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The Challenge of Pseudomonas aeruginosa Pneumonia

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Yearbook of Intensive Care and Emergency Medicine 1997

Part of the book series: Yearbook of Intensive Care and Emergency Medicine ((YEARBOOK,volume 1997))

Abstract

Pseudomonas aeruginosa is recognized as a common causative organism in ventilator-associated pneumonia (VAP) in the critically ill, accounting for 16 to 31% of reported cases [1–4]. In addition, Ps. aeruginosa pneumonia carries with it an overall mortality of approximately 70% [2, 5–8] and an excess mortality of more than 40% [9]. By these observations alone, Ps. aeruginosa pneumonia represents one of the most serious clinical problems facing the intensive care clinician today. The high mortality rate associated with Ps. aeruginosa pneumonia persists despite the availability of potent anti-pseudomonal antibiotics and the resources of modern intensive care.

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References

  1. Torres A, De la Bellacasa J, Rodriguez-Roisin R, De Anta MTJ, Agusti Vidal A (1988) Diagnostic value of telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia using the Metras catheter. Am Rev Respir Dis 138: 117–120

    Article  PubMed  CAS  Google Scholar 

  2. Fagon JY, Chastre J, Domart Y, et al (1989) Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Prospective analysis of 52 episodes with use of a protected brush specimen and quantitative culture techniques. Am Rev Respir Dis 139: 877–884

    PubMed  CAS  Google Scholar 

  3. A’Court C, Garrard C (1992) A simplified lavage technique for microbiological surveillance of the lung. Clin Intensive Care 4: 31 (Abst)

    Google Scholar 

  4. A’Court C, Garrard C, Crook D, et al (1993) Microbiological surveillance of the lungs using non-directed bronchial lavage. Quart J Med 86: 635–648

    Article  PubMed  Google Scholar 

  5. Stevens RM, Teres D, Skillman J, Feingold D (1974) Pneumonia in an ICU: A thirty-month experience. Arch Int Med. 134: 106–111

    Google Scholar 

  6. Bryan CS, Reynolds KL (1984) Bacteremic nosocomial pneumonia. Analysis of 172 episodes from a single metropolitan area. Am Rev Respir Dis 129: 668–671

    PubMed  CAS  Google Scholar 

  7. Brewer SC, Wunderink RG, Jones CB, Leeper KV (1996) Ventilator-associated pneumonia due to Pseudomonas Aeruginosa. Chest 109: 1019–1029

    Article  Google Scholar 

  8. A’Court C, Garrard CS (1992) Nosocomial pneumonia in the intensive care unit: Mechanisms and significance. Thorax, 47: 465–473

    Google Scholar 

  9. Fagon JY, Chastre J, Hance AJ, Domart Y, Trouillet JL, Gibert C (1993) Evaluation of clinical judgement in the identification and treatment of nosocomial pneumonia in ventilated patients. Chest 103: 547–553

    Article  PubMed  CAS  Google Scholar 

  10. Pollack M (1995) Pseudomonas aeruginosa. In: Mandell GL, Bennett GE (eds) Principles and Practice of Infectious Diseases. Churchill Livinstone, New York, pp 1980–2003

    Google Scholar 

  11. Morrison AJ, Wenzel R (1984) Epidemiology of infections due to Pseudomonas aeruginosa. Rev Infect Dis 6: S627–5642

    Article  PubMed  Google Scholar 

  12. British Thoracic Society Research Committee and the Public Health Laboratory Service (1992) The aetiology, management and outcome of severe community-acquired pneumonia on the intensive therapy unit. Respir Med 86: 7–13

    Article  Google Scholar 

  13. Johanson WG, Pierce AK, Sanford JP (1969) Changing pharyngeal bacterial flora of hospitalized patients. N Engl J Med 21: 1137–1140

