Carbapenem-resistant Acinetobacter baumannii in patients with burn injury: A systematic review and meta-analysis

Purpose: In this study, we aimed reviewed the data about the patterns of antimicrobial susceptibility and resistance determinants among carbapenem-resistant Acinetobacter baumannii (CRAB) from patients with bum injury. Methods: A systematic review was conducted using the PRISMA statement in PUBMED/MEDLINE, Scopus, Scientific Electronic Library Online (SciELO), Biblioteca Virtual de Saude (BVS) and Cochrane Library. The data referring to enzymatic resistance mechanisms were evaluated by meta-analyses according to random effect. Results: 17 articles that evaluated 1226 CRAB recovered from patients with burn injury were included in study. The majority of studies are from Iran (12/17; 70.6%), published in 2016 (6/17; 35.3%) and showed prospective design (15/17; 88.2%). The samples were obtained mainly from burn wounds (14/17; 82.3%) and more than half of the studies did not identify if the isolates originated from infected or colonized patients (10/17; 58.8%). Second the metaanalyses, OXA-type carbapenemase was the main mechanism involved in low susceptibility to carbapenems (53.2%; 95% CI= 60, 80.0%, I-2 = 86.0%), followed by metallo-beta-lactamases (MBL) (30.2%; 95% CI =11, 42.0%, I-2 = 93.0%), and Klebsiella pneumoniae carbapenemase (KPC) (16.6%; 95% CI = 5, 63.0%, I-2 = 88.0%). The majority of strains harbored bla(OXA-23-like) (12/17; 70.6%) or bla(OXA-24/40-like) (12/17; 35.3%) genes. The studies included showed that minocycline (69.5%) and colistin (99.9%) susceptibility remains high and is not impacted by carbapenem resistance in these isolates. Conclusions: The results summarized in this review indicate the importance of a high-quality surveillance program to design suitable and effective interventions to control CRAB infection in burn units worldwide. Published by Elsevier Ltd.