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43% of Pseudomonas aeruginosa isolates in Indonesia are carbapenem-resistant, meta-analysis findsHigh rates of drug-resistant bacteria found in hospital samples across Indonesia

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Key Takeaway
Interpret the 43% CRPA prevalence cautiously due to very high heterogeneity across studies.

This systematic review and meta-analysis assessed the pooled prevalence of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in Indonesia. The analysis included 16 studies comprising 3,852 isolates from various regions. The primary outcome was the pooled prevalence of CRPA, which was 43% (95% CI: 29%-58%). Regional prevalence varied: 50% in combined regions (Yogyakarta, West Java, West Sumatra, Central Java, and Bali), 42% in South Sulawesi, 40% in East Java, and 37% in Jakarta. Secondary outcomes included molecular analysis of carbapenemase genes, but specific gene frequencies were not reported.

A major limitation is the high heterogeneity across studies (I²=99.13%), indicating substantial variability that may stem from differences in study populations, laboratory methods, or geographic factors. This heterogeneity reduces the reliability of the pooled estimate. The authors note that strengthening antimicrobial stewardship, expanding surveillance systems, and integrating molecular epidemiology are essential to control the spread of CRPA.

Clinicians should interpret these prevalence data cautiously due to the high heterogeneity and the observational nature of the included studies. No causal conclusions can be drawn, and the clinical impact of CRPA in terms of patient outcomes was not directly assessed. The findings underscore the need for robust local surveillance to guide empiric antibiotic therapy and infection control measures.

Scientists examined data from sixteen different studies involving 3,852 bacterial samples collected in Indonesia. They looked specifically for a dangerous type of bacteria called Pseudomonas aeruginosa that has become resistant to carbapenem antibiotics. These drugs are often the last line of defense against severe infections, making resistance a major concern for patient safety.

The overall results showed that 43 percent of the tested bacteria were resistant to these critical medicines. When looking at specific regions, the rate was even higher in some areas. For example, about half of the samples from Yogyakarta, West Java, and other places showed this dangerous resistance. Other regions like Jakarta and East Java also had high numbers of resistant bacteria.

The differences between the studies were very large, which makes it hard to draw one simple conclusion. Because of this variation, experts say that hospitals must improve their systems for watching for these resistant germs. They also recommend using smarter rules to decide when to use these strong antibiotics. Understanding the specific genes that cause resistance is also important for stopping the spread of these hard-to-treat infections.

What this means for you:
Over 40% of Pseudomonas bacteria in Indonesia are resistant to strong antibiotics, requiring better hospital monitoring and antibiotic use rules.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
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. 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. 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 blaIMP and blaVIM. Heterogeneity was high across studies (I² = 99.13%), while no significant publication bias was detected. 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. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261327390.
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