Pseudomonas aeruginosa
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Etiology
risk factors
- cystic fibrosis
- diabetes mellitus
- intravenous drug abuse (IVDA)
- neutropenia
- wounds
- burns
- urinary catheterization
* ventilator-associated pneumonia after motor vehicle accident with multiple fractures is not a risk factor[5]
Epidemiology
- ubiquitous
- nosocomial infections
- community hot tubs/warm water pools
- a strain of Pseudomonas aeruginosa isolated from a wound in the UK produces an enyme called Pap1 than can break down polycaprolactone (PCL) a plastic commonly used in health care because of its biodegradable properties
* a pathogen that can degrade plastic could compromise plastic-containing medical devices such as sutures, implants, stents or wound dressing
Pathology
- breakdown of normal cutaneous or mucosal barriers
- immunocompromised patients
- normal flora eradicated by broad-spectrum antibiotics
- endophthalmitis shows vascular necrosis without inflammatory cells[8]
- P aeruginosa visible as blue haze surrounding vessel
Clinical manifestations
- pneumonia
- severe
- necrotizing
- empyema may occur
- endocarditis
- sinusitis
- swimmer's ear
- malignant otitis externa in diabetics
- eye infections
- contact lens-associated keratitis
- scleral abscess
- endophthalmitis in adults
- ophthalmia neonatorum in children[8]
- septic arthritis
- osteomyelitis
- urinary tract infections
- pyoderma
- burn infection
- hot-tub folliculitis
- ecthyma gangrenosum in neutropenic patients with bacteremia
Laboratory
- Pseudomonas aeruginosa serology
- Pseudomonas aeruginosa DNA
- Pseudomonas aeruginosa multidrug-resistant in isolate
- culture
- light growth of Pseudomonas on sputum culture when the organism not seen on Gram stain is consistent with colonization rather that infection with Pseudomonas aeruginosa
- glucose -; lactose -; pigment (pyacyanin fluorescein)
- oxidase positive
- growth-temp 42; motility via monotrichous flagella
- MacConkey colorless
- Gram negative bacillus; Gram negative rods
- Blue-green pigment & fruity odor
- Bipolar safety-pin shape
Radiology
- chest X-ray may show bilateral patchy infiltrates
Complications
- endophthalmitis may result in Pseudomonal sepsis
Management
- antibiotic therapy
- empiric therapy for suspected Pseudomonas infection should include at least two antibiotics to which Pseudomona is susceptible
- after culture & sensitivity determine antibiotic susceptibility, single antibiotic therapy is appropriate[9]
- antipseudomonal beta-lactam agent
- 3rd generation cephalosporin
- extended-spectrum penicillin
- mezlocillin
- piperacillin (18-24 g/day divided every 4-6 hours)
- carbenicillin
- ticarcillin
- activity not enhanced by beta-lactamase inhibitor
- Pseudomonas & other gram-negative bacilli may require a longer duration of therapy (10-14 days)[4][6]
- 7 days of therapy for ventilator-pneumonia (Cefepime sensitive)[8]
- carbapenem for ventilator-associated pneumonia due to extended-spectrum beta-lactamase producing gram-negative bacteria[5]
- fluoroquinolone or an aminoglycoside
- among quinolones, ciprofloxacin has the best activity against
- combination therapy of beta-lactam plus fluoroquinolone or an aminoglycoside should be used for synergy & because resistance may develop to single agent therapy
- Cefepime, imipenem, meropenem, or Zosyn plus an aminoglycoside plus a fluoroquinolone (dual Pseudomonas coverage)[5]
- other agents
- imipenem
- aztreonam
- aminoglycoside plus fluoroquinolone
- ceftolozane tazobactam & colistin for multidrug drug-resistant Pseudomonas[5][6]
- ceftazidime avibactam[12]
- cefiderocol[12]
- multidrug-resistant Pseudomonas aeruginosa
- ceftolozane tazobactam[10]
- consider adding once-daily tobramycin or amikacin for pyelonephritis[10]
- empiric therapy for suspected Pseudomonas infection should include at least two antibiotics to which Pseudomona is susceptible
- complications
- empyema
- drainage,
- debridement of:
- removal of infected foreign material
- early valve replacement in left-sided endocarditis
- empyema
- cystic fibrosis
- aggressive pulmonary toilet
- ciprofloxacin 500-750 mg PO BID in adults for acute exacerbations of chronic lung infection
- swimmer's ear
- neomycin/polymixin B 3 drops TID for 7 days
- hot tub folliculitis generally resolves spontaneously within 2 weeks[4]
More general terms
Additional terms
References
- ↑ Manual of Medical Therapeutics, 28th edition, Ewald & McKenzie (eds) Little, Brown & Co, 1995, pg 301
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 227-228
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 797
- ↑ 4.0 4.1 4.2 Journal Watch 21(17):140, 2001 Fiorillo L et al The pseudomonas hot-foot syndrome. N Engl J Med 345:335, 2001 PMID: https://pubmed.ncbi.nlm.nih.gov/11484690
- ↑ 5.0 5.1 5.2 5.3 5.4 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ 6.0 6.1 6.2 Pogue JM, Marchaim D, Kaye D, Kaye KS. Revisiting "older" antimicrobials in the era of multidrug resistance. Pharmacotherapy. 2011 Sep;31(9):912-21 PMID: https://pubmed.ncbi.nlm.nih.gov/21923592
- ↑ Cilloniz C, Gabarrus A, Ferrer M et al Community-Acquired Pneumonia Due to Multidrug- and Non-Multidrug- Resistant Pseudomonas aeruginosa. Chest. 2016 Aug;150(2):415-25. PMID: https://pubmed.ncbi.nlm.nih.gov/27060725
- ↑ 8.0 8.1 8.2 8.3 Elkston CA, Elkston DM Bacterial Skin Infections: More Than Skin Deep. Medscape. July 19, 2021 https://reference.medscape.com/slideshow/infect-skin-6003449
- ↑ 9.0 9.1 NEJM Knowledge+
- ↑ 10.0 10.1 10.2 Tamma PD, Heil EL, Justo JA, Mathers AJ, Satlin MJ, Bonomo RA. Infectious Diseases Society of America 2024 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections. Clin Infect Dis. 2024 Aug 7:ciae403. PMID: https://pubmed.ncbi.nlm.nih.gov/39108079 https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae403/7728556
- ↑ Ibrahim D, Jabbour JF, Kanj SS. Current choices of antibiotic treatment for Pseudomonas aeruginosa infections. Curr Opin Infect Dis. 2020;33:464-473. PMID: https://pubmed.ncbi.nlm.nih.gov/33148986
- ↑ 12.0 12.1 12.2 Bavaro DF et al. Antipseudomonal cephalosporins versus piperacillin/tazobactam or carbapenems for the definitive antibiotic treatment of Pseudomonas aeruginosa bacteraemia: New kids on the ICU block? J Antimicrob Chemother 2025 Mar 15; PMID: https://pubmed.ncbi.nlm.nih.gov/40088112 https://academic.oup.com/jac/advance-article-abstract/doi/10.1093/jac/dkaf080/8078947
- ↑ Fieldhouse R Microbe that infests hospitals can digest medical-grade plastic - a first. Nature News. May 8, 2025 https://www.nature.com/articles/d41586-025-01412-5