Background: Pseudomonas aeruginosa is a clinically important opportunistic pathogen in otorhinolaryngology, where chronic inflammation, impaired drainage, postoperative wounds, and device-associated biofilms may complicate treatment. Specialty-specific data linking anatomical distribution, multidrug resistance (MDR), and clinical outcomes remain limited in regional hospitals in China. Objective: To describe the clinical distribution and antimicrobial susceptibility profile of P. aeruginosa infections in otorhinolaryngology and to identify factors associated with MDR. Methods: This single-center retrospective cohort study included 112 consecutive patients with clinically adjudicated otorhinolaryngological infection and culture-confirmed P. aeruginosa at The First People’s Hospital of Yongkang, Eastern China, from January to December 2024. MDR was defined as non-susceptibility to at least one agent in three or more antimicrobial categories. Group comparisons and multivariable logistic regression were performed. Results: The most common sites were the external ear canal/external ear (31.2%), middle ear/mastoid (25.0%), and nasal cavity/paranasal sinuses (21.4%). MDR was identified in 37 patients (33.0%). The highest susceptibility percentages were observed for colistin/polymyxin B (95.5%), amikacin (84.8%), and piperacillin-tazobactam (79.5%), whereas the highest resistance percentages were observed for aztreonam (32.1%), levofloxacin (27.7%), and ceftazidime (24.1%). Recent carbapenem exposure (adjusted odds ratio aOR 5.09, 95% confidence interval CI 1.22– 21.19), postoperative indwelling devices/drainage (aOR 4.81, 95% CI 1.81– 12.83), and hospital-acquired infection (aOR 2.52, 95% CI 1.02– 6.23) were independently associated with MDR. MDR infections were associated with longer hospitalization, higher C-reactive protein levels, more antimicrobial regimen modifications, and lower clinical success. Conclusion: This study provides specialty- and region-specific evidence that MDR P. aeruginosa is a substantial concern in otorhinolaryngological infections. In patients with recent carbapenem exposure, postoperative drainage or devices, or hospital-acquired infection, early culture acquisition, source control, and susceptibility-guided therapy are particularly important. Keywords: Pseudomonas aeruginosa , otorhinolaryngology, antimicrobial susceptibility testing, multidrug resistance, hospital-acquired infection, carbapenems, eastern China
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