Download PDF
Semin Respir Crit Care Med 2000; 21(4): 331-340
DOI: 10.1055/s-2000-9861
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Problem Pulmonary Pathogens: Pseudomonas Aeruinosa

Ruba Odeh, John P. Quinn
  • Department of Medicine, University of Illinois, Chicago
Further Information

Publication History

Publication Date:
31 December 2000 (online)

    Permissions and Reprints

ABSTRACT

Pseudomonas aeruginosa is a common and highly lethal agent of nosocomial pneumonia, especially among patients receiving mechanical ventilation. It is widespread in the environment and commonly recovered from water in nature and in hospital settings. P. aeruginosa is endowed with a formidable array of virulence factors that facilitate attachment to host cells, tissue invasion, and systemic disease. It is intrinsically resistant to many commonly used antibiotics due to a complex variety of mechanisms that we will briefly review. Recent advances in the understanding of the molecular biology of this organism have shed considerable light on its ability to form biofilms, which facilitate adherence especially in cystic fibrosis patients, and confer resistance to clearance by host immune mechanisms and antimicrobial killing. Treatment studies have demonstrated a significant risk of emergence of resistance during therapy with a variety of agents. Several studies suggest that two drugs are better than one for therapy of serious infections, although dual therapy does not always prevent emergence of resistant strains.

