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Meta-Analysis
. 2019;8(1):1747-1759.
doi: 10.1080/22221751.2019.1698273.

The incidence and prevalence of hospital-acquired (carbapenem-resistant) Acinetobacter baumannii in Europe, Eastern Mediterranean and Africa: a systematic review and meta-analysis

Olaniyi Ayobami  1 , Niklas Willrich  1 , Thomas Harder  1 , Iruka N Okeke  2 , Tim Eckmanns  1 , Robby Markwart  1
Affiliations
Meta-Analysis

The incidence and prevalence of hospital-acquired (carbapenem-resistant) Acinetobacter baumannii in Europe, Eastern Mediterranean and Africa: a systematic review and meta-analysis

Olaniyi Ayobami et al. Emerg Microbes Infect. 2019.

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.

Keywords: Acinetobacter baumannii; carbapenem resistance; healthcare-acquired infections; hospital-acquired infections; nosocomial infections.

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Conflict of interest statement

No potential conflict of interest was reported by the authors.

Figures

Figure 1.
Figure 1.
Study selection flowchart.
Figure 2.
Figure 2.
Forest plot of studies on the incidence of hospital-acquired Acinetobacter baumannii infections. Abbreviations: HA-AB: hospital-acquired Acinetobacter baumannii, ICU: intensive care unit, 95% CI: 95% confidence interval.
Figure 3.
Figure 3.
Forest plot of studies on the incidence density of hospital-acquired Acinetobacter baumannii infections. Abbreviations: HA-AB: hospital-acquired Acinetobacter baumannii, ICU: intensive care unit, 95% CI: 95% confidence interval
Figure 4.
Figure 4.
Forest plot of studies on the incidence of hospital-acquired carbapenem-resistant Acinetobacter baumannii infections. Abbreviations: HA-CRAB: hospital-acquired carbapenem-resistant Acinetobacter baumannii, ICU: intensive care unit, 95% CI: 95% confidence interval.
Figure 5.
Figure 5.
Forest plot of studies on the incidence density of hospital-acquired carbapenem-resistant Acinetobacter baumannii infections. Abbreviations: HA-CRAB: hospital-acquired carbapenem-resistant Acinetobacter baumannii, ICU: intensive care unit, 95% CI: 95% confidence interval.
Figure 6.
Figure 6.
Forest plot of studies on the proportion of hospital-acquired Acinetobacter baumannii infections among all hospital-acquired infections. Abbreviations: HAI: hospital-acquired infections, HA-AB: hospital-acquired Acinetobacter baumannii, ICU: intensive care unit, 95% CI: 95% confidence interval.
Figure 7.
Figure 7.
Forest plot of studies on the proportion of hospital-acquired carbapenem-resistant Acinetobacter baumannii infections among all hospital-acquired infections. Abbreviations: HAI: hospital-acquired infections, HA-CRAB: hospital-acquired carbapenem-resistant Acinetobacter baumannii, ICU: intensive care unit, 95% CI: 95% confidence interval.
See this image and copyright information in PMC

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