Falling Behind In The Fight: The Persistent And Evolving Threat Of Pseudomonas Aeruginosa In Healthcare And Ecosystems

Abstract

Pseudomonas aeruginosa is a ubiquitous Gram-negative opportunistic pathogen associated with high morbidity and mortality in immunocompromised populations, including those with cystic fibrosis, burn wounds, and ventilator-associated pneumonia. Globally, P. aeruginosa continues to demonstrate multidrug resistance (MDR), extensively drug resistance (XDR), and pan-drug resistance (PDR), which complicates therapeutic strategies.

This literature review was conducted by systematically searching for relevant articles published in peer-reviewed journals focusing on Pseudomonas aeruginosa globally. Databases such as PubMed, Scopus, and Google Scholar were utilized to gather studies from the last three decades using the following keywords Pseudomonas aeruginosa, multidrug resistance, carbapenemase, metallo-β-lactamase, nosocomial infections, resistance genes, polymicrobial infections.

Selected articles were analysed for their findings on the epidemiology, resistance patterns, and clinical implications of P. aeruginosa infections globally and to check if the world is catching up with the evolution of this organism.

This review critically evaluates global (non-South African) literature on the prevalence, antimicrobial resistance mechanisms, and clinical impact of P. aeruginosa across clinical and environmental settings. Findings indicate an alarming rise in resistance to β-lactams, fluoroquinolones, aminoglycosides, and carbapenems—largely driven by the dissemination of resistance genes such as blaVIM, blaIMP, blaNDM, blaGES, and blaOXA. Key resistance mechanisms include metallo-β-lactamase production, porin mutations, efflux pump overexpression, and biofilm-mediated tolerance. Geographically, high resistance rates have been observed in Asia (India, China), Europe (Italy, Greece), Latin America (Brazil), and the Middle East (Iran, Saudi Arabia). Despite these findings, there is evidence that research and surveillance efforts are lagging in addressing P. aeruginosa globally, particularly in terms of coordinated monitoring, molecular epidemiology, and the development of novel antimicrobial agents.