Proportions of Pseudomonas aeruginosa and Antimicrobial-Resistant P aeruginosa Among Patients With Surgical Site Infections in China: A Systematic Review and Meta-analysis

Abstract

Background Pseudomonas aeruginosa is one of the most common pathogens in surgical site infections (SSIs). However, comprehensive epidemiological and antibiotic resistance details for Pseudomonas aeruginosa in Chinese SSIs are lacking. We evaluated the proportions and antimicrobial resistance of Pseudomonas aeruginosa among patients with SSIs in China. Methods Relevant papers from January 2010 to August 2022 were searched in databases including PubMed, Embase, Web of Science, CBM, CNKI, Wanfang, and Weipu. A meta-analysis was performed to analyse the proportions and 95% confidence interval (CI) of Pseudomonas aeruginosa among patients with SSIs. Meta-regression analysis was used to investigate the proportions difference among different subgroups and antimicrobial resistance. Results A total of 72 studies met inclusion criteria, involving 33,050 isolated strains. The overall proportion of Pseudomonas aeruginosa among patients with SSIs was 16.0% (95% CI 13.9-18.2). Subgroup analysis showed higher proportions in orthopaedic (18.3%, 95% CI 15.6-21.0) and abdominal surgery (17.3%, 95% CI 9.9-26.2). The proportion in the central region [18.6% (95% CI 15.3-22.1)] was slightly higher than that in other regions. Antibiotic resistance rates significantly increased after 2015: cefoperazone (36.2%), ceftriaxone (38.9%), levofloxacin (20.5%), and aztreonam (24.0%). Notably, Pseudomonas aeruginosa resistance to ampicillin and cefazolin exceeded 90.0%. Conclusions The proportion of Pseudomonas aeruginosa infection among patients with SSIs was higher than the data reported by the Chinese Antimicrobial Resistance Surveillance System, indicating rising antimicrobial resistance. The existing antimicrobial drug management plan should be strengthened to prevent a hospital epidemic of drug-resistant Pseudomonas aeruginosa strains.