{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T16:17:44Z","timestamp":1778084264928,"version":"3.51.4"},"reference-count":108,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,6]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                    is a major cause of health care\u2013associated infections, particularly in intensive care units (ICUs). To the best of our knowledge, this is one of the rare studies reporting the prevalence and antimicrobial resistance patterns of\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    in a Tunisian ICU. This retrospective study included all\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    strains isolated from ICU patients in Sfax, Tunisia, between 2017 and 2024. A total of 1,126 nonredundant\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    strains were obtained from 767 patients.\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    strains accounted for 21.1% of all clinical isolates in the ICU. The majority of strains were isolated from respiratory samples (54.6%) and blood cultures (14.3%). The prevalence of resistance rates was highest for ticarcillin (48.3%) and ticarcillin-clavulanic acid (48.6%). The resistance to both ceftazidime and imipenem was observed in 33.6% of\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    strains. The prevalence of resistance of\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    was 29.8% and 26.2% to ceftazidime-avibactam (CAV) and ceftolozane-tazobactam (C\/T), respectively. The prevalence of resistance to amikacin and ciprofloxacin was 36.2% and 37.9%, respectively. Of the 1,126 isolates, 346 (30.7%) were multidrug-resistant\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    (MDR-PA) strains, presenting resistance to ceftazidime, ciprofloxacin, and amikacin simultaneously. Since 2022, a significant increase in the MDR rate was observed, reaching 46.3% in 2024 (\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.001). The resistance rates of MDR-PA were 52.5% and 56.8% to C\/T and CAV, respectively. None of the tested MDR-PA strains showed resistance to colistin. This study highlights a high prevalence of MDR strains of\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    in our ICU, with increasing resistance over recent years. Prevention is highly warranted.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0161","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T14:52:48Z","timestamp":1773154368000},"page":"837-843","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and Resistance Patterns of Pseudomonas aeruginosa in a Tunisian Intensive Care Unit"],"prefix":"10.4269","volume":"114","author":[{"given":"Olfa","family":"Gargouri","sequence":"first","affiliation":[{"name":"Laboratory of Microbiology, Research Laboratory for Microorganisms and Human Disease LR03SP03, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karama","family":"Bouchaala","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Sfax, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nourelhouda","family":"Ben Ayed","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Research Laboratory for Microorganisms and Human Disease LR03SP03, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sirine","family":"Koubaa","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Research Laboratory for Microorganisms and Human Disease LR03SP03, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fahmi","family":"Smaoui","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Research Laboratory for Microorganisms and Human Disease LR03SP03, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chokri","family":"Ben Hamida","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Sfax, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hela","family":"Karray Hakim","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Research Laboratory for Microorganisms and Human Disease