Hospital-acquired pneumonia is typically polymicrobial; nevertheless, Pseudomonas aeruginosa is a principal causative pathogen, attributable to its link with poor clinical prognoses and extensive antimicrobial resistance. Our study aims to assess the prevalence, microbiological profiles and determinants of hospital-acquired pneumonia with a focus on antibiotic-resistant P. aeruginosa across three hospitals in Addis Ababa. A cross-sectional study was conducted in which 1,800 patients were screened, and 298 cases of hospital-acquired pneumonia were identified between September 2022 and April 2024. Patient interviews and microbiological analysis of lower respiratory tract samples were performed. We detected a 17% prevalence of hospital-acquired pneumonia and 19% prevalence of ventilator-associated pneumonia across the study hospitals. Our patient profiles indicated a predominance of males (59%), with the largest proportion aged 30–39 years (28%), most were married (71%) and had attained secondary-level education (33%). Over half of the patients were admitted to the adult ICU (55%), 60% had a history of prior hospitalization and respiratory disease was the leading cause of admission (30%). Acinetobacter baumannii (n = 24) was the most frequently isolated pathogen, followed by Pseudomonas aeruginosa (n = 21) and Staphylococcus aureus (n = 13). Compounding these challenges, the P. aeruginosa isolates (7%) exhibited high resistance to ceftazidime and cefepime (89% resistance), while retaining relatively high susceptibility to amikacin (90%); notably, 67% of the isolates were multidrug resistant. We tested several patient-level vulnerabilities, only aspiration remained independently associated with presence of pneumonia-associated pathogen in patient samples (AOR = 4.43, 95% CI: 1.74–11.24, p = 0.002). This study demonstrates a substantial burden of multidrug resistance hospital-acquired pneumonia by ESKAPE pathogens that indicate deficiencies in hospital defences against hospital-acquired pathogens and risk of adverse patient outcomes. There is an urgent need to shift infection prevention strategies, emphasizing aspiration prevention measures and strengthened diagnostic stewardship.
Hailemichael et al. (Tue,) studied this question.