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

Figures & data

Figure 1. Study selection flowchart.

Table 1. Study characteristics of the included studies.

Study	Country (WHO region, income level)	Study design	Study time (study duration)	Description of medical wards / patients	HAI definition	Sample size
ICU-based studies
Atici [16]	Italy (EUR, high income)	Incidence study; multicenter	2006–2013 (4 × 6 months)	Patients from 75 ICUs from 52 hospitals (SPIN-UTI project)	ECDC protocol [17]	10,703 patients; 2,255 HAIs
Atici [18]	Turkey (EUR, upper-middle income)	Incidence study; single centre	2011–2014 (47 months)	Children from a 14-bed pediatric ICU in a university hospital	CDC/NHSN criteria [19]	1,007 patients; 224 HAIs
Custovic [20]	Bosnia and Herzegovina (EUR, upper-middle income)	Incidence study; single centre	2013 (12 months)	Patients from the Clinic of Anesthesiology and Reanimation in a university hospital	CDC/NHSN criteria	855 patients; 105 patients with HAIs
Duszynska [21]	Poland (EUR, high income)	Incidence study; single centre	2011–2016 (72 months)	Patients from a 20-bed ICU in a university hospital	CDC/NHSN criteria [22]	2,459 patients; 589 HAIs
El-Nawawy [23]	Egypt (EMR, lower-middle income)	Incidence study; single centre	2016 (12 months)	Children (0-15yrs) from a 9-bed pediatric ICU in a university hospital	CDC/NHSN criteria [24]	264 patients; 36 HAIs
Kolpa [25]	Poland (EUR, high income)	Incidence study; single centre	2007–2016 (120 months)	Adult patients from a 9-bed ICU in a non-teaching secondary hospital	ECDC protocol [26]	1,847 patients; 510 HAIs
Kostakoglu [27]	Turkey (EUR, upper-middle income)	Incidence study; single centre	2013 (12 months)	Patients from 4 ICUs (46 adult beds) in a training and research hospital	CDC/NHSN criteria [22]	566 patients; 309 HAIs
Nageeb [28]	Egypt (EMR, lower-middle income)	Incidence study; single centre	2011–2012 (9 months)	Random samples of patients with nosocomial infections from different ICUs in a university hospital	Infection occurring 48hrs after admission	350 HAIs
Öncül [29]	Turkey (EUR, upper-middle income)	Incidence study; single centre	2001–2012 (108 months)	Burn patients from a 9-bed burn ICU in a military academy hospital	CDC/NHSN criteria [30]	658 patients; 602 HAIs
Sileem [31]	Saudi Arabia (EMR, high income)	Incidence study; single centre	2014–2015 (12 months)	Patients from ICUs in a general hospital	As defined by Vincent et al. [32]	650 patients; 78 patients with HAIs
Uwingabiye [33]	Morocco (EMR, lower-middle income)	Incidence study; single centre	2015–2016 (19 months)	Patients from two 10-bed ICUs (medical and surgical) in a military teaching hospital	CDC/NHSN criteria [22]	964 patients
Yetkin [34]	Turkey (EUR, upper-middle income)	Incidence study; single centre	2007–2015 (96 months)	Patients from all ICUs in a regional referral tertiary hospital	CDC/NHSN criteria [19,22]	48,263 patients; 4,272 HAIs
Yilmaz [35]	Turkey (EUR, upper-middle income)	Incidence study; single centre	2010 (6 months)	Adult patients from a general medicine ICU in a university hospital	Infections occurring 48hrs after admission	269 patients; 109 HAI patients
Hospital-based studies
Ahoyo [36]	Benin (AFR, low income)	Prevalence study; multicenter	2012 (1 d)	Patients from 39/45 hospitals in Benin	CDC/NHSN criteria [30]	3,130 patients; 972 HAIs
Gashaw [37]	Ethiopia (AFR, low income)	Incidence study; single centre	2016 (5 months)	Patients from all wards in a university hospital	Not reported	1,105 patients; 126 HAIs
Kolpa [38]	Poland (EUR, high income)	Incidence study; single centre	2012–2016 (48 months)	Non-teaching secondary care hospital	ECDC protocol [39]	159,028 patients; 2,184 HAIs
Kritsotakis [40]	Greece (EUR, high income)	Prevalence study; multicenter	2012 (1 d)	A nationally representative cross-section of all patients hospitalized in 37 acute care hospitals	ECDC protocol [41]	8,247 patients; 820 HAIs
Matta [42]	Lebanon (EMR, upper-middle income)	Incidence study; multicenter	Not reported (6 months)	Adult patients with infections from 3 private university hospitals and 2 private non-university hospitals	CDC/NHSN criteria [22]	116 patients with HAIs
Studies conducted in specialized clinical departments/wards with ICU- and non-ICU-patients
Armin [43]	Iran (EMR, upper-middle income)	Incidence study; multicenter	2014–2015 (6 months)	Patients with nosocomial infections admitted to surgery, neurosurgery, internal medicine, ICU and post coronary care unit wards in 3 hospitals	Culture-proven infections occurring 48hrs after admission	530 HAIs
Atilla [44]	Turkey (EUR, upper-middle income)	Incidence study; single centre	2009–2011 (29 months)	Patients from a burn unit with an ICU with 4 beds and 9 single rooms in an education and training hospital	CDC/NHSN criteria [22]	465 patients; 68 HAIs
Gecgel [45]	Turkey (EUR, upper-middle income)	Incidence study; single centre	2011–2015 (58 months)	Patients from clinical departments and Cardiology and Cardiovascular surgery ICUs in a training and research hospital	CDC/NHSN criteria	27,886 patients; 606 HAIs
Kuzdan [46]	Turkey (EUR. Upper-middle income)	Incidence study; single centre	2008–2010 (26 months)	Children from pediatric units consisting of 28 beds and 6 rooms and one pediatric intensive care unit of an university hospital	CDC/NHSN criteria [19]	2,350 patients; 389 HAIs
Walaszek [47]	Poland (EUR, high income)	Incidence study; single centre	2003–2012	Patients from the 46-neurosurgery ward (including 6-bed ICU) in a district hospital	CDC/NHSN criteria and ECDC protocol [41]	13,3551 patients; 516 HAIs
Studies conducted in specialized wards with non-ICU-patients only
Cei [48]	Italy (EUR, high income)	Incidence study; single centre	2009–2011 (23 months)	Patients with consecutive recorded bacterial and fungal isolates from an internal medicine ward	CDC/NHSN criteria [22]	249 HAIs

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. 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. 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. 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. 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. 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.

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