Prevalence of Pseudomonas aeruginosa and antimicrobial-resistant Pseudomonas aeruginosa in patients with pneumonia in mainland China: a systematic review and meta-analysis

• This is the first meta-analysis on the prevalence of Pseudomonas aeruginosa pneumonia and its drug resistance patterns in mainland China.
• P. aeruginosa was highly prevalent in nosocomial pneumonia.
• The initial management of P. aeruginosa pneumonia remains challenging due to the high rates of resistance.

SummaryObjectiveTo estimate the prevalence of Pseudomonas aeruginosa and antimicrobial-resistant P. aeruginosa in ventilator-associated pneumonia (VAP), hospital-acquired pneumonia (HAP), and community-acquired pneumonia (CAP) in mainland China.MethodsMeta-analyses of 50 studies published from 2010 to 2014 were conducted, followed by pre-defined subgroup analyses and meta-regressions.ResultsP. aeruginosa accounted for 19.4% (95% confidence interval (CI) 17.6–21.2%) of all isolates in VAP, which was similar to the proportion in HAP of 17.8% (95% CI 14.6–21.6%), but significantly greater than the proportion in CAP of 7.7% (15/195, p < 0.001). Regarding VAP, the prevalence of P. aeruginosa has decreased since 2007. P. aeruginosa exhibited varying resistance to agents recommended for the initial management of VAP, with a high level of resistance to gentamicin (51.1%, 95% CI 37.7–64.4%) and a low level of resistance to amikacin (22.5%, 95% CI 14.3–33.6%). The prevalence of P. aeruginosa isolates resistant to agents recommended for the treatment of HAP ranged from 22.2% (95% CI 13.8–33.6%) for amikacin to 50.0% (95% CI 30.2–69.8%) for cefoperazone.ConclusionsP. aeruginosa was highly prevalent among patients with VAP and HAP in mainland China. The initial empirical treatment of these patients remains challenging because of the strikingly high prevalence of antimicrobial resistance.