New treatments in Pseudomonas aeruginosa ventilator-associated pneumonia

Abstract

Pseudomonas aeruginosa is frequently responsible for hospital-acquired pneumonia, especially in intensive care unit (ICU) patients. A foreseeable increase in antibiotic resistance, evolving faster than development of new antibiotics, favors the high morbidity and mortality of these infections. While former molecules are reemerging due to their sustained efficacy like colistin, new antibiotics, new inhibitors of resistance as well as topical antibiotics by aerosol are currently developed to improve the available therapeutic options. Innovative research has emerged to develop alternatives for prevention and treatment of P. aeruginosa pneumonia. Antimicrobial peptides, carbon monoxidereleasing molecules, and pyocins should widen the field of antimicrobial molecules. New treatments aim to modulate P. aeruginosa phenotype by inhibiting bacterial adhesion and communication including macrolides to inhibit the quorum-sensing. Moreover, rediscovery of lytic bacteriophages, which are specific viruses inducing bacterial lysis, is recent in Western countries despite large-scale use in Eastern Europe following the Second World War. Bacteriophages may be suitable for the treatment of ventilator-associated pneumonia, especially if related to multidrug resistant P. aeruginosa. Finally, epidemiological and experimental data may lead us to focus on the role played by fungal colonization in the pathogenesis of bacterial pneumonia.