Title : Prevalence, antimicrobial susceptibility, and risk factors of carbapenem-resistant Pseudomonas aeruginosa in tertiary referral hospitals in Rwanda, 2023 to 2025
Abstract:
Background: Pseudomonas aeruginosa (PA) is among the major causes of nosocomial infections. Carbapenem-resistant P. aeruginosa is also listed in the critical category of the priority pathogens for which new antibiotics are urgently needed. However, data on PA and its antimicrobial resistance profiles in Rwanda are scarce. This study aimed to determine Prevalence, antimicrobial susceptibility profiles, and risk factors associated with PA in tertiary referral hospitals in Rwanda.
Methods: A retrospective study was conducted on 453 PA isolates from the laboratories of four hospitals: the University teaching Hospital of Kigali (CHUK), the University Teaching Hospital of Butare ( CHUB), Rwanda Military Hospital (RMH), and King Faisal Hospital or KFH), from January 2023 to September 2025. The susceptibility profiles had covered nine antibiotics routinely used in clinical laboratory settings in Rwanda: amikacin, gentamicin, aztreonam, cefepime, ceftazidime, levofloxacin, imipenem, meropenem, and polymyxin. Laboratory register data were supplemented with patients’ age, sex, hospital ward, date of consultation and residence from the electronic clinical database. Season was derived from the date of consultation; and the susceptibility values had been interpreted according to CLSI guidelines. Data were analyzed using Stata version 15, and results were summarized in tables and figures. Logistic regression was used to assess risk factors associated with PA resistance.
Results: Findings revealed that 46.1% of PA isolates were resistant to at least one carbapenem. Seven isolates were resistant to all tested antibiotics except polymyxin B. Carbapenem resistance was high among children aged under 1 year old (OR: 3.06, 95% CI: 1.03-9.06); compared with other wards, the resistance were upper in three hospital wards namely Surgery (OR: 12.02, 95% CI: 3.51-41.12), Gynecology (OR: 10.49, 95% CI: 48-73.95), and outpatient department (OR: 5.87, 95% CI: 1.95-17.66). The risk of carbapenem resistance among patients with PA infection was higher for those living in the Eastern province ( OR: 5.42; 95% CI: 1.51-19.34), and found raised during long rainy season, March-May (OR: 2.07; 95% CI: 1.17-3.36).
Conclusion: Carbapenem resistance in PA is high in Rwanda tertiary hospitals, and multidrug resistant isolates are threatening lives. Resistance was concentrated in specific hospital departments which point to priority areas for infection prevention and control. Continuous surveillance and antimicrobial stewardship are needed to inform decision makers, medicine supply chain actors, and to preserve the remaining effective antibiotics.
Key words: Pseudomonas aeruginosa, antimicrobial resistance, carbapenem resistant pathogens.
