Antimicrobial resistance and molecular epidemiology of Streptococcus pneumoniae in China: a 14‑year serial surveillance study across age groups.

Authors

Lanqing Cui, Yuan Zeng, Yuqin Song, Feng Xue, Jia Zhang, Jie Feng, Fan Zhang, Yun Li

Published in

Journal of infection and public health. Volume 19. Issue 8. Pages 103308. Jul 11, 2026. Epub Jul 11, 2026.

Abstract

Streptococcus pneumoniae poses a significant health threat with rising antimicrobial resistance. In China, long-term, age-stratified data on its molecular epidemiology remain limited. This study investigates resistance trends and serotype distribution across pediatric, adult, and elderly populations over 14 years.
A total of 1312 clinical isolates collected during seven two‑year surveillance phases (2007-2020) from 24 hospitals across China were analyzed using whole-genome sequencing for serotype prediction, multilocus sequence typing (MLST), and Global Pneumococcal Sequence Clustering (GPSC); antibacterial susceptibility was performed using agar dilution method.
Serotypes 19 F and 19 A consistently accounted for the largest proportion of isolates throughout the study period. PCV13 serotype coverage was highest in children (85.8%) and increased nationally from 64.5% to 77.9% over 14 years. MLST identified ST271 and ST320 as the most prevalent clones, often associated with serotypes 19 F and 19 A, respectively. AMR was severe, with > 90% macrolide resistance nationwide. Penicillin non-susceptibility (using non‑meningitis oral breakpoints) increased markedly, especially among pediatric isolates, which also showed higher β-lactam resistance. Fluoroquinolones retained high susceptibility (>97% of isolates susceptible). The resistance gene erm(B) was detected in 96.3% of isolates.
S. pneumoniae in China exhibits persistent high resistance to macrolides and increasing β-lactam non-susceptibility, particularly in children. Dominant clones and serotypes showed no statistically significant change in proportional trends over the 14 years. PCV13 serotype coverage remains high, yet actual vaccine uptake is low; this suggests a missed opportunity for preventing infections caused by vaccine serotypes, highlighting the potential benefit of increased immunization efforts.

PMID:
42435712
Bibliographic data and abstract were imported from PubMed on 12 Jul 2026.

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