Advances in the management of pneumonia caused by drug-resistant bacteria: from antimicrobial optimisation to integrated treatment adaptation
Abstract
Management of drug-resistant bacterial pneumonia has become increasingly precise, but early precision does not remove the need to reinterpret the patient's course during illness. Active and appropriate empirical therapy, informed by local epidemiology, remains essential, yet treatment often begins before the definitive microbiological profile is available or adequate drug exposure can be confirmed. While rapid diagnostics and pharmacological optimisation can narrow this initial uncertainty, the harder problem arises when antimicrobial treatment appears plausible but the patient shows delayed improvement, clinical deterioration, or incomplete recovery. These trajectories should not be treated as a single form of antibiotic failure. Instead, they require reassessment of whether the dominant limitation is persistent infection, inadequate drug exposure, dysregulated host response, a non-infectious mimic, or repair-limited recovery. In this Review, we propose a trajectory-guided conceptual framework that links management to the process most likely to limit recovery and distinguishes clinically implementable interventions from emerging translational concepts.
Related
- Concordance of next-generation sequencing and conventional microbiology for pathogen detection and antimicrobial resistance prediction in pneumonia
- Clinical impact of the BIOFIRE FILMARRAY Pneumonia Panel combined with antimicrobial stewardship education on pediatric patients with lower respiratory tract infection: a pre–post study from a tertiary center in Nara, Japan
- Stroke-associated pneumonia: from immunodepression to bedside management and future research directions.
- Next-generation smart polymeric hydrogels for chronic wound management: integrating antimicrobial, immunomodulatory and regenerative strategies.
- Clinical research advances in pulmonary infections in 2025: a narrative review of multipathogen assessment, precision diagnosis, and integrated management
BibTeX
@article{wu2026advances,
title = {{Advances in the management of pneumonia caused by drug-resistant bacteria: from antimicrobial optimisation to integrated treatment adaptation}},
author = {Zhenping Wu and Lingtong Huang and Lianlian Fu and Chang Zou and Wen Li and Yunsong Yu and Xi Li and Hua Zhou},
journal = {eBioMedicine},
year = {2026},
month = oct,
doi = {10.1016/j.ebiom.2026.106536},
url = {https://linkinghub.elsevier.com/retrieve/pii/S2352396426004202},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Advances in the management of pneumonia caused by drug-resistant bacteria: from antimicrobial optimisation to integrated treatment adaptation
AU - Zhenping Wu
AU - Lingtong Huang
AU - Lianlian Fu
AU - Chang Zou
AU - Wen Li
AU - Yunsong Yu
AU - Xi Li
AU - Hua Zhou
PY - 2026
DA - 2026/10/29
JO - eBioMedicine
DO - 10.1016/j.ebiom.2026.106536
UR - https://linkinghub.elsevier.com/retrieve/pii/S2352396426004202
AB - Management of drug-resistant bacterial pneumonia has become increasingly precise, but early precision does not remove the need to reinterpret the patient's course during illness. Active and appropriate empirical therapy, informed by local epidemiology, remains essential, yet treatment often begins before the definitive microbiological profile is available or adequate drug exposure can be confirmed. While rapid diagnostics and pharmacological optimisation can narrow this initial uncertainty, the harder problem arises when antimicrobial treatment appears plausible but the patient shows delayed improvement, clinical deterioration, or incomplete recovery. These trajectories should not be treated as a single form of antibiotic failure. Instead, they require reassessment of whether the dominant limitation is persistent infection, inadequate drug exposure, dysregulated host response, a non-infectious mimic, or repair-limited recovery. In this Review, we propose a trajectory-guided conceptual framework that links management to the process most likely to limit recovery and distinguishes clinically implementable interventions from emerging translational concepts.
SN - 2352-3964
ER -