Table 1. Comparison of epidemiological stages of carbapenem-resistant Acinetobacter baumannii in European countries, 2013–2019 (n = 37).
| Country | Epidemiological stage of spread of CRAb | Change between 2014–15 and 2019 | ||
|---|---|---|---|---|
| 2013 [2] | 2014–15 (previously unpublished) |
2019 | ||
| Albania | Stage 1 | Stage 1 | Stage 1 | → |
| Austria | Stage 1 | Stage 1 | Stage 2b | ↑ |
| Belgium | Stage 3 | Stage 2b | Stage 2b | → |
| Bosnia and Herzegovinaa | Stage 1 | Stage 3 | Stage 3 | → |
| Bulgaria | Stage 2b | Stage 2a | Stage 2b | → |
| Croatia | Stage 5 | Stage 5 | Stage 5 | → |
| Cyprus | Stage 3 | Stage 4 | Stage 2a | ↓ |
| Czechia | Stage 4 | Stage 2b | Stage 2b | → |
| Denmark | Stage 2b | Stage 1 | Stage 1 | → |
| Estonia | Stage 2a | Uncertain | Stage 2a | NA |
| Finland | Stage 1 | Stage 2a | Stage 1 | ↓ |
| France | Stage 3 | Stage 2b | Stage 3 | ↑ |
| Germany | Stage 4 | Stage 3 | Stage 2b | ↓ |
| Greece | Stage 5 | Stage 5 | Stage 5 | → |
| Hungary | Stage 4 | Stage 4 | Stage 4 | → |
| Iceland | Stage 0 | Stage 1 | Stage 1 | → |
| Ireland | Stage 2a | Stage 1 | Stage 1 | → |
| Italy | Stage 5 | Stage 5 | Stage 5 | → |
| Kosovob | Stage 3 | Stage 5 | Stage 2b | ↓ |
| Latvia | Stage 5 | Stage 2b | Stage 4 | ↑ |
| Lithuania | Stage 5 | Uncertain | Stage 5 | NA |
| Luxembourg | Stage 1 | Stage 0 | Stage 1 | ↑ |
| Malta | Stage 1 | Stage 2a | Stage 1 | ↓ |
| Montenegro | Stage 0 | Uncertain | Uncertainc | NA |
| Netherlands | Stage 1 | Stage 2a | Stage 1 | ↓ |
| North Macedonia | Stage 1 | Stage 1 | Stage 2b | ↑ |
| Norway | Stage 1 | Stage 2a | Stage 1 | ↓ |
| Poland | Stage 2b | Stage 4 | Stage 3 | ↓ |
| Portugal | Stage 4 | Stage 5 | Stage 5 | → |
| Romania | Stage 2b | Stage 5 | Stage 5 | → |
| Serbia | Stage 2b | Stage 5 | Stage 4 | ↓ |
| Slovakia | Stage 4 | Stage 4 | Stage 4 | → |
| Slovenia | Stage 2a | Stage 4 | Stage 3 | ↓ |
| Spain | Stage 3 | Stage 4 | Stage 3 | ↓ |
| Sweden | Stage 2a | Stage 2a | Stage 1 | ↓ |
| Turkey | Stage 2b | Stage 5 | Stage 5 | → |
| United Kingdomd | Stage 4 | Stage 4 | Stage 2b | ↓ |
CRAb: carbapenem-resistant Acinetobacter baumannii. NA: not applicable.
The epidemiological stages of carbapenem-resistant Acinetobacter baumannii are defined as follow: stage 0: no cases reported; stage 1: sporadic occurrence (epidemiologically-unrelated single cases); stage 2a: single hospital outbreak (two or more epidemiologically-associated cases with indistinguishable geno- or phenotype in a single institution); stage 2b: sporadic hospital outbreaks (unrelated hospital outbreaks with epidemiologically unrelated introduction or different strains, no autochthonous inter-institutional transmission reported); stage 3: regional spread (more than one epidemiologically-related hospital outbreak confined to hospitals that are part of the same region or health district, indicating regional autochthonous inter-institutional transmission); stage 4: inter-regional spread (multiple epidemiologically-related outbreaks occurring in different health districts, indicating inter-regional autochthonous inter-institutional transmission); stage 5: endemic situation (most hospitals in a country are repeatedly seeing cases admitted from autochthonous sources).
a The results reported for Bosnia and Herzegovina only apply to the Republic of Srpska.
b This designation is without prejudice to positions on status, and is in line with United Nations Security Council resolution 1244/99 and the International Court of Justice Opinion on the Kosovo declaration of independence.
c Acinetobacter spp. and Pseudomonas spp. are becoming a major problem in Montenegro as they are frequently isolated and are increasingly resistant to carbapenems. However, a National Reference Laboratory for these bacteria does not exist and all answers in the manuscript are connected with that fact. Therefore, it was judged that a realistic picture of the situation cannot be presented.
d The reported results are for the United Kingdom overall. The epidemiological stages vary among countries within the United Kingdom.