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[Multi-drug resistant Pseudomonas aeruginosa: towards a therapeutic dead end?]

François Barbier1, Michel Wolff

  • 1Service de réanimation médicale et des maladies infectieuses, Hôpital Bichat-Claude Bernard, Assistance publique-Hôpitaux de Paris, 46 rue Henri Huchard, Paris, France. francois.barbier@bch.aphp.fr

Medecine Sciences : M/S
|November 26, 2010
PubMed

Insights

Multi-drug resistant Pseudomonas aeruginosa (MDRPA) is a growing threat, often requiring colistin treatment. Emerging colistin resistance in MDRPA signals a potential future of pan-resistant strains.

Area of Science:

  • Clinical microbiology
  • Infectious diseases
  • Antimicrobial resistance

Background:

  • Pseudomonas aeruginosa is a significant hospital-associated pathogen.
  • Increasing incidence of multi-drug resistant P. aeruginosa (MDRPA) poses a serious clinical challenge.
  • MDRPA infections are particularly concerning in intensive care units and for patients with cystic fibrosis.

Purpose of the Study:

  • To review the mechanisms and clinical implications of multi-drug resistance in Pseudomonas aeruginosa.
  • To highlight the role of colistin as a last-resort antibiotic against MDRPA.
  • To discuss the emerging threat of colistin resistance in P. aeruginosa.

Main Methods:

  • Literature review of studies on Pseudomonas aeruginosa resistance mechanisms.
  • Analysis of antibiotic resistance patterns, focusing on MDRPA.
  • Examination of genetic events leading to multi-drug resistance.
  • Review of colistin's efficacy and emerging resistance.

Main Results:

  • MDRPA exhibits resistance to multiple antibiotic classes, including penicillins, cephalosporins, carbapenems, aminoglycosides, and fluoroquinolones.
  • Resistance mechanisms involve active efflux, porin loss, enzymatic inactivation of antibiotics, and target modification.
  • Colistin remains a critical treatment option for MDRPA infections.
  • Emergence of colistin resistance in P. aeruginosa has been reported, raising concerns about pan-resistance.

Conclusions:

  • Multi-drug resistant Pseudomonas aeruginosa is a major clinical concern due to accumulated resistance mechanisms.
  • Colistin is a vital therapeutic agent for MDRPA, but its effectiveness is threatened by emerging resistance.
  • The rise of colistin resistance may herald the future spread of pan-resistant strains, necessitating urgent surveillance and novel therapeutic strategies.

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