**4. Conclusion**

*Pseudomonas aeruginosa* - Biofilm Formation, Infections and Treatments

D-glucose and D-mannose. Psl was significant in the start of the formation of the biofilm and biofilm structure protection. Pel is specified as the 3rd polysaccharide that exists in *P. aeruginosa* biofilm and was glucose rich [61]. Furthermore, the biofilm cells showing increased resistance to the environmental pressures like anti-microbial agents compared to their planktonic form [62]. Also, its populations undergoing characteristic evolutionary adaptation throughout chronic infection related to CF lung, involving decreased virulence factors' production, transition to biofilm related lifestyles, and the evolution regarding high level antibiotics resistance, whereas the populations of *P. aeruginosa* in the chronic CF lung infections generally showing increased phenotypic diversity, involving clinically significant characteristics like antibiotics resistance and toxin production, and such diversity was dynamic throughout the time, which will make precise treatment and diagnosis

*P. aeruginosa* has been considered as a major cause related to nosocomial infections, also it is accountable for about 10% of all the hospital acquired infections in the world. It is still considered as one of the therapeutic challenges due to the high rates of mortality and morbidity related to it and the potential to develop drug resistance throughout the therapy. Also, standard antibiotic regimes against the *P. aeruginosa* were more and more unsuccessful due to the increase in drug resistance [64]. In addition, antibiotics resistance in the multiple strains related to *P. aeruginosa* was a clinical issue that is developing rapidly, while the definitions regarding multidrug resistance *P. aeruginosa* (MDRPA) was isolates resistant to minimum of 3 drugs from various antimicrobial categories, involving cephalosporinsand quinolones, aminoglycosides, carbapenems and anti pseudomonal penicillin were categorized as multidrug resistant. The development of antibiotic resistant bacteria in health-care is dangerous. With regard to health-care premises exactly ICUs were main microbial diversity sources. Recently, a few studies indicated that not just microbial diversity, yet also the drug resistant microbes majorly habitat in the ICUs. Infections resulting from such organism were complicated to treat due to the existence of its innate resistance to various antibiotic types (Beta-lactam and penem group of antibiotics) as well as its capability for acquiring more resistance mechanism for a number of antibiotics classes, involving aminoglycosides, β-lactams and fluoroquinolones. With regard to molecular evolution microbes adopting many mechanisms for maintaining genomic plasticity [2], MDR isolates have been majorly specified via slow growth, cytotoxic type-III secretion system genotype, excellent biofilm forming capability, and the existence of more aminoglycoside modifying enzyme (AME) genes, non MDR isolates are re-sensitized following the inhibition regarding active efflux or improvement of membrane permeability, such target gene alteration along with the enzymatic drug modification that has been specified as the main quinolone mechanisms and aminoglycoside resistance in *P. aeruginosa* keratitis isolates [65]. Extensively drug-resistant *P. aeruginosa* (XDR-PA) that has been characterized as the strains remaining susceptible to only 1 or 2 antipseudomonal agent classes, became a serious issue because of a lack of effective

*P. aeruginosa* became resistant to a number of the antibiotics classes, which include the carbapenems, which have been viewed as reliable antibiotics for treating the multi-drug-resistant *P. aeruginosa* serious infections and have been viewed as a last-resort antibiotic therapy of the infections that have been caused by the carbapenem-resistant *Pseudomonas aeruginosa* has become more problematic, particularly

**12**

anti-microbial treatment [66].

challenging [63].

**3. Antibiotic resistance**

The current review conclude the implication of *P. aeruginosa* in arrays of diseases especially RTIs, UTIs and wound infections. The widespread of it may be due to their adaptation to different environmental conditions along with virulence traits especially biofilm formation and intrinsic and acquired antibiotic resistance strategies.

## **Conflict of interest**

There is no 'conflict of interest' for this work.

#### **Author details**

Hussein Al-Dahmoshi\*, Raad D. Al-Obaidi and Noor Al-Khafaji Biology Department, College of Science, University of Babylon, Hilla, Iraq

\*Address all correspondence to: dr.dahmoshi83@gmail.com

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
