Prevalence and Distribution of Carbapenem-Resistant Acinetobacter baumannii (CRAB) in Indonesia: A Systematic Review and Meta-Analysis

Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a major healthcare-associated pathogen worldwide, particularly in hospital settings and intensive care units, posing significant challenges for clinical management due to limited therapeutic options and the rapid dissemination of resistance mechanisms.This study aimed to estimate the pooled prevalence and distribution of CRAB among clinical isolates in Indonesia through a systematic review and meta-analysis.A comprehensive literature search was conducted in PubMed, Scopus, the Cochrane Library, and GARUDA for studies published between January 2001 and February 2026, selected to capture the early emergence of CRAB and its increasing epidemiological relevance in Indonesia while ensuring methodological consistency across studies.Eligible studies reporting CRAB prevalence in human clinical samples were included.Study quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist, and pooled prevalence estimates were calculated using a random-effects model.A total of 34 studies comprising 7,205 Acinetobacter baumannii isolates, including 3,659 CRAB cases, were included, representing 13 provinces across Indonesia, although several regions remained underrepresented.The pooled prevalence of CRAB was 63% (95% CI: 54%-71%), with substantial heterogeneity (I 2 = 98.88%, p < 0.001).Subgroup analyses indicated temporal and regional variations.Molecular findings showed that OXA-type carbapenemase genes, particularly blaOXA-23, were predominant, followed by blaNDM and blaIMP.These findings highlight a high burden of CRAB in Indonesia and underscore the need to strengthen antimicrobial stewardship, infection prevention, and national AMR surveillance systems.