring (25%) and winter (22%), with the difference also reaching statistical significance (χ² = 15.557, P = 0.001). These findings indicate that intra-abdominal infections are more common in elderly male patients and tend to occur more frequently during warmer months. Detailed results are presented in Table 1 . Table 1. Demographic and Seasonal Characteristics of Patients with Intra-Abdominal Infections from 2019 to 2023 Category n (%) χ² P Gender Male 1824 58% 77.373 <0.001 Female 1330 42% Age (years) <18 15 1% 2533.621 <0.001 18-59 844 27% ≥60 2295 72% Season Spring 782 25% 15.557 0.001 Summer 860 27% Autumn 806 26% Winter 706 22% 3.2 Bacterial Composition of Intra-Abdominal Infections Among the 3,154 bacterial strains, Gram-negative bacteria were predominantly Enterobacteriaceae , with Escherichia coli (E. coli) accounting for 675 strains (21.4% of the total), followed by Klebsiella pneumoniae (K. pneumoniae) with 425 strains (13.4%). Among Gram-positive cocci, enterococci were the main pathogens, with Enterococcus faecalis (E. faecalis) accounting for 260 strains (8.2%) and Enterococcus faecium (E. faecium) for 244 strains (7.7%). Non-fermenting bacteria followed, with Pseudomonas aeruginosa ( P. aeruginosa ) accounting for 119 strains (3.8%) and Acinetobacter baumannii ( A.baumannii ) for 68 strains (2.2%). The detailed composition of the strains was shown in Fig. 1a . To better understand the dynamic distribution of these pathogens, we further analyzed annual trends from 2019 to 2023 ( Fig. 1b ). The relative proportions of major species remained largely stable throughout the five-year period. E. coli consistently ranked first, followed by K. pneumoniae , with only minor year-to-year fluctuations. Notably, the proportion of E. faecium showed a slight increase in 2021, while P. aeruginosa and A. baumannii remained low and relatively constant. These results suggest that the etiological spectrum of intra-abdominal infections in this region has remained steady over time, with Enterobacteriaceae continuing to dominate. In addition, the age and seasonal distribution of bacterial isolates were examined. As shown in Fig. 1c , patients aged 61–90 years consistently accounted for the highest proportion of isolates each year, underscoring the increased vulnerability of elderly individuals to intra-abdominal infections. Summer and autumn generally had higher isolate counts compared to winter and spring, with a notable upward trend in summer isolates over the years ( Fig. 1d ). This suggests that intra-abdominal infections may be more prevalent during warmer months, warranting increased clinical vigilance during these periods. 3.3 Results of Antimicrobial Resistance Profiles of E. coli and K. pneumoniae Among the isolated strains, E. coli and K. pneumoniae were the most frequently detected Gram-negative pathogens. As shown in Table 2 , E. coli exhibited the highest resistance to ampicillin across all five years, with resistance rates consistently exceeding 60%, and reached a peak of 72.3% in 2020. Moderate resistance was observed to levofloxacin and ceftriaxone, with resistance rates mostly above 30%. Conversely, E. coli demonstrated low resistance to imipenem and meropenem (generally <2%), and no resistance was detected to tigecycline over the study period. K. pneumoniae showed a distinct resistance pattern. Although resistance to amikacin and tigecycline remained low (<5%), moderate resistance was observed to cefazolin and cefuroxime, with resistance rates exceeding 20% in several years. The organism also maintained relatively good susceptibility to beta-lactamase inhibitor combinations, such as cefoperazone/sulbactam and piperacillin/tazobactam, with resistance rates below 15%. Figure 2 provides a visual summary of these trends using a dual-color heatmap, where each cell is split to represent the annual resistance rate of both species—left for E. coli and right for K. pneumoniae . Table 2. Five-Year Antimicrobial Resistance Rates of Eco and Kpn (2019–2023) Antibacterial Drugs 2019 ARR (%) 2020 ARR (%) 2021 ARR (%) 2022 ARR (%) 2023 ARR (%) Eco Kpn Eco Kpn Eco Kpn Eco Kpn Eco Kpn Ampicillin 65.9 - 72.3 - 69.4 - 61.6 - 66.7 - Amoxicillin /Clavulanate 10.9 13.3 14.6 17.6 16.5 10.3 14.6 10.4 8.7 12.1 Cefoperazone/ Sulbactam 5.8 5.6 4.6 14.1 6.6 9.3 7.9 9.1 5.4 7.7 Piperacillin/ Tazobactam 2.2 6.7 3.8 13.3 5 7.2 5.3 5.2 6.2 11.1 Cefazolin 57.4 27.3 60.2 42.4 59.3 22.2 39.4 21.2 50 26.2 Cefuroxime 40.9 24.4 46.5 32.9 45 23.7 35.8 21.1 38.9 24.2 Ceftazidime 27 16.9 32.3 20.3 27.3 14.6 19.9 14.3 18.2 14.3 Ceftriaxone 36.3 16.9 38.5 28.4 39.7 14.4 28.5 18.2 37.8 18.7 Cefepime 10.2 5.6 9.2 14.7 13.2 8.2 7.9 10.4 20 8.9 Cefoxitin 9.6 15.7 17.7 23.3 12.4 13.4 13.3 13 10.1 14.3 Aztreonam 24.8 13.3 26.2 20 25.6 10.3 20.5 15.6 22.1 14.3 Imipenem 0 4.4 0 10.7 0.8 6.2 0.7 5.2 2 1.1 Meropenem 0.7 3.4 0 12.2 0.8 6.2 0.7 5.2 2 2.2 Amikacin 2.9 3.3 2.3 8 2.5 3.1 2.6 2.6 1.4 1.1 Gentamicin 17.5 8.9 16.2 16 24 10.3 16.6 6.5 20.3 9.9 Levofloxacin 33.1 14.4 41.5 23 44.6 14.4 30 15.6 43 11 Trimethoprim/ Trimethoprim /Sulfmethoxazole 35 22.2 36.9 25.3 43.8 15.5 29.1 13 42.6 15.4 Tigecycline 0 3.7 0 0 0 1.1 0 0 0 0 Abbreviations: ARR, Antimicrobial Resistance Rate; Eco, Escherichia coli ; Kpn, Klebsiella pneumoniae . 3.4 Results of Antimicrobial Resistance Profiles of P. aeruginosa and A. baumannii Pseudomonas aeruginosa (P. aeruginosa) and Acinetobacter baumannii (A. baumannii) were the predominant non-fermenting Gram-negative bacilli identified in this study. P. aeruginosa exhibited high susceptibility to aminoglycosides, with average resistance rates to gentamicin and amikacin remaining below 5% over the five-year period. It also showed relatively low resistance to carbapenems (imipenem and meropenem), with mean resistance rates around 14%. However, elevated resistance was observed against aztreonam, with rates A. baumannii , in contrast, demonstrated markedly higher resistance levels. While resistance to tigecycline and amikacin remained moderate (average rates around 15%), resistance to the majority of tested antibiotics—including beta-lactams, cephalosporins, fluoroquinolones, and carbapenems—was substantially higher, frequently surpassing 35%. These resistance patterns are detailed in Table 3 and visualized in Fig. 3 . Table 3. Five-Year Antimicrobial Resistance Rates of Pae and Aba (2019–2023) Antibacterial Drugs 2019 ARR (%) 2020 ARR (%) 2021 ARR (%) 2022 ARR (%) 2023 ARR (%) Pae Aba Pae Aba Pae Aba Pae Aba Pae Aba Cefoperazone/ Sulbactam Sulbactam 25 21.4 18.2 35.7 13 33.3 20.7 41.7 34.6 46.2 Ceftazidime 23.8 46.7 24 50 13 33.3 20.7 50 23.1 41.7 Cefepime 23.8 33.3 16 37.5 13 33.3 10.3 41.7 11.5 46.2 Imipenem 14.3 26.7 8 37.5 8.7 33.3 24.1 50 23.1 46.2 Meropenem 14.3 26.7 8 43.8 8.7 33.3 20.7 50 23.1 46.2 Amikacin 0 18.2 0 0 4.3 9.1 0 25 0 8.3 Gentamicin 0 20 0 12.5 4.3 25 0 41.7 7.7 30.8 Ciprofloxacin 15 33.3 12 37.5 30.4 33.3 6.9 45.5 16 41.7 Levofloxacin 19 26.7 12 31.2 26.1 33.3 6.9 50 15.4 46.2 Piperacillin/ Tazobactam Tazobactam 23.8 - 16 - 13 - 17.2 - 23.1 - Aztreonam 33.3 - 15.8 - 28.6 - 18.5 - 38.5 - Trimethoprim/ Sulfamethoxazole - 40 - 31.2 - 0 - 50 - 46.2 Tigecycline - 7.7 - 6.2 - 0 - 25 - 15.4 Abbreviations: ARR, Antimicrobial Resistance Rate; Pae, Pseudomonas aeruginosa ; Aba, Acinetobacter baumannii . 3.5 Results of Antimicrobial Resistance Profiles of E. faecium and E. faecalis Enterococcus faecium ( E. faecium ) and Enterococcus faecalis ( E. faecalis ) were the major Gram-positive cocci isolated in this study. E. faecium exhibited consistently high resistance to penicillin G and ampicillin, with resistance rates remaining above 60% across the five-year period. Its resistance to erythromycin was even higher, with annual rates exceeding 70%, peaking at 87.2% in 2021. In contrast, E. faecalis demonstrated low resistance to penicillin G and ampicillin, with rates typically below 5%, indicating preserved susceptibility. However, its resistance to erythromycin was notably higher, ranging from 30% to 47.8% across the years. Both E. faecium and E. faecalis maintained full susceptibility to linezolid, vancomycin, and tigecycline, with no resistant isolates detected during the entire surveillance period. Additionally, resistance to high-dose gentamicin and high-dose streptomycin remained at 0% in both species. These findings underscore the continued efficacy of glycopeptides and oxazolidinones for treating enterococcal infections. The detailed numerical results are presented in Table 4 , while temporal resistance trends are visualized in Fig. 4 using a split-cell heatmap format. Table 4. Five-Year Antimicrobial Resistance Rates of Efm and Efa (2019–2023) Antibacterial Drugs 2019 ARR (%) 2020 ARR (%) 2021 ARR (%) 2022 ARR (%) 2023 ARR (%) Efm Efa Efm Efa Efm Efa Efm Efa Efm Efa Penicillin G 75 1.7 67.4 4.3 70.2 2 73.8 4.5 65.5 0 Ampicillin 66.1 1.7 58.1 0 63.8 2 73.8 0 63.6 0 High-dose Gentamicin 0 0 0 0 0 0 0 0 0 0 High-dose Streptomycin 0 0 0 0 0 0 0 0 0 0 Erythromycin 78.6 45 74.4 47.8 87.2 30 83.6 31.8 72.7 32.6 Linezolid 0 0 0 0 0 0· 0 0 0 0 Vancomycin 0 0 0 0 0 0 0 0 0 0 Tigecycline 0 0 0 0 0 0 0 0 0 0 Abbreviations: ARR, Antimicrobial Resistance Rate; Efm, Enterococcus faecium; Efa, Enterococcus faecalis . 3.6 Trends in the Detection of Key Drug-Resistant Pathogens from 2019 to 2023 Over the past five years, the detection rate of extended-spectrum β-lactamase (ESBL)-producing E. coli (ECO-ESBL) ranged from 25.8% to 43%, indicating a persistently high level of resistance. Acinetobacter baumannii resistant to carbapenems (CRAB) also showed alarmingly high detection rates, fluctuating between 26.7% and 50%, highlighting its significant clinical threat. In contrast, the detection rates of ESBL-producing K. pneumoniae (KPN-ESBL) remained relatively stable and lower, around 9.1% to 17.3%. Carbapenem-resistant K. pneumoniae (CRKP) showed a declining trend, dropping from 12.2% in 2020 to 2.2% in 2023. E. coli resistant to carbapenems (CREC) remained rare, with resistance rates consistently below 2%. The detection rate of carbapenem-resistant P. aeruginosa (CRPA) varied between 8.0% and 24.1% across the study period. These trends are visually summarized in Fig. 5 , underscoring the ongoing need for robust antimicrobial surveillance and infection control strategies. 