LR03SP03, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mabrouk","family":"Bahloul","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Sfax, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","article-title":"About Pseudomonas aeruginosa","year":"2025"},{"key":"b2","series-title":"Open Forum Infect Dis","first-page":"ofy313","article-title":"Sepsis in intensive care unit patients: Worldwide data from the Intensive Care over Nations audit","volume":"5","author":"Sakr","year":"2018"},{"key":"b3","series-title":"BMC Infect Dis","first-page":"180","article-title":"Pseudomonas aeruginosa device associated\u2013healthcare associated infections and its multidrug resistance at intensive care unit of University Hospital: Polish, 8.5-year, prospective, single-centre study","volume":"21","author":"Litwin","year":"2021"},{"key":"b4","series-title":"Clin Lab Sci","first-page":"43","article-title":"Epidemiology and pathogenesis of Pseudomonas aeruginosa infections","volume":"24","author":"Moore","year":"2011"},{"key":"b5","series-title":"J Hosp Infect","first-page":"325","article-title":"Heterogeneity among infecting strains of Pseudomonas aeruginosa in diverse departments of a large Tunisian hospital","volume":"47","author":"Ben Slama","year":"2001"},{"key":"b6","series-title":"Front Cell Infect Microbiol","first-page":"39","article-title":"Pseudomonas aeruginosa Lifestyle: A paradigm for adaptation, survival, and persistence","volume":"7","author":"Moradali","year":"2017"},{"key":"b7","series-title":"Cells","first-page":"199","article-title":"Pseudomonas aeruginosa: Infections, animal modeling, and therapeutics","volume":"12","author":"Wood","year":"2023"},{"key":"b8","series-title":"Drugs","first-page":"2117","article-title":"The epidemiology and pathogenesis and treatment of Pseudomonas aeruginosa infections: An update","volume":"81","author":"Reynolds","year":"2021"},{"key":"b9","article-title":"WHO Bacterial Priority Pathogens List, 2024: Bacterial Pathogens of Public Health Importance to Guide Research, Development and Strategies to Prevent and Control Antimicrobial Resistance.","year":"2024"},{"key":"b10","series-title":"J Hosp Infect","first-page":"134","article-title":"Incremental clinical and economic burden of suspected respiratory infections due to multi-drug-resistant Pseudomonas aeruginosa in the United States","volume":"103","author":"Tabak","year":"2019"},{"key":"b11","series-title":"Microbes Infect Dis","article-title":"Epidemiology and multidrug resistance of Pseudomonas aeruginosa: A decade of surveillance at a Tunisian Hospital","author":"Mfathia","year":"2024"},{"key":"b12","article-title":"Recommendations 2024, V.1.0 June.","year":"2024"},{"key":"b13","series-title":"Clin Microbiol Infect","first-page":"268","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2012"},{"key":"b14","series-title":"J Assoc Med Microbiol Infect Dis Can","first-page":"130","article-title":"Pseudomonas aeruginosa infection in intensive care: Epidemiology, outcomes, and antimicrobial susceptibilities","volume":"5","author":"Kula","year":"2020"},{"key":"b15","series-title":"Med Sci Monit","first-page":"PH69","article-title":"Risk factors and outcomes of intensive care unit-acquired infections in a Tunisian ICU","volume":"16","author":"Kallel","year":"2010"},{"key":"b16","series-title":"Tunis Med","first-page":"731","article-title":"The prevalence of healthcare-associated infection in medical intensive care units in Tunisia. Results of the multi-centre nosorea1 study","volume":"96","author":"Jamoussi","year":"2018"},{"key":"b17","series-title":"Front Microbiol","first-page":"1477836","article-title":"Prevalence of colistin resistance in clinical isolates of Pseudomonas aeruginosa: A systematic review and meta-analysis","volume":"15","author":"Narimisa","year":"2024"},{"key":"b18","article-title":"R\u00e9sistance Bact\u00e9rienne."