β-Lactam/β-lactamase inhibitor combinations and carbapenems are the first-line treatments for multidrug-resistant Pseudomonas aeruginosa (P. aeruginosa) infections. However, carbapenem resistance is increasing globally at an alarming rate, which is especially concerning given the pivotal role of these agents. This study comprehensively evaluated the global distribution of carbapenem resistance in clinical P. aeruginosa isolates. The keywords including ‘Pseudomonas’, P. aeruginosa’, ‘P. aeruginosa’, ‘resistance’, ‘susceptibility’, ‘carbapenem antibiotics’, ‘carbapenems’, ‘imipenem’, ‘meropenem’, ‘ertapenem’, ‘doripenem’, as well as ‘prevalence’ and ‘incidence’ were searched in electronic databases as the appropriate keywords. After screening, 160 studies were excluded, with 87 eligible studies from diverse geographic regions retained for final analysis. A comprehensive meta-analysis was then conducted on the data collected. The mean resistance rates (95% CI) were 33.3% (imipenem), 23.3% (meropenem), 60.9% (ertapenem), and 36.7% (doripenem). The time trend analysis showed that the resistance to meropenem has increased from the year 1997 to 2023. Meta-analysis showed substantial heterogeneity (I2 = 92%, p < 0.05) but no significant publication bias by Egger’s or Begg’s test. Global carbapenem resistance is alarmingly high in clinical P. aeruginosa isolates. The increasing prevalence of carbapenem-resistant P. aeruginosa is a major global health threat requiring urgent action through new antimicrobials and improved antibiotic stewardship to protect these last-line drugs.

In September 2023, the UK Health Security Agency’s (UKHSA) South West Health Protection Team received notification of patients with Pseudomonas aeruginosa perichondritis. All five cases had attended the same cosmetic piercing studio and a multi-disciplinary outbreak control investigation was subsequently initiated. An additional five cases attending the same studio were found. Seven of the ten cases had isolates available for Variable Number Tandem Repeat (VNTR) typing at the UKHSA national reference laboratory. Clinical and environmental P. aeruginosa isolates from the patients, handwash sink, tap water and throughout the wall-mounted point-of-use water heater (including outlet water) were indistinguishable by VNTR typing (11,6,2,2,1,3,6,3,11). No additional cases were identified after control measures were implemented, which included replacing the sink and point-of-use heater.

The lack of specific recommendations to control for P. aeruginosa within Council-adopted ear-piercing byelaws or national guidance means that a cosmetic piercing artist could inadvertently overlook the risks from this bacterial pathogen despite every intention to comply with the law and follow industry best practice advice. Clinicians, Environmental Health Officers and public health professionals should remain alert for single cases of Pseudomonas perichondritis infections associated with piercings and have a low threshold for notification to local health protection teams.