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Background: 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. Methods: 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. Results: 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 3). A noteworthy correlation between carbapenem use and resistance rate (r = 0.778, p Conclusion: 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.

Additional file 3: Table S3. Oligonucleotides used in this work. Table S4. Mutations detected in MG1655 strains derivatives mutated in ftsI. Table S5. Genomic features of the E. coli ST410 isolate Ec-MAD. Table S6. Antibiotics susceptibility testing of the ST410 isolate Ec-MAD. Table S7. Distribution and effect of point mutations in the OXA-181 E. coli ST410 subclade MRCA. Table S8. Mutations predicted with a functional effect using the SIFT algorithm. Table S10. Antibiotic resistance gene content of ST410 isolates analysed in Fig. 7.

Additional file 4: Figure S1. Number of antibiotic resistance genes (ARG) according to the phylogenetic group among E. coli ST410 isolates. Figure S2. Recombination events in isolates of the E. coli ST410 FQR clade. Figure S3. Phylogenetic distribution of E. coli isolates mutated in ftsI. Figure S4. Recombination events at the dcw and ompC loci. Figure S5. Phylogeny and mutations in non-redundant E. coli ST131 CP-Ec isolates. Figure S6. Phylogeny and mutations in non-redundant CP-Ec isolates of ST48, ST206, ST224, ST359, ST361, ST448 and ST617. Figure S7. Phylogeny and mutations in non-redundant E. coli isolates of phylogroup D. Figure S8. Phylogeny and mutations of ST10, ST226, and ST746 non-redundant E. coli isolates. Figure S9. Estimated fitness of E. coli ST410 strains in rich and minimal media.

Additional file 4: Figure S1. Number of antibiotic resistance genes (ARG) according to the phylogenetic group among E. coli ST410 isolates. Figure S2. Recombination events in isolates of the E. coli ST410 FQR clade. Figure S3. Phylogenetic distribution of E. coli isolates mutated in ftsI. Figure S4. Recombination events at the dcw and ompC loci. Figure S5. Phylogeny and mutations in non-redundant E. coli ST131 CP-Ec isolates. Figure S6. Phylogeny and mutations in non-redundant CP-Ec isolates of ST48, ST206, ST224, ST359, ST361, ST448 and ST617. Figure S7. Phylogeny and mutations in non-redundant E. coli isolates of phylogroup D. Figure S8. Phylogeny and mutations of ST10, ST226, and ST746 non-redundant E. coli isolates. Figure S9. Estimated fitness of E. coli ST410 strains in rich and minimal media.