The problems of antibiotic resistance in cystic fibrosis and solutions

Expert Rev Respir Med. 2015 Feb;9(1):73-88. doi: 10.1586/17476348.2015.995640. Epub 2014 Dec 26.


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.

Keywords: PK/PD parameters; Pseudomonas aeruginosa; biofilms; combined treatment; cystic fibrosis; epidemic strains; hypermutation; infection control; multidrug resistance; sequential treatment.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use*
  • Biofilms / drug effects
  • Biofilms / growth & development
  • Chronic Disease
  • Cystic Fibrosis / complications*
  • Cystic Fibrosis / diagnosis
  • Cystic Fibrosis / physiopathology
  • Drug Resistance, Multiple, Bacterial* / genetics
  • Genotype
  • Humans
  • Lung / drug effects*
  • Lung / microbiology
  • Lung / physiopathology
  • Mutation
  • Pseudomonas Infections / diagnosis
  • Pseudomonas Infections / drug therapy*
  • Pseudomonas Infections / microbiology
  • Pseudomonas Infections / physiopathology
  • Pseudomonas aeruginosa / drug effects*
  • Pseudomonas aeruginosa / genetics
  • Pseudomonas aeruginosa / growth & development
  • Respiratory Tract Infections / diagnosis
  • Respiratory Tract Infections / drug therapy*
  • Respiratory Tract Infections / microbiology
  • Respiratory Tract Infections / physiopathology


  • Anti-Bacterial Agents