},{"key":"b19","series-title":"PLoS One","first-page":"e0285856","article-title":"Ceftazidime resistance in Pseudomonas aeruginosa is multigenic and complex","volume":"18","author":"Ramsay","year":"2023"},{"key":"b20","series-title":"Pathol Biol","first-page":"307","article-title":"\u00c9tude in\u00a0vitro de la sensibilit\u00e9 aux antibiotiques de 213 souches de Pseudomonas aeruginosa isol\u00e9es au service de r\u00e9animation du CHU de Sfax (Tunisie)","volume":"41","author":"Karray","year":"1993"},{"key":"b21","series-title":"IJID","first-page":"250","article-title":"Activity 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de r\u00e9animation des br\u00fbl\u00e9s durant sept ans","volume":"32","author":"Krir","year":"2019"},{"key":"b25","series-title":"Microb Drug Resist","first-page":"1437","article-title":"Characterization of VIM-4 producing clinical Pseudomonas aeruginosa isolates from western Algeria: Sequence type and class 1 integron description","volume":"26","author":"Zaidi","year":"2020"},{"key":"b26","series-title":"Afr J Microbiol Res","first-page":"3005","article-title":"Epidemiology of Pseudomonas aeruginosa in intensive care unit and otolaryngology department of a Tunisian hospital","volume":"5","author":"Ben Slama","year":"2011"},{"key":"b27","series-title":"Antibiotics (Basel)","first-page":"1621","article-title":"Resistance in Pseudomonas aeruginosa: A narrative review of antibiogram interpretation and emerging treatments","volume":"12","author":"Giovagnorio","year":"2023"},{"key":"b28","series-title":"BMC Infect Dis","first-page":"763","article-title":"Phenotypic and genotypic assessment of fluoroquinolones and aminoglycosides resistances in Pseudomonas aeruginosa collected from Minia hospitals, Egypt during COVID-19 pandemic","volume":"24","author":"Boushra","year":"2024"},{"key":"b29","series-title":"3 Biotech","first-page":"1","article-title":"Quinolone-resistant clinical strains of Pseudomonas aeruginosa isolated from University Hospital in Tunisia","volume":"8","author":"Ben Nejma","year":"2018"},{"key":"b30","series-title":"Clin Microbiol Infect","first-page":"794","article-title":"Nosocomial outbreak of OXA-18-producing Pseudomonas aeruginosa in Tunisia","volume":"13","author":"Kalai Blagui","year":"2007"},{"key":"b31","series-title":"Microb Drug Resist","first-page":"295","article-title":"Emergence of SHV-2a extended-spectrum \u03b2-lactamases in clinical isolates of Pseudomonas aeruginosa in a university hospital in Tunisia","volume":"15","author":"Mansour","year":"2009"},{"key":"b32","series-title":"Acute Crit Care","first-page":"84","article-title":"Clinical characteristics and outcomes of critically ill COVID-19 patients in Sfax, Tunisia","volume":"37","author":"Bahloul","year":"2022"},{"key":"b33","series-title":"J Antimicrob Chemother","first-page":"1837","article-title":"Decline of antimicrobial resistance in Pseudomonas aeruginosa bacteraemia following the COVID-19 pandemic: A longitudinal observational study","volume":"80","author":"Butscheid","year":"2025"},{"key":"b34","series-title":"mSphere","first-page":"e00202-21","article-title":"Epidemiology of multidrug-resistant Pseudomonas aeruginosa in the Middle East and North Africa region","volume":"6","author":"Al-Orphaly","year":"2021"},{"key":"b35","series-title":"Clin Microbiol Rev","first-page":"e00031-19","article-title":"Epidemiology and treatment of multidrug-resistant and extensively drug-resistant Pseudomonas aeruginosa infections","volume":"32","author":"Horcajada","year":"2019"},{"key":"b36","series-title":"Antimicrob Agents Chemother","first-page":"43","article-title":"Multidrug-resistant Pseudomonas aeruginosa: Risk factors and clinical impact","volume":"50","author":"Aloush","year":"2006"},{"key":"b37","series-title":"Antimicrob Resist Infect Control","first-page":"79","article-title":"Risk factors for hospitalized patients with resistant or multidrug-resistant Pseudomonas aeruginosa infections: A systematic review and meta-analysis","volume":"7","author":"Raman","year":"2018"},{"key":"b38","series-title":"Pharmacotherapy","first-page":"1279","article-title":"Resurgence