    Article  Google Scholar 

  14. Ismaeel NA (1993) Colonization of intensive care unit patients by Pseudomonas aeruginosa. J Hosp Infection 25: 279–286

    Article  CAS  Google Scholar 

  15. Vincent JL, Bihari DJ, Suter PM et al (1995) The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 274: 639–644

    Google Scholar 

  16. Rello J, Ausina V, Ricart M, et al (1994) Risks factors for infection by Pseudomonas aeruginosa in patients with ventilator-associated pneumonia. Intensive Care Med 20: 193–198

    Article  PubMed  CAS  Google Scholar 

  17. Cross A, Allen JR, Burke J, et al (1983) Nosocomial infections due to Pseudomonas aeruginosa: Review of recent trends. Rev Infect Dis 5 (Suppl 5): S837–S845.

    Article  PubMed  Google Scholar 

  18. Johanson WG, Peirce AK, Sanford JP, et al (1972) Nosocomial respiratory infections with Gram-negative bacilli: The significance of colonization of the respiratory tract. Ann Intern Med 77: 701–706

    Google Scholar 

  19. Woods DE, Straus DC, Johanson WG, Bass JA (1981) Role of salivary protease activity in adherence of Gram-negative bacilli to mammalian buccal epithelial cells in vivo. J Clin Invest 68: 1435–1440

    Article  PubMed  CAS  Google Scholar 

  20. Driks MR, Craven DE, Celli BR, et al (1987) Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. The role of gastric colonization. N Engl J Med 317: 1376–1382

    Google Scholar 

  21. Cook DJ, Laine LA, Guyatt GH, Raffin TA (1991) Nosocomial pneumonia and the role of gastric pH. A meta-analysis. Chest 100: 7–13

    Google Scholar 

  22. Craven DE, Daschner FD (1989) Nosocomial pneumonia in the intubated patient: Role of gastric colonization. Eur J Clin Microbial Infect Dis 8: 40–50

    Google Scholar 

  23. Garrard CS, Crook DWM (1991) Nosocomial pneumonia in the critically ill. Curr Anaesth Crit Care 2: 155–160

    Article  Google Scholar 

  24. Foster TJ, McDevitt D (1994) Molecular basis of adherence of Staphylococci to biomaterials. In: Bisno AL, Waldvogel FA (eds) Infections associated with indwelling medical devices. Am Soc Microbiol: Washington, pp 31–44

    Google Scholar 

  25. Woods DE, Bass JA, Johanson WG, Straus DC (1980) Role of adherence in the pathogenesis of Pseudomonas aeruginosa lung infection in cystic fibrosis patients. Infection Immun 30: 694–699

    CAS  Google Scholar 

  26. Johanson WG, Higuchi JH, Chaudhuri TR, Woods DE (1980) Bacterial adherence to epithelial cells in bacillary colonization of the respiratory tract. Am Rev Respir Dis 121: 55–63

    PubMed  Google Scholar 

  27. Saiman L, Cacalano G, Prince A (1990) Pseudomonas cepacia adherence to respiratory epithelial cells is enhanced by Pseudomonas aeruginosa. Infect Immun 58: 2578–2584

    Google Scholar 

  28. Woods DE, Straus DC, Johanson WG, Berry BK, Bass JA (1980) Role of pili in adherence of Pseudomonas aeruginosa to mammalian buccal epithelial cells. Infection Immun 29: 1146–1151

    CAS  Google Scholar 

  29. Woods DE, Straus DC, Johanson WG Jr, Bass JA (1983) Factors influencing the adherence of Pseudomonas aeruginosa to mammalian buccal epithelial cells. Rev Infect Dis 5 (Suppl 5): S846–5851

    Article  PubMed  Google Scholar 

  30. Doig P, Todd T, Sastry PA, et al (1988) Role of pili in adhesion of Pseudomonas aeruginosa to human respiratory epithelial cells. Infect Immun 56: 1641–1646

