Antibiotic-Resistant Acinetobacter baumannii in Low-Income Countries (2000-2020): Twenty-One Years and Still below the Radar, Is It Not There or Can They Not Afford to Look for It?

Soha S Rizk,Wafaa H Elwakil,Ahmed S Attia

doi:10.3390/antibiotics10070764

Soha S Rizk, Wafaa H Elwakil + Show 1 more

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https://doi.org/10.3390/antibiotics10070764

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Journal: Antibiotics	Publication Date: Jun 23, 2021
Citations: 10	License type: CC BY 4.0

Affiliation: Cairo University

Abstract

Acinetobacter baumannii is an emerging pathogen, and over the last three decades it has proven to be particularly difficult to treat by healthcare services. It is now regarded as a formidable infectious agent with a genetic setup for prompt development of resistance to most of the available antimicrobial agents. Yet, it is noticed that there is a gap in the literature covering this pathogen especially in countries with limited resources. In this review, we provide a comprehensive updated overview of the available data about A. baumannii, the multi-drug resistant (MDR) phenotype spread, carbapenem-resistance, and the associated genetic resistance determinants in low-income countries (LIICs) since the beginning of the 21st century. The coverage included three major databases; PubMed, Scopus, and Web of Science. Only 52 studies were found to be relevant covering only 18 out of the 29 countries included in the LIC group. Studies about two countries, Syria and Ethiopia, contributed ~40% of the studies. Overall, the survey revealed a wide spread of MDR and alarming carbapenem-resistance profiles. Yet, the total number of studies is still very low compared to those reported about countries with larger economies. Accordingly, a discussion about possible reasons and recommendations to address the issue is presented. In conclusion, our analyses indicated that the reported studies of A. baumannii in the LICs is far below the expected numbers based on the prevailing circumstances in these countries. Lack of proper surveillance systems due to inadequate financial resources could be a major contributor to these findings.

Highlights

The ceaseless emergence of new pathogens and the constant mutations into pathogenic resistant strains are today’s humanity’s most tremendous threats
What makes A. baumannii more critical is that the mortality rates associated with it could reach up to 35% and escalate to 43% in intensive care units (ICUs) [7]
We present a comprehensive coverage of how A. baumannii and its resistance to antibiotics have been spreading across geographical borders throughout the low-income countries (LICs) in the last 21 years since the beginning of the 21st century

Summary

Introduction

The ceaseless emergence of new pathogens and the constant mutations into pathogenic resistant strains are today’s humanity’s most tremendous threats. What is considered a low-virulence pathogen with reduced adhesion and invasion abilities has surfaced as a hard to contain agent with the genetic setup for prompt development of resistance mechanisms to most of the available antimicrobial agents [1]. Acinetobacter was first isolated in 1911 from the soil [2] It underwent taxonomic changes from its primary designated name Micrococcus calcoaceticus until it received the genus Acinetobacter due to its nonmotile nature. It is an aerobic Gram-negative, catalase-positive, oxidase-negative, nonfermenting coccobacillus belonging to the Moraxellacea family with a DNA G+C content ranging from 39% to 47% [2,3]. Being a non-lactose-fermenter with the ability to survive on low nutritional requirements enabled its germination in a wide range of environments

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