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Background <p>The emergence of difficult-to-treat resistant (DTR) <i>Pseudomonas aeruginosa</i> infections poses a significant clinical challenge, characterized by limited treatment options, poor outcomes, and increased morbidity and mortality. DTR <i>P. aeruginosa</i> isolates exhibit resistance to all first-line antibiotics, necessitating the use of less effective or more toxic alternatives. This study estimated the incidence of DTR <i>P. aeruginosa</i> infections in Lebanon and identified the associated risk factors.</p> Methods <p>This retrospective observational study was conducted across four tertiary care centers in Beirut, Lebanon, over a three-year period from 2021 to 2023. Univariate and multivariate logistic regression analyses were performed to identify significant predictors associated with DTR <i>P. aeruginosa</i> infections.</p> Results <p>A total of 2,639 cases with positive <i>P. aeruginosa</i> isolates were initially screened, with 477 cases meeting the inclusion criteria for analysis. The mean age of the patients was 66.3 ± 17.8 years, and the mean Charlson Comorbidity Index was 4.46 ± 2.43. Nearly half of the infections were nosocomial (47.6%). The most common primary site of infection was the respiratory tract (38.8%), followed by skin and soft tissue (32.7%). The incidence of DTR <i>P. aeruginosa</i> was 15.3%, and the incidence of carbapenem-resistant <i>P. aeruginosa</i> (CRPA) was 29.9%. Binary logistic regression identified three main risk factors for DTR <i>P. aeruginosa</i> infection acquisition: infections occurring during the winter season (adjusted odds ratio [AOR] = 6.08, 95% CI = 2.75–16.13, <i>P</i> &lt; 0.01), intensive care unit stay (AOR = 2.52, 95% CI = 1.28–4.98, <i>P</i> &lt; 0.01), and infections originating from the respiratory tract (AOR = 2.49, 95% CI = 1.04–5.97, <i>P</i> = 0.04).</p> Conclusions <p>The incidence of DTR <i>P. aeruginosa</i> in Lebanese hospitals is substantial compared to global rates and poses a significant challenge to effective treatment. Urgent measures are required to prevent and mitigate the spread of DTR <i>P. aeruginosa</i> infections. Hospital-based antimicrobial stewardship and infection control programs need to be reinforced, and community-based initiatives should be implemented at the national level. Efforts to combat antimicrobial resistance must be supported by ongoing nationwide annual surveillance.</p>

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Incidence and risk factors of resistant Pseudomonas aeruginosa infections: a multicenter study in Lebanese tertiary hospitals

  • 期刊论文

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  • 发表日期：

    2025年8月20日

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  • Rania Itani,
  • Hani M. J. Khojah,
  • Patricia Shuhaiber,
  • Hamza Raychouni,
  • Carole Dib,
  • Mariam Hassan,
  • Tareq L. Mukattash,
  • Abdalla El-Lakany

摘要

Background

The emergence of difficult-to-treat resistant (DTR) Pseudomonas aeruginosa infections poses a significant clinical challenge, characterized by limited treatment options, poor outcomes, and increased morbidity and mortality. DTR P. aeruginosa isolates exhibit resistance to all first-line antibiotics, necessitating the use of less effective or more toxic alternatives. This study estimated the incidence of DTR P. aeruginosa infections in Lebanon and identified the associated risk factors.

Methods

This retrospective observational study was conducted across four tertiary care centers in Beirut, Lebanon, over a three-year period from 2021 to 2023. Univariate and multivariate logistic regression analyses were performed to identify significant predictors associated with DTR P. aeruginosa infections.

Results

A total of 2,639 cases with positive P. aeruginosa isolates were initially screened, with 477 cases meeting the inclusion criteria for analysis. The mean age of the patients was 66.3 ± 17.8 years, and the mean Charlson Comorbidity Index was 4.46 ± 2.43. Nearly half of the infections were nosocomial (47.6%). The most common primary site of infection was the respiratory tract (38.8%), followed by skin and soft tissue (32.7%). The incidence of DTR P. aeruginosa was 15.3%, and the incidence of carbapenem-resistant P. aeruginosa (CRPA) was 29.9%. Binary logistic regression identified three main risk factors for DTR P. aeruginosa infection acquisition: infections occurring during the winter season (adjusted odds ratio [AOR] = 6.08, 95% CI = 2.75–16.13, P < 0.01), intensive care unit stay (AOR = 2.52, 95% CI = 1.28–4.98, P < 0.01), and infections originating from the respiratory tract (AOR = 2.49, 95% CI = 1.04–5.97, P = 0.04).

Conclusions

The incidence of DTR P. aeruginosa in Lebanese hospitals is substantial compared to global rates and poses a significant challenge to effective treatment. Urgent measures are required to prevent and mitigate the spread of DTR P. aeruginosa infections. Hospital-based antimicrobial stewardship and infection control programs need to be reinforced, and community-based initiatives should be implemented at the national level. Efforts to combat antimicrobial resistance must be supported by ongoing nationwide annual surveillance.