Global epidemiology of carbapenem-resistant Pseudomonas aeruginosa

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a common pathogen that is responsible for infections that cause high morbidity and mortality worldwide. Carbapenem resistance in P. aeruginosa may be mediated by multiple mechanisms, including changes in outer membrane permeability, efflux pumps, or production of carbapenemases. While approximately one-quarter of P. aeruginosa isolates are resistant to carbapenems worldwide, the global distribution of CRPA and carbapenemase-producing isolates varies by geographic region. The proportion of P. aeruginosa isolates that are resistant to carbapenems is particularly high in certain countries in Latin America, Eastern Europe, Southeast Asia, Africa, and the Middle East. Carbapenemase-producing CRPA isolates are rare in the USA (2%) but are more commonly encountered in other regions, with the metallo-β-lactamase (MBL) Verona integron-encoded MBL (VIM) predominating in many countries. Patients at greatest risk for infections due to CRPA include hospitalized patients, particularly those in intensive care units, residents of long-term acute-care hospitals, immunocompromised patients, and patients with cystic fibrosis. When traditional antipseudomonal agents lack activity against CRPA, novel β-lactam/β-lactamase inhibitor combinations may be effective treatment options, and cefiderocol may retain in vitro activity against MBL-producing CRPA. Continued epidemiologic monitoring and development of new antibiotics will be crucial to combatting the global threat of CRPA.