Abstract
BackgroundDue to limited therapeutic options and their association with high mortality and morbidity, carbapenem-non-susceptible Acinetobacter spp. (CNA) are of significant public health importance. This study aimed to describe current epidemiological trends of CNA proportions in Europe and to identify factors that are associated with carbapenem non-susceptibility of isolates from patients with invasive Acinetobacter spp. infections.MethodsData from routine carbapenem susceptibility testing of 18,412 invasive clinical Acinetobacter spp. isolates from 30 European countries in 2013–2017 were analysed using descriptive statistical analyses and uni- and multivariable regression analyses. These data were obtained from the European Antimicrobial Resistance Surveillance Network (EARS-Net).ResultsThe population-weighted mean proportion of carbapenem-non-susceptible Acinetobacter spp. in Europe is 35.6% (95% confidence interval [CI] 29.7–42.0%). With CNA proportions of 75.5% (95% CI 71.2–79.4%) and 71.5% (95% CI 66.7–75.9%) the burden of CNA is particularly high in Southern and Eastern European regions. In contrast, Northern and Western European regions recorded CNA proportions of 2.8% (95% CI 1.2–6.0%) and 6.3% (95% CI 4.5–8.9%), respectively. Population-weighted mean CNA proportions are especially high in Acinetobacter spp. isolates from intensive care units (54.0% [95% CI 47.6–60.3%]). Male gender, age above 20 years and ICU admission were identified as independent factors associated with an increased likelihood of CNA.ConclusionThe burden of carbapenem-non-susceptible Acinetobacter spp. is particularly high in Southern and Eastern Europe. There is a risk that resistance could spread to other parts of Europe. Therefore, increased efforts in infection control and antibiotic stewardship, particularly in Intensive Care Units, are necessary to combat the spread of CNA in Europe.
Highlights
Due to limited therapeutic options and their association with high mortality and morbidity, carbapenem-non-susceptible Acinetobacter spp. (CNA) are of significant public health importance
A recent global study showed that carbapenem-non-susceptibility in Acinetobacter baumannii complex isolates from both invasive and noninvasive infections was considerably higher in the AsiaPacific region (~ 79%), Latin America (~ 85%) and North America (~ 45%) compared to the mean CNA proportion in Europe described in our study [19]
In the Southern and Eastern regions, more than 70% of all Acinetobacter spp. isolates from invasive infections were carbapenem-non-susceptible, while in the North and the West, CNA proportions of less than 10% were observed. This gradient seen in the non-susceptibility of invasive Acinetobacter spp. to carbapenems was observed for other pathogens in Europe, including Pseudomonas aeruginosa and Klebsiella pneumoniae [13], suggesting a systematic higher burden of invasive infections with drug-resistant Gramnegative pathogens in Southern and Eastern European regions
Summary
Due to limited therapeutic options and their association with high mortality and morbidity, carbapenem-non-susceptible Acinetobacter spp. (CNA) are of significant public health importance. Due to limited therapeutic options and their association with high mortality and morbidity, carbapenem-non-susceptible Acinetobacter spp. Acinetobacter baumannii is naturally resistant to several antibiotics, including priority “Watch group” antibiotics as defined by the WHO, such as cephalosporin. It has acquired many more resistance strategies, leading to poorer clinical outcomes across many healthcare settings [5, 6]. (CNA) is increasingly recognised as a nosocomial pathogen of significant public health importance worldwide because it presents limited therapeutic options, high treatment costs and is associated with high mortality and morbidity [7,8,9]. CNA have been implicated in several outbreaks of pneumonia, bloodstream, wound and urinary tract infections, especially among patients with severe morbidities like those on Intensive Care Units (ICU) [11, 12]
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