Prevalence and Resistance Profiles of Acinetobacter baumannii in ICU Patients in Saudi Arabia: A Systematic Review and Meta-Analysis.

Background: Acinetobacter baumannii (A. baumannii), a critical nosocomial pathogen, poses a significant threat in intensive care units (ICUs) due to its multidrug-resistant (MDR) strains. This study systematically reviews and performs a meta-analysis on the prevalence and antibiotic resistance profiles of MDR A baumannii (MDR-A. baumannii) in ICU patients in Saudi Arabia. Methods: A comprehensive search in PubMed, Saudi Digital Library, Scopus, and Web of Science, focusing on studies from January 2014 to September 2025, was performed. The present study followed the reporting guidelines of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA-2020). Data on study characteristics, sample sizes, patient demographics, prevalence of MDR-AB, and antibiotic resistance profiles were extracted and analyzed. Quality assessment was conducted using the Joanna Briggs Institute. Results: The prevalence of MDR-AB in ICU patients varied significantly across studies, with retrospective studies reporting rates from 3.37% to 69% and prospective studies ranging from 3.9% to 72.73%. Colistin remained highly effective, showing 100% susceptibility in some studies. Meanwhile, resistance to carbapenems like imipenem and meropenem often exceeds 50%. Additional antibiotics with notable resistance included gentamicin, tigecycline, ampicillin/sulbactam, trimethoprim-sulfamethoxazole, ceftazidime, piperacillin/tazobactam, and third-generation cephalosporins. Mechanisms of resistance frequently involved OXA-type carbapenemases, particularly OXA-23. While OXA-23 was the most frequently detected carbapenemase, recent genomic data have also revealed the presence of metallo-β-lactamases, such as IMP-type genes, in ICU isolates. Conclusions: MDR-A. baumannii poses a substantial challenge in Saudi Arabian ICUs, with high prevalence and significant resistance to commonly used antibiotics. The results highlight the critical need for continuous monitoring, cautious antibiotic stewardship, and strict infection control methods to manage and lessen the effects of MDR-AB in ICUs.