Background <p>Carbapenem-resistant <i>Acinetobacter baumannii</i> (CRAB) is an urgent global threat and has been designated as a priority pathogen.</p> Methods <p>We conducted a retrospective study of pediatric patients with CRAB infection at a Maternal and Child Health Hospital in Guangxi, China, from January 2019 to December 2024. The bacterial isolates were then subjected to antimicrobial susceptibility testing (AST) and whole-genome sequencing (WGS).</p> Results <p>A total of 132 pediatric patients with CRAB infections were included in this study (83 with positive outcomes and 49 with negative outcomes). AST revealed that all CRAB isolates were multidrug-resistant (MDR). Polymyxin B (99.2% susceptible), minocycline (68.9%), and cefoperazone-sulbactam (65.2%) demonstrated the highest susceptibility rates among the antibiotics tested. WGS revealed that the most prevalent strain was ST2_Pasteur/ST208_Oxford - KL2(65.9%), harboring the OXA-23 carbapenemase. Furthermore, the genetically distinct ST1208_Oxford-KL24 (22.0%), characterized by NDM-1 carriage, is the second most common sequence type and an emerging cause of pediatric hospital infections. A diverse array of antimicrobial resistance (AMR) genes, plasmid replicons, and virulence genes was detected across the isolates. Notably, the overall genetic profile of ST1208_Oxford was similar to that of ST150_Pasteur/ST718_Oxford, but distinct from that of ST2_Pasteur. Multivariable logistic regression identified prior hospitalizations (OR = 3.236; <i>P</i> = 0.015), presence of a central venous catheter (CVC) (OR = 2.683; <i>P</i> = 0.028), and decreased platelet count (OR = 0.996; <i>P</i> = 0.005) as independent risk factors for negative outcomes in pediatric patients with CRAB infections.</p> Conclusions <p>This study details the clinical and molecular features of CRAB infections in pediatric patients in Guangxi, China. Pediatric infection control should be highly alert to the emergence of ST1208_Oxford CRAB, which produces the NDM-1 carbapenemase.</p>