Department of Infectious Diseases, Rural Development Trust Hospital, Kadiri Road, Bathalapalli 515661, AP, India; Fundación Vicente Ferrer, Barcelona, Spain.
Department of Infectious Diseases, Rural Development Trust Hospital, Kadiri Road, Bathalapalli 515661, AP, India.
J Glob Antimicrob Resist. 2018 Sep;14:29-32. doi: 10.1016/j.jgar.2018.05.024. Epub 2018 Jun 4.
This study investigated trends and factors associated with antimicrobial resistance (AMR) in Acinetobacter spp. in Europe.
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$35000 cut-off of the 2016 gross domestic product per capita (GDPPC).
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$35000. 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$35000 and <US$35000, respectively. In a multivariable model, country-level factors associated with a lower risk of Acinetobacter carbapenem resistance were greater GDPPC [adjusted odds ratio (aOR)=0.18 per log-US$, 95% CI 0.09-0.34] and distance from the equator (aOR=0.93 per degree of latitude, 95% CI 0.88-0.98).
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.
本研究旨在调查欧洲不动杆菌属中与抗生素耐药性（AMR）相关的趋势和因素。
利用 EARS-Net 数据，对每个参与国家进行人群加权多水平逻辑回归模型分析，采用随机截距来评估不动杆菌属 AMR 的趋势。根据 2016 年人均国内生产总值（GDPPC）的 35000 美元便利划分标准，将国家分为两组（北部与东南）。
在大多数国家，没有出现随时间上升或下降的趋势。模型显示，在 GDPPC<35000 美元的国家中，氨基糖苷类、碳青霉烯类和氟喹诺酮类药物的 AMR 发生率更高。2016 年不动杆菌属耐药率估计为 6.4%（95%CI 3.2-9.6%）和 66.5%（95%CI 56.3-76.8%），对氨基糖苷类药物；5.9%（95%CI 3.5-8.3%）和 68.5%（95%CI 58.1-79%）对碳青霉烯类药物；9.1%（95%CI 5.8-12.5%）和 74.7%（95%CI 66.2-83.2%）对氟喹诺酮类药物；以及 GDPPC>35000 美元和<35000 美元的国家中，分别为 3.5%（95%CI 1.6-5.4%）和 57.4%（95%CI 43.1-71.7%）的所有三种抗生素组。在多变量模型中，与不动杆菌碳青霉烯类耐药风险较低相关的国家因素为较高的 GDPPC[校正优势比（aOR）=每对数美元 0.18，95%CI 0.09-0.34]和距赤道的距离（aOR=每纬度 0.93，95%CI 0.88-0.98]。
欧洲不动杆菌属的 AMR 未见上升趋势。气候较冷、GDPPC 较高的北方国家的不动杆菌属 AMR 比例低于南方和东方国家。