4. Discussion IAIs are among the most common critical conditions in clinical practice. Due to their high incidence and mortality rates, they pose a significant medical burden on healthcare systems [2]. Timely diagnosis and treatment of such conditions are therefore of utmost importance [10]. Source control is the cornerstone of IAI treatment. In addition to surgical interventions such as puncture, drainage, and removal of necrotic or infected tissue and effusion, timely and appropriate empirical antimicrobial therapy before the availability of bacterial culture and susceptibility results is crucial for improving patient outcomes, reducing mortality, and shortening hospital stays [8]. Studies conducted abroad have shown that E. coli , K. pneumoniae , E. species , A. baumannii , and E. cloacae are common pathogens associated with intra-abdominal infections [11]. In contrast, domestic studies have indicated that the top five bacteria associated with intra-abdominal infections are K. pneumoniae , E. coli , P. aeruginosa , E. faecium , and A. baumannii [12]. The results of this study showed that from 2019 to 2023, Gram-negative Enterobacteriaceae bacteria predominated among isolates from intra-abdominal infection patients in our hospital, accounting for 64.4% of the total isolates. Among these, E. coli and K. pneumoniae were the two most common pathogens, comprising 34% of all isolates. Gram-positive cocci accounted for 35.6%, primarily Enterococcus species, with E. faecalis and E. faecium being the most prevalent, constituting 16% of all isolates. In contrast, staphylococci were relatively uncommon. These findings highlight the differences in pathogen distribution and antimicrobial susceptibility between countries and regions. Therefore, tailoring empirical antimicrobial therapy for intra-abdominal infections based on local epidemiological data is essential, as inadequate initial antimicrobial treatment is associated with poor patient outcomes and the emergence of multidrug-resistant organisms. This study showed that over the past five years, E. coli in our hospital has exhibited high resistance rates to first- and second-generation cephalosporins, exceeding 35%, followed by ceftriaxone and levofloxacin, with resistance rates also surpassing 30%. However, the resistance rate to cefotaxime has shown a downward trend, from 32.3% in 2020 to 18.2% in 2023. E. coli showed the highest sensitivity to tigecycline, with no resistant strains detected. It also displayed high sensitivity to carbapenems, such as imipenem and meropenem, with sensitivity rates exceeding 98%. Furthermore, E. coli showed good sensitivity to β-lactam/β-lactamase inhibitor combinations, including amoxicillin/clavulanate, cefoperazone/sulbactam, and piperacillin/tazobactam, with sensitivity rates over 85%. In the past five years, K. pneumoniae exhibited average resistance rates to cefotaxime, ceftriaxone, and levofloxacin of 14.8%, 18.1%, and 14.5%, respectively, with sensitivity rates ranging from 71.6% to 89%. The resistance rates to imipenem, meropenem, and amikacin have decreased from 10.7%, 12.2%, and 8% in 2020 to 1.1%, 2.2%, and 1.1% in 2023. The resistance rate to tigecycline remains the lowest, averaging 1.1%, with no resistant strains detected in the past two years. The most common antimicrobial resistance threat in IAI is ESBL, primarily produced by Enterobacteriaceae , with E. coli and K. pneumoniae being the most common. ESBLs are enzymes that can hydrolyze and inactivate a wide range of β-lactam antibiotics. These enzymes can also spread resistance genes among bacteria through plasmid-mediated transfer, leading to widespread dissemination of resistant pathogens in healthcare settings [13]. Over the past five years, the detection rates of EC-ESBL and KP-ESBL were 25.8%-43% and 9.1%-17.3%, respectively. The detection rate of E. coli was higher than that of K. pneumoniae , with a statistically significant difference (P < 0.05). Carbapenem antibiotics are an excellent choice for treating infections caused by ESBL-producing bacteria and are recommended as the first-line treatment for IAI infections caused by ESBL-producing bacteria [14]. The widespread use of carbapenem antibiotics has also led to the gradual worsening of plasmid-mediated carbapenem resistance [15], Although the isolation rate of carbapenem-resistant strains in Enterobacterales is low, it still poses a significant challenge to clinical practice [16]. The average detection rates of CREC and CRKP in our hospital were 0.7% and 5.5%, lower than the study by Ding Rui in Beijing [17]. Based on our hospital's bacterial culture and antimicrobial susceptibility results, clinicians can choose empirical treatment with either monotherapy or combination therapy. The first choice for monotherapy is cefoperazone/sulbactam, while the combination therapy can include cefepime plus nitroimidazole antibiotics. Although amikacin shows high sensitivity, due to its nephrotoxicity and ototoxicity, it should be considered as an alternative drug for clinical use. Despite the low resistance to carbapenem antibiotics, the principles outlined in the "Guidelines for the Clinical Application of Antimicrobial Agents" should still be followed [18], Rational selection of antimicrobial agents is essential, with a focus on minimizing the use of broad-spectrum antibiotics, especially carbapenems. These should be reserved as the last line of defense for treating Enterobacteriaceae infections to avoid over-reliance on such antibiotics, and should be considered for the treatment of severe intra-abdominal infections. Tigecycline, due to its lack of activity against Pseudomonas aeruginosa or Proteus vulgaris in vitro, is generally not recommended as part of the empirical treatment for IAI but can be used when other antimicrobial agents are ineffective [19]. Among non-fermenting bacteria, P. aeruginosa and A. baumannii are the main pathogens. Overall, A. baumannii shows much higher resistance rates than P. aeruginosa . A. baumannii exhibits high resistance to almost all drugs, with an average resistance rate to carbapenems exceeding 39%. This is likely related to the increasing use of carbapenems by clinicians in recent years. Our hospital lacks testing for polymyxin resistance, but analysis shows that only amikacin and tigecycline have relatively low resistance rates, at 9.3% and 10.6%, respectively. This leaves very few antibiotic options available for clinicians. In contrast, P. aeruginosa has a relatively low resistance rate, with an average resistance to carbapenems around 14%. The resistance rate in our study is lower than another reported [20]. which ranged from 30% to 52.4%. This difference may be due to the distinct regional and temporal variations in the resistance of IAI pathogens. Among cephalosporins, the resistance rate of cefepime decreased from 23.8% in 2019 to 11.5% in 2023. Aminoglycosides maintain over 95% antibacterial activity against P. aeruginosa , making both cephalosporins and aminoglycosides viable options for clinicians in treating infections. Enterococci are significant pathogens in hospital-acquired infections. A retrospective clinical study found that among 1,182 patients with positive ascitic fluid cultures for intra-abdominal infections, 29% of hospital-acquired intra-abdominal infections were caused by enterococci [21]. Moreover, enterococcal infections can also lead to an increase in hospital-associated mortality [22]. In the past five years, the Gram-positive bacteria isolated in our hospital were primarily E. faecalis and E. faecium . Their sensitivity to penicillin showed significant differences: E. faecalis exhibited high resistance to penicillin G and ampicillin, with resistance rates above 60%, while E. faecium was highly sensitive, with resistance rates below 4.5%. Both species had high resistance to erythromycin. Therefore, for patients suspected of enterococcal infections, penicillins and macrolides should not be considered for empirical treatment. No resistant strains to other antibiotics were found for these two common enterococcal species in our hospital. Linezolid and vancomycin remain important antibiotics for treating enterococcal infections [23]. This study has several limitations, including its retrospective design and the limited clinical data available. There was a lack of information on risk factors, infection characteristics, comorbidities, recent hospitalizations, prior antibiotic use, and treatment responses. The peritoneal specimen was cultured using only blood agar plates and fungal chromogenic plates, without employing selective media (such as MacConkey agar), which may result in the failure to detect certain pathogens. This study relied solely on laboratory reports and did not perform genomic analysis of drug-resistant strains. Additionally, the analysis focused only on the antimicrobial susceptibility and resistance profiles of six common pathogens associated with IAIs, excluding other microorganisms. Current research indicates that integrating clinical indicators and antibiotic usage history can more effectively identify risk factors for drug resistance and provide a basis for optimizing treatment regimens. Therefore, multicenter prospective studies should be conducted to address the evidence gaps in the field of IAIs. 5. Conclusion In summary, understanding the distribution of pathogens and their resistance characteristics in abdominal infections is of great significance for early diagnosis and treatment. However, epidemiological data on bacterial infections show considerable temporal and regional differences, making it essential to incorporate local antimicrobial resistance surveillance data. This study analyzes the distribution of pathogens isolated from clinical abdominal infection patients in our region and their resistance to commonly used antibiotics, providing scientific evidence for the selection of antimicrobial therapy in the empirical treatment of abdominal infections. Additionally, performing bacterial culture on abdominal specimens before administering antibiotics is crucial, as it forms the foundation for subsequent "de-escalation therapy". This approach can guide clinicians in transitioning from combination therapy to monotherapy, reducing the variety of antibiotics used, shortening treatment durations, or discontinuing antibiotic use at appropriate times. These strategies are significant in reducing bacterial resistance, improving patient outcomes, and lowering mortality rates. Abbreviations IAIs Intra-abdominal infections cIAIs Complex intra-abdominal infections WSES World Society of Emergency Surgery SIS Surgical Infection Society IDSA Infectious Diseases Society of America AST Antimicrobial susceptibility testing CLSI Clinical and Laboratory Standards Institute E.Coli Escherichia coli K.Pneumoniae Klebsiella pneumoniae F.Faecalis Enterococcus faecalis E.Faecium Enterococcus faecium P.Aeruginosa Pseudomonas aeruginosa A. baumannii Acinetobacter baumannii ARR Antimicrobial Resistance Rate Eco Escherichia coli Kpn Klebsiella pneumoniae Pae Pseudomonas aeruginosa Aba Acinetobacter baumannii Efm Enterococcus faecium Efa Enterococcus faecalis ESBL Extended-spectrum β-lactamase ECO-ESBL ESBL-producing E. coli CRAB Carbapenem-resistant Acinetobacter baumannii KPN-ESBL ESBL-producing K. pneumoniae CRKP Carbapenem-resistant K. pneumoniae CREC Carbapenem-resistant E. coli CRPA Carbapenem-resistant P. aeruginosa Declarations Ethics approval and consent to participate