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

Abstract 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 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$35 000 and Acinetobacter carbapenem resistance were greater GDPPC [adjusted odds ratio (aOR) = 0.18 per log-US$, 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.