The article provides an overview of the current status and trends of antimicrobial resistance (AMR) among clinical bacterial isolates in China from 2005 to 2022. Two national surveillance networks, CHINET and CARSS, have been established to monitor AMR. The ratio of Gram-negative bacilli to Gram-positive cocci in clinical isolates has been approximately 7:3 over the past 18 years, with Gram-negative bacilli showing higher AMR profiles. Key findings include: - **Escherichia coli**: High prevalence of extended-spectrum β-lactamase (ESBL) production (approximately 50%), and ciprofloxacin resistance rates fluctuating between 56% and 68%. - **Klebsiella pneumoniae**: Increasing prevalence of carbapenem-resistant K. pneumoniae (CRKP) from 2.9% in 2005 to 25% in 2018, then slightly decreasing to 22.6% in 2022. - **Acinetobacter baumannii-calcoaceticus complex (ABC)**: High AMR profile with a carbapenem resistance rate of approximately 66%, showing a decreasing trend from 2018 to 2022. - **Staphylococcus aureus (MRSA)**: Significant decrease in prevalence from 69% in 2005 to 28.7% in 2022, particularly in adults. - **Enterococcus faecium and E. faecalis**: Low prevalence of vancomycin-resistant Enterococcus (VRE), with VRE prevalence <5% for E. faecium and <1% for E. faecalis. - **Streptococcus pneumoniae**: Prevalence of penicillin-resistant S. pneumoniae and penicillin-intermediate S. pneumoniae higher in children than in adults, but the gap has narrowed over time. The review highlights the importance of AMR surveillance systems and the need for continued monitoring and intervention to control the spread of resistant organisms. The decreasing trends in MRSA and VRE prevalence are attributed to effective infection control measures and rational antibiotic use. However, the increasing prevalence of MRSA in children and the high AMR profile of ABC remain concerns.The article provides an overview of the current status and trends of antimicrobial resistance (AMR) among clinical bacterial isolates in China from 2005 to 2022. Two national surveillance networks, CHINET and CARSS, have been established to monitor AMR. The ratio of Gram-negative bacilli to Gram-positive cocci in clinical isolates has been approximately 7:3 over the past 18 years, with Gram-negative bacilli showing higher AMR profiles. Key findings include: - **Escherichia coli**: High prevalence of extended-spectrum β-lactamase (ESBL) production (approximately 50%), and ciprofloxacin resistance rates fluctuating between 56% and 68%. - **Klebsiella pneumoniae**: Increasing prevalence of carbapenem-resistant K. pneumoniae (CRKP) from 2.9% in 2005 to 25% in 2018, then slightly decreasing to 22.6% in 2022. - **Acinetobacter baumannii-calcoaceticus complex (ABC)**: High AMR profile with a carbapenem resistance rate of approximately 66%, showing a decreasing trend from 2018 to 2022. - **Staphylococcus aureus (MRSA)**: Significant decrease in prevalence from 69% in 2005 to 28.7% in 2022, particularly in adults. - **Enterococcus faecium and E. faecalis**: Low prevalence of vancomycin-resistant Enterococcus (VRE), with VRE prevalence <5% for E. faecium and <1% for E. faecalis. - **Streptococcus pneumoniae**: Prevalence of penicillin-resistant S. pneumoniae and penicillin-intermediate S. pneumoniae higher in children than in adults, but the gap has narrowed over time. The review highlights the importance of AMR surveillance systems and the need for continued monitoring and intervention to control the spread of resistant organisms. The decreasing trends in MRSA and VRE prevalence are attributed to effective infection control measures and rational antibiotic use. However, the increasing prevalence of MRSA in children and the high AMR profile of ABC remain concerns.