KEYWORD

Pseudomonas aeruginosa, respiratory infections - pathogenesis

REFERENCES

  • 1 Koneman E W, Allen S D, Janda W M. Color atlas and textbook of diagnostic microbiology, 5th ed. Lippincott 1997: 257-269
    Search in Google Scholar
  • 2 Forkner C E. Pseudomonas aeruginosa infections. In: Wright IS, ed. Modern Medical Monographs No.22 New York: Grune and Stratton 1960: 1-5
    Search in Google Scholar
  • 3 Stratton C W. Pseudomonas aeruginosa revisited.  Infect Control Hosp Epidemiol . 1990;  11 101-104
    PubMedSearch in Google Scholar
  • 4 Mandell G L, Bennett J E, Dolin R. Principles and practice of infectious diseases, 4th ed. Churchill Livingstone Inc 1995: 1980-2003
    Search in Google Scholar
  • 5 Neu H C. The role of Pseudomonas aeruginosa in infections.  J Antimicrob Chemother . 1983;  11 1-13
    PubMedSearch in Google Scholar
  • 6 Rello J, Jubert P. Evaluation of outcome for intubated patients with pneumonia due to Pseudomonas aeruginosa Clin Infect Dis .  1996;  23 973-978
    PubMedSearch in Google Scholar
  • 7 Kush B J, Hoadley A W. A preliminary survey of the association of Pseudomonas aeruginosa with commercial whirlpool bath waters.  AJPH . 1980;  70 279-281
    PubMedSearch in Google Scholar
  • 8 Gould I M, Wise R. Pseudomonas aeruginosa: Clinical manifestation and management.  Lancet . 1985;  1224-1227
    PubMedSearch in Google Scholar
  • 9 Olson B, Weinstein R A, Nathan C. Epidemiology of endemic Pseudomonas aeruginosa: Why infection control efforts have failed. J Infect Dis .  1984;  150 808-816
    PubMedSearch in Google Scholar
  • 10 Richards M J, Edwards J R, Culver D H. Nosocomial infections in medical intensive care units in the United States.  Crit Care Med . 1999;  27 887-893
    CrossrefPubMedSearch in Google Scholar
  • 11 Doig P, Todd T. Role of pili in adhesion of Pseudomonas aeruginosa to human respiratory epithelial cells.  Infect Immun . 1988;  56 1641-1646
    PubMedSearch in Google Scholar
  • 12 Baker N R, Minor V, Deal C. Pseudomonas aeruginosa exoenzyme S is an adhesin.  Infect Immun . 1991;  59 2859-2863
    PubMedSearch in Google Scholar
  • 13 Cross A S, Sadoff J C, Iglewski B H, Sokol P A. Evidence of the role of toxin A in the pathogenesis of infection with Pseudomonas aeruginosa in humans.  J Infect Dis . 1980;  142 538-546
    PubMedSearch in Google Scholar
  • 14 Nicas T I, Bradley J, Lochner J E, Iglewski B H. The role of exoenzyme S in infections with Pseudomonas aeruginosa J Infect Dis .  1985;  152 716-721
    PubMedSearch in Google Scholar
  • 15 Govan J RW, Deretic V. Microbial pathogenesis in cystic fibrosis: Mucoid Pseudomonas aeruginosa and Burkholderia cepacia Microbiol Rev .  1996;  60 539-574
    PubMedSearch in Google Scholar
  • 16 Wilson R, Dowling R B. Pseudomonas aeruginosa and other related species.  Thorax . 1998;  53 213-219
    PubMedSearch in Google Scholar
  • 17 Costerton J W, Stewart P S, Greenberg E P. Bacterial biofilms: A common cause of persistent infections.  Science . 1999;  284 1318-1322
    CrossrefPubMedSearch in Google Scholar
  • 18 Marshall W F, Blair J E. The cephalosporins.  Mayo Clin Proc . 1999;  74 187-195
    PubMedSearch in Google Scholar
  • 19 Morihara K. Production of elastase and proteinase by Pseudomonas aeruginosa J Bacteriol .  1964;  88 745-757
    PubMedSearch in Google Scholar
  • 20 Parmely M, Gale A, Clabaugh M. Proteolytic inactivation of cytokines by Pseudomonas aeruginosa Infect Immun .  1990;  58 3009-3014
    PubMedSearch in Google Scholar
  • 21 Bishop M B, Baltch A L, Hill L A. The effect of Pseudomonas aeruginosa cytotoxin and toxin A on human polymorphonuclear leukocytes.  J Med Microbiol . 1987;  24 315-324
    PubMedSearch in Google Scholar
  • 22 Berka R M, Vasil M L. Phospholipase c (heat-labile hemolysin) of Pseudomonas aeruginosa: Purification and preliminary characterization.  J Bacteriol . 1981;  152 239-245
    PubMedSearch in Google Scholar
  • 23 Johnson M K, Boese-Marrazzo D. Production and properties of heat-stable extracellular hemolysin from Pseudomonas aeruginosa Infect Immun .  1980;  29 1028-1033
    PubMedSearch in Google Scholar
