Multidrug-resistant Pseudomonas aeruginosa in Jordan: epidemiology, trends, determinants, and clinical outcomes

BACKGROUND: (MDR-PA) is a major cause of healthcare-associated infections, yet contemporary multicentre data from Jordan are limited. AIMS: To describe the prevalence, temporal trends, determinants, and in-hospital outcomes of MDR-PA across Jordanian hospitals over an 11-year period, and to define implications for national surveillance, infection prevention, and antimicrobial stewardship. METHODS: isolates per patient from 21 hospitals between 2013 and 2023. MDR-PA was defined as non-susceptibility to ≥3 antipseudomonal classes. Logistic regression was used to identify determinants associated with MDR-PA and in-hospital mortality. RESULTS: Among 4,714 patients, 610 (12.9%) had MDR-PA. Patients with MDR-PA were older and more often nosocomial, with longer median hospital stay than non-MDR-PA. The proportion of MDR-PA increased significantly over time; each calendar year was associated with a 21% higher odds of MDR [adjusted odds ratio (OR) 1.21, 95% CI 1.14-1.28]. Nosocomial acquisition nearly doubled the odds of MDR-PA (aOR 1.91, 95% CI 1.48-2.45). Overall, in-hospital mortality was 17.6% and higher in MDR-PA in crude analyses, but MDR status was not independently associated with mortality after full adjustment. Mortality was driven by older age, ICU admission, community acquisition, and longer stay. CONCLUSION: MDR-PA prevalence and temporal trends in Jordan are alarming. The absence of an independent mortality association should be interpreted cautiously because residual confounding by comorbidity, illness severity, prior antimicrobial exposure, and treatment appropriateness could not be fully addressed.