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.
Highlights
Antimicrobial resistance (AMR) has become a global crisis due to escalating evolution of resistance coupled with a diminished antibiotic pipeline
Antimicrobial sensitivity testing and breakpoints for all antibiotics was detailed in Supplementary Table S2, and for tigecycline and colistin were provided in Supplementary Table S3 and Supplementary Table S4
Our initial analysis found that OECD countries have substantially lower pooled prevalence of antibiotic resistance (2006–2016), which is consistent with our initial expectation as OECD countries have a better antibiotics management system
Summary
Antimicrobial resistance (AMR) has become a global crisis due to escalating evolution of resistance coupled with a diminished antibiotic pipeline. A recent high profile report estimates that, by 2050, 10 million people will die from AMR per year if the current situation continues uncontrolled[1] This prediction was challenged due to the lack of detailed data on AMR burden, its morbidity and mortality, the modeling of future scenarios, etc[2]. Accessing the global prevalence of antibiotic resistance of the pathogens and investigating its developmental trend will aid our understanding of the current situation as well as make proper estimation of future scenario. This will be highly important for policy making. A. baumannii is one of the most challenging pathogens among them due to its particular antibiotic resistance
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