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Bacterial co-detection is associated with higher multidrug-resistant Pseudomonas aeruginosa risk: insights from the

Boshun Zhang1, Xiaoli Wang2, Xiaoling Qi1

  • 1Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Jac-Antimicrobial Resistance
|February 25, 2026
PubMed
Abstract

Insights

Bacterial co-infections increase the risk of multidrug-resistant Pseudomonas aeruginosa (MDR-PA) and mortality. Horizontal gene transfer likely drives antibiotic resistance gene spread within the host microbiota, impacting patient outcomes.

Area of Science:

  • Microbiology
  • Clinical Medicine
  • Genetics

Background:

  • Pseudomonas aeruginosa (PA) is a major cause of antibiotic resistance.
  • The role of microbial communities in the emergence of multidrug-resistant PA (MDR-PA) is not fully understood.
  • This study investigates bacterial interactions and their impact on MDR-PA.

Purpose of the Study:

  • To determine the impact of bacterial co-detection on MDR-PA prevalence.
  • To elucidate the mechanisms underlying MDR-PA emergence in polymicrobial infections.
  • To assess the association between bacterial co-detection and patient mortality.

Main Methods:

  • Retrospective cohort study of 2965 PA-positive patients from the MIMIC-IV database.
  • Propensity score matching and logistic regression to analyze risk factors.
  • Metagenomic sequencing of 19 ventilator-associated pneumonia (VAP) patient samples to construct ARG dissemination networks.

Main Results:

  • Bacterial co-detection with PA significantly increased MDR-PA prevalence and mortality.
  • Co-detection was an independent risk factor for MDR-PA (aOR 2.14) and mortality (aOR 1.67).
  • Metagenomic data suggested horizontal gene transfer (HGT) facilitates ARG dissemination between PA and other bacteria in the lower respiratory tract (LRT).

Conclusions:

  • Bacterial co-detection with PA is linked to increased MDR-PA risk and poorer clinical outcomes.
  • HGT-mediated ARG exchange within the host microbiota is a potential driver of these outcomes.
  • Understanding these interactions is crucial for managing MDR-PA infections.

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