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.

Acknowledgements

This work was supported by the Macau Science and Technology Development Fund (Grant No.: FDCT/066/2015/A2 and FDCT/131/2016/A3), Research Committee of University of Macau (Grant No.: MYRG2016-00073-FHS and MYRG2016-00199-FHS). We thank Dr. Youyan Nie from National Institute of Education, Nanyang Technological University, for her critical review as well as revision on the manuscript.

Authors contributions

R.X. and J.Z. designed the systematic review and meta-analysis protocol. R.X. and J.Z. did the data collection, and R.X., X.D.Z., and J.Z. worked on the data analysis. R.X. and J.Z. performed data interpretation. R.X., B.P., Q.Z., X.D.Z., and J.Z. drafted the manuscript. All authors provide important intellectual revision of the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Supplementary Information accompanies this paper at (10.1038/s41426-018-0038-9).