Pseudomonas aeruginosa

Background:

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Non-fermenting Gram-negative bacilli   
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[cannot catabolize glucose and therefore are not able to ferment. Non-spore forming.]
>Acinetobacter baumannii
>Achromobacter xylosoxidans
>Bordetella pertussis
>Burkholderia species:
     1] Burkholderia cepacia (also known as Pseudomonas cepacia) –  important
            pathogen of pulmonary infections in people with cystic fibrosis.
     2] Burkholderia pseudomallei (also known as Pseudomonas pseudomallei) 
>Elizabethkingia meningoseptica (Previously Chryseobacterium meningosepticum)
>Moraxella catarrhalis (formerly known as Branhamella catarrhalis)
>Pseudomonas aeruginosa led
>Stenotrophomonas maltophilia (Initially classified as Pseudomonas maltophilia)

Pseudomonas aeruginosa:  

  • Gram-negative, aerobic (considered by many as a facultative anaerobe), coccobacillus bacterium that secretes a variety of pigments, including pyocyanin (blue-green), pyoverdine (yellow-green and fluorescent), and pyorubin (red-brown). 
  • Found in soil, water, skin flora, and most man-made environments (found on and in medical equipment, including catheters, causing cross-infections in hospitals and clinics). 
  • The organisms versatility enables it to infect damaged tissues or those with reduced immunity and symptoms of infection include generalized inflammation and sepsis.
  • An opportunistic human pathogen.

 

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Therapy:

Important considerations:  The choice of an agent should be based on local antimicrobial sensitivities, site of infection, cost, and comorbid conditions.   Generally, the most common agents/regimens are listed first.   Listed dosages may need to be adjusted for renal dysfunction.  

Therapy for Pseudomonas should be guided by susceptibility testing.  

  1. Piperacillin-tazobactam (Zosyn ®)  3.375 to 4.5  grams IV q6h
  2. Ceftazidime 2 grams IVPB q8h
  3. Cefepime 2 grams IV every 8-12 hours
  4. Ciprofloxacin  400mg IV q8h
  5. Ciprofloxacin  400mg IV q8h PLUS [Ceftazidime 2 grams IVPB q8h OR Cefepime 2 grams IV every 8-12 hours]
  6. Imipenem 500mg IV every 6 hours [Range: 250-1000 mg q6-8h]
  7. Meropenem 0.5 – 1 gram IV q8h  (life-threatening infection -unlabeled use: 2 grams IV q8h)
  8. Carbapenemase producing strains –
    • Colistimethate (colistin base): 2.5 – 5mg/kg/day in 2-4 divided doses. Max 5 mg/kg/day   PLUS   [ Meropenem 1 gram IV q8h  OR  Imipenem 500mg IV every 6 hours [Range: 250-1000 mg q6-8h]
    • Colistimethate (colistin base): 2.5 – 5mg/kg/day in 2-4 divided doses. Max 5 mg/kg/day   PLUS  Rifampin
    • Colistimethate (colistin base): 2.5 – 5mg/kg/day in 2-4 divided doses. Max 5 mg/kg/day   PLUS Ceftazidime

 

Antibiotics used in combination with agents listed above for resistant strains or severe disease – Examples include – [Cefepime + gent, tobra, or amikacin];  [Ceftazidime  + gent, tobra, or amikacin];   [Zosyn ® +  gent, tobra, or amikacin]; …. :

  1. Gentamicin 1 to 2.5 mg/kg IV q8-12h or consider high-dose extended-interval dosing:  5 to 7 mg/kg q24-48h.  Adjust regimen based on estimated clearance.
  2. Tobramycin 1 to 2.5 mg/kg IV q8-12h or consider high-dose extended-interval dosing:  5 to 7 mg/kg q24-48h.  Adjust regimen based on estimated clearance.
  3. Amikacin 5 to 7.5 mg/kg IV q8h or consider high-dose extended-interval dosing: 15-20 mg/kg q24-48h.  Adjust regimen based on estimated clearance.
  4. Aztreonam: 1-2 grams IV q8-12h.  Severe/Life-threatening: 2 grams IV q6-8h.

Disclaimer

The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user’s use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. Read the disclaimer