43% of Pseudomonas aeruginosa isolates in Indonesia are carbapenem-resistant, meta-analysis finds

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Frontiers in Medicine Published June 3, 2026 Medically reviewed June 3, 2026 Study authors: Fitrotin Azizah, Deivan Pradana Putra, Dita Artanti, Rima Aurelia Dimpudus, Yety Eka Sispita Sari, A… DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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.

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.