Aeromonas Infections in Humans—Antibiotic Resistance and Treatment Options

The genus Aeromonas is widely distributed in aquatic environments, where it is a frequent fish pathogen. It has also been described in association with human infections, with most cases caused by A. caviae, A. veronii biovar sobria, and A. hydrophila. More recently, A. dhakensis has emerged as an increasingly important human pathogen. Transmission occurs primarily through ingestion or contacts with aquatic sources, or by consuming contaminated food, particularly from aquatic origins. Growing resistance in Aeromonas has been reported for penicillins (including their combinations with classical β-lactamase inhibitors), cephalosporins, and carbapenems. Among the β-lactam antibiotics, only fourth-generation cephalosporins remain almost uniformly active. Furthermore, the co-occurrence of resistance genes for third-generation cephalosporins and carbapenems within the same isolates is increasing. Recently, the presence of mobile genes conferring colistin resistance has also been documented, with resistance rates sometimes exceeding 30%. This evolution of colistin resistance is likely linked to its use in aquaculture, and together with the rise in β-lactam resistance, may be transforming Aeromonas into a significant reservoir of resistance genes that could potentially be transferred to species more commonly associated with human infections, such as the Enterobacterales.