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Updated: Aug 25, 2025
Replication of the Ordered, Nonredundant Library of Pseudomonas aeruginosa strain PA14 Transposon Insertion Mutants
Published on: May 4, 2018
How to Manage Pseudomonas aeruginosa Infections
Matthaios Papadimitriou-Olivgeris1, Damien Jacot2, Benoit Guery3
1Department of Medicine, Infectious Diseases Service, University Hospital and University of Lausanne, Lausanne, Switzerland.
Abstract:
Pseudomonas aeruginosa is a pathogen frequently encountered in healthcare-associated infections and immunocompromised patients. In bacteremia, this pathogen is associated with higher mortality than other Gram-negative pathogens. This increase in mortality was also found globally for multi-resistant compared to susceptible strains. Several factors have been associated with the development of resistance: previous ICU stay, use of carbapenems, and comorbidities were identified in multivariate analysis. In the therapeutic choice, previous antibiotic treatment remains the strongest driver suggesting a potential resistant strain. These risk factors will decide whether multi-resistant strains must be considered in the empiric coverage. For susceptible strains, a single agent can be used, β-lactams are usually the first choice. Associations do not provide any advantage on mortality. Optimization of pharmacokinetic/pharmacodynamic parameters, such as prolonged infusion (for time-dependent antibiotics), increased dosage (for concentration-dependent antibiotics), and therapeutic drug monitoring, also influences the outcome. The increasing number of resistant strains led the clinician to use either recently approved new molecules but also associations. For multi-resistant strains, new molecules such as ceftolozane-tazobactam, ceftazidime-avibactam, and cefiderocol have shown an adequate activity against P. aeruginosa. Older molecules like colistin and fosfomycin are also used in this indication. The complexity of the resistance and consequences on a larger scale of antibiotic prescription will probably lead to more individualized prescriptions.
Insights
Pseudomonas aeruginosa bacteremia increases mortality, especially with multi-resistant strains. Risk factors like ICU stay and carbapenem use predict resistance, guiding treatment choices for better patient outcomes.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Pharmacology
Background:
- Pseudomonas aeruginosa is a significant cause of healthcare-associated infections, particularly in immunocompromised patients.
- P. aeruginosa bacteremia is linked to higher mortality rates compared to other Gram-negative pathogens, with multi-resistant strains showing increased global mortality.
- Factors such as prior ICU stay, carbapenem use, and comorbidities are associated with the development of P. aeruginosa resistance.
Purpose of the Study:
- To review the factors associated with Pseudomonas aeruginosa resistance.
- To discuss therapeutic strategies for susceptible and multi-resistant P. aeruginosa infections.
- To highlight the importance of individualized antibiotic prescriptions.
Main Methods:
- Literature review of studies on Pseudomonas aeruginosa infections, resistance mechanisms, and treatment outcomes.
- Analysis of risk factors for multi-drug resistance.
- Evaluation of current and emerging therapeutic options.
Main Results:
- Previous antibiotic treatment is a strong predictor of resistant strains, influencing empirical coverage decisions.
- For susceptible strains, monotherapy with beta-lactams is recommended; combination therapy does not improve mortality.
- Newer agents like ceftolozane-tazobactam, ceftazidime-avibactam, and cefiderocol, along with older drugs like colistin and fosfomycin, show activity against multi-resistant P. aeruginosa.
Conclusions:
- Risk stratification is crucial for determining appropriate empirical antibiotic coverage for P. aeruginosa.
- Optimizing pharmacokinetic/pharmacodynamic parameters and considering newer agents are vital for managing multi-resistant infections.
- The increasing complexity of resistance necessitates personalized antibiotic prescribing strategies.
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