of colistin: A review of resistance, toxicity, pharmacodynamics, and dosing","volume":"30","author":"Lim","year":"2010"},{"key":"b39","series-title":"J Infect","first-page":"1","article-title":"Colistin in multi-drug resistant Pseudomonas aeruginosa blood-stream infections: A narrative review for the clinician","volume":"69","author":"Martis","year":"2014"},{"key":"b40","series-title":"Lancet Infect Dis","first-page":"726","article-title":"Effect of appropriate combination therapy on mortality of patients with bloodstream infections due to carbapenemase-producing Enterobacteriaceae (INCREMENT): A retrospective cohort study","volume":"17","author":"Guti\u00e9rrez-Guti\u00e9rrez","year":"2017"},{"key":"b41","series-title":"Syst Rev","first-page":"309","article-title":"Efficiency of combination therapy versus monotherapy for the treatment of infections due to carbapenem-resistant Gram-negative bacteria: A systematic review and meta-analysis","volume":"13","author":"Lai","year":"2024"},{"key":"b42","series-title":"Clin Infect Dis","first-page":"ciad428","article-title":"Infectious Diseases Society of America 2023 Guidance on the treatment of antimicrobial resistant gram-negative infections","author":"Tamma","year":"2023"},{"key":"b43","article-title":"Antibioth\u00e9rapie Des Infections \u00e0 Ent\u00e9robact\u00e9ries Et \u00e0 Pseudomonas aeruginosa Chez L\u2019adulte: Place Des Carbap\u00e9n\u00e8mes Et De Leurs Alternatives.","year":"2019"},{"key":"b44","series-title":"Drugs","first-page":"31","article-title":"Ceftolozane\/tazobactam: A novel cephalosporin\/\u03b2-lactamase inhibitor combination with activity against multidrug-resistant gram-negative bacilli","volume":"74","author":"Zhanel","year":"2014"},{"key":"b45","series-title":"Future Microbiol","first-page":"465","article-title":"Perspectives on the use of ceftolozane\/tazobactam: A review of clinical trial data and real-world evidence","volume":"19","author":"Martin-Loeches","year":"2024"},{"key":"b46","series-title":"Front Microbiol","first-page":"1035609","article-title":"Molecular mechanisms leading to ceftolozane\/tazobactam resistance in clinical isolates of Pseudomonas aeruginosa from five Latin American countries","volume":"13","author":"Mojica","year":"2022"},{"key":"b47","series-title":"Antimicrob Agents Chemother","first-page":"e01117-20","article-title":"Mechanisms of resistance to ceftolozane\/tazobactam in Pseudomonas aeruginosa: Results of the GERPA Multicenter Study","volume":"65","author":"Fournier","year":"2021"},{"key":"b48","series-title":"Front Microbiol","first-page":"1347521","article-title":"Extensively drug-resistant Pseudomonas aeruginosa: Clinical features and treatment with ceftazidime\/avibactam and ceftolozane\/tazobactam in a tertiary care university hospital center in Portugal \u2013 A cross-sectional and retrospective observational study","volume":"15","author":"Mendes Pedro","year":"2024"},{"key":"b49","series-title":"Microb Drug Resist","first-page":"25","article-title":"Diversity of \u03b2-lactamases in Pseudomonas aeruginosa isolates producing metallo-\u03b2-lactamase in two Tunisian hospitals","volume":"17","author":"Ktari","year":"2011"},{"key":"b50","series-title":"Antibiotics (Basel)","first-page":"1126","article-title":"Review of ceftazidime-avibactam for the treatment of infections caused by Pseudomonas aeruginosa.","volume":"10","author":"Daikos","year":"2021"},{"key":"b51","series-title":"J Antimicrob Chemother","first-page":"1596","article-title":"Avibactam confers susceptibility to a large proportion of ceftazidime-resistant Pseudomonas aeruginosa isolates recovered from cystic fibrosis patients","volume":"70","author":"Chalhoub","year":"2015"},{"key":"b52","series-title":"Infect Dis (Lond)","first-page":"386","article-title":"The activity of ceftazidime\/avibactam against carbapenem-resistant Pseudomonas aeruginosa.","volume":"53","author":"Ito","year":"2021"},{"key":"b53","series-title":"Microbiol