New alternative therapeutic strategies against Pseudomonas aeruginosa, an opportunistic multi-resistant pathogen with a myriad of virulence factors.

Pseudomonas aeruginosa (PA) has emerged as a significant cause of Gram-negative infections, particularly in patients with impaired host defenses. It is one of the six ESKAPE pathogens that majorly cause severe nosocomial infections. In addition to biofilm formation, PA possesses various virulence factors. It can be life-threatening due to his remarkable capacity to resist antibiotics, either intrinsically, developing adaptative resistance, or following the acquisition of resistance genes. The situation worsens when these mechanisms co-exist, conferring worrying multi-resistant phenotypes. Therapeutic options are becoming limited, which has led to the development of new antibiotics and novel alternative therapeutic strategies that require the exploration of other therapeutic avenues. Although mostly at the preclinical stages, many recent studies have reported several innovative therapeutic technologies that have demonstrated pronounced effectiveness in fighting against drug-resistant Pa strains. This literature review aims to discuss the mechanism of pyocyanic bacillus resistance to antibiotics, highlight the current state of some novel antibiotics and combination therapies, and the new alternative therapeutic approaches for treating PA infections.