  • 24 Pollack M, Young L S. Protective activity of antibodies to exotoxin A and lipopolysaccharide at the onset of Pseudomonas aeruginosa septicemia in man.  J Clin Invest . 1979;  63 276-285
    PubMedSearch in Google Scholar
  • 25 Itokazu G S, Quinn J P, Bell-Dixon C, Kahan F M, Weinstein R A. Antimicrobial resistance rates among aerobic gram-negative bacilli recovered from patients in intensive-care units: Evaluation of a national postmarketing surveillance program.  Clin Infect Dis . 1996;  23 779-784
    PubMedSearch in Google Scholar
  • 26 Burwen D R, Banerjee S N, Gaynes R P. Ceftazidime resistance among selected gram-negative bacilli in the United States. National Nosocomial Infections Surveillance System.  J Infect Dis . 1994;  170 1622-1625
    PubMedSearch in Google Scholar
  • 27 Jacobsen K L, Cohen S H, Inciardi J F. The relationship between antecedent antibiotic use and resistance to extended-spectrum cephalosporins in group I Beta-lactamase-producing organisms.  Clin Infect Dis . 1995;  21 1107-1113
    PubMedSearch in Google Scholar
  • 28 Manian F A, Meyer L, Jenne J, Owen A, Taff T. Loss of antimicrobial susceptibility in aerobic gram-negative bacilli repeatedly isolated from patients in intensive-care-units.  Infect Control Hosp Epidemiol . 1996;  17 222-226
    CrossrefPubMedSearch in Google Scholar
  • 29 Harris A. Epidemiology and clinical outcomes of patients with multiresistant Pseudomonas aeruginosa Clin Infect Dis .  1999;  28 1128-1133
    PubMedSearch in Google Scholar
  • 30 Fink M P, Torres-Viera C, Venkataraman L. Treatment of severe pneumonia in hospitalized patients: Results of a multicenter, randomized, double-blind trial comparing intravenous ciprofloxacin with imipenem-cilastin.  Antimicrob Agents Chemother . 1994;  38 547-557
    CrossrefPubMedSearch in Google Scholar
  • 31 Zabner R, Quinn J P. Antimicrobials in cystic fibrosis: Emergence of resistance and implications for treatment.  Semin Respir Infect . 1992;  7 210-217
    PubMedSearch in Google Scholar
  • 32 Hitt C M, Nightingale C H, Quintiliani R, Nicolau D P. Streamling antimicrobial therapy for lower respiratory tract infections.  Clin Infect Dis . 1997;  24(suppl 2) S231-S237
    PubMedSearch in Google Scholar
  • 33 Consensus statement. Hospital-acquired pneumonia in adults: Diagnosis, assessment of severity, initial antimicrobial therapy, and preventative strategies.  Am J Respir Crit Care Med . 1996;  153 1713-1723
    PubMedSearch in Google Scholar
  • 34 Hilf M, Yu V L, Sharp J. Antibiotic therapy for Pseudomonas aeruginosa bacteremia outcome correlations in a prospective study of 200 patients.  Am J Med . 1989;  87 540-546
    CrossrefPubMedSearch in Google Scholar
  • 35 Leibovici L, Paul M, Poznanski O. Monotherapy versus beta-lactam-aminoglycoside combination treatment for gram-negative bacteremia: A prospective, observational study.  Antimicrob Agents Chemother . 1997;  41 1127-1133
    CrossrefPubMedSearch in Google Scholar
  • 36 Isenberg H D, Alperstein P, France K. In vitro activity of ciprofloxacin, levofloxacin, and trovafloxacin, alone and in combination with β-lactams, against clinical isolates of Pseudomonas aeruginosa, Stenotrophomonas maltophilia, and Burkholderia cepacia Diagn Microbiol Infect Dis .  1999;  33 81-86
    PubMedSearch in Google Scholar
  • 37 Iaconis J P, Pitkin D H, Sheikh W, Nadler H L. Comparison of antibacterial activities of meropenem and six other antimicrobials against Pseudomonas aeruginosa isolates from north american studies and clinical trials.  Clin Infect Dis . 1997;  24(suppl 2) S191-S196
    PubMedSearch in Google Scholar
  • 38 Hellinger W C, Brewer N S. Carbapenems and monobactams: Imipenem, meropenem, and aztreonam.  Mayo Clin Proc . 1999;  74 420-434
    PubMedSearch in Google Scholar
  • 39 Carmeli Y, Troillet N, Eliopoulos G M, Samore M H. Emergence of antibiotic resistant Pseudomonas aeruginosa: Comparison of risks associated with different antipseudomonal agents.  Antimicrob Agents Chemother . 1999;  43 1379-1382
    PubMedSearch in Google Scholar
  • 40 Rubin B K. Emerging therapies for cystic fibrosis lung disease.  Chest . 1999;  115 1120-1126
