Risk factors for colonization and infection by multi drug resistant Pseudomonas aeruginosa in Intensive Care Unit: a Systematic Review and Meta-analysis

Background: Currently under debate, there are two contrasting hypotheses on the risk factors of acquisition, colonization, and infection by Multi-Drug 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 generate strong evidence-bases to identify and understand factors associated with MDR-PA infection in the ICU. Methodology: Many databases were screened from 1983 to 2023 and result of electronic searches was uploaded to Rayyan software. After using of a Prisma flow diagram, a descriptive analysis and meta-analysis were carried out. Using fixed-model effects, the polled prevalence and Odds ratio (OR), with their respectives 95% confidence intervals (95% CI) were calculated. Results: A total of 10.791 articles were identified, 13 were retained for the descriptive analysis and 8 for the meta-analysis. Majority of these 13 studies were carried out in West countries. The methodologies were heterogeneous, and few studies addressed environmental factors. The pooled prevalence of MDR-PA in ICU was 4% (95% CI: 0% – 11%). The risk factors identified were: the length of stay in ICU (> 8 days), the mechanical ventilation with OR: 3.19; 95% CI: 2.25 – 4.53, the use of invasives devices with OR: 2.97; 95% CI: 2.40 - 3.68 (the use of central venous catheter with OR: 3.16 95% CI: 1.87-5.33, the use of urinary catheter with OR: 2.65; 95% CI: 2.05-3.44, the use parental alimentation with OR: 2.43; 95% CI: 1.15-5.16 and the use of arterial catheter 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. Conclusion: The most significant risk factors identified in our review were: mechanical ventilation, invasive devices especially urinary catheter, use of antibiotics especially carbapenems, and ICU length stay more than 8 days 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. Systematic review registration: The protocol of this review has been registered under CRD42021233832 in PROSPERO and has been published on Systematic review on November 2022 [1].