Pseudomonas Infections - Causes, Symptoms and Treatments
Pseudomonas is a small gram-negative aerobic bacillus that produces nosocomial infections, superinfections of various parts of the body, and a rare disease called melioidosis. This bacillus is also associated with bacteremia, endocarditis, and osteomyelitis in drug addicts. In local Pseudomonas infections, treatment is usually successful and complications are rare; however, in patients with poor immunologic resistance - premature infants, the elderly, or those with debilitating disease, burns, or wounds- septicemic Pseudomonas infections are serious and sometimes fatal.
Causes of Pseudomonas infections:
The most common species of Pseudomonas is P.aeruginosa. Other species that typically cause disease in humans include P. maltophilia, P. cepacia, P. fluorescens, P. testosteroni, P. acidovorans, P. alcaligenes, P. stutzeri, P. putrefaciens, and P. putida. These organisms are commonly found in hospital liquids that have been allowed to stand for a long time, such as benzalkonium chloride, hexachlorophene soap, saline solution, penicillin, water in flower vases, and fluids in incubators, humidifiers, and inhalation therapy equipment. P. aeruginosa is associated with chronic obstructive pulmonary disease and cystic fibrosis. In elderly patients, Pseudomonas infection usually enters through the genitourinary tract; in infants, through the umbilical cord, skin, and GI tract.
Signs and symptoms of Pseudomonas infections:
The most common infections associated with Pseudomonas include skin infections (such as burns and pressure ulcers), urinary tract infections (UTIs), infant epidemic diarrhea and other diarrheal illnesses, bronchitis, pneumonia, bronchiectasis, meningitis, corneal ulcers, mastoiditis, otitis externa, otitis media, endocarditis, and bacteremia.
Drainage in Pseudomonas infections has a distinct, sickly sweet odor and a greenish blue pus that forms a crust on wounds. Other symptoms depend on the site of infection. For example, when it invades the lungs, Pseudomonas causes pneumonia with fever, chills, and a productive cough.
Diagnosis of Pseudomonas infections:
Diagnosis requires isolation of the Pseudomonas organism in blood, spinal fluid, urine, exudate, or sputum culture.
Treatment of Pseudomonas infections:
In the debilitated or otherwise vulnerable patient with clinical evidence of Pseudomonas infection, treatment should begin immediately, without waiting for results oflaboratory tests. Antibiotic treatment includes aminoglycosides, such as gentamicin or tobramycin, combined with a Pseudomonas-sensitive penicillin, such as carbenicillin disodium or ticarcillin. An alternative combination is amikacin and a similar penicillin. Two newer drugs, imipenem and the anti-pseudomonal fluoroquinolones, in combination with an aminoglycoside, are also effective. Such combination therapy is neccssary because pseudomonas quickly becomes resistant to carbenicillin alone, However, in UTIs, carbenicillin indany1 sodium can be used alone if the organism is suseeptible anld the infection doesn't have systemic effects; the drug is excreted in the urine alld builds up high urine levels that prevent resistance.
Local Pseudomonas infections or septicemia secondary to wound infection requires 1 % acetic acid irrigations, topical applications of colistimethate sodium and polymyxin B, and debridement or drainage of the infected wound.
Special considerations and Prevention tips of Pseudomonas infections:
Protect immunocompromised patients from exposure to this infection. Proper hand washing and aseptic techniques prevent further spread. To prevent Pseudomonas infection, maintain proper endotracheal and tracheostomy suctioning technique: Use strict sterile technique when caring for I.V. lines, catheters, and other tubes; dispose of suction bottle contents properly; and label and date solution bottles and change them frequently, according to policy.
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