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Pseudomonas aeruginosa (P.aeruginosa) remains a prominent nosocomial pathogen responsible for high morbi-mortality in intensive care units (ICUs). P.aeruginosa transmission is known to be partly endogenous and exogenous. Main factors have been highlighted but the precise role of environment in regard to antibiotics use remained unclear.ObjectiveTo assess the role of environment, medical care and individual risks factors for P. aeruginosa colonization and infection.Study design and settingA French multicentric prospective study involved ten ICUs for a five months period. Every adult patient newly hospitalized in ICUs with no P. aeruginosa carriage up to 48 hours after admission was included and weekly screened before discharge or death. Screening swabs were either rectal, sputum or oropharyngeal samples. Hydric environment was also sampled each week. Data on patient clinical features, environmental and device exposures, and antibiotics supports were regularly collected. Multivariate analysis was performed with a multistate model.ResultsThe overall prevalence of P. aeruginosa carriage was 15.3% (201/1314). Risk factors associated with patient colonization were: use of inactive antibiotics against P. aeruginosa (HR = 1.60 [1.15–2.21] p<0.01), tap water contamination at the entry in the room (HR = 1.66 [1.01–2.27] p<0.05) and mechanical invasive ventilation (HR = 4.70 [2.66–8.31] p<0.0001). Active antibiotics prevented from colonization (HR = 0.67 [0.48–0.93] p = 0.02) and from infection (HR = 0.64 [0.41–1.01] p = 0.05). Interaction between hydric environment antibiotics support was not statistically associated with patient colonization.ConclusionHydric contamination and antibiotics pressure seem to remain key independent risk factors in P. aeruginosa colonization. These results advocate the need to carry on preventive and targeted interventions toward healthcare associated infections.