So, I have been doing some research on nosocomial pseudomonas infections. I have found several recent articles on this problem. I will share one of them with you here and others will follow.

This article was published in 2009, it follows a trial that ran from 2005 to 2007 in Lucknow, India. I am sure there are many differences between India and the US in terms of nosocomial infections, but I really enjoyed this article and thought it had great significance to my topic.

The aims of the study were to identify sources of pseudomonas in an ICU. Two hundred patients who presented with clinical symptoms of nosocomial infection were randomly selected for this trial. Numerous cultures were taken from various sites and processed looking specifically for Pseudomonas. Cultures were also obtained from surface sites, or fomites, and the hands of the nursing staff.

All diagnosis were made using the CDCs infection criteria. Of the 200 patients admitted, 67 developed a nosocomial infection during their admission. While there were a total of 193 bacteria isolated, Pseudomonas was found to be the most prevalent. Forty five isolates of Pseudomonas were obtained from the patients, and ninety five isolates were obtained from fomites (61) and staff hands (34).

Of the isolates found in patients, there was a large array of resistance. The largest amount (51.7%) were resistant to ceftazidime, while the smallest showed a 28.3% resistance to piperacillin-tazobatam. All isolates collected from clinical fomites showed similar resistance, however isolates obtained from environmental fomites, such as sinks, showed less resistance.

In discussion it was showed that Pseudomonas was the bacteria most responsible for nosocomial infection in this ICU, with a total of 23.3% Infection (44/193). The most common pathogen seen in their patients with pneumonia, UTI and surgical site infection, it was the 2nd most common in blood stream infections. The pseudomonas serotype most commonly seen was serogroup E, which they found in the patients and also on the nurses hands. This information makes a strong case from cross contamination from one patient to the other via the nursing staff.

So in ending this discussion on the above article, I have decided to write a paper on teaching about Pseudomonas. As I have mentioned earlier in this blog, so many other infections seem to be on our minds that Pseudomonas often gets overlooked by nursing staff. Proper hygiene is essential, but also a proper understanding of the prevalence and danger of this particular pathogen needs to be discussed.

Reference: Mayank, D., Anshuman, M., Singh, R., Afzal, A., Baronia, A., & Prasad, K.(2009). Nosocomial Cross Transmission of Pseudomonas Aeruginosa between Patients in a Tertairy Intensive Care Unit. Indian Journal of Pathology and Microbiology, 52(4), 509-513.

Here is a picture of the bacteria Pseudomonas aeruginosa. Pseudomonas is a gram negative rod shaped bacteria. You will find this bacteria living in soil and also on the human body. Pseudomonas is an opportunistic infection, this means that the bacteria is generally not a threat, however if you are somehow compromised, say an open wound, a burn, or an illness, Pseudomonas will gladly step in and set up shop. This bacteria seems to really enjoy moist environments, which make wounds and burns a prime place to reside.

10% of nosocomial infections, or hospital acquired, are caused by Pseudomonas. Pseudomonas is the leading cause of ICU pneumonia.


Some other Pseudomonas infections include

1. Skin and soft tissue - the second most likely cause of infection in burn patients. Also "hot tub rash" almost always pseudomonas related.
2. Lung infections - as stated earlier, most common cause of ICU acquired pneumonia, also very commonly seen in children with cystic fibrosis.
3. UTI (urinary tract infection)- nosocomial, generally catheter related.
4. Eye and ear - a large portion of swimmers ear is caused by Pseudomonas.

Pseudomonas wound and burn infection will generally be visible as a blue-green drainage and have a very prominent smell. Pseudomonas is rapidly becoming resistant to many drugs and generally must be treated tandemly.

Info found at medical-dictionary.thefreedictionary.com/Pseudomonas+Infections (link added to this post)

As I have been searching for some physiology and epidemiology on Pseudomonas, I have been coming up rather short. The CDC website lists information only on hot tub folliculitis, which is almost always a pseudomonas infection. Hot tub rash, however, is not where my interests lie, therefore I will continue my search. Good info hopefully to follow!!!

Sorry, again I forgot to include the reference.

Gould, D. (2009). Effective strategies for prevention and control of Gram-negative infections. Nursing Standard, 23(48), 42-46. http://search.ebscohost.com.offcampus.lib.washington.edu

The latest article I read was covering effective strategies for prevention of gram negative infections. While the article itself covered a base of many infections, Pseudomonas is included. What struck me the most about this article was the information that there was little to no government tracking of these infections. There was no plan in place to get these gram negative infections under control, although Pseudomonas is growing to become a very prevalent nosocomial infection. The public is not as aware of the Pseudomonas infection as it is, of, say, MRSA, although gram negative bacilli are largely responsible for infection and mortality in serious ill and hospitalized patients.

It seems the focus needs to be broadened and the whole bacterial picture needs to be seen, there are many emerging resistant gram negatives, Pseudomonas among them, and they need to be battled, not looked over for MRSA.