Global strategies to fight carbapenem-resistant Acinetobacter baumannii (CRAB) infections

Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a formidable healthcare-associated pathogen, particularly in intensive care units, where it causes severe infections associated with prolonged hospitalization, limited treatment options, and high mortality. This review provides an integrated analysis of the global epidemiology of CRAB, the molecular mechanisms driving carbapenem resistance, and the increasing clinical significance of antibiotic hetero-resistance, which contributes to diagnostic failure and poor therapeutic outcomes. We highlight advances in diagnostic technologies, including whole-genome sequencing, digital PCR, and CRISPR-based platforms, which enable rapid identification of resistance determinants and detection of hetero-resistant subpopulations that are frequently overlooked by conventional susceptibility testing. Current treatment strategies are critically evaluated, with emphasis on optimized antibiotic combinations and emerging agents such as sulbactam-durlobactam and cefiderocol, alongside alternative approaches including bacteriophage therapy, antimicrobial peptidomimetics, and immune-modulating adjuncts. In parallel, the review underscores the importance of infection prevention and control measures, antimicrobial stewardship programs, and coordinated global surveillance initiatives in limiting CRAB transmission in high-burden healthcare settings. Collectively, the evidence indicates that effective control of CRAB infections requires a multidisciplinary, multimodal strategy integrating accurate diagnostics, sustainable therapeutic interventions, and robust public health policies to mitigate the escalating global impact of this priority pathogen.