Chronic airway colonisation by Pseudomonas aeruginosa, a hallmark of cystic fibrosis (CF) lung disease, is associated with increased morbidity and mortality and despite aggressive antibiotic treatment, P. aeruginosa is able to persist in CF airways. In vitro antibiotic susceptibility assays are poor predictors of antibiotic efficacy to treat respiratory tract infections in the CF patient population and the selection of the antibiotic(s) is often made on an empirical base. In the current review, we discuss the factors that are responsible for the discrepancies between antibiotic activity in vitro and clinical efficacy in vivo. We describe how the CF lung microenvironment, shaped by host factors (such as iron, mucus, immune mediators and oxygen availability) and the microbiota, influences antibiotic activity and varies widely between patients. A better understanding of the CF microenvironment and population diversity may thus help improve in vitro antibiotic susceptibility testing and clinical decision making, in turn increasing the success rate of antibiotic treatment.

铜绿假单胞菌的慢性气道定植是囊性纤维化 (CF) 肺病的标志，与发病率和死亡率增加有关，尽管进行了积极的抗生素治疗，铜绿假单胞菌仍能够在 CF 气道中持续存在。体外抗生素敏感性试验不能很好地预测抗生素治疗 CF 患者呼吸道感染的疗效，并且通常根据经验选择抗生素。在当前的审查中，我们讨论了导致体外抗生素活性与体内临床疗效之间存在差异的因素. 我们描述了由宿主因素（如铁、粘液、免疫介质和氧气可用性）和微生物群形成的 CF 肺微环境如何影响抗生素活性，并且在患者之间差异很大。因此，更好地了解 CF 微环境和种群多样性可能有助于改进体外抗生素敏感性测试和临床决策制定，进而提高抗生素治疗的成功率。