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26 Cards in this Set
- Front
- Back
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What are 3 local infections of p. aeruginosa in motile mode?
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Otitis externa
Invasive otitis externa Hot tub folliculitis |
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What are 3 invasive infections of pseudomonas in motile mode?
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-invasive otitis externa in diabetics
-bacteremia, pneumonia in neutropenic patients -burn wound infections |
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What is one infection of psudomonas in stationary mode?
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tracheobronchial infection in patients with CF
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What are 4 infections of pseudomonas in immunologically normal hosts?
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external otitis
follicululitis, hot foot syndrome puncture wound osteomyelitis endocarditis in IVDU |
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What is the pathogenesis of external otitis?
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thinning of canal epithelium from moisture exposure --> microbes invade through epithelium
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what are 3 causes of pseudomonas folliculitis from swimming pools?
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inadequate chlorination
high pH crowding (nitrogenous waste) |
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where does pseudomonas like to attack in folliculitis?
How do you treat? |
apocrine sweat glands
Resolves spontaneously, keep it dry, DON'T USE STEROIDS |
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How causes puncture wound osteomyelitis?
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infection of small bones of the foot when nail goes through shoe and foot
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What are 2 consequences of pseudomonas bacteremia in addicts?
From where do addicts acquire pseudomonas? |
endocarditis
bone/joint infections acquire from syringe |
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what populations are affected most by otitis externa?
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diabetics, adults >60 yo
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How does p. aeruginosa cause otitis externa?
What are the symptoms? |
invades through fissures of santorini
Cranial nerve palsies, painful ear NO fever, leukocytosis, or systemic symptoms |
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What can psuedomonas cause in an immunocompromised host?
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bacteremia --> ecthyma gangrenosum
pneumonia UTI |
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What is the course of psudeomonas bacteremia in nosocomial neutropenic patients?
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GI colonization (salads maybe) --> penetrates duodenal mucosa --> bacteremia --> pneumonia, skin lesions, septic shock, affects other organs
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What are typical sites of ecthyma gangrenosum?
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buttocks, genitalia, abdomen
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What is the characteristic progression of ecthyma gangrenosum?
What is happening pathologically? |
edema, erythema, hemorrhagic bulla, necrosis
Walls of veins are being replaced by bacteria; no neutrophils |
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How do you acquire pseudomonas pneumonia in a hospital?
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ventilator equipment
neutropenia seeding during bacteremia NO neutrophil response |
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What are 4 virulence factors in motile p. aeruginosa?
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pili - adherance to epithelial cells
LPS - endotoxin flagella - motility secreted proteins - exotoxin A, exoenzyme S, elastase, PLC |
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when does p. aeruginose switch to stationary mode?
how? |
in airways in CF patients, protected from defenses by biofilm
loses flagella, LPS O-antigen; produces alginate |
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What are 5 methods of treatment of pseudomonas?
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penicillins: ticarcillin, pipercillin
carbapenems: imipenem, meropnem aminoglycosides: tobramcin, amikacin quinolones: ciprofloxacin, levofloxacin synergistic: beta-lactam + aminoglycoside |
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In AIDS patients, what characterizes the pneumonia that occurs with pseudomonas?
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cavitary pneumonia with bacteremia
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What are the key mechanisms (5) for aspiration of oropharyngeal in non intubated patients?
Intubated patients (2) |
abnormal swallowing
depressed consciousness GI tract instrumentation recent surgery supine position -Secretions leak around cuff of endotracheal tube -altered cough reflex |
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What are possible pathogens in early onset nosocomial pneumonia?
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community-acquired, Ab-susceptible
s. pneumoniae, h. influenzae, methicillin-susceptible s. aureas, anaerobes |
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What are the possible pathogens in late onset nosocomial pneumonia?
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Hospital acquired, drug-resistent
Gram neg bacilli: Pseudomonas, acinetobacter, stenotrophomonas, MRSA |
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What is the most common MDR gram-neg. bacterium that causes nosocomial pneumonia
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pseudomonas aeruginosa
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How do you treat hospital acquired pneumonia caused by
a. gram neg rods b. MRSA |
a. antipseudomonal cephalosporin, carbepenem, b-lactam
b. vacomycin or linezolid START QUICKLY WITH EMPIRIC |
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What are 3 methods of non-pharmacologic prevention of nosocomial pneumonia?
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1. hand washing
2. prevent aspiration positioning, avoid large gastric volume, subglottic suctioning 3. Routine maintenance of ventilator circuits |