The study was approved by the ethics committee of the First Hospital of Jiaxing (No. 2025-LP-042). Due to the retrospective design of this study, the ethics review board waived the requirement for written informed consent. Anonymized patient data were obtained from the hospital's microbiology laboratory, which provided bacterial strain isolation records. This research strictly adhered to the ethical guidelines outlined in the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials The summarized data are available from the corresponding author (Jiayuan Peng, [email protected] ) upon reasonable request. Raw data are not publicly available due to institutional restrictions. Competing interests The authors have no conflicts of interest to declare in this work. Funding This study was funded by the Science and Technology Plan Project of Jiaxing of Zhejiang Province of China under Grant 2024AD30030 and Jiaxing Key Discipline of Medicine-Clinical Diagnostics under Grant 2023-ZC-002. Authors’ contributions J.P., B.L., and X.N. conceived and designed the experiments. Q.Y., J.T., and X.T. collected and analyzed the data. B.L., J.P., and X.N. drafted and revised the manuscript. All authors read and approved the final manuscript. Acknowledgements Not applicable. References Sartelli M, Abu-Zidan FM, Catena F, Griffiths EA, Di Saverio S, Coimbra R, Ordoñez CA, Leppaniemi A, Fraga GP, Coccolini F et al : Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study) . World journal of emergency surgery : WJES 2015, 10 :61. Clements TW, Tolonen M, Ball CG, Kirkpatrick AW: Secondary Peritonitis and Intra-Abdominal Sepsis: An Increasingly Global Disease in Search of Better Systemic Therapies . 2021, 110 (2):139-149. 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Menichetti F, Sganga G: Definition and Classification of Intra-abdominal Infections . Journal of Chemotherapy 2009, 21 (sup1):3-4. Chang Y-T, Coombs G, Ling T, Balaji V, Rodrigues C, Mikamo H, Kim M-J, Rajasekaram DG, Mendoza M, Tan TY et al : Epidemiology and trends in the antibiotic susceptibilities of Gram-negative bacilli isolated from patients with intra-abdominal infections in the Asia-Pacific region, 2010–2013 . International Journal of Antimicrobial Agents 2017, 49 (6):734-739. Huston JM, Barie PS, Dellinger EP, Forrester JD, Duane TM, Tessier JM, Sawyer RG, Cainzos MA, Rasa K, Chipman JG et al : The Surgical Infection Society Guidelines on the Management of Intra-Abdominal Infection: 2024 Update . 2024, 25 (6):419-435. Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJC, Baron EJ, O'Neill PJ, Chow AW, Dellinger EP, Eachempati SR et al : Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America . Clinical Infectious Diseases 2010, 50 (2):133-164. Napolitano LM: Intra-abdominal Infections . Semin Respir Crit Care Med 2022, 43 (01):010-027. Park CH, Lee JW, Lee HJ, Oh DK, Park MH, Lim C-M, Hong S-K, Lim C-M, Hong S-B, Oh DK et al : Clinical outcomes and prognostic factors of patients with sepsis caused by intra-abdominal infection in the intensive care unit: a post-hoc analysis of a prospective cohort study in Korea . BMC Infectious Diseases 2022, 22 (1):953. Wu M, Chen Y, Li J, Zhou Z, Wu L, Wu W, Wang J, Tian S, Wu X, Zheng T et al : Antimicrobial Resistance Trends and Epidemiological Characteristics of Isolates from Intra-Abdominal Infections in China: A 6-Year Retrospective Study (2017–2022) . 2025, 26 (1):24-32. Ghafourian S, Sadeghifard N, Soheili S, Sekawi Z: Extended Spectrum Beta-lactamases: Definition, Classification and Epidemiology . Current issues in molecular biology 2015, 17 :11-21. Sheu C-C, Lin S-Y, Chang Y-T, Lee C-Y, Chen Y-H, Hsueh P-R: Management of infections caused by extended-spectrum β–lactamase-producing Enterobacteriaceae: current evidence and future prospects . Expert Review of Anti-infective Therapy 2018, 16 (3):205-218. Hawkey PM: Multidrug-resistant Gram-negative bacteria: a product of globalization . Journal of Hospital Infection 2015, 89 (4):241-247. Jean S-S, Harnod D, Hsueh P-R: Global Threat of Carbapenem-Resistant Gram-Negative Bacteria . Frontiers in Cellular and Infection Microbiology 2022, 12 . Rui -D, Rui -MR, Li -LY, Ying -Z, Na -GL, Tao -DH, Li -SH, Jing -LW, Li -Z, Yao -W et al : - Causative Microorganisms Isolated from Patients with Intra-Abdominal Infections and Their Drug Resistance Profiles: An 11-Year (2011–2021) Single-Center Retrospective Study %J - Biomedical and Environmental Sciences . 2023, - 36 (- 8):- 732. DN G, HF C, MS S, GM E: The Sanford Guide to Antimicrobial Therapy. 53rd ed. Sperryville, VA: Antimicrobial Therapy, Inc.; 2023. 2023. Wu X, Wu J, Wang P, Fang X, Yu Y, Tang J, Xiao Y, Wang M, Li S, Zhang Y et al : Diagnosis and Management of Intraabdominal Infection: Guidelines by the Chinese Society of Surgical Infection and Intensive Care and the Chinese College of Gastrointestinal Fistula Surgeons . Clinical Infectious Diseases 2020, 71 (Supplement_4):S337-S362. Fu Y, Zhao F, Lin J, Li P, Yu Y: Antibiotic susceptibility patterns and trends of the gram-negative bacteria isolated from the patients in the emergency departments in China: results of SMART 2016–2019 . BMC Infectious Diseases 2024, 24 (1):501. Swenson BR, Metzger R, Hedrick TL, McElearney ST, Evans HL, Smith RL, Chong TW, Popovsky KA, Pruett TL, Sawyer RG: Choosing Antibiotics for Intra-Abdominal Infections: What Do We Mean by “High Risk”? 2009, 10 (1):29-39. Luo X, Li L, Xuan J, Zeng Z, Zhao H, Cai S, Huang Q, Guo X, Chen Z: Risk Factors for Enterococcal Intra-Abdominal Infections and Outcomes in Intensive Care Unit Patients . Surgical Infections 2021, 22 (8):845-853. Xiong Y-m, Rao X: Clinical and Microbiological Characteristics of Patients with Complicated Intra-abdominal Infections in Intensive Care Unit . Current Medical Science 2020, 40 (1):104-109. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7626254","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":527132788,"identity":"f8554548-b802-4a03-ba14-b1a5d5d53079","order_by":0,"name":"Binbin Lu","email":"","orcid":"","institution":"The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University","correspondingAuthor":false,"prefix":"","firstName":"Binbin","middleName":"","lastName":"Lu","suffix":""},{"id":527132789,"identity":"affec621-2c87-435a-88e6-c40d5f2c88ba","order_by":1,"name":"Xiaoqin Niu","email":"","orcid":"","institution":"The First Hospital of 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14:21:04","extension":"xml","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":131481,"visible":true,"origin":"","legend":"","description":"","filename":"2f6930e67818462a8689bdcf66438f5e1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7626254/v1/dbec5b6b77dd73927fa1ad80.xml"},{"id":93338456,"identity":"9af6239e-8187-4084-af0d-99247c05f263","added_by":"auto","created_at":"2025-10-12 14:21:04","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":140367,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7626254/v1/5fcfc2291ab4a78d0095aed7.html"},{"id":93340133,"identity":"45dcf089-3a07-44fb-a751-c17b1cdf19c3","added_by":"auto","created_at":"2025-10-12 14:29:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":73595,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of the top 10 bacterial species isolated from intra-abdominal infection cases between 2019 and 2023.\u003c/p\u003e\n\u003cp\u003e(a) Total number and overall proportion of each species over five years. (b) Yearly trends in the proportion of each species (%), showing relative stability with \u003cem\u003eE. coli\u003c/em\u003eand \u003cem\u003eK. pneumoniae \u003c/em\u003econsistently dominant. (c) Proportion of bacterial isolates by age group from 2019 to 2023. (d) Seasonal trends in bacterial isolates.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7626254/v1/5249991c645ddc4b7cc671ca.png"},{"id":93338437,"identity":"91fbe8ea-784e-4bb3-be29-7a8d598bc73d","added_by":"auto","created_at":"2025-10-12 14:21:03","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":123434,"visible":true,"origin":"","legend":"\u003cp\u003eDual-Tile Heatmap of Annual Antimicrobial Resistance Rates in \u003cem\u003eE. coli\u003c/em\u003e and \u003cem\u003eK. pneumoniae\u003c/em\u003e (2019–2023)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7626254/v1/c42efea53e544a247ce7f2db.png"},{"id":93343361,"identity":"2834d570-fca8-4f6c-9755-fc329d6c2fed","added_by":"auto","created_at":"2025-10-12 14:53:04","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":96726,"visible":true,"origin":"","legend":"\u003cp\u003eDual-Tile Heatmap of Annual Antimicrobial Resistance Rates of \u003cem\u003eP. aeruginosa\u003c/em\u003e and \u003cem\u003eA. baumannii \u003c/em\u003e(2019–2023)\u003c/p\u003e\n\u003cp\u003eEach tile is divided vertically into two halves: the left represents the resistance rate of P. aeruginosa\u003cem\u003e \u003c/em\u003eand the right represents that of \u003cem\u003eA.baumannii\u003c/em\u003e for a given antibiotic and year.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7626254/v1/ca14f87a5066d892b412cb98.png"},{"id":93340985,"identity":"ef4c6b0c-6c79-4c3e-ac01-7254699ae002","added_by":"auto","created_at":"2025-10-12 14:37:03","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":55070,"visible":true,"origin":"","legend":"\u003cp\u003eHeatmap of Annual Antimicrobial Resistance Rates of \u003cem\u003eE. faecium\u003c/em\u003e and \u003cem\u003eE. faecalis \u003c/em\u003e(2019–2023)\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7626254/v1/40dd783290d85e197219672c.png"},{"id":93338438,"identity":"7dde8d2a-041a-41ef-a9d4-d07dfa4b7363","added_by":"auto","created_at":"2025-10-12 14:21:03","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":40001,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in the Detection Rates of Major Drug-Resistant Bacteria from 2019 to 2023\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7626254/v1/140ae5ad8378a15121555ff4.png"},{"id":98441855,"identity":"eaa3bca8-be2d-4c72-8fee-fdccbffc60de","added_by":"auto","created_at":"2025-12-17 17:05:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2744103,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7626254/v1/05854884-4dab-4018-96f9-045ae1330ae2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bacterial Distribution and Antimicrobial Resistance in Intra-Abdominal Infections: A Five- Year Study in Jiaxing, China","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eIntra-abdominal infections (IAIs) are common acute and severe infectious diseases primarily caused by bacterial invasion of the abdominal cavity, retroperitoneal space, or associated organs. These infections often occur secondary to surgical conditions such as gastrointestinal perforation, acute appendicitis, biliary tract infections, or pancreatitis. According to a study by the World Society of Emergency Surgery (WSES) on the complexity scoring of