Analysis of global prevalence of antibiotic resistance in Acinetobacter baumannii infections disclosed a faster increase in OECD countries

Abstract

Acinetobacter baumannii is one of the most challenging nosocomial pathogens due to the emergence and widespread of antibiotic resistance. We aimed to provide the first analysis of global prevalence of antibiotic resistance in A. baumannii infections, by synthesizing data and knowledge through a systematic review. We searched studies reporting antibiotic resistance in A. baumannii infections using the Medline, Embase, Web of Science, and Cochrane databases from January 2000 to December 2016. Studies were eligible if they investigated and reported antibiotic resistance in A. baumannii infections with inpatients or outpatients in hospital. Our investigation showed a high prevalence of resistance to the common prescribed antibiotics in A. baumannii infections in both OECD (Organization for Economic Co-operation and Development) and non-OECD countries. Strikingly, though OECD countries have substantially lower pooled prevalence of resistance compared to non-OECD countries based on the data during 2006-2016, a further investigation in a time scale disclosed a faster increase in OECD countries during the past 11 years, and currently both of them have a comparable prevalence of resistance (2011-2016). Tigecycline and colistin are still active but their resistances are expected to become common if the preventative measures are not taken. Antibiotic resistance in A. baumannii infection developed fast and is a crisis for both OECD and non-OECD countries. A "post-antibiotic era" for A. baumannii infection is expected in the next 10-20 years without immediate actions from pharmaceutical companies and governments.

Fig. 1

Flow diagram of study selection

Fig. 2

Geographical distribution of the prevalence of antibiotics resistance in A. baumannii infections to imipenem (%) by two periods. n is the number of included studies per country

Fig. 3

a The pooled prevalence of antibiotic resistance to the common antibiotics except for tigecycline and colistin during the three periods (years of 2000–2005, 2006–2010, and 2011–2016) in OECD and two periods (years of 2006–2010 and 2011–2016) in non-OECD countries. b The proportion of antibiotic resistance growth between different time period in OECD and non-OECD countries

Fig. 4

a The pooled prevalence of MDR in A. baumannii isolates from 2006–2016 in OECD and non-OECD countries. b The pooled crude odds ratios between antibiotic resistance in A. baumannii infections and prior exposure to any antibiotic. c The pooled crude odds ratios between antibiotic resistance in A. baumannii infections and ICU or non-ICU hospitalization. PIP-TAZ piperacillin-tazobactam, AMP-SUL ampicillin-sulbactam