Spectr","first-page":"e0426623","article-title":"Resistance to ceftazidime-avibactam and other new \u03b2-lactams in Pseudomonas aeruginosa clinical isolates: A multi-center surveillance study","volume":"12","author":"Valzano","year":"2024"},{"key":"b54","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"2533","article-title":"The ERACE-PA Global Surveillance Program: Ceftolozane\/tazobactam and Ceftazidime\/avibactam in\u00a0vitro activity against a global collection of carbapenem-resistant Pseudomonas aeruginosa.","volume":"40","author":"Gill","year":"2021"},{"key":"b1","article-title":"About Pseudomonas aeruginosa","year":"2025"},{"key":"b2","series-title":"Open Forum Infect Dis","first-page":"ofy313","article-title":"Sepsis in intensive care unit patients: Worldwide data from the Intensive Care over Nations audit","volume":"5","author":"Sakr","year":"2018"},{"key":"b3","series-title":"BMC Infect Dis","first-page":"180","article-title":"Pseudomonas aeruginosa device associated\u2013healthcare associated infections and its multidrug resistance at intensive care unit of University Hospital: Polish, 8.5-year, prospective, single-centre study","volume":"21","author":"Litwin","year":"2021"},{"key":"b4","series-title":"Clin Lab Sci","first-page":"43","article-title":"Epidemiology and pathogenesis of Pseudomonas aeruginosa infections","volume":"24","author":"Moore","year":"2011"},{"key":"b5","series-title":"J Hosp Infect","first-page":"325","article-title":"Heterogeneity among infecting strains of Pseudomonas aeruginosa in diverse departments of a large Tunisian hospital","volume":"47","author":"Ben Slama","year":"2001"},{"key":"b6","series-title":"Front Cell Infect Microbiol","first-page":"39","article-title":"Pseudomonas aeruginosa Lifestyle: A paradigm for adaptation, survival, and persistence","volume":"7","author":"Moradali","year":"2017"},{"key":"b7","series-title":"Cells","first-page":"199","article-title":"Pseudomonas aeruginosa: Infections, animal modeling, and therapeutics","volume":"12","author":"Wood","year":"2023"},{"key":"b8","series-title":"Drugs","first-page":"2117","article-title":"The epidemiology and pathogenesis and treatment of Pseudomonas aeruginosa infections: An update","volume":"81","author":"Reynolds","year":"2021"},{"key":"b9","article-title":"WHO Bacterial Priority Pathogens List, 2024: Bacterial Pathogens of Public Health Importance to Guide Research, Development and Strategies to Prevent and Control Antimicrobial Resistance.","year":"2024"},{"key":"b10","series-title":"J Hosp Infect","first-page":"134","article-title":"Incremental clinical and economic burden of suspected respiratory infections due to multi-drug-resistant Pseudomonas aeruginosa in the United States","volume":"103","author":"Tabak","year":"2019"},{"key":"b11","series-title":"Microbes Infect Dis","article-title":"Epidemiology and multidrug resistance of Pseudomonas aeruginosa: A decade of surveillance at a Tunisian Hospital","author":"Mfathia","year":"2024"},{"key":"b12","article-title":"Recommendations 2024, V.1.0 June.","year":"2024"},{"key":"b13","series-title":"Clin Microbiol Infect","first-page":"268","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2012"},{"key":"b14","series-title":"J Assoc Med Microbiol Infect Dis Can","first-page":"130","article-title":"Pseudomonas aeruginosa infection in intensive care: Epidemiology, outcomes, and antimicrobial susceptibilities","volume":"5","author":"Kula","year":"2020"},{"key":"b15","series-title":"Med Sci Monit","first-page":"PH69","article-title":"Risk factors and outcomes of intensive care unit-acquired infections in a Tunisian ICU","volume":"16","author":"Kallel","year":"2010"},{"key":"b16","series-title":"Tunis Med","first-page":"731","article-title":"The prevalence of healthcare-associated infection in medical intensive care units in Tunisia. Results of the multi-centre nosorea1 study","volume":"96","author":"Jamoussi","year":"2018"},{"key":"b17","series-title":"Front Microbiol","first-page":"1477836","article-title":"Prevalence of colistin resistance in clinical isolates of Pseudomonas aeruginosa: A systematic review and meta-analysis","volume":"15","author":"Narimisa","year":"2024"},{"key":"b18","article-title":"R\u00e9sistance Bact\u00e9rienne."