Incidence and risk factors of resistant Pseudomonas aeruginosa infections: a multicenter study in Lebanese tertiary hospitals
Abstract 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 fir...
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BMC
2025-08-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-025-11467-4 |
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| author | Rania Itani Hani M. J. Khojah Patricia Shuhaiber Hamza Raychouni Carole Dib Mariam Hassan Tareq L. Mukattash Abdalla El-Lakany |
| author_facet | Rania Itani Hani M. J. Khojah Patricia Shuhaiber Hamza Raychouni Carole Dib Mariam Hassan Tareq L. Mukattash Abdalla El-Lakany |
| author_sort | Rania Itani |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-3fe36b9421a245febe356bd038f83fe2 |
| institution | Kabale University |
| issn | 1471-2334 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj-art-3fe36b9421a245febe356bd038f83fe22025-08-24T11:10:14ZengBMCBMC Infectious Diseases1471-23342025-08-0125111410.1186/s12879-025-11467-4Incidence and risk factors of resistant Pseudomonas aeruginosa infections: a multicenter study in Lebanese tertiary hospitalsRania Itani0Hani M. J. Khojah1Patricia Shuhaiber2Hamza Raychouni3Carole Dib4Mariam Hassan5Tareq L. Mukattash6Abdalla El-Lakany7Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab UniversityDepartment of Pharmacy Practice, College of Pharmacy, Taibah UniversityPharmacy Department, Mount Lebanon Hospital Balamand University Medical CenterIntensive Care Unit, Anesthesia Department, Central Military Hospital, Military Healthcare, Lebanese ArmyPharmacy Department, Lebanese Hospital Geitaoui University Medical CenterEmergency Department, Sahel General HospitalDepartment of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and TechnologyDepartment of Pharmaceutical Sciences, Faculty of Pharmacy, Beirut Arab UniversityAbstract 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.https://doi.org/10.1186/s12879-025-11467-4Pseudomonas aeruginosaAntimicrobial resistanceSusceptibility patternsRisk factorsAntibioticsLebanon |
| spellingShingle | Rania Itani Hani M. J. Khojah Patricia Shuhaiber Hamza Raychouni Carole Dib Mariam Hassan Tareq L. Mukattash Abdalla El-Lakany Incidence and risk factors of resistant Pseudomonas aeruginosa infections: a multicenter study in Lebanese tertiary hospitals BMC Infectious Diseases Pseudomonas aeruginosa Antimicrobial resistance Susceptibility patterns Risk factors Antibiotics Lebanon |
| title | Incidence and risk factors of resistant Pseudomonas aeruginosa infections: a multicenter study in Lebanese tertiary hospitals |
| title_full | Incidence and risk factors of resistant Pseudomonas aeruginosa infections: a multicenter study in Lebanese tertiary hospitals |
| title_fullStr | Incidence and risk factors of resistant Pseudomonas aeruginosa infections: a multicenter study in Lebanese tertiary hospitals |
| title_full_unstemmed | Incidence and risk factors of resistant Pseudomonas aeruginosa infections: a multicenter study in Lebanese tertiary hospitals |
| title_short | Incidence and risk factors of resistant Pseudomonas aeruginosa infections: a multicenter study in Lebanese tertiary hospitals |
| title_sort | incidence and risk factors of resistant pseudomonas aeruginosa infections a multicenter study in lebanese tertiary hospitals |
| topic | Pseudomonas aeruginosa Antimicrobial resistance Susceptibility patterns Risk factors Antibiotics Lebanon |
| url | https://doi.org/10.1186/s12879-025-11467-4 |
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