Pseudomonas is a small gram-negative 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 rare; however, in patients with any type of lowered immunologic resistance — premature neonates; elderly patients; patients with debilitating disease, burns, or wounds; or patients receiving chemotherapy or radiation therapy — septicemic Pseudomonas infections are serious and commonly fatal.
The most common species of Pseudomonas is P. aeruginosa. Other species that typically cause disease in humans include Xanthomonas maltophilia (formerly known as P. maltophilia), Burkholderia cepacia (formerly known as P. cepacia), P. fluorescens, P. testosteroni, P. acidovorans, P. alcaligenes, P. stutzeri, P. putrefaciens, and P. putida. These organisms are commonly found in liquids that have been allowed to stand for a long time, such as benzalkonium chloride, 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. B. cepacia is the organism most closely associated with cystic fibrosis, although P. aeruginosa is also associated with it. In elderly patients, Pseudomonas infection usually enters through the genitourinary tract; in neonates and infants,through the umbilical cord, skin, and GI tract.
The most common infections associated with Pseudomonas include skin infections (such as burns and pressure ulcers), urinary tract infections, 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. (See Melioidosis.) For example, when it invades the lungs, Pseudomonas causes pneumonia with fever, chills, and a productive cough.
CONFIRMING DIAGNOSIS Diagnosis requires isolation of the Pseudomonas organism in blood, spinal fluid, urine, exudate, or sputum culture.
In the debilitated or otherwise vulnerable patient with clinical evidence of Pseudo-monas infection, treatment should begin immediately, without waiting for results of laboratory tests. Antibiotic treatment includes aminoglycosides, such as gentamicin or tobramycin, combined with an antipseudomonal penicillin, such as ticarcillin or piperacillin. An alternative combination is amikacin and a similar penicillin or imipenem and cilastatin. Such combination therapy is necessary because Pseudomonas quickly becomes resistant to ticarcillin alone.
Local Pseudomonas infections or septicemia secondary to wound infection requires 1% acetic acid irrigations; topical applications of colistimethate, polymyxin B, and silver sulfadiazine cream; and debridement or drainage of the infected wound.
❑Observe and record the character of wound exudate and sputum.
❑Before administering antibiotics, ask the patient about a history of drug allergies, especially to penicillin. If combinations of piperacillin or ticarcillin and an aminoglycoside are ordered, schedule the doses 1 hour apart (ticarcillin may decrease the antibiotic effect of the aminoglycoside). Don’t give both antibiotics through the same administration set.
❑Monitor the patient's renal function (output, blood urea nitrogen level, specific gravity, urinalysis, and creatinine level) during treatment with aminoglycosides. Obtain drug levels to ensure effectiveness.
❑Protect immunocompromised patients from exposure to this infection. Proper hand hygiene and sterile 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. Discard suction bottles, irrigating fluid, and open bottles of saline solution every 24 hours. Be sure to change I.V. tubing according to hospital policy and to empty ventilator water reservoirs before refilling them with sterile water. Remember to use suction catheters only once.
Review other book chapters online related to Melioidosis:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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