Resistance to carbapenems by Acinetobacter spp. reported to GLASS according to the income level of the countries




Microbial sensitivity tests; Drug utilization; Epidemiological monitoring; Drug resistance bacterial.


This work aims to evaluate the resistance to carbapenems of Acinetobacter spp. reported to the GLASS (Global Antimicrobial Resistance and Use Surveillance System), stratifying these data by per capita income bracket. A retrospective observational study was conducted on carbapenem sensitivity of Acinetobacter spp., reported to GLASS, including all data available at the time of collection, february 2021, stratifying these findings by each country's income level and number of tests of sensitivity to carbapenemics performed. Higher-income countries had the lowest reported non-susceptibility, yet within them there are examples that have a high incidence of non-susceptibility. For all four income groups there was a high standard deviation variance for the mean of the carbapenem sensitivity tests, thus revealing points of inconsistency. The data worked in this article show a worrying level of resistance to carbapenems observed in GLASS. Even within rich countries, there are those that have alarming levels of non-susceptibility, and for the poorest countries, there is a lack of more complete data, because in those with the most worrying levels of non-susceptibility, strains of Acinetobacter spp. are already found with multidrug resistance phenotype.


Amiri, S., Hammami, S., Amoura, K., Dekhil, M., & Boubaker, I. B.-B. (2017). Characterization of carbapenem resistant Acinetobacter baumannii isolated from intensive care units in two teaching hospitals from Algeria and Tunisia. Pan African Medical Journal, 28.

Ayobami, O., Willrich, N., Suwono, B., Eckmanns, T., & Markwart, R. (2020). The epidemiology of carbapenem-non-susceptible Acinetobacter species in Europe: analysis of EARS-Net data from 2013 to 2017. Antimicrobial Resistance & Infection Control, 9(1), 89.

CDC. (2009). Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities. MMWR. Morbidity and Mortality Weekly Report, 58(10), 256–260.

CLSI. (2020). CLSI AST News Update. CLSI.

Fleming Fund. (2021). Aims & Values. 2021.

Goel, N., Wattal, C., Oberoi, J. K., Raveendran, R., Datta, S., & Prasad, K. J. (2011). Trend analysis of antimicrobial consumption and development of resistance in non-fermenters in a tertiary care hospital in Delhi, India. Journal of Antimicrobial Chemotherapy, 66(7), 1625–1630.

Harbarth, S., Balkhy, H. H., Goossens, H., Jarlier, V., Kluytmans, J., Laxminarayan, R., Saam, M., Van Belkum, A., & Pittet, D. (2015). Antimicrobial resistance: one world, one fight! Antimicrobial Resistance and Infection Control, 4(1), 49.

Hawkey, P. M., & Livermore, D. M. (2012). Carbapenem antibiotics for serious infections. BMJ, 344(may31 1), e3236–e3236.

Hsu, L.-Y., Tan, T.-Y., Tam, V. H., Kwa, A., Fisher, D. A., & Koh, T.-H. (2010). Surveillance and Correlation of Antibiotic Prescription and Resistance of Gram-Negative Bacteria in Singaporean Hospitals. Antimicrobial Agents and Chemotherapy, 54(3), 1173–1178.

Jaidane, N., Naas, T., Oueslati, S., Bernabeu, S., Boujaafar, N., Bouallegue, O., & Bonnin, R. A. (2018). Whole-genome sequencing of NDM-1-producing ST85 Acinetobacter baumannii isolates from Tunisia. International Journal of Antimicrobial Agents, 52(6), 916–921.

Kritsotakis, E. I., Kontopidou, F., Astrinaki, E., Roumbelaki, M., Ioannidou, E., & Gikas, A. (2017). Prevalence, incidence burden, and clinical impact of healthcare-associated infections and antimicrobial resistance: a national prevalent cohort study in acute care hospitals in Greece. Infection and Drug Resistance, 10, 317–328.

Laxminarayan, R., Duse, A., Wattal, C., Zaidi, A. K. M., Wertheim, H. F. L., Sumpradit, N., Vlieghe, E., Hara, G. L., Gould, I. M., Goossens, H., Greko, C., So, A. D., Bigdeli, M., Tomson, G., Woodhouse, W., Ombaka, E., Peralta, A. Q., Qamar, F. N., Mir, F., … Cars, O. (2013). Antibiotic resistance—the need for global solutions. The Lancet Infectious Diseases, 13(12), 1057–1098.

LSHTM. (2016). AMR Surveillance in low- and middle-income settings. London School of Hygiene & Tropical Medicine.

Mansour, W. (2018). Tunisian antibiotic resistance problems: three contexts but one health. African Health Sciences, 18(4), 1202.

