The global prevalence of multidrug-resistance among Acinetobacter baumannii causing hospital-acquired and ventilator-associated pneumonia and its associated mortality: A systematic review and meta-analysis

• Published in: The Journal of infection Vol. 79; no. 6; pp. 593 - 600
• Main Authors: Mohd Sazlly Lim, S., Zainal Abidin, A., Liew, S.M., Roberts, J.A., Sime, F.B.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-12-2019
• Subjects: Acinetobacter baumannii; Antibiotic resistance; Carbapenem-resistant; Hospital-acquired pneumonia; Mortality; Multidrug-resistance; Nosocomial pneumonia; Prevalence; Ventilator-associated pneumonia; Hospital-acquired pneumonia; Ventilator-associated pneumonia; Acinetobacter baumannii; Carbapenem-resistant; Prevalence; Nosocomial pneumonia; Mortality; Antibiotic resistance; Multidrug-resistance
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/j.jinf.2019.09.012

•The majority of A. baumannii stains causing nosocomial pneumonia.are multi-drug resistant.•The overall mortality rate estimate for A. baumannii pneumonia is very high (∼43%).•The prevalence rates of A. baumannii pneumonia are highly variable across the world.•The mortality rates of A. baumannii pneumonia are highly variable across the world.
The objective of this works was to assess the global prevalence of multidrug-resistance among A. baumannii causing hospital-acquired (HAP) and ventilator-associated pneumonia (VAP), and describe its associated mortality.
We performed a systematic search of four databases for relevant studies. Meta-analysis was done based on United Nations geoscheme regions, individual countries and study period. We used a random-effects model to calculate pooled prevalence and mortality estimates with 95% confidence intervals (CIs), weighted by study size.
Among 6445 reports screened, we identified 126 relevant studies, comprising data from 29 countries. The overall prevalence of multidrug-resistance among A. baumannii causing HAP and VAP pooled from 114 studies was 79.9% (95% CI 73.9–85.4%). Central America (100%) and Latin America and the Caribbean (100%) had the highest prevalence, whereas Eastern Asia had the lowest (64.6%; 95% CI, 50.2–77.6%). The overall mortality estimate pooled from 27 studies was 42.6% (95% CI, 37.2–48.1%).
We observed large amounts of variation in the prevalence of multidrug-resistance among A. baumannii causing HAP and VAP and its mortality rate among regions and lack of data from many countries. Data from this review can be used in the development of customized strategies for infection control and antimicrobial stewardship.