Pseudomonas aeruginosa antimicrobial susceptibility profiles, resistance mechanisms and international clonal lineages: update from ESGARS-ESCMID/ISARPAE Group

Antonio Oliver*, Estrella Rojo-Molinero, Jorge Arca-Suarez, Yeşim Beşli, Pierre Bogaerts, Rafael Cantón, Cansu Cimen, Peter D. Croughs, Olivier Denis, Christian G. Giske, Tíscar Graells, Te Din Daniel Huang, Bogdan I. Iorga, Onur Karatuna, Béla Kocsis, Andreas Kronenberg, Carla López-Causapé, Surbhi Malhotra-Kumar, Luis Martínez Martínez, Annarita MazzariolSylvain Meyer, Thierry Naas, Daan W. Notermans, Jesús Oteo-Iglesias, Torunn Pedersen, Mateja Pirš, Patricia Poeta, Laurent Poirel, Spyros Pournaras, Arnfinn Sundsfjord, Dora Szabó, Arjana Tambić-Andrašević, Rossitza Vatcheva-Dobrevska, ESGARS-ISARPAE members, Astra Vitkauskienė, Katy Jeannot

*Corresponding author for this work

Research output: Contribution to journalShort surveyPopular



Pseudomonas aeruginosa, a ubiquitous opportunistic pathogen considered one of the paradigms of antimicrobial resistance, is among the main causes of hospital-acquired and chronic infections associated with significant morbidity and mortality. This growing threat results from the extraordinary capacity of P. aeruginosa to develop antimicrobial resistance through chromosomal mutations, the increasing prevalence of transferable resistance determinants (such as the carbapenemases and the extended-spectrum β-lactamases), and the global expansion of epidemic lineages. The general objective of this initiative is to provide a comprehensive update of P. aeruginosa resistance mechanisms, especially for the extensively drug-resistant (XDR)/difficult-to-treat resistance (DTR) international high-risk epidemic lineages, and how the recently approved β-lactams and β-lactam/β-lactamase inhibitor combinations may affect resistance mechanisms and the definition of susceptibility profiles. 


To address this challenge, the European Study Group for Antimicrobial Resistance Surveillance (ESGARS) from the European Society of Clinical Microbiology and Infectious Diseases launched the ‘Improving Surveillance of Antibiotic-Resistant Pseudomonas aeruginosa in Europe (ISARPAE)’ initiative in 2022, supported by the Joint programming initiative on antimicrobial resistance network call and included a panel of over 40 researchers from 18 European Countries. Thus, a ESGARS-ISARPAE position paper was designed and the final version agreed after four rounds of revision and discussion by all panel members. 

Questions addressed in the position paper: 

To provide an update on (a) the emerging resistance mechanisms to classical and novel anti-pseudomonal agents, with a particular focus on β-lactams, (b) the susceptibility profiles associated with the most relevant β-lactam resistance mechanisms, (c) the impact of the novel agents and resistance mechanisms on the definitions of resistance profiles, and (d) the globally expanding XDR/DTR high-risk lineages and their association with transferable resistance mechanisms. 


The evidence presented herein can be used for coordinated epidemiological surveillance and decision making at the European and global level.

Original languageEnglish
Pages (from-to)469-480
Number of pages12
JournalClinical Microbiology and Infection
Issue number4
Early online date30 Dec 2023
Publication statusPublished - Apr 2024

Bibliographical note

Publisher Copyright:
© 2023 The Authors


Dive into the research topics of 'Pseudomonas aeruginosa antimicrobial susceptibility profiles, resistance mechanisms and international clonal lineages: update from ESGARS-ESCMID/ISARPAE Group'. Together they form a unique fingerprint.

Cite this