    PubMed  CAS  Google Scholar 

  31. Irvin RT, Doig P, Lee KK et al (1989) Characterization of the Pseudomonas aeruginosa pilus adhesin: Confirmation that the pilin structural protein subunit contains a human epithelial cell-binding domain. Infect Immun 57: 3720–3726

    Google Scholar 

  32. Farinha MA, Conway BD, Glasier LMG, et al (1994) Alteration of the pilin adhesin of Pseudomonas aeruginosa PAO results in normal pilus biogenesis but a loss of adherence to human pneumocyte cells and decreased virulence in mice. Infection Immun 62: 4118–4123

    CAS  Google Scholar 

  33. Tang H, Kays M, Prince A (1995) Role of Pseudomonas aeruginosa pili in acute pulmonary infection. Infect Immun 63: 1278–1285

    PubMed  CAS  Google Scholar 

  34. Landsperger WJ, Kelly-Wintenberg KD, Montie TC, et al (1994) Inhibition of bacterial motility with human antiflagellar monclonal antibodies attenuates Pseudomonas aeruginosa-induced pneumonia in the immunocompetent rat. Infection Immun 62: 4825–4830

    CAS  Google Scholar 

  35. Ramphal R, Pier GB (1985) Role of Pseudomonas aeruginosa mucoid exopolysaccharide in adherence to tracheal cells. Infect Immun 47: 1–4

    PubMed  CAS  Google Scholar 

  36. Pollack M (1984) The virulence of Pseudomonas aeruginosa. Rev Infect Dis 6: S617–S626

    Article  PubMed  Google Scholar 

  37. Rivera M, Nicotra MB (1982) Pseudomonas aeruginosa mucoid strain. Its significance in adult chest diseases. Am Rev Respir Dis 126: 833–836

    Google Scholar 

  38. Baker NR, Minor V, Deal C, Shahrabadi MS, Simpson DA, Woods DE (1991) Pseudomonas aeruginosa exoenzyme S is an adhesion. Infect Immun 59: 2859–2863

    Google Scholar 

  39. Tang HB, Di Mango E, Bryan R, et al (1996) Contribution of specific Pseudomonas aeruginosa virulence factors to pathogenesis of pneumonia in a neonatal mouse model of infection. Infect Immun 64: 37–43

    PubMed  CAS  Google Scholar 

  40. Finlay B, Falkow S (1989) Common themes in microbial pathogenicity. Microbiol Rev 53: 210–230

    PubMed  CAS  Google Scholar 

  41. Buret A, Cripps AW (1993) The immunoevasive activities of Pseudomonas aeruginosa. Relevance for cystic fibrosis. Am Rev Respir Dis 148: 793–805

    Google Scholar 

  42. Fink RBJ, Naegel GP, Matthay RA, Reynolds HY (1981) Cystic fibrosis Pseudomonas opsonins: Inhibitory nature in an in vitro phagocytic assay. J Clin Invest 68: 899–914

    Article  Google Scholar 

  43. Biggar WD, Holmes B, Good RA (1971) Opsonic defect in patients with cystic fibrosis of the pancreas. Proc Natl Acad Sci, USA 68: 1716–1719

    Google Scholar 

  44. Thomassen M, Boxerbaum B, Demko C, Kuchenbrod P, Dearborn D, Wood R (1979) Inhibitory effect of cystic fibrosis serum on Pseudomonas phagocytosis by rabbit and human alveolar macrophages. Pediatr Res 13: 1085 1088

    Google Scholar 

  45. Garrard CS, ACourt CD (1995) The diagnosis of pneumonia in the critically ill. Chest, 108 (2 Suppl): 17S–25S

    Article  PubMed  CAS  Google Scholar 

  46. Chastre J, Fagon JY, Domart Y, Gibert C (1989) Diagnosis of nosocomial pneumonia in intensive care unit patients. Eur J Clin Microbiol Infect Dis 8: 35–39

