Treatment of central nervous system infections caused by Pseudomonas aeruginosa with difficult-to-treat resistance: a narrative review.

Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-PA) refers to Pseudomonas aeruginosa that is non-susceptible to all first-line antimicrobial agents. With limited therapeutic options available, it poses a severe challenge to anti-infective therapy. For central nervous system infections caused by DTR-PA (DTR-PA-CNSI), the selection of antimicrobial agents is further restricted due to the presence of the blood-brain barrier. The continuous emergence of novel antimicrobial agents, especially new β-lactam antimicrobials, has provided more therapeutic alternatives for DTR-PA infections. This paper mainly discusses the pharmacokinetic/pharmacodynamic studies and clinical research of traditional antimicrobial agents (ceftolozane-tazobactam, ceftazidime-avibactam, aztreonam-avibactam, and cefiderocol) and novel antimicrobial agents (aminoglycosides, polymyxins, and fosfomycin) in the treatment of DTR-PA-CNSI, to evaluate their feasibility and the selection of therapeutic regimens for DTR-PA-CNSI and provide new strategies for clinical medication.