Mayanskiy, N., Chebotar, I., Alyabieva, N., Kryzhanovskaya, O., Savinova, T., Turenok, A., Bocharova, Y., Lazareva, A., Polikarpova, S., & Karaseva, O. (2017). Emergence of the Uncommon Clone ST944/ST78 Carrying bla OXA-40-like and bla CTX-M-like Genes Among Carbapenem-Nonsusceptible Acinetobacter baumannii in Moscow, Russia. Microbial Drug Resistance, 23(7), 864–870.

McGettigan, P., Roderick, P., Kadam, A., & Pollock, A. (2019). Threats to global antimicrobial resistance control: Centrally approved and unapproved antibiotic formulations sold in India. British Journal of Clinical Pharmacology, 85(1), 59–70.

Patel, G., & Bonomo, R. A. (2013). “Stormy waters ahead”: global emergence of carbapenemases. Frontiers in Microbiology, 4, 48.

Patino, C. M., & Ferreira, J. C. (2015). Confidence intervals: a useful statistical tool to estimate effect sizes in the real world. Jornal Brasileiro de Pneumologia, 41(6), 565–566.

Perez, F., Hujer, A. M., Hujer, K. M., Decker, B. K., Rather, P. N., & Bonomo, R. A. (2007). Global Challenge of Multidrug-Resistant Acinetobacter baumannii. Antimicrobial Agents and Chemotherapy, 51(10), 3471–3484.

Petrović, T., Uzunović, S., Barišić, I., Luxner, J., Grisold, A., Zarfel, G., Ibrahimagić, A., Jakovac, S., Slaćanac, D., & Bedenić, B. (2018). Arrival of carbapenem-hydrolyzing-oxacillinases in Acinetobacter baumannii in Bosnia and Herzegovina. Infection, Genetics and Evolution, 58, 192–198.

Sousa, D., Castelo-Corral, L., Gutierrez-Urbon, J.-M., Molina, F., Lopez-Calvino, B., Bou, G., & Llinares, P. (2013). Impact of ertapenem use on Pseudomonas aeruginosa and Acinetobacter baumannii imipenem susceptibility rates: collateral damage or positive effect on hospital ecology? Journal of Antimicrobial Chemotherapy, 68(8), 1917–1925.

The Lancet. (2005). Stumbling around in the dark. Lancet (London, England), 365(9476), 1983.

The World Bank. (2021). DataBank. The World Bank.

Theuretzbacher, U. (2017). Global antimicrobial resistance in Gram-negative pathogens and clinical need. Current Opinion in Microbiology, 39, 106–112.

UNDP. (2021). Human Development Report 2020. United Nations Development Programme (UNDP).

United Nations. (2019). Follow-up to the political declaration of the high-level meeting of the General Assembly on antimicrobial resistance. United Nations.

Van Boeckel, T. P., Gandra, S., Ashok, A., Caudron, Q., Grenfell, B. T., Levin, S. A., & Laxminarayan, R. (2014). Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. The Lancet Infectious Diseases, 14(8), 742–750.

WHO. (2015a). Global Action Plan: on Antimicrobial Resistance. WHO.

WHO. (2015b). Global Antimicrobial Resistance Surveillance System: Manual for Early Implementation.

WHO. (2015c). Global Antimicrobial Resistance Surveillance System: Manual for Early Implementation. WHO.

WHO. (2017). Global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics. World Health Organization (WHO).

WHO. (2018). GLASS Early Implementation Report: 2016-2017. WHO.

WHO. (2019). GLASS Early Implementation Report: 2017-2018. WHO.

WHO. (2020). GLASS Early Implementation Report: 2020. WHO.

WHO. (2021). Global Antimicrobial Resistance Surveillance System (GLASS). WHO.

Williams, J. D. (1999). Beta-lactamases and beta-lactamase inhibitors. International Journal of Antimicrobial Agents, 12 Suppl 1, S3-7; discussion S26-7.

Xu, J., Sun, Z., Li, Y., & Zhou, Q. (2013). Surveillance and Correlation of Antibiotic Consumption and Resistance of Acinetobacter baumannii complex in a Tertiary Care Hospital in Northeast China, 2003–2011. International Journal of Environmental Research and Public Health, 10(4), 1462–1473.



How to Cite

ARAUJO, P. M.; BRAÚNA, C. da C.; LEMOS, S. C. L.; GOMES, D. M.; SANTOS, V. R. dos; SILVA, S. F. da; LOPES, L. da S. Resistance to carbapenems by Acinetobacter spp. reported to GLASS according to the income level of the countries. Research, Society and Development, [S. l.], v. 10, n. 17, p. e116101724115, 2021. DOI: 10.33448/rsd-v10i17.24115. Disponível em: Acesso em: 25 jan. 2022.



Health Sciences