{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T13:09:25Z","timestamp":1785762565698,"version":"3.56.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate microbial distribution and antimicrobial resistance (AMR) patterns in clinical isolates from 13 tertiary hospitals and one secondary hospital in Tianjin (2021\u20132023) to inform precision-driven antimicrobial stewardship and infection control interventions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this retrospective, multicenter study, we collected routine diagnostic specimens\u2014including sputum, fecal samples, secretions, blood, and drainage fluids. Data were processed per standardized protocols (CARSS, CHINET) and interpreted using current CLSI-M100 breakpoints. Statistical analyses were performed with SPSS 20.0 (significance set at two\u2010tailed <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sputum specimens increased from 39.1% to 43.0%, while urine samples and secretions declined. <jats:italic>Klebsiella pneumoniae<\/jats:italic> prevalence rose from 18.3% to 20.3%, whereas <jats:italic>Escherichia coli<\/jats:italic> remained stable. <jats:italic>E. coli<\/jats:italic> maintained excellent susceptibility to carbapenems and amikacin (\u22642% resistance); notably, ceftazidime\/avibactam resistance declined from 7.2% to 3.4% (<jats:italic>P<\/jats:italic>\u2009=\u20090.005) amid a significant increase in cefepime resistance (24.4% to 29.6%, <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001). <jats:italic>K. pneumoniae<\/jats:italic> exhibited parallel trends, with escalating resistance to \u03b2-lactam\/\u03b2-lactamase inhibitor agents. In <jats:italic>Pseudomonas aeruginosa<\/jats:italic>, aminoglycoside, and carbapenem profiles remained stable, while ceftazidime\/avibactam sensitivity markedly improved, suggesting shifts in underlying resistance mechanisms. <jats:italic>Acinetobacter baumannii<\/jats:italic> showed enhanced susceptibility to aminoglycosides, \u03b2-lactam inhibitors, and fluoroquinolones; however, carbapenem-resistant isolates continued to exhibit near-universal resistance. Among gram-positive pathogens, methicillin-resistant <jats:italic>Staphylococcus aureus<\/jats:italic> sustained near-universal \u03b2-lactam resistance with improved rifampicin sensitivity, while glycopeptides and linezolid remained fully active. <jats:italic>Enterococcus faecalis<\/jats:italic> demonstrated reduced ampicillin resistance, contrasting with <jats:italic>E. faecium<\/jats:italic>\u2019s near-pan-resistance to \u03b2-lactams and fluoroquinolones.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Evolving, species-specific AMR patterns in Tianjin hospitals highlight the urgent need for real-time, regionally stratified surveillance and molecularly informed stewardship strategies to guide targeted antimicrobial interventions and improve clinical outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcimb.2025.1629038","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T05:54:51Z","timestamp":1757310891000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Navigating an evolving microbial landscape: emerging antimicrobial resistance trends and precision stewardship in Tianjin tertiary hospitals (2021\u20132023)"],"prefix":"10.3389","volume":"15","author":[{"given":"Yong-li","family":"Wan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donghao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-jie","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing-guo","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-guang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Bao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi-yong","family":"Fei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu-liang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-bo","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2748","DOI":"10.1093\/jac\/dkab212","article-title":"dfrA trimethoprim resistance genes found in Gram-negative bacteria: compilation and unambiguous numbering","volume":"76","author":"Ambrose","year":"2021","journal-title":"J. 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