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

H Diao; G Lu; Y Zhang; Z Wang; X Liu; Q Ma; H Yu; Y Li

doi:10.1016/j.jhin.2024.04.013

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

J Hosp Infect. 2024 May 6:149:77-87. doi: 10.1016/j.jhin.2024.04.013. Online ahead of print.

Authors

H Diao¹, G Lu², Y Zhang¹, Z Wang³, X Liu⁴, Q Ma⁴, H Yu⁴, Y Li⁵

Affiliations

¹ School of Nursing, Medical College of Yangzhou University, Yangzhou University, China.
² School of Public Health, Medical College of Yangzhou University, Yangzhou University, China.
³ Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China; Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China.
⁴ Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China.
⁵ Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China; Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China; Department of Neurosurgery, Yangzhou Clinical Medical College of Xuzhou Medical University, Xuzhou, China. Electronic address: yupingli@yzu.edu.cn.

PMID: 38710306
DOI: 10.1016/j.jhin.2024.04.013

Abstract

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.

Keywords: Acinetobacter baumannii infection; Extensively drug resistant; Intensive care unit; Multidrug resistant; Risk factors.

Publication types

Review