Pseudomonas aeruginosa Infections Follow-up

Updated: Dec 05, 2016
  • Author: Marcus Friedrich, MD, MBA, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Follow-up

Further Outpatient Care

Carefully monitor patients for adverse effects of medications.

Relapses are common in meningitis, and re-treatment may be necessary. Intrathecal antibiotics may be required.

Treatment failures can occur after terminating antibiotic therapy for malignant otitis, thereby requiring careful outpatient follow-up care.

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Further Inpatient Care

Patients receiving intravenous therapy are usually admitted, although home antibiotic programs exist.

Admission is required for surgical management, if necessary.

Critically ill patients require ICU care.

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Inpatient & Outpatient Medications

Aminoglycosides in combination with beta-lactam agents with good antipseudomonal activity may be prescribed on an inpatient or outpatient basis.

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Transfer

Patients may need transfer to a facility where ICU care is available.

Patients with endocarditis refractory to antibiotics may need transfer to a facility with arrangements for cardiothoracic surgery for valve replacement.

Patients with malignant otitis may need to be transferred to a facility where surgery can be performed.

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Deterrence/Prevention

Catheter-induced UTIs are very common, and preventive measures are extremely important. An obvious preventive measure is to avoid catheterization. If this is not possible, the catheter should be removed as soon as possible. Catheters should be inserted aseptically under sterile conditions. The most important hygienic measure is hand washing by health care personnel. If a urinary catheter is required for long periods, it should be replaced often. Patients should drink plenty of fluids every day. Catheters and the area around the urethra should be cleaned with soap and water daily and after each bowel movement. Prophylactic use of antibiotics is not recommended because it leads to the emergence of antibiotic-resistant strains of bacteria.

Intravenous catheters should be inserted under sterile conditions and with aseptic precautions. Palpate the catheter site for tenderness daily through an intact dressing. Record the date and time of catheter insertion in an obvious location near the insertion site.

To prevent cross-contamination, strict isolation is required for patients with severe burns.

Pseudomonas can multiply in nebulizer fluid; therefore, proper cleaning, sterilization, and disinfection of reusable equipment are required.

Failure to cover bacteremic pneumonia with double antibiotics may lead to a potential lawsuit.

Obtain ophthalmology consultation without delay in cases of suspected pseudomonal eye infections.

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Complications

Pseudomonal endocarditis may cause brain abscess, cerebritis, and mycotic aneurysms. Septic emboli to the lungs and spleen are not uncommon, and cardiac complications may include conduction blocks and congestive heart failure.

Pseudomonal bacteremia can cause septic shock and death.

Pseudomonal pneumonia may be severe enough to require respiratory support.

Ear infections can cause perichondritis; sinusitis; mastoiditis; osteomyelitis of the temporal bones; cranial nerve involvement of seventh, ninth, eleventh, and twelfth nerves; and thrombosis of the lateral and sigmoid sinuses. Meningitis and brain abscesses are relatively rare.

Eye infections can result in corneal perforations, endophthalmitis, and orbital cellulitis.

GI involvement by Pseudomonas can cause typhlitis, cecal perforation, and peritonitis.

A severe bout of diarrhea can result in vascular collapse and death.

Pseudomonas skin and soft tissue infections can be destructive and can cause massive necrosis and gangrene.

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Prognosis

Pseudomonas causes a wide spectrum of diseases; therefore, prognosis is varied.

Prognosis of malignant otitis is improving with earlier recognition of the disease and appropriate antibiotic therapy.

Pseudomonal bacteremia, septicemia, meningitis, burn wound sepsis, and eye infections carry a grave prognosis.

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Patient Education

Patients should be educated about good hygiene in the care of their ears.

Patients should be educated about the potential adverse effects of medications and should be monitored for the same.

For excellent patient education resources, visit eMedicineHealth's Ear, Nose, and Throat Center. Also, see eMedicineHealth's patient education article Swimmer's Ear.

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