How to manage Pseudomonas aeruginosa infections

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Matteo Bassetti MD, PhD, Antonio Vena MD, Antony Croxatto PhD, Elda Righi MD, PhD, Benoit Guery MD, PhD

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Infections with Pseudomonas aeruginosa have become a real concern in hospital-acquired infections, especially in critically ill and immunocompromised patients. The major problem leading to high mortality lies in the appearance of drug-resistant strains. Therefore, a vast number of approaches to develop novel anti-infectives is currently pursued. Diverse strategies range from killing (new antibiotics) to disarming (antivirulence) the pathogen. In this review, selected aspects of P. aeruginosa antimicrobial resistance and infection management will be addressed. Many studies have been performed to evaluate the risk factors for resistance and the potential consequences on mortality and attributable mortality. The review also looks at the mechanisms associated with resistance – P. aeruginosa is a pathogen presenting a large genome, and it can develop a large number of factors associated with antibiotic resistance involving almost all classes of antibiotics. Clinical approaches to patients with bacteremia, ventilator-associated pneumonia, urinary tract infections and skin soft tissue infections are discussed. Antibiotic combinations are reviewed as well as an analysis of pharmacokinetic and pharmacodynamic parameters to optimize P. aeruginosa treatment. Limitations of current therapies, the potential for alternative drugs and new therapeutic options are also discussed.

Keywords: bloodstream infection, ceftazidime-avibactam, ceftolozane-tazobactam, multidrug resistance, new antibiotics, Pseudomonas aeruginosa, ventilator associated pneumonia.

Citation: Bassetti M, Vena A, Croxatto A, Righi E, Guery B. How to manage Pseudomonas aeruginosa infections. Drugs in Context 2018; 7: 212527. DOI: 10.7573/dic.212527

Disclosure and potential conflicts of interest: The authors declare no conflicts of interest. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors are available for download at

Copyright: Copyright © 2018 Bassetti M, Vena A, Croxatto A, Righi E, Guery B. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2018 Bassetti M, Vena A, Croxatto A, Righi E, Guery B. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

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Correspondence: Matteo Bassetti, Clinica di Malattie Infettive, Azienda Ospedaliera Universitaria Integrata di Udine, Piazzale Santa Maria della Misericordia 15, 33010 Udine, Italy.

Provenance: invited; externally peer reviewed.

Submitted: 1 February 2018; Peer review comments to author: 8 March 2018; Revised manuscript received: 3 April 2018; Accepted: 4 April 2018; Publication date: 29 May 2018.

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