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It is responsible for approximately 7.1\u20137.3% of HAIs worldwide and up to 23% of intensive care unit infections, specifically ventilator-associated pneumonia, where mortality can reach 32\u201342.8%. In chronic lung diseases, especially cystic fibrosis,\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    commonly becomes the dominant pathogen in adulthood and contributes to progressive lung function decline. A major factor supporting long-term survival is biofilm formation, which can increase antimicrobial tolerance by up to 1000-fold compared with free-living bacteria. Virulence is further regulated through coordinated production of phenazines, rhamnolipids, exopolysaccharides, and quorum sensing signalling systems. The toxin pyocyanin, produced by 90\u201395% of clinical isolates, damages host tissues by disrupting cellular respiration, impairing ciliary activity, disturbing calcium balance, and promoting neutrophil apoptosis. During chronic infection, host defence mechanisms, including epithelial barriers, mucociliary clearance (~90% removal of inhaled particles), antimicrobial peptides, and immune cell responses, become less effective, while biofilms promote persistent inflammation and poor bacterial clearance. Increasing multidrug and carbapenem resistance (up to 47.6% in Europe and 32.8% in Asia) is driving interest in alternative therapies, including anti virulence agents, biofilm-disrupting enzymes, nanoparticles, bacteriophage therapy, and host-directed approaches targeting excessive inflammatory responses.\n                  <\/jats:p>","DOI":"10.1007\/s00203-026-04839-0","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T06:22:44Z","timestamp":1777011764000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Pseudomonas aeruginosa: associated pathogenesis, epidemiology, resistance mechanisms, host response and emerging treatment strategies"],"prefix":"10.1007","volume":"208","author":[{"given":"Sheeba","family":"Sawant","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safura","family":"Shaikh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy C.","family":"Baldwin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikaterini","family":"Karakoula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayesha","family":"Rahman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"4839_CR1","doi-asserted-by":"publisher","DOI":"10.1186\/s12934-024-02508-9","volume":"23","author":"SS Abdel-Fatah","year":"2024","unstructured":"Abdel-Fatah SS, Mohammad NH, Elshimy Rana, Mosallam FM (2024) Impeding microbial biofilm formation and *Pseudomonas aeruginosa* virulence genes using biologically synthesized silver Carthamus nanoparticles. 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