Carbapenem-resistant infections kill about half of patients in Asian hospitals

Design

Prospective multinational cohort study, 41 hospitals

Population

9496 patients with ventilator-associated pneumonia or hospital bloodstream infection in 19 Asian countries

Primary outcome

28-day mortality

Effect

73.7% of episodes resistant; mortality 51.3% with carbapenem-resistant Acinetobacter, 48.4% with CRE; attributable mortality 19.4% (95% CI 14.1–24.7) and 16.2% (12.8–19.6)

ACORN-HAI prospectively followed 9496 patients with microbiologically confirmed ventilator-associated pneumonia or hospital-acquired bloodstream infection in 41 hospitals across 19 Asian countries and regions, between 2022 and 2025.

Antimicrobial resistance was the norm: 73.7% of 9642 infection episodes involved resistant bacteria, mostly Gram-negative. Crude 28-day mortality was 51.3% with carbapenem-resistant Acinetobacter and 48.4% with carbapenem-resistant Enterobacterales (CRE). These two also carried the highest mortality attributable to resistance, about 19% and 16%. Most carbapenem-resistant infections were still treated with carbapenems or polymyxins.

For Indian ICUs this describes daily reality. The study underlines two points: prevention of ventilator and line infections saves more lives than any single drug, and access to newer agents such as ceftazidime-avibactam with aztreonam, or cefiderocol, remains uneven. Attributable mortality was highest in younger patients and in lower-middle-income countries.

• Audit ventilator-associated pneumonia and central line bundle compliance in your unit
• Know your ICU's carbapenem resistance rates and the mechanisms locally common
• Involve microbiology early for carbapenem-resistant isolates to guide combination or newer agents
• Record 28-day outcomes for resistant infections to track your own burden

Why it matters

It puts a number on how often hospital infections in Asia are resistant, and how lethal carbapenem resistance is.

Don't overread it

This was observational — attributable mortality is estimated, and treatment choices were not randomised, so it cannot show which regimen is best.

The statistics, in plain English

Crude mortality includes deaths from underlying illness; attributable mortality estimates the extra deaths linked to resistance itself. For carbapenem-resistant Acinetobacter that was 19.4% (95% CI 14.1–24.7), meaning resistance alone is associated with about one in five of these patients dying. Hospitals were selected for data capacity, so they may not represent smaller centres.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.