Geographical mapping and temporal trends of Acinetobacter baumannii carbapenem resistance: A comprehensive meta-analysis

Abstract

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is of critical concern in healthcare settings, leading to limited treatment options. In this study, we conducted a comprehensive meta-analysis to assess the prevalence of CRAB by examining temporal, geographic, and bias-related variations.

Methods: We systematically searched prominent databases, including Scopus, PubMed, Web of Science, and EMBASE. Quality assessment was performed using the JBI checklist. Subgroup analyses were performed based on the COVID-19 timeframes, years, countries, continents, and bias levels, antimicrobial susceptivity test method and guidelines.

Results: Our comprehensive meta-analysis, which included 795 studies across 80 countries from 1995 to 2023, revealed a surge in carbapenem resistance among A. baumannii, imipenem (76.1%), meropenem (73.5%), doripenem (73.0%), ertapenem (83.7%), and carbapenems (74.3%). Temporally, 2020-2023 witnessed significant peaks, particularly in carbapenems (81.0%) and meropenem (80.7%), as confirmed by meta-regression, indicating a steady upward trend.

Conclusion: This meta-analysis revealed an alarmingly high resistance rate to CRAB as a global challenge, emphasizing the urgent need for tailored interventions. Transparency, standardized methodologies, and collaboration are crucial for the accurate assessment and maintenance of carbapenem efficacy.

Fig 1. PRISMA flow chart summarizes the article selection procedure.

Fig 2. Worldwide weighted pooled proportion of CRAB isolates.

Fig 3

Worldwide Map for Prevalence of CRAB; A: Imipenem, B: Meropenem, C: Doripenem, D: Ertapenem, and E: Carbapenem. Global map visualization created using OpenStreetMap data, available under the Open Database License (ODbL). Map data © OpenStreetMap contributors, licensed under ODbL.

Fig 4

Subgroup analysis results are illustrated as follows: A: Prevalence of CRAB isolates across continents; B: Compression prevalence of CRAB isolates according to different AST guidelines; C: Compression prevalence of CRAB isolates using various AST techniques; D: Compression prevalence of CRAB isolates according to the risk of bias in the JBI checklist results. E: Compression prevalence of CRAB isolates between year subgroups. F: Compression prevalence of CRAB isolates before and after the COVID-19 pandemic (1995–2019, and 2020–2023).

Fig 5

Meta regression of carbapenem resistance A. baumannii isolates during years; A: Imipenem, B: meropenem, C: Doripenem, D: Ertapenem E: carbapenem.