    Article  PubMed  CAS  Google Scholar 

  47. Andrews C, Coalson J, Johanson W (1981) Diagnosis of nosocomial pneumonia in acute diffuse lung injury. Chest 1980, 80: 254–258

    Article  Google Scholar 

  48. Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM (1991) Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and non-bronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis 143: 1121–1129

    PubMed  CAS  Google Scholar 

  49. Torres A, Puig BJ, Xaubet A, et al (1989) Diagnostic value of quantitative cultures of bronchoalveolar lavage and telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia. Am Rev Respir Dis 140: 306–310

    Article  PubMed  CAS  Google Scholar 

  50. Fagon JY, Chastre J, Hance AJ, et al (1988) Detection of nosocomial lung infection in ventilated patients. Use of a protected specimen brush and quantitative culture techniques in 147 patients. Am Rev Respir Dis 138: 110–116

    Article  PubMed  CAS  Google Scholar 

  51. Salata RA, Lederman MM, Shlaes DM, et al (1987) Diagnosis of nosocomial pneumonia in intubated, intensive care unit patients. Am Rev Respir Dis 135: 426–432

    PubMed  CAS  Google Scholar 

  52. Shepard K (1988) Diagnosis of pneumonia in patients with adult respiratory distress syndrome (ARDS). Chest 94: 4S (Abst)

    Google Scholar 

  53. Papazian L, Martin C, Albanese J, Saux P, Charrel J, Gouin F (1989) Comparison of two methods of bacteriologic sampling of the lower respiratory tract: A study in ventilated patients with nosocomial bronchopneumonia. Crit Care Med 17: 461–464

    Google Scholar 

  54. El Biari M, Torres A, Gonzalez J, et al (1991) Diagnosis of ventilator-associated pneumonia: Diagnostic value of quantitative culture of tracheal aspirates. Am Rev Resp Dis 143: 108 (Abst)

    Google Scholar 

  55. Torres A, Martos A, Puig BJ, et al (1993) Specificity of endotracheal aspiration, protected brush specimen, and bronchoalveolar lavage in mechanically ventilated patients. Am Rev Respir Dis 147: 952–957

    PubMed  CAS  Google Scholar 

  56. Bartlett J, Alexander J, Mayhew 1 (1976) Should bronchoscopy aspirates be cultured? Am Rev Resp Dis 114: 247–251

    Google Scholar 

  57. Storer D (1984) BAL in the diagnosis of diffuse pulmonary infiltrates in the immunocompromised host. Ann Int Med 101: 1–7

    Google Scholar 

  58. Chastre J, Viau F, Brun P, et al (1984) Prospective evaluation of the protected brush specimen for the diagnosis of pulmonary infections in ventilated patients. Am Rev Respir Dis 130: 924–929

    PubMed  CAS  Google Scholar 

  59. Fink MP, Snydman DR, Niederman MS, et al (1994) Treatment of severe pneumonia in hospitalized patients: Results of a multicenter, randomised, double blind trial comparing intravenous ciprofloxacin with imepenem-cilastin. The severe pneumonia study group. Antimicrob Agents Chemother 38: 547–557

    Google Scholar 

  60. Society AT (1995) Hospital-acquired pneumonia in adults: Diagnosis, assessment of severity, initial antimicrobial therapy and prevention. A consensus statement. Am J Respir Crit Care Med 153: 1711–1725

    Google Scholar 

  61. Moore RD, Smith CR, Lietman PS (1984) The association of aminoglycoside plasma levels with mortality in patients with Gram-negative bacteremia. J Infect Dis 149: 443–448

    Article  PubMed  CAS  Google Scholar 

  62. Hilf M, Yu VL, Sharp J, Zuravleff JJ, Korvick JA, Muder RR (1989) Antibiotic therapy for Pseudomonas aeruginosa bacteremia: Outcome correlations in a prospective study of 200 patients. Am J Med. 87: 540–546

