Risk factors for multidrug-resistant and extensively drug-resistant Acinetobacter baumannii infection of patients admitted in intensive care unit: a systematic review and meta-analysis

Background: Multidrug-resistant (MDR) and extensively drug -resistant (XDR) Acinetobacter baumannii infections pose challenges for clinical treatment and cause high mortality, particularly in intensive care units (ICUs). Aim: To systematically summarize and analyse the risk factors for MDR/XDR A. baumannii - infected patients admitted to ICUs. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched for eligible original studies published in English before October 2023. Meta -analysis was conducted where appropriate, with mean differences (MDs) and odds ratios (ORs) calculated for continuous and nominal scaled data. The quality of included studies was assessed using the Newcastle - Ottawa Scale (NOS). Findings: Ten studies reporting 1199 ICU patients (604 from general ICUs, 435 from neonatal ICUs, and 160 from paediatric ICUs) from eight countries were included in our analysis. Risk factors associated with MDR A. baumannii infection among patients admitted to general ICUs included high Acute Physiology And Clinical Health II (APACHE II) score (mean difference (MD): 7.52; 95% confidence interval (CI): 3.24 - 11.80; P = 0.0006), invasive procedures (odds ratio (OR): 3.47; 95% CI: 1.70 - 7.10; P = 0.0006), longer ICU stay (MD: 3.40; 95% CI: 2.94 - 3.86; P < 0.00001), and use of antibiotics (OR: 2.69; 95% CI: 1.22 - 5.94; P = 0.01). In the sub -group analysis, longer neonatal ICU stay (MD: 16.88; 95% CI: 9.79 - 23.97; P < 0.00001) was associated with XDR A. baumannii infection. Conclusion: Close attention should be paid to patients with longer ICU stays, undergoing invasive procedures, using antibiotics, and with high APACHE II scores to reduce the risk of MDR and XDR A. baumannii infections. (c) 2024 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.