IAIs, the overall mortality rate among patients aged 18 years and older with IAIs was 9.2% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. IAIs impose a significant healthcare burden worldwide [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn recent years, advancements in diagnostic techniques, antibiotic application, and surgical procedures have significantly reduced the mortality rate of intra-abdominal infections. However, due to variations in the infection site, pathogenic microorganisms involved, and underlying conditions of patients, mortality rates still exhibit considerable heterogeneity [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A multicenter observational epidemiological study revealed that secondary peritonitis is the most common type of intra-abdominal infection, followed by biliary tract infections, intra-abdominal abscesses, and pancreatic infections, Elderly individuals and those with comorbidities such as cancer, diabetes, or chronic pulmonary diseases are at higher risk of developing IAIs [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to pathophysiology, intra-abdominal infections can be classified into uncomplicated intra-abdominal infections and complicated intra-abdominal infections [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Complex intra-abdominal infections (cIAIs) typically require comprehensive treatment, including antimicrobial therapy and organ function support, even after source control has been achieved. The predominant pathogens include \u003cem\u003eEnterobacteriaceae\u003c/em\u003e, \u003cem\u003eEnterococci\u003c/em\u003e, and Bacteroides species, with their distribution and resistance profiles varying by region and time. Based on the source of infection, IAIs can be classified as community-acquired or healthcare-associated. Community-acquired IAIs are commonly associated with conditions such as appendicitis, with pathogens predominantly comprising anaerobes and Gram-negative bacteria that exhibit relatively low resistance. In contrast, healthcare-associated IAIs are often related to postoperative complications or severe trauma, involving highly resistant pathogens and frequently accompanied by multi-organ dysfunction [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe treatment of intra-abdominal infections requires an appropriate empirical antimicrobial regimen, guided by the spectrum of pathogens and resistance patterns. Both the Surgical Infection Society (SIS) and the Infectious Diseases Society of America (IDSA) emphasize that timely and effective antimicrobial therapy not only improves cure rates but also reduces hospital stay and healthcare costs [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, studies on the distribution and antimicrobial resistance patterns of pathogens causing IAIs in the Jiaxing region are limited, particularly regarding long-term trends. This research gap constrains the optimization of clinical management strategies. Strengthening such studies would not only aid in guiding the rational use of antibiotics and reducing the emergence of resistant bacteria but also improve patient outcomes and lower the mortality rate associated with IAIs.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Source of Strains\u003c/h2\u003e\u003cp\u003eA total of 3,154 pathogenic strains were isolated from specimens submitted by intra-abdominal infections patients at our hospital between January 2019 and December 2023. Duplicate strains from the same site in the same patient were excluded. This study was approved by the Medical Ethics Committee of the hospital (Ethics Approval No.: 2025-LP-042).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Bacterial Identification\u003c/h2\u003e\u003cp\u003eBacterial isolates were identified using the MALDI-TOF MS system (BioM\u0026eacute;rieux, France), following the manufacturer\u0026rsquo;s instructions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Antimicrobial Susceptibility Testing\u003c/h2\u003e\u003cp\u003eAntimicrobial susceptibility testing (AST) was performed using the VITEK-2 Compact automated system (BioM\u0026eacute;rieux, France). For antibiotics not included in the automated panel, the disk diffusion method (Oxoid, UK) was applied. AST results were interpreted according to Clinical and Laboratory Standards Institute (CLSI) guidelines for the corresponding year (CLSI 2023). Quality control was performed using the following standard strains: Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922 and ATCC 8739, Klebsiella pneumoniae ATCC 700603, and Klebsiella oxytoca ATCC 13048 (supplied by the Clinical Laboratory Center of the National Health Commission).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Statistical Analysis\u003c/h2\u003e\u003cp\u003eDescriptive analysis of bacterial distribution across clinical departments and antimicrobial susceptibility test results was performed using WHONET 5.6 software. Statistical analyses were conducted using SPSS 25.0 software. All visualizations were generated using R software (version 4.3.0). Categorical variables were expressed as frequencies or percentages, and the chi-square test (χ\u0026sup2; test) was used for comparisons. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Epidemiological Profile of Patients with Intra-Abdominal Infections\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 3,154 patients with confirmed intra-abdominal infections, 58% were male and 42% were female, indicating a significantly higher prevalence in males (\u0026chi;\u0026sup2; = 77.373, P \u0026lt; 0.001). The patients ranged in age from 1 month to 99 years. Elderly individuals aged 60 years and above accounted for the majority of cases (72%), while those aged 18\u0026ndash;59 and under 18 represented 27% and 1%, respectively. The difference in age distribution was statistically significant (\u0026chi;\u0026sup2; = 2,533.621, P \u0026lt; 0.001), suggesting that advanced age is a major risk factor for intra-abdominal infections. Seasonal analysis revealed that infections were most frequently reported in summer (27%) and autumn (26%), followed by spring (25%) and winter (22%), with the difference also reaching statistical significance (\u0026chi;\u0026sup2; = 15.557, P = 0.001). These findings indicate that intra-abdominal infections are more common in elderly male patients and tend to occur more frequently during warmer months. Detailed results are presented in \u003cstrong\u003eTable 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eDemographic and Seasonal Characteristics of Patients with Intra-Abdominal Infections from 2019 to 2023\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"544\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026chi;\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e1824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e58%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e77.373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e1330\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e42%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026lt;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 109px;\"\u003e\n \u003cp\u003e2533.621\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e18-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e844\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e27%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026ge;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e2295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e72%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeason\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003eSpring\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e782\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 109px;\"\u003e\n \u003cp\u003e15.557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 109px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003eSummer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e860\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e27%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003eAutumn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e806\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e26%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003eWinter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e706\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Bacterial Composition of Intra-Abdominal Infections\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 3,154 bacterial strains, Gram-negative bacteria were predominantly \u003cem\u003eEnterobacteriaceae\u003c/em\u003e, with \u003cem\u003eEscherichia coli (E. coli)\u0026nbsp;\u003c/em\u003eaccounting for 675 strains (21.4% of the total), followed by \u003cem\u003eKlebsiella pneumoniae (K. pneumoniae)\u003c/em\u003e with 425 strains (13.4%). Among Gram-positive cocci, \u003cem\u003eenterococci\u003c/em\u003e were the main pathogens, with \u003cem\u003eEnterococcus faecalis (E. faecalis)\u003c/em\u003e accounting for 260 strains (8.2%) and\u003cem\u003e\u0026nbsp;Enterococcus faecium (E. faecium)\u003c/em\u003e for 244 strains (7.7%). Non-fermenting bacteria followed, with \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (\u003cem\u003eP. aeruginosa\u003c/em\u003e) accounting for 119 strains (3.8%) and Acinetobacter baumannii (\u003cem\u003eA.baumannii\u003c/em\u003e) for 68 strains (2.2%). The detailed composition of the strains was shown in \u003cstrong\u003eFig. 1a\u003c/strong\u003e. To better understand the dynamic distribution of these pathogens, we further analyzed annual trends from 2019 to 2023 (\u003cstrong\u003eFig. 1b\u003c/strong\u003e). The relative proportions of major species remained largely stable throughout the five-year period. \u003cem\u003eE. coli\u0026nbsp;\u003c/em\u003econsistently ranked first, followed by \u003cem\u003eK. pneumoniae\u003c/em\u003e, with only minor year-to-year fluctuations. Notably, the proportion of \u003cem\u003eE. faecium\u0026nbsp;\u003c/em\u003eshowed a slight increase in 2021, while \u003cem\u003eP. aeruginosa\u003c/em\u003e and \u003cem\u003eA. baumannii\u003c/em\u003e remained low and relatively constant. These results suggest that the etiological spectrum of intra-abdominal infections in this region has remained steady over time, with \u003cem\u003eEnterobacteriaceae\u003c/em\u003e continuing to dominate.\u003c/p\u003e\n\u003cp\u003eIn addition, the age and seasonal distribution of bacterial isolates were examined. As shown in \u003cstrong\u003eFig. 1c\u003c/strong\u003e, patients aged 61\u0026ndash;90 years consistently accounted for the highest proportion of isolates each year, underscoring the increased vulnerability of elderly individuals to intra-abdominal infections. Summer and autumn generally had higher isolate counts compared to winter and spring, with a notable upward trend in summer isolates over the years (\u003cstrong\u003eFig. 1d\u003c/strong\u003e). This suggests that intra-abdominal infections may be more prevalent during warmer months, warranting increased clinical vigilance during these periods.