Mortalidade em infecções da corrente sanguínea e bacteremia por Acinetobacter baumannii resistente aos carbapenêmicos: revisão sistemática e meta-análise de proporções

Abstract

Carbapenem resistance in Acinetobacter baumannii represents an important challenge in hospital care, particularly among patients with bloodstream infection, because of limited therapeutic options and poor prognosis. This study aimed to estimate 28- or 30-day mortality among hospitalized patients with bloodstream infection or bacteremia caused by carbapenem-resistant A. baumannii, as well as to narratively synthesize clinical factors associated with death and resistance mechanisms reported in the selected countries. A systematic review was conducted according to the PRISMA 2020 recommendations, with searches performed in PubMed/MEDLINE and SciELO and Scopus. Clinical studies providing specific and comparable mortality data were considered for quantitative synthesis, whereas epidemiological, microbiological, and genomic studies contributed to the narrative synthesis. Three studies from Brazil, Argentina, and India included 257 patients and 149 deaths. Individual mortality estimates ranged from 46.2% to 67.2%. The random-effects meta-analysis of proportions estimated a pooled mortality of 57.4% (95% CI: 43.7%–70.1%), with substantial heterogeneity (I² = 78.1%). OXA-23, OXA-58, and NDM-1 were the main resistance determinants reported. The findings indicate high mortality among the evaluated patients; however, they do not estimate the independent effect of antimicrobial resistance on the risk of death because no consistent comparative synthesis with susceptible isolates was available. The small number of studies, heterogeneity, and geographic restrictions limit the generalizability of the findings.