Infections Caused By Pseudomonas And Related Pathogens

Pseudomonas aeruginosa and other members of this group of Gram-negative bacteria are opportunistic pathogens that frequently nosocomial infections, particularly in ventilated patients, patients with burn wounds and chronic patients such cause. It can be infected many parts of the body, and the infection is usually difficult. The diagnosis is made by the cultural detection of pathogens. The selection of the appropriate antibiotic varies depending on the detected pathogens and must be aligned on a susceptibility testing due to the widespread development of resistance.

Pseudomonas aeruginosa and other members of this group of Gram-negative bacteria are opportunistic pathogens that frequently nosocomial infections, particularly in ventilated patients, patients with burn wounds and chronic patients such cause. It can be infected many parts of the body, and the infection is usually difficult. The diagnosis is made by the cultural detection of pathogens. The selection of the appropriate antibiotic varies depending on the detected pathogens and must be aligned on a susceptibility testing due to the widespread development of resistance. Epidemiology Pseudomonas is ubiquitous and prefers moist habitats. In humans, P. aeruginosa is the most common pathogens in this group, but infections can P. putida, P. fluorescens or P. acidovorans also be caused by P. paucimobilis. Other important nosocomial pathogens that were previously classified as Pseudomonas, Burkholderia cepacia and Stenotrophomonas maltophilia include. B. pseudomallei and cause a distinct disease known as melioidosis and mostly limited to the Asian tropics. P. aeruginosa is detected in the axilla and anogenital regions with normal skin but rarely in stool unless antibiotics are given. In hospitals, the pathogen can be often found in sinks, disinfectant solutions and urine bottles. There may be transfers by medical personnel to patients, especially in intensive care units for newborns and patients with burn wounds unless the infection control measures are strictly adhered to. Pseudomonas caused diseases Most P. aeruginosa infections occur in hospitalized patients, particularly in debilitated or immunocompromised. P. aeruginosa is a frequent cause of infections in intensive care units. HIV-infected patients, particularly in advanced stages and patients with cystic fibrosis have an increased risk of community-acquired P. aeruginosa infections. Pseudomonas infections can develop in many anatomic regions, incl. Skin, subcutaneous tissue, bone, ears, eyes, urinary tract, lungs, and heart valves. The location depends on the portal of entry and the individual disposition. In hospitalized patients, the first sign may be a fulminant gram negative sepsis. an often lethal complication – skin and soft tissue infections For burns, the region can be infiltrated under the eschar massively from pathogens and constitute a focus for subsequent bacteremia. Deep puncture wounds of the foot are often infected by P. aeruginosa. Draining sinuses, cellulitis and osteomyelitis can occur. The secretion of stab wounds often has a sweet, fruity smell. In whirlpools acquired folliculitis is often caused by P. aeruginosa. The most common manifestation of Pseudomonas infection in the ear, especially in tropical regions, is otitis externa. In diabetic patients, a more severe form can develop, called malignant otitis externa. It manifests itself with severe ear pain, often with unilateral cranial nerve palsies and requires parenteral therapy. A ecthyma gangrenosum is a skin lesion that occurs in neutropenic patients, and is usually caused by P. aeruginosa. There is characteristically erythematous from centrally ulcerated, purple-black areas about 1 cm in diameter that occur in the axilla, in inguinal or in the anogenital area most often. Ecthyma gangrenosum typically occurs in patients with P. aeruginosa bacteremia auf.Atemwegsinfektionen P. aeruginosa is a frequent cause of ventilator-associated pneumonia. In HIV-infected patients Pseudomonas often causes pneumonia or sinusitis. Later in cystic fibrosis often leads to a Pseudomonas bronchitis. Isolates from patients with cystic fibrosis characteristically have a slimy colony morphology and result in a poorer prognosis than non-slimy Pseudomonas.Sonstige infections Pseudomonas is a common cause of nosocomial urinary tract