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Results of Antimicrobial Resistance Profiles of \u003cem\u003eE. coli\u003c/em\u003e and \u003cem\u003eK. pneumoniae\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the isolated strains,\u003cem\u003e\u0026nbsp;E. coli\u0026nbsp;\u003c/em\u003eand \u003cem\u003eK. pneumoniae\u003c/em\u003e were the most frequently detected Gram-negative pathogens. As shown in\u003cstrong\u003e\u0026nbsp;Table 2\u003c/strong\u003e, \u003cem\u003eE. coli\u003c/em\u003e exhibited the highest resistance to ampicillin across all five years, with resistance rates consistently exceeding 60%, and reached a peak of 72.3% in 2020. Moderate resistance was observed to levofloxacin and ceftriaxone, with resistance rates mostly above 30%. Conversely, \u003cem\u003eE. coli\u003c/em\u003e demonstrated low resistance to imipenem and meropenem (generally \u0026lt;2%), and no resistance was detected to tigecycline over the study period. \u003cem\u003eK. pneumoniae\u003c/em\u003e showed a distinct resistance pattern. Although resistance to amikacin and tigecycline remained low (\u0026lt;5%), moderate resistance was observed to cefazolin and cefuroxime, with resistance rates exceeding 20% in several years. The organism also maintained relatively good susceptibility to beta-lactamase inhibitor combinations, such as cefoperazone/sulbactam and piperacillin/tazobactam, with resistance rates below 15%. \u003cstrong\u003eFigure 2\u003c/strong\u003e provides a visual summary of these trends using a dual-color heatmap, where each cell is split to represent the annual resistance rate of both species\u0026mdash;left for \u003cem\u003eE. coli\u0026nbsp;\u003c/em\u003eand right for\u003cem\u003e\u0026nbsp;K. pneumoniae\u003c/em\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eFive-Year Antimicrobial Resistance Rates of Eco and Kpn (2019\u0026ndash;2023)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"553\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntibacterial\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDrugs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2019\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eARR (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2020\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;ARR (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2021\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eARR (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2022\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eARR (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2023\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;ARR (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEco\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKpn\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEco\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKpn\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEco\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKpn\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEco\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKpn\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEco\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKpn\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eAmpicillin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e65.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e72.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e69.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e61.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eAmoxicillin /Clavulanate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e17.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eCefoperazone/\u0026nbsp;Sulbactam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e14.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003ePiperacillin/\u0026nbsp;Tazobactam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;Cefazolin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e57.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e27.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e60.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e42.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e59.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e22.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e39.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e21.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e26.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eCefuroxime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e40.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e24.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e46.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e32.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e23.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e35.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e21.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e38.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e24.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eCeftazidime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e32.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e27.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e19.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e18.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eCeftriaxone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e36.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e38.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e28.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e39.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e28.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e18.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e37.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e18.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eCefepime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e10.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eCefoxitin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e17.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eAztreonam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e24.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e26.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e25.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e20.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e15.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e22.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eImipenem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eMeropenem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eAmikacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eGentamicin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e17.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e16.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eLevofloxacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e33.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e41.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e44.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e15.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eTrimethoprim/\u003c/p\u003e\n \u003cp\u003eTrimethoprim /Sulfmethoxazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e22.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e36.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e25.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e43.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e29.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e42.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eTigecycline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: ARR, Antimicrobial Resistance Rate; Eco, \u003cem\u003eEscherichia coli\u003c/em\u003e; Kpn, \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Results of Antimicrobial Resistance Profiles of \u003cem\u003eP. aeruginosa\u003c/em\u003e and \u003cem\u003eA. baumannii\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePseudomonas aeruginosa (P. aeruginosa)\u0026nbsp;\u003c/em\u003eand \u003cem\u003eAcinetobacter baumannii (A. baumannii)\u0026nbsp;\u003c/em\u003ewere the predominant non-fermenting Gram-negative bacilli identified in this study. \u003cem\u003eP. aeruginosa\u003c/em\u003e exhibited high susceptibility to aminoglycosides, with average resistance rates to gentamicin and amikacin remaining below 5% over the five-year period. It also showed relatively low resistance to carbapenems (imipenem and meropenem), with mean resistance rates around 14%. However, elevated resistance was observed against aztreonam, with rates \u003cem\u003eA. baumannii\u003c/em\u003e, in contrast, demonstrated markedly higher resistance levels. While resistance to tigecycline and amikacin remained moderate (average rates around 15%), resistance to the majority of tested antibiotics\u0026mdash;including beta-lactams, cephalosporins, fluoroquinolones, and carbapenems\u0026mdash;was substantially higher, frequently surpassing 35%. These resistance patterns are detailed in \u003cstrong\u003eTable 3\u003c/strong\u003e and visualized in \u003cstrong\u003eFig. 3\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eFive-Year Antimicrobial Resistance Rates of Pae and Aba (2019\u0026ndash;2023)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"560\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntibacterial\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDrugs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2019\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eARR (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2020\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;ARR (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2021\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eARR (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2022\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eARR (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2023\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;ARR (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePae\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAba\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePae\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAba\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePae\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAba\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePae\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAba\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePae\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAba\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003eCefoperazone/\u0026nbsp;Sulbactam\u003c/p\u003e\n \u003cp\u003eSulbactam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e18.