Updated: 8/7/2019

Pseudomonas Aeruginosa Infection

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Snapshot
  • A 55-year-old man presents to the emergency department from a subacute rehabilitation center for altered mental status. The patient has been slowly becoming confused over the course of a few days. His temperature is 102°F (38.8°C), blood pressure is 138/101 mmHg, pulse is 102/min, and respirations are 18/min. On physical exam, the patient is only oriented to self but not to place or time. His short-term memory is impaired. Of note, the patient has a Foley catheter.  Chest auscultation is unremarkable. The patient grimaces upon palpation of the suprapubic area. Laboratory studies are significant for a leukocytosis with left shift and positive blood and urine cultures grow Pseudomonas aeruginosa. (Urosepsis)
Introduction
  • Aerobic, non-lactose fermenting, oxidase-positive, gram-negative bacillus
  • Epidemiology
    • risk factors
      • hot tubs
      • contaminated contact lenses
      • contaminated water
      • ventilator use
      • burns
      • immunocompromised
      • cystic fibrosis
        • most common pathogen found in this patient population
  • Microbiology
    • culture has a sweet and grape-like odor
    • green pigment
  • Pathogenesis
    • Pseudomonas aeruginosa has the ability to
      • be an indolent colonizer within the lungs (which explains why it is associated with cystic fibrosis)
      • invade tissue resulting in pneumonia and bacteremia
  • Associated conditions
    • cystic fibrosis
    • ecthyma gangrenosum
    • hot tub folliculitis
    • osteomyelitis
    • burns
    • nosocomial infections (e.g., catheter use)
    • otitis externa (swimmers ear)
  • Prognosis
    • varied due to causing a wide spectrum of disease
      • pseudomonas bacteremia can lead to septic shock if untreated
Presentation
  • Symptoms/physical exam
    • depends on which organ is involved (e.g., pneumonia can lead to a cough, fever, and shortness of breath)
Studies
  • Lab studies
    • complete blood count
      • may reveal a leukocytosis with a left shift
    • blood culture
    • urine culture
    • Gram staining of the cerebral spinal fluid if meningitis is suspected
 Differential
  • Upper respiratory tract infection caused by other organisms
    • differentiating factors
      • patients with have microbiologic testing suggestive of a different pathogen
Treatment
  • Conservative
    • source control
      • indication
        • should be performed in all patients in which a source (e.g., catheter) is introducing the pathogen into the host
  • Medical
    • antipseudomonal antibiotics 
      • indication
        • first-line medical treatment to eradicate the pathogen
      • medications
        • penicillins
          • piperacillin-tazobactam 
          • ticarcillin-clavulanate
        • cephalosporins
          • ceftazidime
          • cefepime
        • monobactam
          • aztreonam
        • fluoroquinolones
          • ciprofloxacin
          • levofloxacin
        • carbapenems
          • meropenem
          • doripenem
Complications
  • Septic shock

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