Current and future options for the treatment of serious infections due to carbapenem-resistant Pseudomonas aeruginosa.

SUMMARYPseudomonas aeruginosa is a frequent cause of hospital-acquired infections and is notable both for its virulence and its resistance to multiple antibiotics. In the absence of head-to-head clinical trials and availability of all potential options on a global basis, we have systematically analyzed potential antibiotics for carbapenem-resistant P. aeruginosa. Monotherapy with ceftazidime-avibactam, imipenem-cilastatin-relebactam, cefiderocol, or high doses of ceftolozane-tazobactam is generally considered an acceptable option for serious infections due to carbapenem-resistant P. aeruginosa. The role of testing combinations of antimicrobial agents for in vitro susceptibility is uncertain, as is the administration of nebulized colistin or amikacin in patients with ventilator-associated pneumonia. With regard to new therapies, 10 clinical trials are underway or have been completed on bacteriophage therapy for P. aeruginosa infections. However, no phage options are yet widely approved for use. Other new options in clinical trials include beta-lactam antibiotics combined with new beta-lactamase inhibitors and antibody-based therapies.