},{"key":"b19","series-title":"PLoS One","first-page":"e0285856","article-title":"Ceftazidime resistance in Pseudomonas aeruginosa is multigenic and complex","volume":"18","author":"Ramsay","year":"2023"},{"key":"b20","series-title":"Pathol Biol","first-page":"307","article-title":"\u00c9tude in\u00a0vitro de la sensibilit\u00e9 aux antibiotiques de 213 souches de Pseudomonas aeruginosa isol\u00e9es au service de r\u00e9animation du CHU de Sfax (Tunisie)","volume":"41","author":"Karray","year":"1993"},{"key":"b21","series-title":"IJID","first-page":"250","article-title":"Activity 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de r\u00e9animation des br\u00fbl\u00e9s durant sept ans","volume":"32","author":"Krir","year":"2019"},{"key":"b25","series-title":"Microb Drug Resist","first-page":"1437","article-title":"Characterization of VIM-4 producing clinical Pseudomonas aeruginosa isolates from western Algeria: Sequence type and class 1 integron description","volume":"26","author":"Zaidi","year":"2020"},{"key":"b26","series-title":"Afr J Microbiol Res","first-page":"3005","article-title":"Epidemiology of Pseudomonas aeruginosa in intensive care unit and otolaryngology department of a Tunisian hospital","volume":"5","author":"Ben Slama","year":"2011"},{"key":"b27","series-title":"Antibiotics (Basel)","first-page":"1621","article-title":"Resistance in Pseudomonas aeruginosa: A narrative review of antibiogram interpretation and emerging treatments","volume":"12","author":"Giovagnorio","year":"2023"},{"key":"b28","series-title":"BMC Infect Dis","first-page":"763","article-title":"Phenotypic and genotypic assessment of fluoroquinolones and aminoglycosides resistances in Pseudomonas aeruginosa collected from Minia hospitals, Egypt during COVID-19 pandemic","volume":"24","author":"Boushra","year":"2024"},{"key":"b29","series-title":"3 Biotech","first-page":"1","article-title":"Quinolone-resistant clinical strains of Pseudomonas aeruginosa isolated from University Hospital in Tunisia","volume":"8","author":"Ben Nejma","year":"2018"},{"key":"b30","series-title":"Clin Microbiol Infect","first-page":"794","article-title":"Nosocomial outbreak of OXA-18-producing Pseudomonas aeruginosa in Tunisia","volume":"13","author":"Kalai Blagui","year":"2007"},{"key":"b31","series-title":"Microb Drug Resist","first-page":"295","article-title":"Emergence of SHV-2a extended-spectrum \u03b2-lactamases in clinical isolates of Pseudomonas aeruginosa in a university hospital in Tunisia","volume":"15","author":"Mansour","year":"2009"},{"key":"b32","series-title":"Acute Crit Care","first-page":"84","article-title":"Clinical characteristics and outcomes of critically ill COVID-19 patients in Sfax, Tunisia","volume":"37","author":"Bahloul","year":"2022"},{"key":"b33","series-title":"J Antimicrob Chemother","first-page":"1837","article-title":"Decline of antimicrobial resistance in Pseudomonas aeruginosa bacteraemia following the COVID-19 pandemic: A longitudinal observational study","volume":"80","author":"Butscheid","year":"2025"},{"key":"b34","series-title":"mSphere","first-page":"e00202-21","article-title":"Epidemiology of multidrug-resistant Pseudomonas aeruginosa in the Middle East and North Africa region","volume":"6","author":"Al-Orphaly","year":"2021"},{"key":"b35","series-title":"Clin Microbiol Rev","first-page":"e00031-19","article-title":"Epidemiology and treatment of multidrug-resistant and extensively drug-resistant Pseudomonas aeruginosa infections","volume":"32","author":"Horcajada","year":"2019"},{"key":"b36","series-title":"Antimicrob Agents 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