infections, especially in patients undergoing urological procedures were performed or an obstructive uropathy to have. Pseudomonas frequently colonizes the urinary tract in catheterized patients, especially in those who have received broad spectrum antibiotics. Eye involvement usually manifests as corneal ulceration, usually after a trauma, some cases were also contamination of contact lenses or lens cleaning fluid in context. Pseudomonas rarely causes acute bacterial endocarditis, usually on artificial heart valves in patients undergoing open heart surgery or native valves in i.v. Drogenabusus.Bakteriämie Many Pseudomonas infections can lead to bacteremia. For non-intubated patients without evidence of a urinary focus, especially when infections caused by species other than P. aeruginosa bacteremia has a point to contaminated infusion solutions, medications or disinfectants that were used when placing the intravenous catheter. Diagnosis Culture The diagnosis is based on the cultural detection of pathogens from the infection localization – blood, skin lesions, wound secretion, urine, cerebrospinal fluid, or eye. A local infection may have a fruity odor and pus formed may be greenish. Therapy Various antibiotics, depending on location and severity of the infection and the susceptibility testing Local infections A hot tub folliculitis heals spontaneously and does not require antibiotic therapy. Otitis externa is with washes with 1% acetic acid or topical drugs such. B. polymyxin B or colistin treated. More severe infections are treated with fluoroquinolones. Focal soft-tissue infections in addition to antibiotics require an early surgical debridement of necrotic tissue and drainage of abscesses. Small corneal ulcers are treated with ciprofloxacin 0.3% or 0.5% Levofloxacin. In extensive ulcers are highly concentrated (higher than the commercially usual concentration) drops antibiotics such. B. tobramycin 15 mg / ml and applied Cefazolin 50 mg / ml. Initially, a frequent administration (eg. As hourly around the clock) is required. The taping of the eye is contraindicated, as it creates a dark and warm environment that promotes bacterial growth and prevents use of local medicines. Asymptomatic bacteriuria is not treated with antibiotics, except during pregnancy and before urologic procedures. Patients with symptomatic urinary tract infection can often with levofloxacin 500 mg po 1 times daily or ciprofloxacin 500 mg po treated 2 times a day werden.Systemische infectious Parenteral treatment is required. Recently, it was shown that the single-drug treatment with an active anti-Pseudomonas beta-lactam (z. B. ceftazidime) or a fluoroquinolone produced results similar to those of the previously recommended combination therapy with an aminoglycoside plus an anti-pseudo-beta-lactam, an anti-pseudo-cephalosporin (eg. B. ceftazidime, cefepime, cefoperazone), a monobactam (z. B. aztreonam) or a carbapenem (meropenem, imipenem, doripenem) correspond. Such single-drug treatment is satisfactory for patients with neutropenia. A right-sided can be treated with antibiotics, but usually the infected valve must be removed to achieve a cure by participating in the mitral, aortic or artificial valve. P. aeruginosa can be formed at a treatment with ceftazidime, cefepime, ciprofloxacin, gentamicin, meropenem, imipenem or doripenem resistance. Older antibiotics (eg. As colistin) may be needed to treat infections with multidrug-resistant Pseudomonas sp. Ceftolozane / tazobactam keeps Activity upright against many multi-resistant strains of P. aeruginosa. Important Points Most P. aeruginosa infections occur in hospitalized patients, particularly in debilitated or immunocompromised, but patients with cystic fibrosis or advanced HIV can acquire the infection in public. Infection can develop in many places, what with the point of entry (for example, skin in burn patients, lung in patients on a ventilator, urinary tract in patients who have had a urologic manipulation or obstructive uropathy) varies; an overwhelming gram-negative sepsis can occur. Superficial infections (eg. As folliculitis, otitis externa, keratitis) can develop in healthy people. To diagnose cultures are used. A systemic infection is treated with a parenteral therapy with a single drug (eg. As an anti-Pseudomonas beta-lactam, a fluoroquinolone).

Health Life Media Team

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