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Systematic review and meta-analysis of antibiotic strategies for survival in patients with drug-resistant Acinetobacter baumannii infection: does quantity matter?

Universa Medicina · Vol. 44 No. 2 (2025) · hlm. 232–244

DOI
10.18051/UnivMed.2025.v44.232-244
ISSN
2407-2230, 1907-3062
Terbit
2025-08-11
Penerbit
Faculty of Medicine, Universitas Trisakti
Bahasa
eng
Lisensi
creativecommons.org/licenses/by-nc-sa/4.0

Abstrak

Background Acinetobacter baumannii is an opportunistic pathogen frequently associated with severe hospital-acquired infections, particularly in intensive care units, and is characterized by high levels of antibiotic resistance, including to carbapenems. The rising prevalence of multidrug- and pan-drug-resistant strains poses significant therapeutic challenges and underscores the need for optimized treatment strategies to improve survival outcomes. This systematic review and meta-analysis evaluates the impact of different antibiotic treatment modalities (monotherapy versus combination) on the clinical outcome of patients with Acinetobacter baumannii infection. Methods This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To find pertinent studies released up to 3 January 2025 a thorough search was done in electronic databases such as PubMed, Embase, ScienceDirect, Cochrane, EBSCOhost, Google Scholar, and Scopus. Results This systematic review and meta-analysis identified 20 studies for inclusion. No statistically significant overall survival difference was found (Pooled OR = 0.83, 95% CI [0.66- 1.03], p = 0.09), but subgroup analyses indicated that combination therapy markedly enhanced survival rates in patients with carbapenem-resistant Acinetobacter baumannii (CRAB) infection, APACHE II scores below 20, and bloodstream infections. Meta-regression suggested that age may adversely affect treatment efficacy. A trend favoring combination therapy was consistent across subgroups, despite some results not reaching statistical significance. Conclusion This systematic review and meta-analysis highlights the treatment challenges of drug-resistant Acinetobacter baumannii, particularly MDRAB, XDRAB, and CRAB strains. Combination therapy offers potential benefits in CRAB and moderate-severity cases but is not universally superior to monotherapy. Treatment outcomes are influenced by patient-specific factors such as age, infection type, and disease severity.

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Enny SuswatiAfiliasi tidak diketahui2
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Sumber metadata: OAI-PMH (metadata jurnal) https://univmed.org/ejurnal/index.php/medicina/oai, pertama di-harvest 10 Nov 2026, terakhir terlihat 10 Nov 2026.
Metadata asli (oai_dc) 
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	<dc:title xml:lang="en">Systematic review and meta-analysis of antibiotic strategies for survival in patients with drug-resistant Acinetobacter baumannii infection: does quantity matter?</dc:title>
	<dc:creator xml:lang="en">De Rorna, Masrahma Reinataya</dc:creator>
	<dc:creator xml:lang="en">Ramadhani, Alfiyah</dc:creator>
	<dc:creator xml:lang="en">Hibatulloh, Muhammad Farhan</dc:creator>
	<dc:creator xml:lang="en">Agustina, Dini</dc:creator>
	<dc:subject xml:lang="en">Acinetobacter baumannii</dc:subject>
	<dc:subject xml:lang="en">combination</dc:subject>
	<dc:subject xml:lang="en">drug-resistant</dc:subject>
	<dc:subject xml:lang="en">meta-analysis</dc:subject>
	<dc:subject xml:lang="en">monotherapy</dc:subject>
	<dc:description xml:lang="en">
Background
Acinetobacter baumannii is an opportunistic pathogen frequently associated with severe hospital-acquired infections, particularly in intensive care units, and is characterized by high levels of antibiotic resistance, including to carbapenems. The rising prevalence of multidrug- and pan-drug-resistant strains poses significant therapeutic challenges and underscores the need for optimized treatment strategies to improve survival outcomes. This systematic review and meta-analysis evaluates the impact of different antibiotic treatment modalities (monotherapy versus combination) on the clinical outcome of patients with Acinetobacter baumannii infection.
Methods
This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To find pertinent studies released up to 3 January 2025 a thorough search was done in electronic databases such as PubMed, Embase, ScienceDirect, Cochrane, EBSCOhost, Google Scholar, and Scopus. 
Results
This systematic review and meta-analysis identified 20 studies for inclusion. No statistically significant overall survival difference was found (Pooled OR = 0.83, 95% CI [0.66- 1.03], p = 0.09), but subgroup analyses indicated that combination therapy markedly enhanced survival rates in patients with carbapenem-resistant Acinetobacter baumannii  (CRAB) infection, APACHE II scores below 20, and bloodstream infections. Meta-regression suggested that age may adversely affect treatment efficacy.   A trend favoring combination therapy was consistent across subgroups, despite some results not reaching statistical significance.
Conclusion
This systematic review and meta-analysis highlights the treatment challenges of drug-resistant Acinetobacter baumannii, particularly MDRAB, XDRAB, and CRAB strains. Combination therapy offers potential benefits in CRAB and moderate-severity cases but is not universally superior to monotherapy. Treatment outcomes are influenced by patient-specific factors such as age, infection type, and disease severity.
</dc:description>
	<dc:publisher xml:lang="en">Faculty of Medicine, Universitas Trisakti</dc:publisher>
	<dc:date>2025-08-11</dc:date>
	<dc:type>info:eu-repo/semantics/article</dc:type>
	<dc:type>info:eu-repo/semantics/publishedVersion</dc:type>
	<dc:format>application/pdf</dc:format>
	<dc:identifier>https://univmed.org/ejurnal/index.php/medicina/article/view/1709</dc:identifier>
	<dc:identifier>10.18051/UnivMed.2025.v44.232-244</dc:identifier>
	<dc:source xml:lang="en">Universa Medicina; Vol. 44 No. 2 (2025); 232-244</dc:source>
	<dc:source>2407-2230</dc:source>
	<dc:source>1907-3062</dc:source>
	<dc:source>10.18051/UnivMed.2025.v44.i2</dc:source>
	<dc:language>eng</dc:language>
	<dc:relation>https://univmed.org/ejurnal/index.php/medicina/article/view/1709/831</dc:relation>
	<dc:rights xml:lang="en">Copyright (c) 2025 Masrahma Reinataya De Rorna, Alfiyah Ramadhani, Muhammad Farhan Hibatulloh, Dini Agustina</dc:rights>
	<dc:rights xml:lang="en">https://creativecommons.org/licenses/by-nc-sa/4.0</dc:rights>
</oai_dc:dc>