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e35.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e20.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e34.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e46.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003eCeftazidime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e23.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e46.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e20.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e23.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003eCefepime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e23.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e37.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e46.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003eImipenem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e26.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e37.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e24.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e23.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e46.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003eMeropenem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e26.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e43.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e20.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e23.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e46.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003eAmikacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e18.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003eGentamicin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e30.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003eCiprofloxacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e37.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e45.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003eLevofloxacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e26.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e31.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e26.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e46.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003ePiperacillin/\u0026nbsp;Tazobactam\u003c/p\u003e\n \u003cp\u003eTazobactam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e23.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e17.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e23.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003eAztreonam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e38.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003eTrimethoprim/\u0026nbsp;Sulfamethoxazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e31.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e46.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003eTigecycline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: ARR, Antimicrobial Resistance Rate; Pae, \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e; Aba, \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5 Results of Antimicrobial Resistance Profiles of \u003cem\u003eE. faecium\u003c/em\u003e and \u003cem\u003eE. faecalis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEnterococcus faecium (\u003cem\u003eE. faecium\u003c/em\u003e) and Enterococcus faecalis (\u003cem\u003eE. faecalis\u003c/em\u003e) were the major Gram-positive cocci isolated in this study. \u003cem\u003eE. faecium\u003c/em\u003e exhibited consistently high resistance to penicillin G and ampicillin, with resistance rates remaining above 60% across the five-year period. Its resistance to erythromycin was even higher, with annual rates exceeding 70%, peaking at 87.2% in 2021. In contrast, \u003cem\u003eE. faecalis\u003c/em\u003e demonstrated low resistance to penicillin G and ampicillin, with rates typically below 5%, indicating preserved susceptibility. However, its resistance to erythromycin was notably higher, ranging from 30% to 47.8% across the years. Both \u003cem\u003eE. faecium\u003c/em\u003e and \u003cem\u003eE. faecalis\u003c/em\u003e maintained full susceptibility to linezolid, vancomycin, and tigecycline, with no resistant isolates detected during the entire surveillance period. Additionally, resistance to high-dose gentamicin and high-dose streptomycin remained at 0% in both species. These findings underscore the continued efficacy of glycopeptides and oxazolidinones for treating enterococcal infections. The detailed numerical results are presented in \u003cstrong\u003eTable 4\u003c/strong\u003e, while temporal resistance trends are visualized in \u003cstrong\u003eFig. 4\u003c/strong\u003e using a split-cell heatmap format.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eFive-Year Antimicrobial Resistance Rates of Efm and Efa (2019\u0026ndash;2023)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"552\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntibacterial\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDrugs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2019\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eARR (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2020\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;ARR (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2021\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eARR (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2022\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eARR (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2023\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;ARR (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003eEfm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003eEfa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eEfm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003eEfa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003eEfm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003eEfa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eEfm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003eEfa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eEfm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eEfa\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003ePenicillin G\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e67.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e70.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e73.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e65.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eAmpicillin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e66.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e58.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e63.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e73.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e63.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eHigh-dose Gentamicin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eHigh-dose Streptomycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eErythromycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e78.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e74.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e47.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e87.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e83.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e31.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e72.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e32.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eLinezolid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0\u0026middot;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eVancomycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eTigecycline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: ARR, Antimicrobial Resistance Rate; Efm, \u003cem\u003eEnterococcus faecium;\u003c/em\u003e Efa, \u003cem\u003eEnterococcus faecalis\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.6 Trends in the Detection of Key Drug-Resistant Pathogens from 2019 to 2023\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOver the past five years, the detection rate of extended-spectrum \u0026beta;-lactamase (ESBL)-producing \u003cem\u003eE. coli\u003c/em\u003e (ECO-ESBL) ranged from 25.8% to 43%, indicating a persistently high level of resistance. Acinetobacter baumannii resistant to carbapenems (CRAB) also showed alarmingly high detection rates, fluctuating between 26.7% and 50%, highlighting its significant clinical threat. In contrast, the detection rates of ESBL-producing \u003cem\u003eK. pneumoniae\u003c/em\u003e (KPN-ESBL) remained relatively stable and lower, around 9.1% to 17.3%. Carbapenem-resistant \u003cem\u003eK. pneumoniae\u003c/em\u003e (CRKP) showed a declining trend, dropping from 12.2% in 2020 to 2.2% in 2023. \u003cem\u003eE. coli\u003c/em\u003e resistant to carbapenems (CREC) remained rare, with resistance rates consistently below 2%. The detection rate of carbapenem-resistant \u003cem\u003eP. aeruginosa\u003c/em\u003e (CRPA) varied between 8.0% and 24.1% across the study period. These trends are visually summarized in \u003cstrong\u003eFig. 5\u003c/strong\u003e, underscoring the ongoing need for robust antimicrobial surveillance and infection control strategies.\u003c/p\u003e"},{"header":"4. Discussion ","content":"\u003cp\u003eIAIs are among the most common critical conditions in clinical practice. Due to their high incidence and mortality rates, they pose a significant medical burden on healthcare systems [2]. Timely diagnosis and treatment of such conditions are therefore of utmost importance [10]. Source control is the cornerstone of IAI treatment. In addition to surgical interventions such as puncture, drainage, and removal of necrotic or infected tissue and effusion, timely and appropriate empirical antimicrobial therapy before the availability of bacterial culture and susceptibility results is crucial for improving patient outcomes, reducing mortality, and shortening hospital stays [8]. Studies conducted abroad have shown that \u003cem\u003eE. coli\u003c/em\u003e, \u003cem\u003eK. pneumoniae\u003c/em\u003e, \u003cem\u003eE. species\u003c/em\u003e, \u003cem\u003eA. baumannii\u003c/em\u003e, and \u003cem\u003eE. cloacae\u003c/em\u003e are common pathogens associated with intra-abdominal infections [11]. In contrast, domestic studies have indicated that the top five bacteria associated with intra-abdominal infections are \u003cem\u003eK. pneumoniae\u003c/em\u003e, \u003cem\u003eE. coli\u003c/em\u003e, \u003cem\u003eP. aeruginosa\u003c/em\u003e, \u003cem\u003eE. faecium\u003c/em\u003e, and \u003cem\u003eA. baumannii\u003c/em\u003e [12].