Risk factors for colonisation and infection with multidrug-resistant Pseudomonas aeruginosa in intensive care unit: a...

There are currently two opposing hypotheses regarding the risk factors for acquisition, colonisation and infection with multidrug-resistant Pseudomonas aeruginosa (MDR-PA) in the intensive care unit (ICU). Acquisition could be either endogenous or exogenous or both. It is of great interest to estimate pooled prevalence and describe individual and environmental factors associated with the colonisation and infection with MDR Pseudomonas aeruginosa in intensive care units.

This systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol of this review has been registered under CRD42021233832 in the International Prospective Register of Systematic Reviews (PROSPERO) and has been published on Systematic review on November 2022All types of studies carried out in intensive care units (ICUs) were included. MEDLINE (Pubmed), EMBASE (OVID), the Cochrane Library (Wiley), Web of Science, CINAHL (EBSCOHost), LILACS (BIREME), Google Scholar and Open Grey were searched from 1983 to 2023 and the results of electronic searches were uploaded to Rayyan software. The methodological quality of the studies was assessed using the National Heart, Lung, and Blood Institute Critical Appraisal Tools. The I² test was performed to assess the statistical heterogeneity among the included studies. The publication bias was assessed by using the funnel plot and Egger's test. Descriptive analysis and meta-analysis were performed. Fixed effect model were used to calculate the surveyed prevalence and odds ratio (OR) with their respective 95% confidence intervals (95% CI).

A total of 10,791 articles were identified, of which 13 were retained for descriptive analysis and 8 for meta-analysis. The majority of these 13 studies were conducted in Western countries. Methods were heterogeneous and few studies addressed environmental factors. The pooled prevalence of MDR-PA in the ICU was 4% (95% CI: 0%-11%). Identified risk factors were: length of stay in ICU (> 8 days), mechanical ventilation with OR: 3.19; 95% CI: 2.25-4.53, use of invasive devices with OR: 2.97; 95% CI: 2.40-3.68 (use of central venous catheter with OR: 3.16 95% CI: 1.87-5.33, the use of urinary catheters with OR: 2.65; 95% CI: 2.05-3.44, the use of parenteral nutrition with OR: 2.43; 95% CI: 1.15-5.16 and the use of arterial catheters with OR: 7.00; 95% CI: 2.77-17.68) and the use of antibiotics with OR: 3.69; 95% CI: 3.16-4.27 (carbapenem with OR: 4.12; 95% CI: 3.29-5.16, quinolones with OR: 3.31; 95% CI: 2.45-4.47, bectalactam with OR: 3.58; 95% CI: 2.4-5.24, and aminoglycosides with OR: 3.32; 95% CI: 2.33-4.73) and environmental factors.

All this suggest that acquisition or infection by MDR-PA in ICU could be due to endogenous and exogenous transmission. Due to the few numbers of studies analysed, further investigation with more studies is needed to draw definitive conclusions.

The protocol of this review has been registered under CRD42021233832 in PROSPERO and has been published on Systematic review on November 2022. Eyebe et al. (Syst Rev 11:270, 2022).