Metallo-β-lactamase-producing Pseudomonas aeruginosa: epidemiology, diagnostic challenges and therapeutic strategies in the era of MDR/XDR resistance
Abstract
Background: The management of multidrug-resistant (MDR) Pseudomonas aeruginosa has evolved from an antibiotic-centric approach to a mechanism-driven paradigm. Among resistance determinants, metallo-β-lactamases (MBLs) represent a critical challenge due to their ability to hydrolyse most β-lactams and their increasing global dissemination within high-risk clones.
Methods: This narrative review aims to summarize the epidemiology, diagnostic approaches and therapeutic strategies for infections caused by MBL-producing P. aeruginosa, emphasizing a mechanism-based clinical framework. A PubMed-MEDLINE search was conducted up to 1 June 2026 using the terms "Pseudomonas aeruginosa", "carbapenem resistance", and "metallo-β-lactamase". Relevant studies were selected based on the authors' assessment of methodological quality and clinical relevance.
Results: P. aeruginosa exhibits multifactorial resistance involving intrinsic mechanisms (efflux pumps, AmpC overexpression, porin loss), adaptive responses and acquired carbapenemases. MBLs, especially VIM, IMP, and emerging NDM variants, are increasingly associated with carbapenem resistance and epidemic high-risk clones (e.g., ST235, ST111). Global epidemiology shows marked geographic variability in prevalence and molecular types. Diagnostic workup remains challenging due to the coexistence of enzymatic and non-enzymatic mechanisms, requiring integrated use of phenotypic antibiotic susceptibility testing (AST), carbapenemase detection…
Read the paper
Related studies
- Association of lower urinary tract symptoms and OAB severity with quality of life and mental health in China, Taiwan and South Korea: results from a cross-sectional, population-based study
- Ten-Day Quadruple Therapy Comprising Low-Dose Rabeprazole, Bismuth, Amoxicillin, and Tetracycline Is an Effective and Safe First-Line Treatment for Helicobacter pylori Infection in a Population with High Antibiotic Resistance: a Prospective, Multicenter, Randomized, Parallel-Controlled Clinical Trial in China
- The Role of the NLR and PLR in Urinary Tract Infection
- Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic
- Leclercia adecarboxylata urinary tract infection in a patient with bladder cancer and recurrent hematuria
- A Case Series of Staphylococcus lugdunensis Infection in Cancer Patients at an Academic Cancer Institute in the United States
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.