    Article  PubMed  CAS  Google Scholar 

  63. Cometta A (1994) Prospective randomized comparison of imepenem monothreapy with imepenem plus netilmicin for treatment of severe infections in non-neutropenic patients. Antimicrob Agents Chemother 38: 1309–1313

    Article  PubMed  CAS  Google Scholar 

  64. Haddow A, Greene S, Heinz G, Wantuck D (1989) Ciprofloxacin (intravenous/oral) versus ceftazidime in lower respiratory tract infections. Am J Med 87: 113S–115S

    Article  PubMed  CAS  Google Scholar 

  65. Khan FA, Basir R (1989) Sequential intravenous-oral administration of ciprofloxacin vs ceftazidime in serious bacterial respiratory tract infections. Chest 96: 528–537

    Article  PubMed  CAS  Google Scholar 

  66. Wunderink R, Mayhall C, Gibert C (1992) Methodology for clinical investigation of ventilator associated pneumonia. Chest 102: 5805–588S

    Article  Google Scholar 

  67. Montravers P, Fagon JY, Chastre J, et al (1993) Follow-up protected brushe specimens assess treatment in nosocomial pneumonia. Am Rev Respir Dis 147: 38–44

    Article  PubMed  CAS  Google Scholar 

  68. Hodson ME (1988) Antibiotic treatment. Aerosol therapy. Chest 94 (Suppl): 156S–1625

    PubMed  CAS  Google Scholar 

  69. Jensen T, Pedersen SS, Garne S, Heilmann C, Hoiby N, Koch C (1987) Colistin inhalation therapy in cystic fibrosis patients with chronic Pseudomonas aeruginosa lung infection. J Antimicrob Chemother 19: 831–838

    Article  PubMed  CAS  Google Scholar 

  70. Vinnicombe J, Stamey TA (1969) The relative nephrotoxicities of polymyxin B sulfate, sodium sulfomethyl-polymyxin B. sodium sulfomethyl-colistin (colymycin), and neomycin sulfate. Invest Urol 6: 505–519

    PubMed  CAS  Google Scholar 

  71. Duncan IB (1974) Susceptibility of 1,500 isolates of Pseudomonas aeruginosa to gentamicin, carbenicillin, colistin, and polymyxin B. Antimicrob Agents Chemother 5: 9–15

    Article  PubMed  CAS  Google Scholar 

  72. Di Salvo AF, Stern WR (1967) Susceptibility of Pseudomonas to colistin, kanamycin and polymyxin-B. Am J Med Technol 33: 482–489

    PubMed  Google Scholar 

  73. Rogers MJ, Cohen J (1986) Comparison of the binding of Gram-negative bacterial endotoxin by polymyxin B sulphate, colistin sulphate and colistin sulphomethate sodium. Infection 14: 79–81

    Article  PubMed  CAS  Google Scholar 

  74. Brown RB, Phillips D, Barker MJ, Pieczarka R, Sands M, Teres D (1989) Outbreak of nosocomial Flavobacterium meningosepticum respiratory infections associated with use of aerosolized polymyxin B. Am J Infect Control 17: 121–125

    Article  PubMed  CAS  Google Scholar 

  75. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 40: 373–383

    Google Scholar 

  76. Kovaks K, Yu VL (1994) Anti-pseudomonal antimicrobial agent therapy. Drugs Today 30: 155–170

    Google Scholar 

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© 1997 Springer-Verlag Berlin Heidelberg

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Peacock, S.J., Garrard, C.S. (1997). The Challenge of Pseudomonas aeruginosa Pneumonia. In: Vincent, JL. (eds) Yearbook of Intensive Care and Emergency Medicine 1997. Yearbook of Intensive Care and Emergency Medicine, vol 1997. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-13450-4_51

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  • DOI: https://doi.org/10.1007/978-3-662-13450-4_51

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