{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T07:01:49Z","timestamp":1784962909903,"version":"3.55.0"},"reference-count":26,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T00:00:00Z","timestamp":1722902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T00:00:00Z","timestamp":1722902400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100004737","name":"National Health Research Institutes","doi-asserted-by":"crossref","award":["IV-108-SP01"],"award-info":[{"award-number":["IV-108-SP01"]}],"id":[{"id":"10.13039\/501100004737","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004737","name":"National Health Research Institutes","doi-asserted-by":"publisher","award":["IV-109-SP01"],"award-info":[{"award-number":["IV-109-SP01"]}],"id":[{"id":"10.13039\/501100004737","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2024,8,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:sec>\n            <jats:title\/>\n            <jats:p>\n              Bacteremia is associated with significant morbidity and mortality. The emergence of bacteria with antimicrobial resistance (AMR) has further exacerbated the poor outcomes associated with bacteremia. The Taiwan Surveillance of Antimicrobial Resistance (TSAR) program was established in 1998 to monitor bacterial epidemiology and antimicrobial resistance trends across all patient types and age groups. Between 2002 and 2020, a total of 14,539 non-duplicate bacteremia isolates were collected biennially from 29 hospitals during the months of July\u2013September as part of the TSAR program. The three most common bacteremia agents were\n              <jats:italic>Escherichia coli<\/jats:italic>\n              (31%),\n              <jats:italic>Staphylococcus aureus<\/jats:italic>\n              (13.6%), and\n              <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n              (12.7%) overall. However, there was a steady increase in the proportions of\n              <jats:italic>E. coli<\/jats:italic>\n              and\n              <jats:italic>Enterococcus faecium<\/jats:italic>\n              isolated from bacteremia cases (both\n              <jats:italic>P<\/jats:italic>\n              &lt; 0.001), while the proportions of\n              <jats:italic>Acinetobacter<\/jats:italic>\n              spp. decreased. Regarding antimicrobial resistance, there was a notable increase in rates of third-generation cephalosporin and fluoroquinolone non-susceptibility among\n              <jats:italic>E. coli<\/jats:italic>\n              and\n              <jats:italic>K. pneumoniae<\/jats:italic>\n              , while the rates of carbapenem non-susceptibility were elevated but remained milder in these two species, especially in\n              <jats:italic>E. coli<\/jats:italic>\n              . Of concern is the alarming increase in vancomycin resistance among\n              <jats:italic>E. faecium<\/jats:italic>\n              , rising from 10.0% in 2004 to 47.7% in 2020. In contrast, the prevalence of methicillin-resistant\n              <jats:italic>S. aureus<\/jats:italic>\n              has remained stable at 51.2% overall. In conclusion,\n              <jats:italic>E. coli<\/jats:italic>\n              , with increasing third-generation cephalosporin and fluoroquinolone resistance, is the predominant cause of bacteremia in Taiwan during the 18-year surveillance. The escalating proportion of\n              <jats:italic>E. faecium<\/jats:italic>\n              in bacteremia, coupled with a concurrent upsurge in vancomycin resistance, presents a therapeutic challenge in the recent decade.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>IMPORTANCE<\/jats:title>\n            <jats:p>\n              AMR surveillance not only enables the identification of regional variations but also supports the development of coordinated efforts to combat AMR on a global scale. The TSAR has been a biennial, government-endorsed, multicenter study focusing on pathogens isolated from inpatients and outpatients in Taiwan hospitals since 1998. Our report presents an 18-year comprehensive analysis on blood isolates in the 2002\u20132020 TSAR program. The study highlights an alarming increase in the proportion of\n              <jats:italic>E. faecium<\/jats:italic>\n              causing bacteremia accompanied by elevated vancomycin resistance. It is worth noting that this trend differs from the observations in the United States and China. Understanding the composition of bacteria causing bacteremia, along with their prevalence of antimicrobial resistance, holds significant importance in establishing healthcare and research priorities. Additionally, this knowledge serves as a critical factor in evaluating the effectiveness of preventive interventions.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1128\/spectrum.00608-24","type":"journal-article","created":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T13:01:46Z","timestamp":1719320506000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":12,"title":["Changing epidemiology and antimicrobial resistance of bacteria causing bacteremia in Taiwan: 2002\u20132020"],"prefix":"10.1128","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4466-8486","authenticated-orcid":true,"given":"Ying-Chi","family":"Huang","sequence":"first","affiliation":[{"name":"National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan"},{"name":"Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6940-6450","authenticated-orcid":true,"given":"Shu-Chen","family":"Kuo","sequence":"additional","affiliation":[{"name":"National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7380-1699","authenticated-orcid":true,"given":"Chi-Tai","family":"Fang","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan"},{"name":"Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2927-020X","authenticated-orcid":true,"given":"Tsai-Ling","family":"Lauderdale","sequence":"additional","affiliation":[{"name":"National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2018.03.005"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/1469-0691.12144"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00355-19"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy657"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004371"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1128\/Spectrum.00283-21"},{"key":"e_1_3_4_10_2","volume-title":"WHO bacterial priority pathogens list, 2024: Bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance","author":"World Health Organization","year":"2024","unstructured":"World Health Organization. 2024. WHO bacterial priority pathogens list, 2024: Bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance. Geneva. https:\/\/iris.who.int\/bitstream\/handle\/10665\/376776\/9789240093461-eng.pdf?sequence=1."},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1086\/345476"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1086\/313694"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid2007.121004"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2003.10.005"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2003.09.021"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmii.2023.04.010"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkab141"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2020.557404"},{"key":"e_1_3_4_19_2","volume-title":"Performance Standards for Antimicrobial Susceptibility Testing","author":"CLSI","year":"2023","unstructured":"CLSI. 2023. Performance Standards for Antimicrobial Susceptibility Testing. 33rd ed. Clinical and Laboratory Standards Institute, Wayne, PA.","edition":"33"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00021-10"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0144103"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1038\/srep36280"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.03554-22"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-018-0410-5"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(19)30418-9"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofy270"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2021.26.45.2001628"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/20.5.1126"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz900"}],"container-title":["Microbiology Spectrum"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.00608-24","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/spectrum.00608-24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T13:07:38Z","timestamp":1722949658000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/spectrum.00608-24"}},"subtitle":[],"editor":[{"given":"Po-Yu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,8,6]]},"references-count":26,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,8,6]]}},"alternative-id":["10.1128\/spectrum.00608-24"],"URL":"https:\/\/doi.org\/10.1128\/spectrum.00608-24","relation":{},"ISSN":["2165-0497"],"issn-type":[{"value":"2165-0497","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,6]]},"assertion":[{"value":"2024-03-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e00608-24"}}