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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
ARTICLE HIGHLIGHTS
Research background
The surge of carbapenem-resistant Acinetobacter baumannii (CRAB) in neonatal intensive care units (NICUs) has emerged as a significant healthcare concern, particularly due to its role in healthcare-acquired infections (HAIs). CRAB doubles the mortality risk compared to patients with carbapenem-susceptible Acinetobacter baumannii.
Research motivation
The asymptomatic nature of CRAB colonization, especially in NICU settings, and its potential transmission through healthcare workers (HCWs) or the environment, intensify the risks to vulnerable neonates with developing immune systems.
Research objectives
This review aims to examine the prevalence of CRAB colonization in NICUs, focusing on neonates, HCWs, and the NICU environment.
Research methods
Our systematic review was conducted following the PRISMA 2020 guidelines. We initiated our search across MEDLINE (Ovid), EMBASE (Ovid), Global Health (Ovid), Web of Science, and Global Index Medicus. We also conducted a manual search through the references of relevant papers. Our inclusion criteria focused on studies in English or French that investigated CRAB colonization in neonates, HCWs, and environmental samples using culture or molecular techniques. Studies that did not focus on NICUs, were duplicates, or lacked adequate data were excluded. A random-effects model was applied to calculate the pooled prevalence and 95% confidence intervals, with subgroup analysis stratified by regional location.
Research results
Our systematic review collated data from 13 studies across ten countries. We found that neonates had a pooled CRAB colonization prevalence of 4.8%, though this varied widely by region, with South-East Asia reporting the highest rates. The prevalence in HCWs was only documented in a single study from India, suggesting a significant research gap in understanding the role of HCWs as potential vectors in CRAB transmission. Environmental samples exhibited CRAB presence, with a pooled prevalence of 2.3%, again with the highest rates in South-East Asia.
Research conclusions
The study revealed significant geographical variability in CRAB colonization rates, with a pooled prevalence of 4.8% among neonates and notable higher rates in South-East Asia and lower in high-income countries. A critical gap in research was identified regarding HCW colonization, with only a single study from India reporting a prevalence of 3.3%. Environmental samples showed a 2.3% pooled prevalence, with the highest rates again in South-East Asia.
Research perspectives
This study underscores the necessity of tailored research and intervention strategies in NICUs to address the unique challenges of neonatal populations and combat the threat of CRAB colonization effectively.
