Chapter 96 Rods

TREATMENT
MEDICATIONS
▪ Uncomplicated UTIs
▫ Cystitis: TMP/SMX, nitrofurantoin,
quinolones, fosfomycin
▫ Pyelonephritis: quinolone/ampicillin,
gentamicin/third-generation
cephalosporin
▪ Complicated UTIs
▫ E.g. diabetes, nephrolithiasis, pregnancy,
anatomic abnormalities of urinary tract
▫ Therapy should be prolonged

SURGERY Figure 96.3 Proteus species spread in a

▪ Drainage of collections (e.g. perinephric swarming fashion on an agar plate.
abscesses)
▪ Removal of struvite renal calculus

PSEUDOMONAS AERUGINOSA
osms.it/pseudomonas-aeruginosa
▪ Virulence factors
PATHOLOGY & CAUSES ▫ Exotoxin A → inactivates elongation
factor (EF-2) → inhibition of protein
▪ One of most common causes of hospital- synthesis → death of host cells
acquired infections in immunocompromised
▫ Phospholipase C → degrades
individuals; motile; aerobic; nonlactose
membranes
fermenter (derives energy from
carbohydrates by oxidation); nonfastidious; ▫ Endotoxin → fever, shock
oxidase, catalase, elastase, leukocidin, ▫ Mucoid exopolysaccharide → biofilm
hemolysin positive; resistant to many formation → protection from immune
antibiotics system
▪ Grows on variety of culture media
Commonly associated diseases
▫ Colonies greenish-blue due to
▪ Pneumonia; sepsis; genitourinary tract
production of procyanin (blue),
infections; skin, soft tissue infections; ear
pyoverdin (yellow-green); fruity, grape-
infections (e.g. external otitis, chronic otitis
like odor
media); eye infections (e.g. keratitis); GI
▪ Natural reservoir infections; bone, joint infections (usually
▫ Water, soil sources (e.g. rivers, ponds), affects vertebral column); infective
animals, plants, hospital equipment; endocarditis
hospitalized individuals asymptomatic
carriers
RISK FACTORS
▪ Mode of transmission
▪ Prolonged hospitalization, catheterization,
▫ Direct contact with contaminated
IV drug use, severe burns, contact lenses,
materials/infected individuals
eye trauma

OSMOSIS.ORG 533
 ▪ Mechanical ventilation/endotracheal
intubation DIAGNOSIS
▫ P. aeruginosa second most common
cause of ventilator-associated
DIAGNOSTIC IMAGING
pneumonia Chest X-ray
▪ Cystic fibrosis (CF) → chronic infection with ▪ Pneumonia
P. aeruginosa
▫ Bilateral bronchopneumonia with
▪ Immune system deficits (e.g. neutropenia, nodular infiltrates with/without pleural
diabetes) effusion

COMPLICATIONS LAB RESULTS

▪ Sepsis/necrotizing pneumonia can be fatal ▪ Culture (blood/other specimens) on
in immunocompromised individuals selective media
▪ Chronic infections in CF → bronchiectasis, ▫ Enhances production of procyanin
pulmonary fibrosis → pulmonary failure
▪ Oxidase test
▪ Disseminated intravascular coagulation due
▪ PCR assays
to sepsis
▪ Complete blood count
▪ Eye infections → vision loss
▫ Leukocytosis
▪ Serological tests
SIGNS & SYMPTOMS ▫ Only individuals with CF/COPD

▪ Generally nonspecific, depend on organ

system
▪ Eye infections (esp. cornea) extremely
painful, rapidly destructive
▪ Ecthyma gangrenosum
▫ Due to sepsis, typically appears in
immunocompromised individuals
▫ Well-demarcated, black, necrotic
cutaneous lesion; rapidly progressive
TREATMENT
MEDICATIONS
▪ Antimicrobial therapy
▫ Extended-spectrum penicillins, beta-
lactamase inhibitors, aminoglycosides,
carbapenems, monobactams,
polymyxins, fluoroquinolones, third/
fourth-generation cephalosporins

Figure 96.4 Pseudomonas species will

adopt a greenish hue when cultured on
cetrimide agar.

534 OSMOSIS.ORG