Resistance mechanisms and therapeutic strategies for <i>Pseudomonas aeruginosa</i> infections

<i>Pseudomonas aeruginosa</i> is one of the most clinically important Gram-negative bacteria and is related to many severe and life-threatening infections worldwide. It presents intrinsic resistance against many antibiotics and has the ability to acquire or develop additional mechanisms to overcome the action of all anti-pseudomonal drugs. Formerly abandoned antibiotics and new compounds such as cefiderocol and combinations of β-lactams with new β-lactamase inhibitors are considered for the treatment of infections due to multi- or extensively-drug-resistant strains. In the present review, the antimicrobial resistance mechanisms of <i>P. aeruginosa</i> and the potential treatment options for the difficult to treat <i>P. aeruginosa</i> infections are discussed in an attempt to correlate microbiological and laboratory data to the choice of optimal treatment in everyday clinical practice.