Clinical burden of community-associated infections caused by multidrug-resistant Pseudomonas aeruginosa: a propensity-matched longitudinal cohort study in Southern China

Background: Limited research has been conducted on the burden of community-associated infections caused by multidrug-resistant (CA-MDRPa). We quantitatively modeled the incidence rate and clinical factors associated with CA-MDRPa among hospitalized patients in Southern China.Methods: Data were obtained from the local nosocomial surveillance system. Poisson regression was applied to estimate annual incidence rate ratios (IRRs) from 2018 to 2021. After propensity-score 1:2 matching, multivariable conditional logistic regression was used to identify factors for CA-MDRPa upon admission and adverse clinical outcomes during hospitalization. Results: 278 patients were clinically and microbiologically diagnosed with CA-MDRPa and 647 with CA-non-MDRPa. CA-MDRPa rate exhibited a slight, non-significant, increase during the research period (IRR=1.03; 95% confidence interval [CI], 0.93–1.15). Neurological conditions, cardiovascular diseases, respiratory disorders, urinary tract infections, and use of cefoperazone/sulbactam prior to admission were identified as risk factors for CA-MDRPa upon admission. CA-MDRPa upon admission was associated with ESBL-producing acquisition during hospitalization (odds ratio [OR], 2.70; 95% CI, 1.53–4.77) and increased in-hospital mortality (OR, 2.24; 95% CI, 1.17–4.28).Conclusions: The findings emphasize the importance of regular targeted screening for CA-MDRPa upon hospital admission and offer valuable insights for strengthening infection control and antimicrobial stewardship programs.