Pseudomonas aeruginosa Infections Workup

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

Laboratory Studies

  • A CBC count may reveal leukocytosis with a left shift and bandemia. In patients with hematologic malignancy or status postchemotherapy, leukopenia with neutropenia is expected. Leukopenia is a poor prognostic indicator.
  • Blood cultures
    • Obtain at least 2 sets of blood cultures (2 aerobic, 2 anaerobic bottles) from different sites.
    • Positive results on blood culture in the absence of extracardiac sites of infection may indicate pseudomonal endocarditis. However, bacteremia may complicate intravenous catheter infections, urinary tract instrumentation, trauma, and surgery in the absence of endocarditis.
  • In UTI, urinalysis is helpful in determining a diagnosis.
  • In pneumonia, sputum and respiratory secretions should be cultured. However, the isolation of Pseudomonas from sputum and tracheal secretions might indicate airway colonization. The poor sensitivity and specificity of sputum in determining the bacterial cause of pneumonia in patients who are mechanically ventilated has led to greater use of quantitative cultures obtained from protected bronchoalveolar lavage and protected specimen brushings. Blood gas analysis to evaluate for hypoxia or hypercarbia should also be performed in patients with pneumonia.
  • Obtain wound and burn cultures and cultures from other body fluids and secretions according to the clinical scenario. To aid in diagnosis, obtaining burn wound biopsies with quantitative bacterial cultures is recommended. A bacterial count of greater than 105 organisms per gram of tissue is diagnostic of a burn wound infection.
  • Obtain Gram stain and culture of cerebrospinal fluid if meningitis is suspected.
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Imaging Studies

  • Chest radiography
    • Abnormalities observed in pseudomonal pneumonia depend on the pathogenesis of the infections. In primary pseudomonal pneumonia, in which aspiration of infected secretions results in pneumonia, the chest radiograph often reveals bilateral bronchopneumonia consisting of nodular infiltrates with or without pleural effusion. Lobar pneumonia is uncommon.
    • Early pulmonary vascular congestion is found in patients with bacteremic pseudomonal pneumonia and rapidly progresses to pulmonary edema and necrotizing bronchopneumonia. Within 48-72 hours, the radiograph demonstrates a mixture of alveolar and interstitial infiltrates, and cavitation may be present.
  • Triple-phase bone scan may be useful in patients with suspected skeletal infection, although many would preferentially rely on MRI.
  • Brain CT scan or MRI allows for evaluation of patients suspected of having a pseudomonal brain abscess.
  • Renal ultrasonography is useful in evaluating patients suspected of having a perinephric abscess complicating UTI.
  • Echocardiography should be considered in patients with positive blood culture findings in whom endocarditis is suspected. Normal transthoracic echocardiography findings do not rule out endocarditis in patients in whom clinical suspicion is high. Transesophageal echocardiography should then be considered.
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Other Tests

  • Gram stain of respiratory secretions and cerebrospinal fluid
  • Fluorescein staining and slit-lamp examination of the cornea for keratitis
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Procedures

  • Procedures indicated for pseudomonal infections depend on the clinical picture and the site of infection.
  • Flexible fiberoptic bronchoscopy with bronchoalveolar lavage or bronchial brushing may be useful in pneumonia. Pleural effusions may require thoracocentesis.
  • Lumbar puncture with cell count and cultures is indicated in suspected pseudomonal meningitis.
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Histologic Findings

Pseudomonas infection causes necrotizing inflammation. Histologically, gram-negative rods are observed in the walls of blood vessels, causing coagulation necrosis, along with thrombosis and hemorrhage.

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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.

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