Pseudomonas aeruginosa
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Etiology
risk factors
- cystic fibrosis
- diabetes mellitus
- intravenous drug abuse (IVDA)
- neutropenia
- wounds
- burns
- urinary catheterization
Epidemiology
- ubiquitous
- nosocomial infections
- community hot tubs/warm water pools
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]
- 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://www.ncbi.nlm.nih.gov/pubmed/11484690
- ↑ 5.0 5.1 5.2 5.3 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018
- ↑ 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://www.ncbi.nlm.nih.gov/pubmed/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://www.ncbi.nlm.nih.gov/pubmed/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://www.ncbi.nlm.nih.gov/pubmed/39108079 https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae403/7728556