Pseudomonas

Clasificación

Características Generales

• Bacilos gramnegativos
• Encapsulados
• Móvil: flagelo polar único
• Aerobio obligado
• Oxidasa positivo
• Catalasa positivo
• No fermenta lactosa
• Produce un pigmento azul verdoso: debido a la producción de piocianina y fluoresceína
• Produce un característico olor afrutado, parecido a la uva
• Especies clínicamente relevantes: Pseudomonas aeruginosa Pseudomonas aeruginosa A species of gram-negative, aerobic, rod-shaped bacteria commonly isolated from clinical specimens (wound, burn, and urinary tract infections). It is also found widely distributed in soil and water. P. Aeruginosa is a major agent of nosocomial infection. Pseudomonas ( P. aeruginosa P. aeruginosa A species of gram-negative, aerobic, rod-shaped bacteria commonly isolated from clinical specimens (wound, burn, and urinary tract infections). It is also found widely distributed in soil and water. P. Aeruginosa is a major agent of nosocomial infection. Pseudomonas)

Patogénesis

Reservorio y transmisión

Reservorio:

• Ubicuo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el medio ambiente
• Reservorios húmedos:
  • Lavabos
  • Equipos respiratorios y de diálisis

Transmisión:

• Transmisión de persona a persona a partir reservorios infectados

Factores de riesgo

• Neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia
• Lesiones por quemaduras
• Asplenia Asplenia Asplenia is the absence of splenic tissue or function and can stem from several factors ranging from congenital to iatrogenic. There is a distinction between anatomic asplenia, which is due to the surgical removal of the spleen, and functional asplenia, which is due to a condition that leads to splenic atrophy, infarct, congestion, or infiltrative disease. Asplenia
• Fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans quística
• Intubación endotraqueal
• Catéteres permanentes crónicos

Patogénesis de P. aeruginosa P. aeruginosa A species of gram-negative, aerobic, rod-shaped bacteria commonly isolated from clinical specimens (wound, burn, and urinary tract infections). It is also found widely distributed in soil and water. P. Aeruginosa is a major agent of nosocomial infection. Pseudomonas

Enfermedades Causadas por P. aeruginosa

Antimicrobianos

Tratamiento

• P. aeruginosa P. aeruginosa A species of gram-negative, aerobic, rod-shaped bacteria commonly isolated from clinical specimens (wound, burn, and urinary tract infections). It is also found widely distributed in soil and water. P. Aeruginosa is a major agent of nosocomial infection. Pseudomonas tiene una resistencia variable Variable Variables represent information about something that can change. The design of the measurement scales, or of the methods for obtaining information, will determine the data gathered and the characteristics of that data. As a result, a variable can be qualitative or quantitative, and may be further classified into subgroups. Types of Variables a los LOS Neisseria antibióticos:
  • Resistente a múltiples medicamentos: resistente, por los LOS Neisseria menos, a 1 agente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum > 3 categorías de antibióticos
  • Altamente resistente a los LOS Neisseria medicamentos: resistente, por lo menos, a 1 agente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum todas las categorías de antibióticos excepto 2
  • Panrresistente a los LOS Neisseria medicamentos: resistente a todas las categorías de antibióticos
• La elección del antibiótico se adapta a los LOS Neisseria patrones de resistencia locales (tratamiento antibiótico combinado):
  • 1ra línea:
    • Combinación de penicilina/inhibidores de betalactamasas (piperacilina/ tazobactam Tazobactam A penicillanic acid and sulfone derivative and potent beta-lactamase inhibitor that enhances the activity of other anti-bacterial agents against beta-lactamase producing bacteria. Cephalosporins)
    • Cefalosporinas (ceftazidima)
    • Monobactámico ( aztreonam Aztreonam The carbapenems and aztreonam are both members of the bactericidal beta-lactam family of antibiotics (similar to penicillins). They work by preventing bacteria from producing their cell wall, ultimately leading to bacterial cell death. Carbapenems and Aztreonam)
    • Fluoroquinolonas (ciprofloxacino) (solo oral)
    • Carbapenémicos ( meropenem Meropenem A thienamycin derivative antibacterial agent that is more stable to renal dehydropeptidase I than imipenem, but does not need to be given with an enzyme inhibitor such as cilastatin. It is used in the treatment of bacterial infections, including infections in immunocompromised patients. Carbapenems and Aztreonam)
  • Las cepas multirresistentes se tratan con antibióticos recientemente desarrollados:
    • Combinaciones de betalactámicos-inhibidores de betalactamasas (ceftolozano/ tazobactam Tazobactam A penicillanic acid and sulfone derivative and potent beta-lactamase inhibitor that enhances the activity of other anti-bacterial agents against beta-lactamase producing bacteria. Cephalosporins)
    • Cefalosporinas ( cefiderocol Cefiderocol Multidrug-resistant Organisms and Nosocomial Infections)
    • Combinación de carbapenem-betalactamasa (imipenem-cilastatina-relebactam)
    • Polimixinas
  • Antibióticos adjuntos: aminoglucósidos (tobramicina, gentamicina, amikacina)

