Systematic review of urinary tract infections caused by Acinetobacter baumannii: Resistance patterns and clinical outcomes (2020–2025)

Urinary tract infections (UTIs) caused by Acinetobacter baumannii have become an important public health concern due to the pathogen’s multidrug-resistant (MDR) nature. Its increasing prevalence in clinical and environmental settings underscores the need to better understand resistance mechanisms, epidemiology, and therapeutic challenges. Objectives. To systematically review studies published between 2020 and 2025 that investigated the prevalence, antimicrobial resistance patterns, genomic characteristics, and therapeutic strategies for A. baumannii-associated UTIs, with the aim of identifying regional and global trends, resistance determinants, and emerging interventions. Eligibility criteria. Studies were included if they focused on A. baumannii isolated from UTI cases and reported antimicrobial resistance profiles, genomic analyses, or therapeutic aspects. Only peer-reviewed articles published between January 2020 and May 2025 were considered. Sources of evidence. Data were retrieved from PubMed, Scopus, and Web of Science using predefined keywords (e.g., “Acinetobacter baumannii,” “urinary tract infection”). Methods. A standardized data extraction template was used to collect information on study design, geographic location (Iraq [Baghdad, Diyala, Duhok], China, South Korea, and South-East Nigeria), resistance patterns, molecular findings, and potential therapeutic strategies. Study selection and review processes followed PRISMA 2020 guidelines. Results. The review demonstrates a high prevalence of multidrug-resistant A. baumannii in UTIs across diverse regions. Genomic data revealed multiple resistance determinants, while therapeutic options remain limited, with few promising alternatives under evaluation. Limitations. The number of eligible studies was relatively small, and regional representation was uneven, limiting generalizability. Conclusions. Multidrug-resistant A. baumannii represents a growing challenge in the management of UTIs. Enhanced surveillance, genomic monitoring, and the development of innovative therapies are urgently needed. Multinational collaboration is essential to mitigate the global burden of A. baumannii infections. Systematic review registration: PROSPERO, CRD420251041315.