Twenty-Three Years Of Pseudomonas Aeruginosa Trends In South Africa: A Critical Review And Early Warning Of Post-Flood Polymicrobial Risks In Eastern Cape’s Vulnerable Or Tambo And Amathole Districts

Abstract

Background: Pseudomonas aeruginosa (P. aeruginosa) is a Gram-negative opportunistic pathogen recognized globally for its increasing antimicrobial resistance (AMR), biofilm formation, environmental persistence, and emerging ability to degrade medical-grade plastics. In South Africa, the pathogen has posed significant clinical and environmental challenges, particularly in flood-vulnerable and resource-constrained regions like KwaZulu-Natal and the Eastern Cape. Despite its global priority status, national preparedness for the evolving threat posed by P. aeruginosa remains unevenly documented and inadequately addressed.

Aim: This review aims to synthesize 23 years of South African literature on P. aeruginosa, identify gaps in AMR surveillance, and provide early warning of polymicrobial risks following climate-related disasters in vulnerable districts such as OR Tambo and Amathole in the Eastern Cape.

Methodology: A systematic literature review was conducted using electronic databases (PubMed, Scopus, African Journals Online, Web of Science) to retrieve studies published between 2002 and 2025 focusing on P. aeruginosa in clinical and environmental settings across South Africa. Studies were included if they addressed antibiotic resistance trends, carbapenemase gene prevalence, biofilm formation, plastic-degrading enzymes, or hospital outbreaks. Data were synthesized thematically to map resistance trends, identify geographic hotspots, and assess emerging risk factors including climate-related disruptions.

Results: Across more than two decades, P. aeruginosa consistently ranked among the top isolated Gram-negative pathogens in tertiary hospitals across KwaZulu-Natal, with growing reports of multidrug resistance (MDR), extended-spectrum beta-lactamase (ESBL) production, and limited carbapenem susceptibility. Recent studies have detected strains capable of degrading polycaprolactone (PCL), using it as a carbon source to enhance survival and virulence. Environmental isolates have also been reported in Eastern Cape freshwater sources, signaling a broader ecological threat. Flood-related infrastructure damage and water contamination are predicted to escalate the spread of these resistant strains in underserved communities.

Conclusion: P. aeruginosa represents an escalating threat to South African public health, with mounting evidence of its ability to adapt, persist, and resist treatment. Surveillance gaps, especially in high-risk flood-prone provinces, raise serious questions about the country’s disaster readiness. Urgent investment in AMR monitoring, plastic-degradation screening, and climate-health integrated policies is recommended to mitigate the long-term impact of this versatile pathogen.