The Epidemiology, Pathogenesis and Treatment of Pseudomonas aeruginosa Infections

Abstract

Pseudomonas aeruginosa is an important bacterial pathogen, particularly as a cause of infections in hospitalised patients, immunocompromised hosts and patients with cystic fibrosis. Surveillance of nosocomial P. aeruginosa infections has revealed trends of increasing antimicrobial resistance, including carbapenem resistance and multidrug resistance. Mechanisms of antimicrobial resistance include multidrug efflux pumps, ss-lactamases and downregulation of outer membrane porins. Mechanisms of virulence include secreted toxins and the ability to form biofilms. The effective treatment of infections caused by P. aeruginosa includes prevention when possible, source control measures as necessary and prompt administration of appropriate antibacterial agents. Antibacterial de-escalation should be pursued in patients with an appropriate clinical response, especially when antibacterial susceptibilities are known. Multidrug-resistant P. aeruginosa may require treatment with less commonly used antibacterials (e.g. colistin), but newer anti-pseudomonal antibacterials are expected to be available in the near future.

Airway epithelial control of Pseudomonas aeruginosa infection in cystic fibrosis

“…The most effective methods prevent or limit infection or the consequences of infection, whereas the more experimental and newer approaches attempt to correct the defective airway epithelial response to P. aeruginosa and produce an environment more akin to that of the WT-CFTR-expressing lung ( Table 1). As for modern methods of treating established CF lung disease, several recent publications have reviewed the current practices and latest clinical evidence for efficacious treatments [62][63][64][65].…”

First report of an acute purulent maxillary sinusitis caused by Pseudomonas aeruginosa secondary to dental implant placement in an immunocompetent patient

“…[18][19][20] P. aeruginosa is a medically important pathogenic bacteria, causing a broad spectrum of diseases, especially in immunocompromised individuals. 4,5 A prospective study showed that P. aeruginosa isolates recovered from the turbine waterlines caused gingival abscesses only in two immunocompromised patients, while a transient colonisation of the oral cavity of 78 healthy patients did not provoke any adverse health consequences. 4 Although the infective dose for colonisation in healthy individuals (>1.5 × 10 6 cfu/ ml) is rarely encountered in DUWLs, 21 it could be plausible that previous antibiotic treatment made the present patient more susceptible, thus lowering the required P. aeruginosa infectious dose.…”

“…5 However, antibiotic therapy with imipenem designed on the basis of in vitro antibiotic susceptibility tests led to successful infection eradication. The ability shown by P. aeruginosa to grow as highly antibiotic-resistant biofilm communities on the mucosa of patients with chronic sinusitis 23 could provide a plausible explanation for the very long-term (one year) antibiotic therapy needed before achieving infection eradication.…”

“…[1][2][3] Pseudomonas aeruginosa infection following dental treatment, though not frequent, is well described in the immunocompromised population, including the elderly, organ transplant recipients, HIVinfected patients, cancer patients, and those on immunosuppressive therapy. 4,5 It is, however, very uncommon in immunocompetent patients.…”

Genetic engineering ofFrancisella tularensisLVS for use as a novel live vaccine platform againstPseudomonas aeruginosainfections

“…5 P. aeruginosa is a leading cause of nosocomial and burn wound infections, and chronically infects those afflicted with cystic fibrosis. 6 Treating these infections therapeutically is challenging, as many strains of P. aeruginosa are drug resistant. This magnifies the need for an effective vaccine.…”