ORIGINAL RESEARCH article
Front. Cell. Infect. Microbiol.
Sec. Clinical and Diagnostic Microbiology and Immunology
This article is part of the Research TopicA One Health Approach to Infection Prevention and Antimicrobial ResistanceView all 8 articles
CRAB-RSS: Development and Validation of a Single-Center Risk Stratification Model for Carbapenem-Resistant Acinetobacter baumannii in ICU Patients Based on Mechanical Ventilation, Carbapenem Exposure, and Hospitalization Duration
Provisionally accepted
- Suining Central Hospital, Suining, China
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Purpose This study aimed to develop and validate the Carbapenem-Resistant Acinetobacter baumannii Risk Scoring System (CRAB-RSS), a novel predictive model designed to assess the risk of carbapenem-resistant A. baumannii (CRAB) infection in intensive care unit (ICU) patients. Methods A retrospective cohort analysis was performed on 412 patients (315 with CRAB and 97 with carbapenem-susceptible A.baumannii [CSAB]) from 2020 to 2024. Three independent risk factors were identified: mechanical ventilation (adjusted odds ratio [aOR] = 3.2 , 95% confidence interval [CI]: 1.8–5.6), prior carbapenem exposure (≥48 hours; aOR = 1.89, 95% CI : 1.32–2.71), and hospitalization duration exceeding 14 days (aOR = 1.67, 95% CI : 1.25–2.23). Results The model demonstrated robust discriminative ability, with an area under the receiver operating characteristic curve (AUROC) of 0.887 in the derivation cohort and 0.918 in the validation cohort, along with satisfactory calibration (Brier score: 0.094 versus 0.088). Its performance was significantly superior to that of the Sequential Organ Failure Assessment (SOFA) score (ΔAUROC = +0.21). Conclusions CRAB-RSS is a quantitative risk stratification tool derived from a single-center cohort for CRAB infections in intensive care unit patients, demonstrating superior performance to SOFA in local validation. External multicenter validation is warranted before broad clinical implementation. Its innovative features include: (1) a fixed-weighting design (e.g., assigning a baseline score of 2 points for mechanical ventilation),and (2) reliance on only three readily obtainable clinical variables to complete the assessment. Decision curve analysis revealed that the application of CRAB-RSS could reduce unnecessary carbapenem use by 28%–42% across probability thresholds of 10%–30%,with a maximum reduction of 38% achieved at the 20% threshold.
Keywords: Carbapenem-resistant Acinetobacter baumannii, Risk stratification model, Intensive Care Unit, antimicrobial resistance, Infection Control
Received: 04 Jul 2025; Accepted: 27 Oct 2025.
Copyright: © 2025 Li, Wang and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Kun Li, 286483463@qq.com
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