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Pseudomonas aeruginosa Pneumonia: Evolution of Antimicrobial Resistance and Implications for Therapy

Joseph P Lynch1, George G Zhanel2

  • 1Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California.

Seminars in Respiratory and Critical Care Medicine
|January 21, 2022
PubMed

Insights

Pseudomonas aeruginosa (PA) causes serious hospital infections, especially in vulnerable patients. Antimicrobial resistance in PA is a growing global problem, complicating treatment and increasing mortality.

Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • Pseudomonas aeruginosa (PA) is a gram-negative bacillus frequently causing nosocomial infections in critically ill patients.
  • PA infections occur in the lungs (ventilator-associated pneumonia), urinary tract, bloodstream, and other sites, posing significant risks.
  • Healthy individuals are rarely affected, but those with comorbidities, advanced age, or medical devices are highly susceptible.

Purpose of the Study:

  • To highlight the significance of Pseudomonas aeruginosa as a cause of various nosocomial pneumonias.
  • To discuss the escalating challenge of antimicrobial resistance (AMR) in PA.
  • To review current therapeutic strategies for pseudomonal infections, including empirical and definitive treatments.

Main Methods:

  • Literature review and synthesis of existing data on Pseudomonas aeruginosa epidemiology, pathogenicity, and antimicrobial resistance.
  • Analysis of treatment challenges and outcomes associated with PA infections, particularly VAP and bacteremia.
  • Discussion of the global dissemination of multidrug-resistant PA clones.

Main Results:

  • Antimicrobial resistance in Pseudomonas aeruginosa has significantly increased globally over the past three decades.
  • PA exhibits intrinsic resistance to many antimicrobials and can acquire further resistance during treatment.
  • Mortality rates for pseudomonal ventilator-associated pneumonia and bacteremia are high, exceeding 35%.

Conclusions:

  • Pseudomonas aeruginosa remains a critical pathogen in healthcare settings, necessitating careful management.
  • The rise of antimicrobial resistance in PA poses a major therapeutic challenge.
  • Optimal treatment strategies for PA infections, especially pneumonia and bacteremia, require ongoing research and clinical consensus.

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