title: [Chronic bronchial infection: the problem of Pseudomonas aeruginosa].
abstract: Pathogenic bronchopulmonary colonizations and the exacerbations produced are among the most important causes of reduced pulmonary function in patients with bronchiectasis. The most frequent pathogens in these patients are Haemophilus influenzae and Pseudomonas aeruginosa. Lesions are produced by the local inflammatory process and the vicious circle developed by antigen stimulation, the release of inflammatory mediators, the presence of neutrophils, the increase of bacterial inoculum and the release of bacterial exoproducts. P. aeruginosa has been demonstrated to affect the patients with bronchiectasis and poorest quality of life and to colonize those with the poorest pulmonary function and the highest number of antimicrobial treatments. In bronchiectasis, as in chronic obstructive pulmonary disease (COPD) or cystic fibrosis, P. aeruginosa is able to colonize the respiratory mucosa chronically. Due to the ecological niche occupied by P. aeruginosa and the multitude of cycles with antimicrobial agents to which these patients are subjected, the development of antimicrobial resistance is highly likely, encouraged by the high proportion of hypermutation variants in existence. Likewise, P. aeruginosa naturally grows in the form of biofilms on the mucosal surface, greatly contributing to its persistence. Antimicrobial treatment in patients with bronchiectasis and P. aeruginosa colonization should be based on antimicrobial agents, alone or in combination, that do not lose activity when acting on biofilms.
authors.affiliation: Servicio de Microbiología y CIBER en Epidemiología y Salud Pública, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón y Cajal, Madrid, España. rcanton.hrc@salud.madrid.org
authors.forename: Rafael
authors.initials: R
authors.lastname: Cantón
authors.forename: Ana
authors.initials: A
authors.lastname: Fernández Olmos
authors.forename: Elia Gómez G
authors.initials: EG
authors.lastname: de la Pedrosa
authors.forename: Rosa
authors.initials: R
authors.lastname: del Campo
authors.forename: María
authors.initials: M
authors.lastname: Antonia Meseguer
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D018441:Biofilms / Q000187:drug effects; D001987:Bronchiectasis / Q000382:microbiology*; D002908:Chronic Disease; D024881:Drug Resistance, Bacterial; D006801:Humans; D011552:Pseudomonas Infections / Q000150:complications* / Q000188:drug therapy; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000502:physiology
chemical_list: D000900:Anti-Bacterial Agents