Carbapenem-resistant Acinetobacter baumannii (CRAB) has become a major global health threat, particularly in intensive care units (ICUs), due to multidrug resistance, limited therapeutic options, and high mortality. Understanding its prevalence, risk factors, resistance patterns, and outcomes is essential to guide therapy and infection control. To determine the prevalence of CRAB among ICU patients, evaluate its antimicrobial susceptibility, identify associated risk factors, and compare clinical outcomes with carbapenem-sensitive A. baumannii (CSAB) infections. A prospective observational study from January 2024 to July 2024. A total of 870 respiratory samples (sputum and endotracheal aspirates) yielded 105 A. baumannii isolates, identified by conventional methods and MALDI-TOF. Antimicrobial susceptibility was performed using Kirby–Bauer disc diffusion. Clinical and demographic data were collected, and statistical analysis was carried out to determine risk factors and outcomes. Among 105 isolates, 30 (28.6%) were CRAB. Patients with CRAB were older (mean 65 years), more frequently hypertensive (66.7%), had longer ICU stays (22.6 ± 8.1 days), and required mechanical ventilation more often (93.3%). Independent risk factors included prior antibiotic use (OR 5.33), prolonged ventilation (OR 10.45), and ICU stay >7 days (OR 10.4). CRAB were 100% sensitive to colistin, and 70% sensitive to tigecycline. Mortality higher in CRAB patients compared with CSAB (50% vs. 20%, p =0.004). CRAB infections in ICU patients are associated with high mortality, extensive resistance. Reinforced infection control practices, rational antibiotic use, and antimicrobial stewardship are critical to reducing CRAB burden.

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