| Summary: | <p><strong>Objectives: </strong>To characterise the clinical features of <em>Acinetobacter baumannii</em> infections and investigate the phylogenetic structure and transmission dynamics of <em>A. baumannii</em> in Vietnam.</p>
<p><strong>Methods:</strong> Between 2019 and 2020, a surveillance of <em>A. baumannii</em> (AB) infections was conducted at a tertiary hospital in Ho Chi Minh City, Vietnam. Risk factors for in-hospital mortality were analysed using logistic regressions. Whole-genome sequence data were used to characterise genomic species, sequence types (STs), antimicrobial resistance genes, surface antigens, and phylogenetic relatedness of AB isolates.</p>
<p><strong>Results:</strong> Eighty-four patients with AB infections were enrolled in the study, 96% of whom were hospital-acquired. Half of the AB isolates were identified from ICU-admitted patients, while the remaining isolates were from non-ICU patients. The overall in-hospital mortality was 56%, with associated risk factors including advanced age, ICU stay, exposure to mechanical ventilation/central venous catheterization, pneumonia as source of AB infection, prior use of linezolid/aminoglycosides, and AB treatment with colistin-based therapy. Nearly 91% of isolates were carbapenem-resistant; 92% were multidrug-resistant; and 6% were colistin-resistant. ST2, ST571, and ST16 were the three dominant carbapenem-resistant <em>A. baumannii</em> (CRAB) genotypes, exhibiting distinct AMR gene profiles. Phylogenetic analysis of CRAB ST2 isolates together with previously published ST2 collection provided evidence of intra- and inter-hospital transmission of this clone.</p>
<p><strong>Conclusions:</strong> Our study highlights a high prevalence of carbapenem resistance and multidrug resistance in <em>A. baumannii</em> and elucidates the spread of CRAB within and between hospitals. Strengthening infection control measures and routine genomic surveillance are crucial to reducing the spread of CRAB and detecting novel pan-drug-resistant variants in a timely fashion.</p>
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