Pseudomonas aeruginosa Infections in Cancer Patients

Abstract

Pseudomonas aeruginosa (P. aeruginosa) is one of the most frequent opportunistic microorganisms causing infections in oncological patients, especially those with neutropenia. Through its ability to adapt to difficult environmental conditions and high intrinsic resistance to antibiotics, it successfully adapts and survives in the hospital environment, causing sporadic infections and outbreaks. It produces a variety of virulence factors that damage host cells, evade host immune responses, and permit colonization and infections of hospitalized patients, who usually develop blood stream, respiratory, urinary tract and skin infections. The wide intrinsic and the increasing acquired resistance of P. aeruginosa to antibiotics make the treatment of infections caused by this microorganism a growing challenge. Although novel antibiotics expand the arsenal of antipseudomonal drugs, they do not show activity against all strains, e.g., MBL (metalo-β-lactamase) producers. Moreover, resistance to novel antibiotics has already emerged. Consequently, preventive methods such as limiting the transmission of resistant strains, active surveillance screening for MDR (multidrug-resistant) strains colonization, microbiological diagnostics, antimicrobial stewardship and antibiotic prophylaxis are of particular importance in cancer patients. Unfortunately, surveillance screening in the case of P. aeruginosa is not highly effective, and a fluoroquinolone prophylaxis in the era of increasing resistance to antibiotics is controversial.

Three-Year Evaluation of Pseudomonas aeruginosa Bacteremia in Patients Admitted to a University-Affiliated Hospital, Mashhad, Iran

“…These results are in line with the previous evidence and suggest that P. aeruginosa has become resistant to antibiotics (both MDR and XDR), especially to betalactams (7,22). The significant effect of appropriate initial empirical antibiotics in bacteremia with P. aeruginosa on patient mortality has been previously emphasized, especially in immunocompromised patients, like those with cancer or neutropenia (6,23,24). Some have suggested beta-lactams and amikacin, ciprofloxacin, or colistin as appropriate therapies, while the most appropriate treatment should be based on the local resistance rates (25).…”

“…P. aeruginosa can cause infection in almost any body part; the one with the worst prognosis is blood, resulting in bloodstream infection (BSI) (4). BSI occurs mainly in immunodeficient patients and results in an annual mortality rate of 40% (5,6). The pulmonary focus of infection, substance abuse, and comorbidities, such as cancer, cardiac, liver, and lung diseases, are considered the main risk factors for P. aeruginosa BSI and worse patients' prognosis (7).…”

Application of Decision-Tree-Based Machine Learning Algorithms for Prediction of Antimicrobial Resistance

“…Pseudomonas aeruginosa ( P. aeruginosa ) is Gram-negative, encapsulated, aerobic, rod-shaped pathogen, and is an opportunistic organism. It causes different acute and chronic persistent infections such as urinary tract infections, dermatitis, respiratory system infections, soft-tissue infections, and bacteremia [ 3 ]. It also causes a range of systemic infections, mostly in cancer patients, victims of severe burns, and in AIDS patients who are immunosuppressed [ 3 ].…”

Azithromycin and Ceftriaxone Differentially Activate NLRP3 in LPS Primed Cancer Cells

“…It appears that the pathogenesis of this resistance could involve inflammasome mechanisms, as a study by Müller et al reported that exacerbation of MRSA immunopathology by lactamides is IL-1β-dependent [ 37 ]. It should be noted that these antibiotics are commonly used for the treatment of bacterial infection in cancer patients [ 20 , 39 , 40 ]. As NLRP3 activation and IL-1β secretion could promote tumor growth and contribute to chemotherapy resistance [ 41 ], considerations should be made before using lactamides.…”

“…As NLRP3 activation and IL-1β secretion could promote tumor growth and contribute to chemotherapy resistance [ 41 ], considerations should be made before using lactamides. Although lactamides and macrolides are frequently used for treating a bacterial infection in cancer patients [ 20 , 39 , 40 ], our understanding of these antibiotics’ effects on NLRP3 activation remains limited.…”