Trends and factors associated with antimicrobial resistance of Acinetobacter spp. invasive isolates in Europe: A country-level analysis

Objectives: This study investigated trends and factors associated with antimicrobial resistance (AMR) in Acinetobacter spp. in Europe. Methods: Using data from EARS-Net, population-weighted multilevel logistic regression models with random intercepts for each participating country were performed to assess trends in Acinetobacter AMR. Countries were divided into two groups (Northern versus Southern-Eastern) using a convenient US $35 000 cut-off of the 2016 gross domestic product per capita (GDPPC). Results: In most countries, there were no ascending or descending trends over time. The models showed a consistent higher prevalence of AMR to aminoglycosides, carbapenems and fluoroquinolones in countries with GDPPC US$35 000. The estimated 2016 proportion of Acinetobacter resistance was 6.4% (95% CI 3.2-9.6%) and 66.5% (95% CI 56.3-76.8%) to aminoglycosides, 5.9% (95% CI 3.5-8.3%) and 68.5% (95% CI 58.1-79%) to carbapenems, 9.1% (95% CI 5.8-12.5%) and 74.7% (95% CI 66.2-83.2%) to fluoroquinolones, and 3.5% (95% CI 1.6-5.4%) and 57.4% (95% CI 43.1-71.7%) to all three antibiotic groups in countries with GDPPC >US$35 000 and and <US$35 000, respectively. In a multivariable model, country-level factors associated with a lower risk of Acinetobacter carbapenem resistance were greater GDPPC [adjusted odds ratio (aOR)= 0.18 per log-US$, 95% CI 0.09-0.34] and distance from the equator (aOR = 0.93 per degree of latitude, 95% CI 0.88-0.98). Conclusions: No rising trends of AMR in Acinetobacter spp. in Europe were observed. Northern countries, with colder climate and greater GDPPC, have a lower proportion of Acinetobacter AMR than Southern and Eastern countries. (C) 2018 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.