Pseudomonas aeruginosa Infections Follow-up

  • Author: Klaus-Dieter Lessnau, MD, FCCP; Chief Editor: Michael Stuart Bronze, MD   more...
 
Updated: Jan 11, 2012
 

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

Klaus-Dieter Lessnau, MD, FCCP  Clinical Associate 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 Thoracic Society, and Society 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, Internal Medicine, United Medical Park

Pratibha Dua, MD, MBBS is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

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.

Specialty Editor Board

Thomas J Marrie, MD  Dean of Faculty of Medicine, Dalhousie University Faculty of Medicine, Canada

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

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 Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

  1. Pollack M. Pseudomonas Aeruginosa. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 5th ed. New York, NY: Churchill Livingstone; 2000:2310-27.

  2. Textbook of Bacteriology. Todar's Online Textbook of Bacteriology [serial online]. Accessed 29/12/07. Available at www.textbookofbacteriology.net..

  3. Ratjen F, Munck A, Kho P, Angyalosi G. Treatment of early Pseudomonas aeruginosa infection in patients with cystic fibrosis: the ELITE trial. Thorax. Apr 2010;65(4):286-91. [Medline].

  4. Bitsori M, Maraki S, Koukouraki S, Galanakis E. Pseudomonas aeruginosa urinary tract infection in children: risk factors and outcomes. J Urol. Jan 2012;187(1):260-4. [Medline].

  5. 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].

  6. 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].

  7. 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].

  8. Crouch Brewer S, Wunderink RG, Jones CB, Leeper KV Jr. Ventilator-associated pneumonia due to Pseudomonas aeruginosa. Chest. Apr 1996;109(4):1019-29. [Medline].

  9. Cunha BA. Clinical relavance of penicillin resistant Streptococcus pneumoniae. Semin Respir Infect. Sep 2002;17(3):204-14. [Medline].

  10. Cunha BA. New uses for older antibiotics: nitrofurantoin, amikacin, colistin, polymyxin B, doxycycline, and minocycline revisited. Med Clin North Am. Nov 2006;90(6):1089-107. [Medline].

  11. Cunha BA. Ventilator associated pneumonia: monotherapy is optimal if chosen wisely. Crit Care. 2006;10(2):141. [Medline].

  12. Cunha BA. Multidrug resistant (MDR) Klebsiella, Acinetobacter, and Pseudomonas aeruginosa. Antibiotics for Clinicians. 2006;10:354-355.

  13. Cunha BA. Pseudomonas aeruginosa: resistance and therapy. Semin Respir Infect. 2002;17:231-239. [Medline].

  14. Edgeworth JD, Treacher DF, Eykyn SJ. A 25-year study of nosocomial bacteremia in an adult intensive care unit. Crit Care Med. Aug 1999;27(8):1421-8. [Medline].

  15. Fiorillo L, Zucker M, Sawyer D, Lin AN. The pseudomonas hot-foot syndrome. N Engl J Med. Aug 2 2001;345(5):335-8. [Medline].

  16. Garcia-Lechuz JM, Cuevas O, Castellares C, Perez-Fernandez C, Cercenado E, Bouza E. Streptococcus pneumoniae skin and soft tissue infections: characterization of causative strains and clinical illness. Eur J Clin Microbiol Infect Dis. Apr 2007;26(4):247-53. Epub. [Medline].

  17. Gavin PJ, Suseno MT, Cook FV, Peterson LR, Thomson RB Jr. Left-sided endocarditis caused by Pseudomonas aeruginosa: successful treatment with meropenem and tobramycin. Diagn Microbiol Infect Dis. Oct 2003;47(2):427-30. [Medline].

  18. Heal CF, Buettner PG, Cruickshank R, Graham D, Browning S, Pendergast J, et al. Does single application of topical chloramphenicol to high risk sutured wounds reduce incidence of wound infection after minor surgery? Prospective randomised placebo controlled double blind trial. BMJ. Jan 15 2009;338:a2812. [Medline].