\u003c/p\u003e\n\u003cp\u003eThe results of this study showed that from 2019 to 2023, Gram-negative \u003cem\u003eEnterobacteriaceae\u003c/em\u003e bacteria predominated among isolates from intra-abdominal infection patients in our hospital, accounting for 64.4% of the total isolates. Among these, \u003cem\u003eE. coli\u003c/em\u003e and \u003cem\u003eK. pneumoniae\u003c/em\u003e were the two most common pathogens, comprising 34% of all isolates. Gram-positive cocci accounted for 35.6%, primarily Enterococcus species, with \u003cem\u003eE. faecalis\u003c/em\u003e and \u003cem\u003eE. faecium\u003c/em\u003e being the most prevalent, constituting 16% of all isolates. In contrast, \u003cem\u003estaphylococci\u003c/em\u003e were relatively uncommon. These findings highlight the differences in pathogen distribution and antimicrobial susceptibility between countries and regions. Therefore, tailoring empirical antimicrobial therapy for intra-abdominal infections based on local epidemiological data is essential, as inadequate initial antimicrobial treatment is associated with poor patient outcomes and the emergence of multidrug-resistant organisms.\u003c/p\u003e\n\u003cp\u003eThis study showed that over the past five years, \u003cem\u003eE. coli\u003c/em\u003e in our hospital has exhibited high resistance rates to first- and second-generation cephalosporins, exceeding 35%, followed by ceftriaxone and levofloxacin, with resistance rates also surpassing 30%. However, the resistance rate to cefotaxime has shown a downward trend, from 32.3% in 2020 to 18.2% in 2023. \u003cem\u003eE. coli\u003c/em\u003e showed the highest sensitivity to tigecycline, with no resistant strains detected. It also displayed high sensitivity to carbapenems, such as imipenem and meropenem, with sensitivity rates exceeding 98%. Furthermore, \u003cem\u003eE. coli\u003c/em\u003e showed good sensitivity to β-lactam/β-lactamase inhibitor combinations, including amoxicillin/clavulanate, cefoperazone/sulbactam, and piperacillin/tazobactam, with sensitivity rates over 85%. In the past five years,\u003cem\u003e\u0026nbsp;K. pneumoniae\u003c/em\u003e exhibited average resistance rates to cefotaxime, ceftriaxone, and levofloxacin of 14.8%, 18.1%, and 14.5%, respectively, with sensitivity rates ranging from 71.6% to 89%. The resistance rates to imipenem, meropenem, and amikacin have decreased from 10.7%, 12.2%, and 8% in 2020 to 1.1%, 2.2%, and 1.1% in 2023. The resistance rate to tigecycline remains the lowest, averaging 1.1%, with no resistant strains detected in the past two years.\u003c/p\u003e\n\u003cp\u003eThe most common antimicrobial resistance threat in IAI is ESBL, primarily produced by \u003cem\u003eEnterobacteriaceae\u003c/em\u003e, with \u003cem\u003eE. coli\u003c/em\u003e and \u003cem\u003eK. pneumoniae\u003c/em\u003e being the most common. ESBLs are enzymes that can hydrolyze and inactivate a wide range of β-lactam antibiotics. These enzymes can also spread resistance genes among bacteria through plasmid-mediated transfer, leading to widespread dissemination of resistant pathogens in healthcare settings [13]. Over the past five years, the detection rates of EC-ESBL and KP-ESBL were 25.8%-43% and 9.1%-17.3%, respectively. The detection rate of \u003cem\u003eE. coli\u003c/em\u003e was higher than that of \u003cem\u003eK. pneumoniae\u003c/em\u003e, with a statistically significant difference (P \u0026lt; 0.05). Carbapenem antibiotics are an excellent choice for treating infections caused by ESBL-producing bacteria and are recommended as the first-line treatment for IAI infections caused by ESBL-producing bacteria [14].\u003c/p\u003e\n\u003cp\u003eThe widespread use of carbapenem antibiotics has also led to the gradual worsening of plasmid-mediated carbapenem resistance [15], Although the isolation rate of carbapenem-resistant strains in \u003cem\u003eEnterobacterales\u003c/em\u003e is low, it still poses a significant challenge to clinical practice [16]. The average detection rates of CREC and CRKP in our hospital were 0.7% and 5.5%, lower than the study by Ding Rui in Beijing [17]. Based on our hospital's bacterial culture and antimicrobial susceptibility results, clinicians can choose empirical treatment with either monotherapy or combination therapy. The first choice for monotherapy is cefoperazone/sulbactam, while the combination therapy can include cefepime plus nitroimidazole antibiotics. Although amikacin shows high sensitivity, due to its nephrotoxicity and ototoxicity, it should be considered as an alternative drug for clinical use. Despite the low resistance to carbapenem antibiotics, the principles outlined in the \"Guidelines for the Clinical Application of Antimicrobial Agents\" should still be followed [18], Rational selection of antimicrobial agents is essential, with a focus on minimizing the use of broad-spectrum antibiotics, especially carbapenems. These should be reserved as the last line of defense for treating Enterobacteriaceae infections to avoid over-reliance on such antibiotics, and should be considered for the treatment of severe intra-abdominal infections. Tigecycline, due to its lack of activity against Pseudomonas aeruginosa or Proteus vulgaris in vitro, is generally not recommended as part of the empirical treatment for IAI but can be used when other antimicrobial agents are ineffective [19].\u003c/p\u003e\n\u003cp\u003eAmong non-fermenting bacteria, \u003cem\u003eP. aeruginosa\u003c/em\u003e and \u003cem\u003eA. baumannii\u003c/em\u003e are the main pathogens. Overall, \u003cem\u003eA. baumannii\u003c/em\u003e shows much higher resistance rates than \u003cem\u003eP. aeruginosa\u003c/em\u003e. \u003cem\u003eA. baumannii\u003c/em\u003e exhibits high resistance to almost all drugs, with an average resistance rate to carbapenems exceeding 39%. This is likely related to the increasing use of carbapenems by clinicians in recent years. Our hospital lacks testing for polymyxin resistance, but analysis shows that only amikacin and tigecycline have relatively low resistance rates, at 9.3% and 10.6%, respectively. This leaves very few antibiotic options available for clinicians. In contrast, \u003cem\u003eP. aeruginosa\u003c/em\u003e has a relatively low resistance rate, with an average resistance to carbapenems around 14%. The resistance rate in our study is lower than another reported [20]. which ranged from 30% to 52.4%. This difference may be due to the distinct regional and temporal variations in the resistance of IAI pathogens. Among cephalosporins, the resistance rate of cefepime decreased from 23.8% in 2019 to 11.5% in 2023. Aminoglycosides maintain over 95% antibacterial activity against \u003cem\u003eP. aeruginosa\u003c/em\u003e, making both cephalosporins and aminoglycosides viable options for clinicians in treating infections.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEnterococci\u003c/em\u003e are significant pathogens in hospital-acquired infections. A retrospective clinical study found that among 1,182 patients with positive ascitic fluid cultures for intra-abdominal infections, 29% of hospital-acquired intra-abdominal infections were caused by enterococci [21]. Moreover, \u003cem\u003eenterococcal\u003c/em\u003e infections can also lead to an increase in hospital-associated mortality [22]. In the past five years, the Gram-positive bacteria isolated in our hospital were primarily \u003cem\u003eE. faecalis\u0026nbsp;\u003c/em\u003eand \u003cem\u003eE. faecium\u003c/em\u003e. Their sensitivity to penicillin showed significant differences: \u003cem\u003eE. faecalis\u003c/em\u003e exhibited high resistance to penicillin G and ampicillin, with resistance rates above 60%, while \u003cem\u003eE. faecium\u003c/em\u003e was highly sensitive, with resistance rates below 4.5%. Both species had high resistance to erythromycin. Therefore, for patients suspected of enterococcal infections, penicillins and macrolides should not be considered for empirical treatment. No resistant strains to other antibiotics were found for these two common enterococcal species in our hospital. Linezolid and vancomycin remain important antibiotics for treating enterococcal infections [23].\u003c/p\u003e\n\u003cp\u003eThis study has several limitations, including its retrospective design and the limited clinical data available. There was a lack of information on risk factors, infection characteristics, comorbidities, recent hospitalizations, prior antibiotic use, and treatment responses. The peritoneal specimen was cultured using only blood agar plates and fungal chromogenic plates, without employing selective media (such as MacConkey agar), which may result in the failure to detect certain pathogens. This study relied solely on laboratory reports and did not perform genomic analysis of drug-resistant strains. Additionally, the analysis focused only on the antimicrobial susceptibility and resistance profiles of six common pathogens associated with IAIs, excluding other microorganisms. Current research indicates that integrating clinical indicators and antibiotic usage history can more effectively identify risk factors for drug resistance and provide a basis for optimizing treatment regimens. Therefore, multicenter prospective studies should be conducted to address the evidence gaps in the field of IAIs.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eIn summary, understanding the distribution of pathogens and their resistance characteristics in abdominal infections is of great significance for early diagnosis and treatment. However, epidemiological data on bacterial infections show considerable temporal and regional differences, making it essential to incorporate local antimicrobial resistance surveillance data. This study analyzes the distribution of pathogens isolated from clinical abdominal infection patients in our region and their resistance to commonly used antibiotics, providing scientific evidence for the selection of antimicrobial therapy in the empirical treatment of abdominal infections. Additionally, performing bacterial culture on abdominal specimens before administering antibiotics is crucial, as it forms the foundation for subsequent \"de-escalation therapy\". This approach can guide clinicians in transitioning from combination therapy to monotherapy, reducing the variety of antibiotics used, shortening treatment durations, or discontinuing antibiotic use at appropriate times. These strategies are significant in reducing bacterial resistance, improving patient outcomes, and lowering mortality rates.