    CrossrefPubMedSearch in Google Scholar
  • 41 Edson R S, Terell C L. The aminoglycosides.  Mayo Clin Proc . 1999;  74 519-528
    PubMedSearch in Google Scholar
  • 42 Levin A S, Barone A A, Penco J. Intravenous colistin as therapy for nosocomial infections caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii Clin Infect Dis .  1999;  28 1008-1011
    PubMedSearch in Google Scholar
  • 43 Hancock R EW. Resistance mechanisms in Pseudomonas aeruginosa and other nonfermentative gram-negative bacteria.  Clin Infect Dis . 1998;  27(suppl 1) S93-S99
    CrossrefPubMedSearch in Google Scholar
  • 44 Hancock R EW, Bellido F. Antibacterial in vitro activity of fourth generation cephalosporins.  J Chemother . 1995;  7(suppl 5) 29-34
    PubMedSearch in Google Scholar
  • 45 Fung-Tomc J C, Gradelski E, Huczko E. Differences in the resistant variants of Enterobacter cloacae selected by extended-spectrum cephalosporins.  Antimicrob Agents Chemother . 1996;  40 1289-1293
    PubMedSearch in Google Scholar
  • 46 Quinn J P, Studemeister A E, DiVincenzo C A, Lerver S A. Resistance to imipenem in Pseudomonas aeruginosa: Clinical experience and biochemical mechanisms.  Rev Infect Dis . 1988;  10 892-898
    PubMedSearch in Google Scholar
  • 47 Masuda N, Sakagawa E, Ohya S. Outer membrane proteins responsible for multiple drug resistance I Pseudomonas aeruginosa Antimicrob Agents Chemother .  1995;  39 645-649
    PubMedSearch in Google Scholar
  • 48 Kohler T, Michea-Hamzehpour M, Epp S F, Pechere J C. Carbapenem activities against Pseudomonas aeruginosa: Respective contributions of OprD and efflux systems.  Antimicrob Agents Chemother . 1999;  43 424-427
    PubMedSearch in Google Scholar
  • 49 Bryan L E, O-Hara K, Wong S. Lipopolysaccharide changes in impermeability-type aminoglycoside resistance in Pseudomonas aeruginosa.  Antimicrob Agents Chemother . 1984;  26 250-255
    PubMedSearch in Google Scholar
  • 50 Yoshida H, Nakamura M, Bogaki M, Nakamura S. Proportion of DNA gyrase mutants among quinolone-resistant strains of Pseudomonas aeruginosa.  Antimicrob Agents Chemother . 1990;  34 1273-1275
    PubMedSearch in Google Scholar
  • 51 Poole K, Krebes K, McNally C, Neshat S. Multiple antibiotic resistance I Pseudomonas aeruginosa: Evidence for involvement of an efflux operon.  J Bacteriol . 1993;  175 7363-7372
    PubMedSearch in Google Scholar
  • 52 Ma D, Cook D N, Hearst J E, Nikaido H. Efflux pumps and drug resistance in Gram-negative bacteria.  Trends Microbiol . 1994;  2 489-493
    CrossrefPubMedSearch in Google Scholar
  • 53 McCall C Y, Spruill W J. The use of aerosolized tobramycin in the treatment of a resistant pseudomonal pneumonitis.  Ther Drug Monit . 1989;  11 692-695
    PubMedSearch in Google Scholar
  • 54 McCarthy M. Inhaled antibiotics effective for cystic fibrosis.  Lancet . 1999;  353 215
    PubMedSearch in Google Scholar
  • 55 McCall C Y, Spruill W J. The use of aerosolized tobramycin in the treatment of a resistant pseudomonal pneumonitis.  Ther Drug Monit . 1989;  11 692-695
    PubMedSearch in Google Scholar
  • 56 Ramsey B W, Dorkin H L. Efficacy of aerosolized tobramycin in patients with cystic fibrosis.  N Engl J Med . 1993;  328 1740-1746
    CrossrefPubMedSearch in Google Scholar
  • 57 Ramsey B W, Pepe M S, Quan J M. Intermittent administration of inhaled tobramycin in patients with cystic fibrosis.  N Engl J Med . 1999;  340 23-30
    CrossrefPubMedSearch in Google Scholar
  • 58 Nelson S, Belknap S M. A randomized controlled trial of filgastim as an adunct to antibiotics for treatment of hospitalized patients with community-acquired pneumonia.  J Infect Dis . 1998;  178 1075-1080
    PubMedSearch in Google Scholar
  • 59 Knapp B, Hundt E, Lenz U. A recombinant hybrid outer membrane protein for vaccination against Pseudomonas aeruginosa Vaccine .  1999;  17 1663-1666
    PubMedSearch in Google Scholar
  • 60 Mansouri E, Gabelsberger J, Knapp B. Safety and immunogenicity of a Pseudomonas aeruginosa hybrid outer membrane protein F-1 vaccine in human volunteers.  Infect Immun . 1999;  67 1461-1470
    PubMedSearch in Google Scholar