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However, the impact of intra-patient heterogeneity of\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    on eradication outcomes remains unclear.\n                  <\/jats:p>\n                  <jats:p>\n                    We enrolled 30 patients receiving inpatient care for COPD and\/or NCFBE exacerbation with known or newly detected\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    colonization into an observational study. The analysis cohort consisted of 22 participants receiving in-hospital antibiotic eradication therapy, from whom a total of 91 lower respiratory tract samples were collected prior to, during, and after antibiotic therapy. To explore intra-host clonal heterogeneity, a maximum of 10 randomly selected\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    isolates were collected from all patient samples containing\n                    <jats:italic>Pseudomonas.<\/jats:italic>\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    -positive cultures were detected in 11 of 22 patients at baseline or during antibiotic therapy. Among these patients, short-term microbiological eradication, defined as a\n                    <jats:italic>Pseudomonas<\/jats:italic>\n                    -negative culture during or at the conclusion of antibiotic treatment, was achieved in 10 of 11 cases (90.9%). Extended antimicrobial susceptibility testing was performed on all isolates and indicated low levels of resistance in isolates obtained from patients before the initiation of eradication therapy and overall limited intra-host phenotypic resistance variability. Whole-genome sequencing of isolates from four patients with at least three longitudinal\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    -positive samples confirmed colonization by a single clonal lineage in each case.\n                  <\/jats:p>\n                  <jats:p>\n                    While concordance between phenotypic resistance and detected genetic resistance determinants was limited, overall resistance levels were low. Our data suggest that\n                    <jats:italic>P. aeruginosa<\/jats:italic>\n                    colonization in our cohort of COPD\/NCFBE patients was predominantly associated with a single clonal lineage and with limited intra-host resistance heterogeneity. These findings, based on a small sample size, suggest that susceptibility testing of a single isolate could inform eradication therapy in selected patients. The high rate of short-term eradication success is consistent with the effectiveness of current antibiotic regimens. Yet, more comprehensive longitudinal studies with larger patient numbers and more diverse patient backgrounds are warranted to clarify persistence and re-infection dynamics.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Trial registration<\/jats:bold>\n                  <\/jats:p>\n                  <jats:p>German Clinical Trials Register (DRKS), DRKS00023975. Registered 28 December 2020. Retrospectively registered.<\/jats:p>","DOI":"10.1186\/s12866-026-05147-9","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T10:14:56Z","timestamp":1779358496000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Antibiotic pressure does not uncover intra-host heterogeneity of Pseudomonas aeruginosa in patients with chronic lung disease"],"prefix":"10.1186","volume":"26","author":[{"given":"Lisa","family":"G\u00f6pel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Espen E","family":"Groth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sina","family":"Minke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hinrich","family":"Schulenburg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Kalsdorf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Kirchhoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leif","family":"Tueffers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus F","family":"Rabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9bastien","family":"Boutin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Nurjadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Rupp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"5147_CR1","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1097\/QCO.0000000000000717","volume":"34","author":"N Spernovasilis","year":"2021","unstructured":"Spernovasilis N, Psichogiou M, Poulakou G. 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All procedures involving human participants were performed in accordance with the ethical standards of the institutional and\/or national research committee and with the Declaration of Helsinki and its later amendments. Written informed consent was obtained from all participants prior to inclusion.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"E. Groth reports consulting fees from GlaxoSmithKline, payment or honoraria for presentations from Insmed, AstraZeneca and Pfizer, and support for attending meetings and\/or travel from AstraZeneca. B. Kalsdorf reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AstraZeneca and Insmed, and support for attending meetings and\/or travel from AstraZeneca, GSK and Boehringer Ingelheim. K. F. Rabe reports consulting fees from AstraZeneca, Boehringer Ingelheim, Chiesi, and Sanofi & Regeneron, payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, Boehringer Ingelheim, Chiesi Pharmaceuticals, CSL Behring, Sanofi & Regeneron, GlaxoSmithKline, Berlin Chemie and Menarini, participation on a data safety monitoring board or advisory board with AstraZeneca, Boehringer Ingelheim, Sanofi & Regeneron and CSL Behring, and leadership roles with German Center for Lung Research (DZL), German Chest Society (DGP) and American Thoracic Society (ATS). S. Boutin reports grants or contracts from German Center for Lung Research (DZL) and CAPNETZ Stiftung. The remaining authors have no potential conflicts of interest to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"480"}}