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIAIs \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Intra-abdominal infections\u003c/p\u003e\n\u003cp\u003ecIAIs \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Complex intra-abdominal infections\u003c/p\u003e\n\u003cp\u003eWSES \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;World Society of Emergency Surgery\u003c/p\u003e\n\u003cp\u003eSIS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Surgical Infection Society\u003c/p\u003e\n\u003cp\u003eIDSA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Infectious Diseases Society of America\u003c/p\u003e\n\u003cp\u003eAST \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Antimicrobial susceptibility testing\u003c/p\u003e\n\u003cp\u003eCLSI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Clinical and Laboratory Standards Institute\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eE.Coli \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Escherichia coli\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eK.Pneumoniae \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Klebsiella pneumoniae\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eF.Faecalis \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; Enterococcus faecalis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eE.Faecium \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Enterococcus faecium\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eP.Aeruginosa \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Pseudomonas aeruginosa\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA.\u003cem\u003ebaumannii \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/em\u003eAcinetobacter baumannii\u003c/p\u003e\n\u003cp\u003eARR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Antimicrobial Resistance Rate\u003c/p\u003e\n\u003cp\u003eEco \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cem\u003eEscherichia coli\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eKpn \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePae \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAba \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEfm \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cem\u003eEnterococcus faecium\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEfa \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cem\u003eEnterococcus faecalis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eESBL \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Extended-spectrum β-lactamase\u003c/p\u003e\n\u003cp\u003eECO-ESBL \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;ESBL-producing \u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCRAB \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Carbapenem-resistant Acinetobacter baumannii\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eKPN-ESBL \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;ESBL-producing \u003cem\u003eK. pneumoniae\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCRKP \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Carbapenem-resistant \u003cem\u003eK. pneumoniae\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCREC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Carbapenem-resistant \u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCRPA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Carbapenem-resistant \u003cem\u003eP. aeruginosa\u003c/em\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the ethics committee of the First Hospital of Jiaxing (No. 2025-LP-042). Due to the retrospective design of this study, the ethics review board waived the requirement for written informed consent. Anonymized patient data were obtained from the hospital\u0026apos;s microbiology laboratory, which provided bacterial strain isolation records. This research strictly adhered to the ethical guidelines outlined in the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe summarized data are available from the corresponding author (Jiayuan Peng, [email protected]) upon reasonable request. Raw data are not publicly available due to institutional restrictions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to declare in this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the Science and Technology Plan Project of Jiaxing of Zhejiang Province of China under Grant 2024AD30030 and Jiaxing Key Discipline of Medicine-Clinical Diagnostics\u0026nbsp;under Grant 2023-ZC-002.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJ.P., B.L., and X.N. conceived and designed the experiments. Q.Y., J.T., and X.T. collected and analyzed the data. B.L., J.P., and X.N. drafted and revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSartelli M, Abu-Zidan FM, Catena F, Griffiths EA, Di Saverio S, Coimbra R, Ordo\u0026ntilde;ez CA, Leppaniemi A, Fraga GP, Coccolini F\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eGlobal validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study)\u003c/strong\u003e. \u003cem\u003eWorld journal of emergency surgery : WJES \u003c/em\u003e2015, \u003cstrong\u003e10\u003c/strong\u003e:61.\u003c/li\u003e\n\u003cli\u003eClements TW, Tolonen M, Ball CG, Kirkpatrick AW: \u003cstrong\u003eSecondary Peritonitis and Intra-Abdominal Sepsis: An Increasingly Global Disease in Search of Better Systemic Therapies\u003c/strong\u003e. 2021, 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Sciences\u003c/strong\u003e. 2023, \u003cstrong\u003e- 36\u003c/strong\u003e(- 8):- 732.\u003c/li\u003e\n\u003cli\u003eDN G, HF C, MS S, GM E: \u003cstrong\u003eThe Sanford Guide to Antimicrobial Therapy. 53rd ed. Sperryville, VA: Antimicrobial Therapy, Inc.; 2023.\u003c/strong\u003e 2023.\u003c/li\u003e\n\u003cli\u003eWu X, Wu J, Wang P, Fang X, Yu Y, Tang J, Xiao Y, Wang M, Li S, Zhang Y\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eDiagnosis and Management of Intraabdominal Infection: Guidelines by the Chinese Society of Surgical Infection and Intensive Care and the Chinese College of Gastrointestinal Fistula Surgeons\u003c/strong\u003e. \u003cem\u003eClinical Infectious Diseases \u003c/em\u003e2020, \u003cstrong\u003e71\u003c/strong\u003e(Supplement_4):S337-S362.\u003c/li\u003e\n\u003cli\u003eFu Y, Zhao F, Lin J, Li P, Yu Y: \u003cstrong\u003eAntibiotic susceptibility patterns and trends of the gram-negative bacteria isolated from the patients in the emergency departments in China: results of SMART 2016\u0026ndash;2019\u003c/strong\u003e. \u003cem\u003eBMC Infectious Diseases \u003c/em\u003e2024, \u003cstrong\u003e24\u003c/strong\u003e(1):501.\u003c/li\u003e\n\u003cli\u003eSwenson BR, Metzger R, Hedrick TL, McElearney ST, Evans HL, Smith RL, Chong TW, Popovsky KA, Pruett TL, Sawyer RG: \u003cstrong\u003eChoosing Antibiotics for Intra-Abdominal Infections: What Do We Mean by \u0026ldquo;High Risk\u0026rdquo;?\u003c/strong\u003e 2009, \u003cstrong\u003e10\u003c/strong\u003e(1):29-39.\u003c/li\u003e\n\u003cli\u003eLuo X, Li L, Xuan J, Zeng Z, Zhao H, Cai S, Huang Q, Guo X, Chen Z: \u003cstrong\u003eRisk Factors for Enterococcal Intra-Abdominal Infections and Outcomes in Intensive Care Unit Patients\u003c/strong\u003e. \u003cem\u003eSurgical Infections \u003c/em\u003e2021, \u003cstrong\u003e22\u003c/strong\u003e(8):845-853.\u003c/li\u003e\n\u003cli\u003eXiong Y-m, Rao X: \u003cstrong\u003eClinical and Microbiological Characteristics of Patients with Complicated Intra-abdominal Infections in Intensive Care Unit\u003c/strong\u003e. \u003cem\u003eCurrent Medical Science \u003c/em\u003e2020, \u003cstrong\u003e40\u003c/strong\u003e(1):104-109.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Intra-abdominal infections, Clinical distribution, Pathogens, Antimicrobial resistance","lastPublishedDoi":"10.21203/rs.3.rs-7626254/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7626254/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIntra-abdominal infections (IAIs) represent a common and serious clinical condition, often caused by polymicrobial pathogens. The increasing prevalence of antimicrobial resistance among these pathogens poses a growing challenge to effective treatment and public health.\u003c/p\u003e\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo investigate the distribution of bacterial isolates from IAIs patients and their antimicrobial resistance patterns, providing a basis for empirical anti-infective therapy and rational antimicrobial use in clinical practice.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eClinical data, pathogen distribution, and antimicrobial resistance profiles were collected from specimens of IAI patients submitted to the Jiaxing First Hospital between 2019 and 2023. Statistical and retrospective analyses of clinical and microbiological characteristics were conducted using WHONET 5.6 and SPSS 25.0.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 3,154 bacterial isolates were identified, with \u003cem\u003eEscherichia coli\u003c/em\u003e and \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e being the predominant Gram-negative pathogens (64.4%). \u003cem\u003eEscherichia coli\u003c/em\u003e showed high resistance to ampicillin (\u0026gt;\u0026thinsp;60%) and moderate resistance to cephalosporins and fluoroquinolones, but remained highly susceptible to carbapenems and tigecycline. \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e had similar trends with slightly lower resistance overall. \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e and \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e were the main non-fermenters; the former was sensitive to aminoglycosides and carbapenems, while the latter showed extensive resistance. Gram-positive isolates (35.6%) were mainly \u003cem\u003eEnterococcus faecium\u003c/em\u003e and \u003cem\u003eEnterococcus faecalis\u003c/em\u003e, with the former showing high resistance to several agents. Most infections occurred in elderly males, especially during summer.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe most commonly isolated pathogens in intra-abdominal infections were \u003cem\u003eEscherichia coli\u003c/em\u003e, \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e, \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e, \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e, \u003cem\u003eEnterococcus faecium\u003c/em\u003e, and \u003cem\u003eEnterococcus faecalis\u003c/em\u003e. High resistance rates to multiple antimicrobial agents were observed among these pathogens. Antimicrobial resistance monitoring should guide empirical antibiotic therapy to ensure effective treatment of intra-abdominal infections.\u003c/p\u003e","manuscriptTitle":"Bacterial Distribution and Antimicrobial Resistance in Intra-Abdominal Infections: A Five- Year Study in Jiaxing, China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-12 14:20:59","doi":"10.21203/rs.3.rs-7626254/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e0f683fc-6f72-45a2-96f9-d7d38d6e4c9b","owner":[],"postedDate":"October 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-17T10:54:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-12 14:20:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7626254","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7626254","identity":"rs-7626254","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}