eMedicine Specialties > Infectious Diseases > Bacterial Infections

Pseudomonas aeruginosa Infections: Follow-up

Author: Samer Qarah, MD, Pulmonary Critical Care Consultant, Department of Internal Medicine, Division of Pulmonary and Critical Care, The Brooklyn Hospital Center and Cornell University
Coauthor(s): Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital; Pratibha Dua, MD, MBBS, Staff Physician, Department of Internal Medicine, The Brooklyn Hospital Center; Klaus-Dieter Lessnau, MD, FCCP, Clinical Assistant Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory, Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital; Tarun Madappa, MD, MPH, Pulmonary Fellow, Section of Pulmonary Medicine, Lenox Hill Hospital
Contributor Information and Disclosures

Updated: Mar 17, 2008

Follow-up

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.

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.

Inpatient & Outpatient Medications

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

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.

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.

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.

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.

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 eMedicine's Ear, Nose, and Throat Center. Also, see eMedicine's patient education article Swimmer's Ear.

Miscellaneous

Medicolegal Pitfalls

  • Failure to monitor for the adverse effects of medications
  • Failure to cover bacteremic pneumonia with double antibiotics

Special Concerns

  • Infections of the lower respiratory tract in patients with cystic fibrosis are a special concern because they represent long-standing conditions complicated by acute exacerbations, signaling a downhill course.
 


More on Pseudomonas aeruginosa Infections

Overview: Pseudomonas aeruginosa Infections
Differential Diagnoses & Workup: Pseudomonas aeruginosa Infections
Treatment & Medication: Pseudomonas aeruginosa Infections
Follow-up: Pseudomonas aeruginosa Infections
References
Further Reading
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References

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  3. Abuqaddom AI, Darwish RM, Muti H. The effects of some formulation factors used in ophthalmic preparations on thiomersal activity against Pseudomonas aeruginosa and Staphylococcus aureus. J Appl Microbiol. 2003;95(2):250-5. [Medline].

  4. Bliziotis IA, Samonis G, Vardakas KZ, Chrysanthopoulou S, Falagas ME. Effect of aminoglycoside and beta-lactam combination therapy versus beta-lactam monotherapy on the emergence of antimicrobial resistance: a meta-analysis of randomized, controlled trials. Clin Infect Dis. Jul 15 2005;41(2):149-58. [Medline].

  5. Chamot E, Boffi El Amari E, Rohner P, Van Delden C. Effectiveness of combination antimicrobial therapy for Pseudomonas aeruginosa bacteremia. Antimicrob Agents Chemother. Sep 2003;47(9):2756-64. [Medline].

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Further Reading

For additional information, see Medscape’s Pneumonia Resource Center, Sepsis Resource Center, and Cystic Fibrosis Resource Center.

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Keywords

Pseudomonas aeruginosa, P aeruginosa, Pseudomonas aeruginosa infection, P aeruginosa infection, swimmer's ear, Shanghai fever, tropical immersion foot syndrome, green nail syndrome, green foot, Pseudomonas hot-foot syndrome, nosocomial infections, nosocomial pneumonia, urinary tract infection, UTI, bacteremia, Pseudomonas aeruginosa pneumonia, Pseudomonas aeruginosa endocarditis, vertebral osteomyelitis, pseudomonal infection, pseudomonal pneumonia, pseudomonal endocarditis, cystic fibrosis, pseudomonal bacteremia, chronic otitis media, ecthyma gangrenosum, burn wound infection, neutropenia

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Contributor Information and Disclosures

Author

Samer Qarah, MD, Pulmonary Critical Care Consultant, Department of Internal Medicine, Division of Pulmonary and Critical Care, The Brooklyn Hospital Center and Cornell University
Samer Qarah, MD is a member of the following medical societies: American College of Critical Care Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pratibha Dua, MD, MBBS, Staff Physician, Department of Internal Medicine, The Brooklyn Hospital Center
Pratibha Dua, MD, MBBS is a member of the following medical societies: American Medical Association
Disclosure: Nothing to disclose.

Klaus-Dieter Lessnau, MD, FCCP, Clinical Assistant Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory, Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital
Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Artificial Internal Organs, American Thoracic Society, Physicians for Social Responsibility, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Tarun Madappa, MD, MPH, Pulmonary Fellow, Section of Pulmonary Medicine, Lenox Hill Hospital
Tarun Madappa, MD, MPH is a member of the following medical societies: American College of Chest Physicians and American Thoracic Society
Disclosure: Nothing to disclose.

Medical Editor

Thomas J Marrie, MD, Chair, Professor, Department of Medicine, Division of Infectious Diseases, University of Alberta College of Medicine
Thomas J Marrie, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, Canadian Infectious Disease Society, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

John L Brusch, MD, FACP, Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance
John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

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