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Review
. 2024 Aug;52(4):1235-1268.
doi: 10.1007/s15010-024-02313-x. Epub 2024 Jul 2.

Impact of multidrug resistance on the virulence and fitness of Pseudomonas aeruginosa: a microbiological and clinical perspective

Elena Sendra #  1 , Almudena Fernández-Muñoz  2 , Laura Zamorano  2 , Antonio Oliver  2   3 , Juan Pablo Horcajada  1   3 , Carlos Juan #  4   5 , Silvia Gómez-Zorrilla #  6   7
Affiliations
Review

Impact of multidrug resistance on the virulence and fitness of Pseudomonas aeruginosa: a microbiological and clinical perspective

Elena Sendra et al. Infection. 2024 Aug.

Abstract

Pseudomonas aeruginosa is one of the most common nosocomial pathogens and part of the top emergent species associated with antimicrobial resistance that has become one of the greatest threat to public health in the twenty-first century. This bacterium is provided with a wide set of virulence factors that contribute to pathogenesis in acute and chronic infections. This review aims to summarize the impact of multidrug resistance on the virulence and fitness of P. aeruginosa. Although it is generally assumed that acquisition of resistant determinants is associated with a fitness cost, several studies support that resistance mutations may not be associated with a decrease in virulence and/or that certain compensatory mutations may allow multidrug resistance strains to recover their initial fitness. We discuss the interplay between resistance profiles and virulence from a microbiological perspective but also the clinical consequences in outcomes and the economic impact.

Keywords: Pseudomonas aeruginosa; Antibiotic resistance; Biological cost; Difficult to treat resistance; Fitness; Multidrug resistance; Virulence.

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Conflict of interest statement

The authors declare no competing interests.

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