Clinical impact of active screening cultures for carbapenem-resistant Acinetobacter baumannii: A systematic review and meta-analysis

Abstract

Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a significant health care-associated infection carrying substantial mortality. We assessed the clinical impact of active screening cultures for CRAB. A systematic review and meta-analysis, aiming to answer 2 questions: (1) Does screening versus no screening improve clinical outcomes? (2) Does positive screening ("CRAB carrier") predict CRAB infections? We searched the literature until January 2024 for comparative studies reporting clinical outcomes (mortality, invasive CRAB infections). Of 5,407 screened publications, 9 studies (10,865 individuals) were included. Invasive CRAB infection rate was significantly higher among CRAB carriers (OR 11.14, 95% CI 4.95-25.05, with substantial heterogeneity stemming from size rather than direction of the effect). Negative predictive value of noncarriage for invasive infection was 97%. CRAB bloodstream infectionrate was significantly higher among carriers (odds ratio 16.23, 95% confidence interval 2.9-110.08). No difference was demonstrated between the groups forCRAB ventilator-associated pneumonia, length of stay, and mortality. Only 1 study reported outcomes for study question #1. Data to support active CRAB screening are scarce regarding its clinical benefit for patients. Positively screened patients are at significantly higher risk for invasive CRAB infections, with high negative predictive value for noncarriage. This did not translate to reduced mortality.