Abstract
Pseudomonas aeruginosa is the most frequent cause of infection among non-fermenting Gram-negative bacteria, predominantly affecting immunocompromised patients, but its pathogenic role should not be disregarded in immunocompetent patients. These pathogens present a concerning therapeutic challenge to clinicians, both in community and in hospital settings, due to their increasing prevalence of resistance, and this may lead to prolonged therapy, sequelae, and excess mortality in the affected patient population. The resistance mechanisms of P. aeruginosa may be classified into intrinsic and acquired resistance mechanisms. These mechanisms lead to occurrence of resistant strains against important antibiotics—relevant in the treatment of P. aeruginosa infections—such as β-lactams, quinolones, aminoglycosides, and colistin. The occurrence of a specific resistotype of P. aeruginosa, namely the emergence of carbapenem-resistant but cephalosporin-susceptible (Car-R/Ceph-S) strains, has received substantial attention from clinical microbiologists and infection control specialists; nevertheless, the available literature on this topic is still scarce. The aim of this present review paper is to provide a concise summary on the adaptability, virulence, and antibiotic resistance of P. aeruginosa to a readership of basic scientists and clinicians.
Highlights
It may be said that the continuous expression of resistance-determinants hinders the virulence of the microorganism; the fitness burden associated with maintaining the MDR-phenotype was observed to be lower in case of the ST235 clones [71]
Some reports suggest that there may be an association between virulence and antibiotic resistance in P. aeruginosa isolates, as the carriage of the exoU genes was shown to correlate with resistance to aminoglycosides and fluoroquinolones
Lee et al performed a retrospective, case-control study including patients with Car-R/Ceph-S and pan-susceptible P. aeruginosa bacteremia over a 6-year period (2004–2010): n = 25 patients were recorded with CarR/Ceph-S bloodstream infections, their mortality was almost three times higher than the mortality of the control group (72% vs. 26%), and carbapenem-resistance was found as the only independent risk factor for mortality [241]
Summary
Gram-negative bacteria, predominantly affecting immunocompromised patients, but its pathogenic role should not be disregarded in immunocompetent patients These pathogens present a concerning therapeutic challenge to clinicians, both in community and in hospital settings, due to their increasing prevalence of resistance, and this may lead to prolonged therapy, sequelae, and excess mortality in the affected patient population. P. aeruginosa, namely the emergence of carbapenem-resistant but cephalosporin-susceptible (CarR/Ceph-S) strains, has received substantial attention from clinical microbiologists and infection control specialists; the available literature on this topic is still scarce. The aim of this present review paper is to provide a concise summary on the adaptability, virulence, and antibiotic resistance of P. aeruginosa to a readership of basic scientists and clinicians.
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