OBJECTIVES:  The prevalence of carbapenem resistant Acinetobacter baumannii (CRAB) was seen a marked increasing in China. There is a significant impact of carbapenem resistance on both clinical and economic outcomes. This study aims to examine hospital mortality, length of stay, intensive care unit stays and average hospitalization expenses among inpatients with CRAB infection or colonization (CRAB/CSAB infection or colonization is replaced with CRAB/CSAB) and carbapenem susceptible A. baumannii (CSAB) in a tertiary teaching and general hospital in Hangzhou, Zhejiang Province, China. METHODS: Sixty-five percent inpatients, whose clinical specimens were submitted to the microbiological laboratory, between January 1, 2013, and December 31, 2015, were randomly selected every year, due to the large quantity of inpatients. The 1:2 propensity-matched samples were used for analysis to address the selection bias. Univariate analysis was performed to compare the characteristics of inpatients with CRAB versus CSAB. Kruskal-Wallis non-parametric test and multivariate linear regression model was conducted to evaluate the average hospitalization expenses. RESULTS: A total of 1007 inpatients with CRAB and 773 inpatients with CSAB were included. Compared to inpatients with CSAB, those with CRAB were significantly associated with a more than 3-fold increase in hospital mortality, a 3-day increase in mean length of stay, an 8-day increase in intensive care units stays and a 2-fold increase in average hospitalization expenses. CONCLUSIONS:  The results of this study highlight the heavy burden CRAB posing on current Chinese healthcare system, emphasizing the importance of optimizing treatment pathway as early as empirical treatment stage and enhanced efforts in controlling carbapenem resistance, which calls for reliable resistance surveillance data, better prediction of the risk of CRAB infections, and improved antimicrobial stewardship programs in Chinese hospitals.