title: The problems of antibiotic resistance in cystic fibrosis and solutions.
abstract: Chronic respiratory infection is the main cause of morbidity and mortality in cystic fibrosis (CF) patients. One of the hallmarks of these infections, led by the opportunistic pathogen Pseudomonas aeruginosa, is their long-term (lifelong) persistence despite intensive antimicrobial therapy. Antimicrobial resistance in CF is indeed a multifactorial problem, which includes physiological changes, represented by the transition from the planktonic to the biofilm mode of growth and the acquisition of multiple (antibiotic resistance) adaptive mutations catalyzed by frequent mutator phenotypes. Emerging multidrug-resistant CF pathogens, transmissible epidemic strains and transferable genetic elements (such as those encoding class B carbapenemases) also significantly contribute to this concerning scenario. Strategies directed to combat biofilm growth, prevent the emergence of mutational resistance, promote the development of novel antimicrobial agents against multidrug-resistant strains and implement strict infection control measures are thus needed.
authors.affiliation: Servicio de Microbiología and Unidad de Investigación, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Ctra. Valldemossa 79, 07010 Palma de Mallorca, Spain.
authors.forename: Carla
authors.initials: C
authors.lastname: López-Causapé
authors.forename: Estrella
authors.initials: E
authors.lastname: Rojo-Molinero
authors.forename: María D
authors.initials: MD
authors.lastname: Macià
authors.forename: Antonio
authors.initials: A
authors.lastname: Oliver
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018441:Biofilms / Q000187:drug effects / Q000254:growth & development; D002908:Chronic Disease; D003550:Cystic Fibrosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D005838:Genotype; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000382:microbiology / Q000503:physiopathology; D009154:Mutation; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000235:genetics / Q000254:growth & development; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology
chemical_list: D000900:Anti-Bacterial Agents
keywords: PK/PD parameters; Pseudomonas aeruginosa; biofilms; combined treatment; cystic fibrosis; epidemic strains; hypermutation; infection control; multidrug resistance; sequential treatment