National prevalence of carbapenem-resistance Pseudomonas aeruginosa in Indonesia: a systematic review and meta-analysis

Objective Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a critical priority pathogen associated with limited therapeutic options and increased morbidity and mortality. However, national-level evidence regarding CRPA prevalence in Indonesia remains fragmented. This study aimed to estimate the pooled prevalence and evaluate the epidemiological distribution of CRPA across Indonesia. Methods A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines and registered in PROSPERO (CRD420261327390). PubMed, Scopus, Cochrane Library, and Garuda databases were searched for studies published between January 2001 and February 2026. Observational studies reporting CRPA prevalence in Indonesia were included. Data were extracted independently, and pooled prevalence estimates were calculated using a random-effects model. Heterogeneity and publication bias were assessed using I² statistics, Begg’s test, and Egger’s test. Results A total of 16 studies comprising 3,852 Pseudomonas aeruginosa isolates were included. The pooled prevalence of CRPA was 43% (95% CI: 29%–58%), indicating a substantial burden. Subgroup analysis showed higher prevalence in combined regions (Yogyakarta, West Java, West Sumatra, Central Java, and Bali) (50%), followed by South Sulawesi (42%), East Java (40%), and Jakarta (37%). Spatial distribution demonstrated concentration of cases in East Java and major referral centers. Molecular analysis revealed diverse carbapenemase genes, predominantly bla IMP and bla VIM . Heterogeneity was high across studies (I² = 99.13%), while no significant publication bias was detected. Conclusion CRPA prevalence in Indonesia is high and widely distributed with significant regional variability. Strengthening antimicrobial stewardship, expanding surveillance systems, and integrating molecular epidemiology are essential to control the spread of CRPA. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420261327390.