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Updated: Aug 7 2019

Pseudomonas Aeruginosa Infection

  • 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
    • Microbiology
      • culture has a sweet and grape-like odor
      • green pigment
    • Associated conditions
      • cystic fibrosis
      • ecthyma gangrenosum
      • hot tub folliculitis
      • osteomyelitis
      • burns
      • nosocomial infections (e.g., catheter use)
      • otitis externa (swimmers ear)
  • Epidemiology
    • Risk factors
      • hot tubs
      • contaminated contact lenses
      • contaminated water
      • ventilator use
      • burns
      • immunocompromised
      • cystic fibrosis
        • most common pathogen found in this patient population
    • 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
  • 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
  • Prognosis
    • Varied due to causing a wide spectrum of disease
      • pseudomonas bacteremia can lead to septic shock if untreated
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