Approach to the treatment of patients with serious multidrug‐resistant Pseudomonas aeruginosa infections

Multidrug resistance among Pseudomonas aeruginosa (MDR-PSA) isolates presents a significant clinical challenge and can substantially complicate the approach to selection of optimal antibiotic therapy. This review addresses major considerations in antibiotic selection for patients with suspected or documented serious MDR-PSA infections. Common mechanisms contributing to MDR among clinical PSA isolates are summarized. Empiric and definitive therapy considerations are addressed including the potential role of combination therapy. Newer agents with in vitro activity against MDR-PSA (e.g. ceftolozane/tazobactam, ceftazidime/avibactam, imipenem/relebactam and cefiderocol) and their potential roles in clinical settings are discussed. Though these newer agents are promising options for the treatment of MDR-PSA, clinical data remain generally limited. Future studies are needed to determine optimal agents for the empiric and definitive treatment of MDR-PSA.