Temporal Variation in Antibiotic Resistance of Acinetobacter baumannii in a Teaching Hospital in Tunisia: Correlation with Antimicrobial Consumption

Jaidane Nadia1, 2, 3, Mansour Wejdene1, Bonnin Remy A.3, 4, 5, Ghardallou Meriam6, Chaouch Cherifa1, 2, Golli Rachida7, Kalboussi Nesrine7, Boujaafar Noureddine1, 2, Bouallegue Olfa1, 2, Naas Thierry3, 4, 5, *
1 UR 12 SP 37, Emerging Bacterial Resistance and Safety of Care, Department of Clinical Microbiology, University Hospital of Sahloul, Sousse, Tunisia
2 Clinical Microbiology Laboratory, University Hospital of Sahloul, Sousse, Tunisia
3 EA7361, Université Paris-Sud, Université Paris-Saclay, LabEx Lermit, Bacteriology-Hygiene unit, APHP, Hôpital Bicêtre,Le Kremlin-Bicêtre, France
4 EERA “Evolution and Ecology of Resistance to Antibiotics” Unit, Institut Pasteur-APHP-Université Paris Sud, Paris, France
5 Associated French National Reference Center for Antibiotic Resistance “Carbapenemase-producing Enterobacteriaceae” APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
6 Department of Community Health-Laboratory of research LR12ES03, Faculty of Medicine 16 Ibn El Jazzar, University of Sousse, Sousse, Tunisia
7 Pharmacy department of University, Hospital of Sahloul, Sousse, Tunisia

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© 2019 Jaidane et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Service de Bactériologie-Hygiène, Hôpital de 27 Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin-Bicêtre Cedex, France; Tel: + 28 33145212019; Fax:+ 33145216340;



To investigate the potential correlation between the rates of antimicrobial drug consumption and the prevalence of antimicrobial resistance among clinical Acinetobacter baumannii recovered in a tertiary care hospital in Tunisia.


The microbiological and epidemiological profiles of A. baumannii infections at the Hospital Sahloul, Sousse, were investigated between 2001 to 2004 and 2012 to 2015 along with the consumption record of broad-spectrum antibiotics.


Our data showed that extensively drug-resistant A. baumannii (XDRAb) isolates increased from 11.2% to 30.5% between 2012 and 2015 and disseminated endemically for a long time. Furthermore, we evidenced a drastic increase of carbapenem-resistant A. baumannii isolates from 29.5% in 2001 up to 88.6% in 2015 (612/691). This rise could be paralleled with a significant increase in antibiotic consumption over the last 15 years, especially with the sharp increase in the annual consumption of imipenem (r = 0.816 and p <103). A noteworthy correlation between carbapenem use and resistance rate (r = 0.778, p<0.001) was evidenced.


Feedback of these data to clinicians and decision-makers in the local setting was crucial to promote the rational use of antimicrobials and to raise awareness to strictly implement hygiene measures to limit the spread of these XDRAb isolates, to prevent colonization and subsequent infection.

Keywords: Antimicrobial resistance, Antimicrobial consumption, MDR-Ab, XDR-Ab, DDD/1000 patient-day, Imipenem.