Prevención

• Higiene dentro del hospital:
  • Uso de técnica estéril adecuada
  • Limpieza cuidadosa de lavabos y duchas comunes
• Supervisión periódica, reemplazo y limpieza de:
  • Equipo de soporte respiratorio
  • Vías intravenosas (especialmente vías de larga duración)
  • Catéteres

Mnemotecnia

Para ayudar a recordar los múltiples datos clínicamente relevantes sobre Pseudomonas, use la mnemotecnia “PSEUDOMONAS” ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés):

• P – Pneumonia Pneumonia Pneumonia or pulmonary inflammation is an acute or chronic inflammation of lung tissue. Causes include infection with bacteria, viruses, or fungi. In more rare cases, pneumonia can also be caused through toxic triggers through inhalation of toxic substances, immunological processes, or in the course of radiotherapy. Pneumonia, pyocyanin Pyocyanin Antibiotic pigment produced by pseudomonas aeruginosa. Pseudomonas (neumonía, piocianina)
• S – Sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock ( sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock)
• E – Ecthyma gangrenosum Ecthyma gangrenosum Pseudomonas (ectima gangrenoso)
• U – UTIs (ITU)
• D – Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus, drug use ( diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus, uso de drogas)
• O – Osteomyelitis Osteomyelitis Osteomyelitis is an infection of the bone that results from the spread of microorganisms from the blood (hematogenous), nearby infected tissue, or open wounds (non-hematogenous). Infections are most commonly caused by Staphylococcus aureus. Osteomyelitis (osteomielitis)
• M – Mucoid, polysaccharide  capsule Capsule An envelope of loose gel surrounding a bacterial cell which is associated with the virulence of pathogenic bacteria. Some capsules have a well-defined border, whereas others form a slime layer that trails off into the medium. Most capsules consist of relatively simple polysaccharides but there are some bacteria whose capsules are made of polypeptides. Bacteroides (cápsula de polisacárido mucoide)
• O – Otitis externa Otitis externa Otitis externa (also known as external otitis or swimmer’s ear) is an infection of the external auditory canal that is most often caused by acute bacterial infection and is frequently associated with hot, humid weather and water exposure. Patients commonly present with ear pain, pruritus, discharge, and hearing loss. Otitis Externa ( otitis externa Otitis externa Otitis externa (also known as external otitis or swimmer’s ear) is an infection of the external auditory canal that is most often caused by acute bacterial infection and is frequently associated with hot, humid weather and water exposure. Patients commonly present with ear pain, pruritus, discharge, and hearing loss. Otitis Externa, “oído de nadador”)
• N – Nosocomial infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease (infecciones nosocomiales (catéteres, tubos endotraqueales))
• A – Exotoxin A Exotoxin A Pseudomonas (exotoxina A)
• S – Skin infections (infecciones de la piel (foliculitis de “jacuzzi” y quemaduras))