Sendra, ElenaFernández Muñoz, AlmudenaZamorano, LauraOliver, AntonioHorcajada Gallego, Juan PabloJuan, CarlosGómez-Zorrilla, Silvia2025-04-032025-04-032024Sendra E, Fernández-Muñoz A, Zamorano L, Oliver A, Horcajada JP, Juan C, et al. Impact of multidrug resistance on the virulence and fitness of Pseudomonas aeruginosa: a microbiological and clinical perspective. Infection. 2024 Aug;52(4):1235-68. DOI: 10.1007/s15010-024-02313-x0300-8126http://hdl.handle.net/10230/70081Pseudomonas aeruginosa is one of the most common nosocomial pathogens and part of the top emergent species associated with antimicrobial resistance that has become one of the greatest threat to public health in the twenty-first century. This bacterium is provided with a wide set of virulence factors that contribute to pathogenesis in acute and chronic infections. This review aims to summarize the impact of multidrug resistance on the virulence and fitness of P. aeruginosa. Although it is generally assumed that acquisition of resistant determinants is associated with a fitness cost, several studies support that resistance mutations may not be associated with a decrease in virulence and/or that certain compensatory mutations may allow multidrug resistance strains to recover their initial fitness. We discuss the interplay between resistance profiles and virulence from a microbiological perspective but also the clinical consequences in outcomes and the economic impact.application/pdfeng© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.info:eu-repo/semantics/articlehttp://dx.doi.org/10.1007/s15010-024-02313-xPseudomonas aeruginosaAntibiotic resistanceBiological costDifficult to treat resistanceFitnessMultidrug resistanceVirulenceinfo:eu-repo/semantics/openAccess