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

Figures & data

Fig. 1 Flow diagram of study selection

The characteristics of included papers on antibiotic resistance of A. baumannii infections by OECD status of each country

Study characteristics	No of papers from OECD countries (n = 35/supplementary reference)	No of papers from non-OECD countries (n = 19/supplementary reference)
Study design
Retrospective observational	25^1,4,7,8,12,13,15–19,21–32,34,35	18^36–39,41–54
Prospective observational	5^2,6,9,14,20	1^40
Case–control	3^3,5,10	0
Cross-sectional	2^11,33	0
Antibiotic susceptibilities reported
Imipenem	31^2–9,11–15,18–35	18^36–48,50–54
Amikacin	29^3–14,16–25,27,28,30–34	18^36–45,47–54
Ampicillin-sulbactam	14^7,8,11,13,15,18,22,24,25,27–29,31,34	7^36,38,42,44,48,53,54
Tobramycin	14^5,9,10,12–15,17,19,20,22,25,28,31	6^39,42,43,47,52,54
Ceftazidime	27^2–9,11,12,14,15,17–24,27–30,32,34,35	17^36-49,51,52,54
Meropenem	26^4,6–9,11,13–20,22–24,26–29,31–35	16^37–41,43-47,49–54
Piperacillin-tazobactam	26^2,4–10,12,13,15–21,24,25,27–30,32,34,35	12^36–38,40–42,44,45,48,52–54
Cefepime	23^4,6–13,15–19,23–25,27,29,30,32,34,35	14^36–39,41–46,48,51,52,54
Colistin	17^3,13,16–20,22,24–27,30–34	13^39,40,42–50,52,53
Tigecycline	7^8,16,18,20,24,25,28	9^40,42,44,46–49,52,53
MDR	10^7,15–18,21,24,25,28,31	4^37,42,48,54
Method of antimicrobial susceptibility testing
Standard susceptibility testing methods	6^3,4,8,9,13,31	4^38,39,41,45
Disk diffusion	8^6,12,14,22,25,27,28,30	10^25,37,40,42,45,47–49,52,53
Broth microdilution	10^2,4,7,11,15,16,18,27,32,33	4^44,47,50,54
Vitek2	16^1,5,10,15,17,19–21,24–29,33	5^36,37,46,51,54
Agar dilution	0	2^36,44
Etests	6^24,25,28,30,33,34	4^36,43,51,52
Sensititre ARIS® 2×	1^23	0
Guidelines used to interpret antimicrobial sensitivities
CLSI	30^1–4,6–9,13,14,16–35	17^36–45,47–51,53,54
EUCAST	5^20,26,27,33,34	3^42,47,49
DIN	1^15	0
CA-SFM	0	2^12,52
Not reported	3^5,10,11	1^46

CLSI The Clinical and Laboratory Standards Institute, EUCAST the criteria of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) for Enterobacteriaceae, DIN German Institute for Standardization, CA-SFM Antibiogram Committee of the French Society for Microbiology

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

The pooled prevalence of antibiotic resistance to the commonly prescribed antibiotics in OECD and non-OECD countries during 2006–2016

	OECD				Non-OECD
Antibiotic	Pooled prevalence (%)	No of isolates tested	No of reporting studies (countries)	I^2 (%)	Pooled prevalence (%)	No of isolates tested	No of reporting studies (countries)	I^2 (%)
Imipenem	53.8 (36.8–70.8)	26,376	22 (11)	64.3	76.8 (67.4–86.2)	7085	18 (10)	44.5
Amikacin	44.6 (24.9–64.3)	25,988	18(10)	60.8	75.9 (66.1–85.8)	7113	18 (10)	46.0
AMP-SUL	47.6 (24.7–70.6)	17,908	12 (7)	60.8	68.1 (61.9–74.3)	3172	7 (4)	15.1
Tobramycin	48.1 (23.1–89.9)	23,064	8 (4)	59.2	67.9 (43.7–92.0)	774	6 (4)	57.1
Ceftazidime	75.2 (60.8–90.3)	5370	19 (11)	62.4	91.5 (84.3–98.6)	7055	17 (11)	28.1
Meropenem	55.7 (38.5–72.9)	23,106	26 (10)	60.4	82.7 (71.6–93.9)	6825	16 (11)	56.7
PIP-TAZ	64.4 (43.6–85.3)	4393	19 (10)	64.6	84.6 (73.8–95.3)	6423	12 (8)	40.6
Cefepime	65.4 (47.6–83.1)	6175	16 (11)	62.7	88.2 (78.9–97.5)	6804	14 (9)	45.6
Colistin	1.4 (0.2–2.6)	5867	15 (11)	18.6	1.3 (0.1–2.7)	1587	13 (9)	16.9
Tigecycline	14.4 (3.6–25.4)	2601	7 (7)	46.7	15.0 (2.0–28.0)	1059	9 (7)	50.7
MDR	56.9 (27.3–86.5)	24,215	8 (6)	63.1	80.4 (69.9–90.8)	508	4 (4)	33.8

AMP-SUL ampicillin-sulbactam, PIP-TAZ piperacillin-tazobactam

The pooled prevalence of antibiotic resistance to the commonly prescribed antibiotics at three different periods in OECD and non-OECD countries

	OECD (95% CI)			Non-OECD (95% CI)
Antibiotic	2000–2005	2006–2010	2011–2016	2006–2010	2011–2016
Imipenem	23.8 (9.7–38.0)	51.6 (34.4–68.9)	73.9 (54.8–95.6)	72.1 (58.2–86.0)	77.8 (66.7–88.4)
Amikacin	38.2 (18.0–58.8)	43.6 (21.9–65.3)	66.6 (40.4–92.7)	72.2 (61.6–82.7)	76.2 (59.0–93.4)
AMP-SUL	29.2 (5.6–52.8)	44.7 (23.1–66.1)	72.3 (48.9–95.8)	66.7 (63.7–69.8)	74.0 (58.9–88.1)
Tobramycin	27.4 (13.6–41.1)	46.7 (21.6–71.8)	62.3 (37.1–87.5)	51.4 (41.0–58.9)	72.4 (49.8–95.0)
Ceftazidime	57.3 (37.5–77.2)	74.7 (55.6–93.8)	81.8 (65.4–95.5)	78.6 (66.0–91.0)	89.7 (82.2–97.1)
Meropenem	25.4 (10.4–40.2)	55.6 (42.9–68.3)	70.1 (46.5–93.6)	75.8 (58.6–93.1)	81.1 (69.4–92.7)
PIP-TAZ	49.9 (25.7–74.1)	63.7 (36.1–91.4)	80.1 (61.0–100)	84.0 (72.9–95.2)	85.2 (77.0–93.5)
Cefepime	57.9 (46.0–69.8)	65.0 (46.9–82.1)	78.2 (51–100)	79.7 (63.8–95.6)	89.4 (81.4–97.6)
Colistin	NA	0.0 (0.0–1.0)	1.3 (0.0–2.9)	0.0 (0.0–1.0)	1.6 (0.0–3.7)
Tigecycline	NA	11.3 (3.1–19.4)	13.1 (3.5–22.7)	14.0 (3.9–25.1)	14.1 (2.3–25.8)

AMP-SUL ampicillin-sulbactam, PIP-TAZ piperacillin-tazobactam, NA not avalibale

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