Abstract
ABSTRACT Due to therapeutic challenges, hospital-acquired infections (HAIs) caused by Acinetobacter baumannii (HA-AB), particularly carbapenem-resistant strains (HA-CRAB) pose a serious health threat to patients worldwide. This systematic review sought to summarize recent data on the incidence and prevalence of HA-AB and HA-CRAB infections in the WHO-defined regions of Europe (EUR), Eastern Mediterranean (EMR) and Africa (AFR). A comprehensive literature search was performed using MEDLINE, EMBASE and GMI databases (01/2014-02/2019). Random-effects meta-analyses were performed to determine the pooled incidence of HA-AB and HA-CRAB infections as well as the proportions of A. baumannii among all HAIs. 24 studies from 3,340 records were included in this review (EUR: 16, EMR: 6, AFR: 2). The pooled estimates of incidence and incidence density of HA-AB infection in intensive care units (ICUs) were 56.5 (95% CI 33.9-92.8) cases per 1,000 patients and 4.4 (95% CI 2.9-6.6) cases per 1,000 patient days, respectively. Five studies conducted at a hospital-wide level or in specialized clinical departments/wards (ICU + non-ICU patients) showed HA-AB incidences between 0.85 and 5.6 cases per 1,000 patients. For carbapenem-resistant A. baumannii infections in ICUs, the pooled incidence and incidence density were 41.7 (95% CI 21.6-78.7) cases per 1,000 patients and 2.1 (95% CI 1.2-3.7) cases per 1,000 patient days, respectively. In ICUs, A. baumannii and carbapenem-resistant A. baumannii strains accounted for 20.9% (95% CI 16.5-26.2%) and 13.6% (95% CI 9.7-18.7%) of all HAIs, respectively. Our study highlights the persistent clinical significance of hospital-acquired A. baumannii infections in the studied WHO regions, particularly in ICUs.
Highlights
Acinetobacter spp. are non-fermenting, largely opportunistic Gram-negative bacteria that are ubiquitous in the environment
Similar to the analyses described above, the burden of A. baumannii was especially high in intensive care units, where A. baumannii infections accounted for 20.9% of all hospital-acquired infections, considerable inter-study variation was observed (I2 = 96%, p < 0.01)
In addition to the high incidence of hospital-acquired A. baumannii infections (HA-AB) infections in intensive care units (ICUs), we found that the pooled incidence of carbapenem-resistant A. baumannii infections is 42 HA-CRAB cases per 1,000 ICU patients, with individual study estimates ranging between 7 and 213 cases per 1,000 ICU patients
Summary
Acinetobacter spp. are non-fermenting, largely opportunistic Gram-negative bacteria that are ubiquitous in the environment. Of all Acinetobacter species, A. baumannii sensustricto (shortened to A. baumannii) is responsible for about 90% of the clinical infections caused by Acinetobacter spp. in humans [1]. Infections from A. baumannii, in particular carbapenem-resistant A. baumannii (CRAB), are of significant public health importance worldwide because of their association with high treatment costs, mortality and morbidity [2,3]. Treating carbapenem-resistant A. baumannii infections is very challenging since they are naturally resistant to antibiotics in the WHO “Access” and “Watch” list. They are associated with poor clinical outcomes across many healthcare settings [9]. Depending on the variables under study (e.g. study location, included patient cohorts and clinical wards), the incidence or prevalence estimates of (carbapenem-resistant) A. baumannii vary
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