[Strategies for management of difficult to treat Gram-negative infections: focus on Pseudomonas aeruginosa].

Pseudomonas aeruginosa is often involved in the aetiology of numerous infections, particularly those occurring in hospital. The infections in which P. aeruginosa most frequently has a pathogenic role include respiratory tract infections, particularly those occurring in patients with chronic obstructive pulmonary disease (COPD), nosocomial pneumonia, ventilator-associated pneumonia, and cystic fibrosis, as well as those developing in patients with AIDS, bacteraemia, sepsis, urinary tract infections, especially those related to catheterisation or kidney transplants, infections in neutropenic patients, and skin infections, particular those developing in surgical wounds or in burns. Thus, in practice, P. aeruginosa is ubiquitously present in all body districts. Particular attention should also be given to the presence of P. aeruginosa in the community setting, for example when it causes community-acquired pneumonia in the elderly or pneumonia in patients with advanced stage COPD. The mortality rate of patients with severe P. aeruginosa infections is very high. Treatment should be initiated very promptly with the most suitable drug, perhaps making use of combination therapy with a beta-lactam and a fluoroquinolone when indicated, and continued for a sufficiently long period. As far as concerns future therapeutic options for the treatment of P. aeruginosa infections, the only two new molecules that will probably become available are doripenem and ceftobiprole. Given this prospective, trust must be placed in the already known drugs, exploiting them more appropriately.