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

Mohd Sazlly Lim S 1 , Zainal Abidin A 2 , Liew SM 3 , Roberts JA 4 , Sime FB 5

Affiliations 

  • 1 Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, University of Queensland, Australia; Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
  • 2 Centre for Clinical Outcomes Research (CCORe), Institute for Clinical Research (ICR), National Institutes of Health (NIH), Ministry of Health, Malaysia
  • 3 Department of Family Medicine, Faculty of Medicine, University of Malaya, Malaysia
  • 4 UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Australia; Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
  • 5 UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, University of Queensland, Australia. Electronic address: f.sime@uq.edu.au
J Infect, 2019 12;79(6):593-600.
PMID: 31580871 DOI: 10.1016/j.jinf.2019.09.012

Abstract

OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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%).

CONCLUSIONS: 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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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