Multidrug-resistant Pseudomonas aeruginosa infections: current status, challenges, and prospects of phage therapy

The emergence of drug-resistant bacterial infections has profoundly impacted global public health. Key pathogens include multidrug-resistant <i>Pseudomonas aeruginosa</i> (MDR-PA), MDR <i>Acinetobacter baumannii</i>, and methicillin-resistant <i>Staphylococcus aureus</i>. Among these pathogens, MDR-PA carries numerous virulence factors that induce extensive tissue destruction. Its inherent ability to form biofilms promotes chronic infection persistence and multidrug resistance, leading to mortality rates up to 40%. Currently, antibiotics remain the mainstay for the treatment of MDR-PA infections. Nevertheless, the escalating prevalence of drug resistance has rendered conventional antibiotic regimens increasingly recalcitrant. Consequently, the imperative for innovative antimicrobial therapeutic modalities to combat <i>Pseudomonas aeruginosa</i> has intensified in the realm of public health. In this context, phage therapy, with its precise bactericidal activity and high host biosafety, has emerged as a compelling alternative. This review provides a comprehensive synthesis of recent advancements in phage therapy targeting MDR-PA, covering clinical applications, current therapeutic approaches, and emerging technological platforms. It further dissects the resistance mechanisms encountered during treatment and puts forward novel counterstrategies to address antimicrobial resistance challenges-including optimized phage-antibiotic synergy, phage genome engineering, and dynamic adaptive therapeutic frameworks-aimed at advancing clinical translation.