OBJECTIVES: Carbapenem-resistant Acinetobacter baumannii (CRAB) is one of the most common multidrug resistant bacteria in China, causing significant problems in many hospitals, especially in intensive care units (ICU). This studies aims to evaluate the direct hospitalization costs, length of stay (LOS) and mortality among patients with CRAB infection or colonization in a 50-bed general ICU of a 4300-bed teaching hospital in China.  METHODS: A matched case-control (1:1) study was conducted to compare the differences in economic costs and outcomes between patients with CRAB infection or colonization and those without CRAB from 2012 to 2014. Case and control patients were matched on the basis of age, the principal diagnosis and APACHE II score. A subgroup analysis for patients with CRAB bacteremia was also performed. Between-group differences were tested using the non-parametric Wilcoxon signed-rank test. RESULTS: A total of 301 (60.08%) of 501 eligible patients were identified for the study and matched with appropriate control patients. The mortality for cases and controls were 27.24% and 14.29%, respectively (P<0.001). Compared with control group, case group had significantly longer LOS (37 vs 21 days; P<0.001), longer length of ICU stay (25 vs 11 days; P<0.001), higher total hospitalization costs (RMB RMB RMB out-of-pocket costs (RMB CONCLUSIONS: Patients with CRAB infection or colonization may pose significant burden on current Chinese healthcare system, as it is associated with higher mortality, longer hospital stay and more costs than those without CRAB.