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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Epidemiology of carbapenem-resistant Acinetobacter baumannii colonization in neonatal intensive care units: A systematic review and meta-analysis
Donatien Serge Mbaga, Sebastien Kenmoe, Seraphine Nkie Esemu, Arnol Bowo-Ngandji, Nene Kaah Keneh, Jane-Francis Tatah Kihla Akoachere, Hortense Kamga Gonsu, Roland Ndip Ndip, Jean Thierry Ebogo-Belobo, Cyprien Kengne-Ndé, Nicholas Tendongfor, Jean Paul Assam Assam, Lucy Mande Ndip, Jacky Njiki Bikoï, Sara Honorine Riwom Essama
Donatien Serge Mbaga, Arnol Bowo-Ngandji, Jean Paul Assam Assam, Jacky Njiki Bikoï, Sara Honorine Riwom Essama, Department of Microbiology, The University of Yaounde I, Yaounde 00237, Cameroon
Sebastien Kenmoe, Seraphine Nkie Esemu, Nene Kaah Keneh, Jane-Francis Tatah Kihla Akoachere, Roland Ndip Ndip, Nicholas Tendongfor, Lucy Mande Ndip, Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
Hortense Kamga Gonsu, Faculty of Medicine and Biomedical Sciences, The University of Yaounde I, Yaounde 00237, Cameroon
Jean Thierry Ebogo-Belobo, Center for Research in Health and Priority Pathologies, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
Cyprien Kengne-Ndé, Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Douala 00237, Cameroon
Author contributions: Mbaga DS, Kenmoe S, Njiki Bikoï J and Riwom Essama SH were responsible for conception and design of the study as well as project administration; Mbaga DS, Kenmoe S, Nkie Esemu S, Kaah Keneh N, Tatah Kihla Akoachere JF, Gonsu Kamga H, Ndip Ndip R, Ebogo-Belobo JT, Kengne-Ndé C, Mbaga DS, Tendongfor N, Mande Ndip L, Assam Assam JP, Njiki Bikoï J and Riwom Essama SH were responsible for the data curation and interpretation of results; Kengne-Nde C and Kenmoe S were responsible for statistical analysis; Kenmoe S Njiki Bikoï J and Riwom Essama SH were responsible for the project supervision; Mbaga DS and Kenmoe S wrote the original draft; All authors critically reviewed the first draft and approved the final version of the paper for submission, and have read and approve the final manuscript.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Sebastien Kenmoe, PhD, Lecturer, Department of Microbiology and Parasitology, University of Buea, Molyko, Buea 00237, Cameroon. sebastien.kenmoe@ubuea.cm
Received: November 27, 2023
Peer-review started: November 27, 2023
First decision: December 28, 2023
Revised: January 5, 2024
Accepted: January 31, 2024
Article in press: January 31, 2024
Published online: March 18, 2024
Processing time: 101 Days and 14.4 Hours
BACKGROUND
The rising prevalence of carbapenem-resistant Acinetobacter baumannii (CRAB) in neonatal intensive care units (NICUs) represents an escalating challenge in healthcare settings, particularly in managing hospital-acquired infections (HAIs). Studies across various World Health Organization regions have documented a significant incidence of CRAB-related HAIs, with rates as high as 41.7 cases per 1000 patients in ICUs, accounting for 13.6% of all HAIs. These infections pose a doubled mortality risk compared to infections with carbapenem-susceptible Acinetobacter baumannii. A particularly concerning aspect of CRAB colonization is its asymptomatic nature, enabling its transmission through healthcare workers (HCWs) or the NICU environment to vulnerable neonates with developing immune systems.
AIM
To explore the prevalence of CRAB colonization in NICUs, focusing on neonates, healthcare workers, and the environmental samples, to enhance epidemiological understanding and inform targeted interventions.
METHODS
We conducted according to PRISMA 2020 checklist guidelines, a comprehensive literature search across multiple databases including MEDLINE (Ovid), EMBASE (Ovid), Global Health (Ovid), Web of Science, and Global Index Medicus. Studies were selected based on predetermined criteria, primarily involving neonates, HCWs, and environmental swabs, using culture or molecular methods to detect CRAB colonization. We excluded studies that did not specifically focus on NICUs, were duplicates, or lacked necessary data. The study selection and quality assessment were conducted independently by two reviewers. Data extraction involved collecting comprehensive details about each study. Our statistical analysis used a random-effects model to calculate the pooled prevalence and confidence intervals, stratifying results by regional location. We assessed study heterogeneity using Cochran's Q statistic and I² statistic, with regression tests employed to evaluate potential publication bias.
RESULTS
We analyzed 737 records from five databases, ultimately including 13 studies from ten countries. For neonates, the pooled prevalence was 4.8% (95%CI: 1.1% to 10.5%) with the highest rates observed in South-East Asia (10.5%; 95%CI: 2.4% to 23.3%). Among HCWs, a single Indian study reported a 3.3% prevalence. Environmental samples showed a prevalence of 2.3% (95%CI: 0% to 9.3%), with the highest rates in South-East Asia (10%; 95%CI: 4.2% to 17.7%). Significant heterogeneity was found across studies, and no publication bias was detected.
CONCLUSION
This systematic review highlights a significant prevalence of CRAB colonization in neonates across various regions, particularly in South-East Asia, contrasting with lower rates in high-income countries. The study reveals a gap in research on HCWs colonization, with only a single study from India reporting moderate prevalence. Environmental samples indicate moderate levels of CRAB contamination, again higher in South-East Asia. These findings underscore the need for more extensive and focused research on CRAB colonization in NICUs, including exploring the roles of HCWs and the environment in transmission, understanding antimicrobial resistance patterns, and developing effective prevention measures.
Core Tip: This study reveals a notable prevalence of carbapenem-resistant Acinetobacter baumannii colonization in neonatal intensive care units. The analysis revealed a pooled prevalence of 4.8% in neonates, with a considerable gap in research on healthcare workers colonization and a 2.3% prevalence in environmental samples. The substantial heterogeneity across studies and the observed regional variations underlines the need for more targeted research.
