Epidemiology

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Microbiology

• Member of Pseudomonas Genus (see Pseudomonas, [[Pseudomonas]])
  • Non-Fermenting Gram-negative Rod

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Clinical

Cardiac Manifestations

Endocarditis (see Endocarditis, [[Endocarditis]])

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Ear Manifestations

Otitis Externa

Otitis Media

Dermatologic Manifestations

Ecthyma Gangrenosum (see Ecthyma Gangrenosum, [[Ecthyma Gangrenosum]])

• Etiology
  • In addition to Pseudomonas aeruginosa, can also be caused less commonly by Staph, Mucor, Candida, and Herpes
• Diagnosis
  • Skin Biopsy: quite characteristic, showing bacterial invasion of the media and adventitia of veins deep in the dermis (intima and lumen of the vein are spared)
• Clinical
  • Begins as red/purpuric macular rash -> progresses to indurated vesicles -> progresses to bullous, pustular, or hemorrhagic lesions -> gangrenous ulcers with surrounding erythema (may occur within 12-24 hrs)
  • Usually less than 10 lesions are present, most often found in the gluteal or perineal regions, but also appearing on the extremities, trunk, and face in descending order, respectively
• Treatment
  • Aminoglycoside + Antipseudomonal PCN:
  • Ceftazidime:
  • Imipenem:
  • Surgical Debridement: often required
• Prognosis
  • The lower the absolute neutrophil count (ANC), the poorer the prognosis
  • Patients with an ANC < 500 cells/mm3 (0.5 x 109/L) rarely survive

Gastroenterologic Manifestations

Diarrhea

Enterocolitis

Neurologic Manifestations

Brain Abscess (see xxxx, [[]])

Meningitis (see xxxx, [[]])

Opthalmologic Manifestations

Bacterial Keratitis

Endophthalmitis

Pulmonary Manifestations

Necrotizing Pneumonia (see Necrotizing Pneumonia, [[Necrotizing Pneumonia]])

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Pneumonia (see Pneumonia, [[Pneumonia]])

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Ventilator-Associated Pneumonia (see Ventilator-Associated Pneumonia, [[Ventilator-Associated Pneumonia]])

• Epidemiology
  • Risk Factors: prior antibiotic use
• Prognosis
  • Isolation of Pseudomonas aeruginosa from the lungs of mechanically ventilated patient with VAP indicates a worse prognosis

Renal Manifestations

Urinary Tract Infection (UTI) (see Urinary Tract Infection, [[Urinary Tract Infection]])

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Rheumatologic/Orthopedic Manifestations

Osteomyelitis

Other Manifestations

Bacteremia

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Treatment

• Aminoglycosides (see Aminoglycosides, [[Aminoglycosides]])
  • Amikacin (see Amikacin, [[Amikacin]])
  • Gentamicin (see Gentamicin, [[Gentamicin]])
  • Tobramycin (see Tobramycin, [[Tobramycin]])
• Anti-Pseudomonal Penicillins
  • Piperacillin/Tazobactam (Zosyn) (see Piperacillin-Tazobactam, [[Piperacillin-Tazobactam]]
  • Ampicillin/Sulbactam (Unasyn) (see Ampicillin/Sulbactam, [[Ampicillin-Sulbactam]])
• Fluoroquinolones (see Fluoroquinolones, [[Fluoroquinolones]])
  • Ciprofloxacin (Cipro) (see Ciprofloxacin, [[Ciprofloxacin]])
  • Levofloxacin (Levaquin) (see Levofloxacin, [[Levofloxacin]])
• Cefepime (Maxipime) (see Cefepime, [[Cefepime]])

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References

• Lopez FA. Bacterial skin infections. Infect Dis Clin North Am 2001; 15:671-690
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