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Clinical Microbiology Reviews, October 2009, p. 582-610, Vol. 22, No. 4
0893-8512/09/$08.00+0     doi:10.1128/CMR.00040-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Antibacterial-Resistant Pseudomonas aeruginosa: Clinical Impact and Complex Regulation of Chromosomally Encoded Resistance Mechanisms

Philip D. Lister,1* Daniel J. Wolter,2 and Nancy D. Hanson1 Author Bios

Department of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, Nebraska,1 Department of Pediatrics, University of Washington, Seattle, Washington2

Summary: Treatment of infectious diseases becomes more challenging with each passing year. This is especially true for infections caused by the opportunistic pathogen Pseudomonas aeruginosa, with its ability to rapidly develop resistance to multiple classes of antibiotics. Although the import of resistance mechanisms on mobile genetic elements is always a concern, the most difficult challenge we face with P. aeruginosa is its ability to rapidly develop resistance during the course of treating an infection. The chromosomally encoded AmpC cephalosporinase, the outer membrane porin OprD, and the multidrug efflux pumps are particularly relevant to this therapeutic challenge. The discussion presented in this review highlights the clinical significance of these chromosomally encoded resistance mechanisms, as well as the complex mechanisms/pathways by which P. aeruginosa regulates their expression. Although a great deal of knowledge has been gained toward understanding the regulation of AmpC, OprD, and efflux pumps in P. aeruginosa, it is clear that we have much to learn about how this resourceful pathogen coregulates different resistance mechanisms to overcome the antibacterial challenges it faces.

* Corresponding author. Mailing address: Department of Medical Microbiology and Immunology, Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68178. Phone: (402) 280-1224. Fax: (402) 280-1875. E-mail: pdlister{at}creighton.edu

Clinical Microbiology Reviews, October 2009, p. 582-610, Vol. 22, No. 4
0893-8512/09/$08.00+0     doi:10.1128/CMR.00040-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.





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