During the chronic lung infection of patients with cystic fibrosis, Pseudomonas aeruginosa can survive for long periods of time under the challenging selective pressure imposed by the immune system and the antibiotic treatment due to the biofilm mode of growth and the adaptive evolution mediated by genetic variation. Mucoidy, hypermutabillity and acquirement of mutational antibiotic resistance are important adaptive phenotypes that are selected during the chronic P. aeruginosa infection. This review presents the knowledge about the role played by these phenotypes for the tolerance of biofilms to antibiotics and show that mucoidy and hypermutabillity change the architecture of in vitro formed biofilms and lead to increase tolerance to antibiotics. Production of high levels of beta-lactamase determines impaired penetration of beta-lactam antibiotics due to inactivation of the antibiotic. In conclusion, these data underline the importance of biofilms prevention strategies by early aggressive antibiotic prophylaxis or therapy before the phenotypic diversification during the chronic lung infection if patients with cystic fibrosis. © 2012 Federation of European Microbiological Societies. Published by Blackwell Publishing Ltd. All rights reserved.
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