  19. Hoban DJ, Zhanel GG. Clinical implications of macrolide resistance in community-acquired respiratory tract infections. Expert Rev Anti Infect Ther. Dec 2006;4(6):973-80. [Medline].

  20. Ibrahim EH, Ward S, Sherman G, Kollef MH. A comparative analysis of patients with early-onset vs late-onset nosocomial pneumonia in the ICU setting. Chest. May 2000;117(5):1434-42. [Medline].

  21. Karlowsky JA, Draghi DC, Jones ME, Thornsberry C, Friedland IR, et al. Surveillance for antimicrobial susceptibility among clinical isolates of Pseudomonas aeruginosa and Acinetobacter baumannii from hospitalized patients in the United States, 1998 to 2001. Antimicrob Agents Chemother. May 2003;47(5):1681-8. [Medline].

  22. Klibanov OM, Raasch RH, Rublein JC. Single versus combined antibiotic therapy for gram-negative infections. Ann Pharmacother. Feb 2004;38(2):332-7. [Medline].

  23. Micek ST, Lloyd AE, Ritchie DJ, Reichley RM, Fraser VJ, Kollef MH. Pseudomonas aeruginosa bloodstream infection: importance of appropriate initial antimicrobial treatment. Antimicrob Agents Chemother. Apr 2005;49(4):1306-11. [Medline].

  24. Muramatsu H, Horii T, Morita M, Hashimoto H, Kanno T, Maekawa M. Effect of basic amino acids on susceptibility to carbapenems in clinical Pseudomonas aeruginosa isolates. Int J Med Microbiol. Jun 2003;293(2-3):191-7. [Medline].

  25. [Best Evidence] Paul M, Silbiger I, Grozinsky S, Soares-Weiser K, Leibovici L. Beta lactam antibiotic monotherapy versus beta lactam-aminoglycoside antibiotic combination therapy for sepsis. Cochrane Database Syst Rev. 2006;(1):CD003344. [Medline].

  26. Quittner AL, Modi AC, Wainwright C, Otto K, Kirihara J, Montgomery AB. Determination of the minimal clinically important difference scores for the Cystic Fibrosis Questionnaire-Revised respiratory symptom scale in two populations of patients with cystic fibrosis and chronic Pseudomonas aeruginosa airway infection. Chest. Jun 2009;135(6):1610-8. [Medline].

  27. Retsch-Bogart GZ, Quittner AL, Gibson RL, Oermann CM, McCoy KS, Montgomery AB, et al. Efficacy and safety of inhaled aztreonam lysine for airway pseudomonas in cystic fibrosis. Chest. May 2009;135(5):1223-32. [Medline].

  28. Schoni MH. Macrolide antibiotic therapy in patients with cystic fibrosis. Swiss Med Wkly. May 31 2003;133(21-22):297-301. [Medline].

  29. Shorr AF. Review of studies of the impact on Gram-negative bacterial resistance on outcomes in the intensive care unit. Crit Care Med. Apr 2009;37(4):1463-9. [Medline].

  30. van Delden C. Pseudomonas aeruginosa bloodstream infections: how should we treat them?. Int J Antimicrob Agents. Nov 2007;30 Suppl 1:S71-5. [Medline].

  31. Veesenmeyer JL, Hauser AR, Lisboa T, Rello J. Pseudomonas aeruginosa virulence and therapy: evolving translational strategies. Crit Care Med. May 2009;37(5):1777-86. [Medline].

  32. Vonberg RP, Gastmeier P. Isolation of infectious cystic fibrosis patients: results of a systematic review. Infect Control Hosp Epidemiol. Apr 2005;26(4):401-9. [Medline].

  33. Wang S, Kwok M, McNamara JK, Cunha BA. Colistin for multi-drug resistant (MDR) gram-negative bacillary infections. Antibiotics for Clinicians. 2007;11:389-396.

 
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