Video:Multidrug-resistant Pseudomonas aeruginosa

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Description

Multidrug-resistant Pseudomonas aeruginosa is a bacteria that has resistance to multiple antibiotics, making infections difficult to treat.[1] In treatment we find that β-lactams, aminoglycosides, and fosfomycin are antibiotics that may be effective. [2]Around 13 percent of Pseudomonas aeruginosa infections are MDR-PA. [3]

Presentation

In terms of presentation of multidrug-resistant Pseudomonas aeruginosa in a bloodstream infection we find: fever, hypotension and rapid heartbeat.[4]

Risk factors

As to the risk factors that might augment the possibility of having MDR-PA we find the following: an ICU stay, Broad-spectrum antibiotic usage and chronic conditions ( such as diabetes mellitus, and chronic obstructive pulmonary disease).[5][6]

Mechanism

We find that the mechanism of multidrug-resistant Pseudomonas aeruginosa have several elements to its mode of resistance which include: the bacteria's outer membrane which acts as a barrier and prevents antibiotics from gaining access, AmpC β-lactamase breaks β-lactam antibiotics down, leaving them ineffective, efflux pumps expel antibiotics out of cell and biofilms protect the bacteria from antibiotics.[7][8][9]

Diagnosis

In terms of the diagnosis of multidrug-resistant Pseudomonas aeruginosa we find the following: doing a culture and antimicrobial susceptibility test.[10]

Differential diagnosis

The differential diagnosis for multidrug-resistant Pseudomonas aeruginosa is as follows (though it should be noted the differential diagnosis for MDR-PA needs to consider the specific resistance profile of the bacteria which are not completely reflected here):Acute respiratory distress syndrome , bacterial pneumonia , bacterial sepsis, Community-acquired pneumonia , fungal pneumonia and Pneumocystis jiroveci Pneumonia.[11]

Treatment

The management of MDR-PA is difficult, however ceftolozane-tazobactam or ceftazidime-avibactam are currently recommended.[12][13]Polymyxins are another possibility, drugs like colistin (polymyxin E) are used as a last resort due to the toxicity involved.[14][15]

Prognosis

In terms of the prognosis for multidrug-resistant Pseudomonas aeruginosa we find it is usually poor, with a high risk of mortality and longer hospitalization.[6]We also find a 2018 meta-analysis that determined individuals with MDR-PA had a mortality rate of 44 (point) 65 percent, in contrast to 24 (point) 8 percent for those with non-MDR Pseudomonas aeruginosa per the article.[16]

Epidemiology 1

In terms of the prevalence of MDR-PA we find it has increased globally over the last decades, with estimates ranging from 15 to 30 percent in multiple areas worldwide.[14]

Epidemiology 2

Generally speaking, there is high prevalence of MDR-PA in the MENA (Middle east and North Africa region).[17]

History

One finds that it was Carle Gessard who discovered Pseudomonas aeruginosa in the year 1882.[18]The first case of multidrug-resistant Pseudomonas aeruginosa was isolated in 1992 in the hematologic unit of university hospital in Rome, Italy.[19]

References

  1. ↑ "MULTIDRUG-RESISTANT PSEUDOMONAS AERUGINOSA" (PDF). cdc. Retrieved 16 October 2024.
  2. ↑ Horcajada, Juan P.; Montero, Milagro; Oliver, Antonio; Sorlí, Luisa; Luque, Sònia; Gómez-Zorrilla, Silvia; Benito, Natividad; Grau, Santiago (18 September 2019). "Epidemiology and Treatment of Multidrug-Resistant and Extensively Drug-Resistant Pseudomonas aeruginosa Infections". Clinical Microbiology Reviews. 32 (4). doi:10.1128/CMR.00031-19. ISSN 0893-8512.
  3. ↑ Division, Infectious Disease Epidemiology & Prevention (22 April 2021). "Multidrug-Resistant Pseudomonas aeruginosa (MDR-PA)". Infectious Disease Epidemiology & Prevention Division. Retrieved 16 October 2024.
  4. ↑ "Pseudomonas aeruginosa Infections Clinical Presentation: History, Physical, Causes". emedicine.medscape.com. Retrieved 28 October 2024.
  5. ↑ Raman, Gowri; Avendano, Esther E.; Chan, Jeffrey; Merchant, Sanjay; Puzniak, Laura (4 July 2018). "Risk factors for hospitalized patients with resistant or multidrug-resistant Pseudomonas aeruginosa infections: a systematic review and meta-analysis". Antimicrobial Resistance & Infection Control. 7 (1): 79. doi:10.1186/s13756-018-0370-9. ISSN 2047-2994.
  6. ↑ 6.0 6.1 Nathwani, Dilip; Raman, Gowri; Sulham, Katherine; Gavaghan, Meghan; Menon, Vandana (20 October 2014). "Clinical and economic consequences of hospital-acquired resistant and multidrug-resistant Pseudomonas aeruginosa infections: a systematic review and meta-analysis". Antimicrobial Resistance and Infection Control. 3 (1): 32. doi:10.1186/2047-2994-3-32. ISSN 2047-2994.
  7. ↑ Chegini, Zahra; Khoshbayan, Amin; Taati Moghadam, Majid; Farahani, Iman; Jazireian, Parham; Shariati, Aref (30 September 2020). "Bacteriophage therapy against Pseudomonas aeruginosa biofilms: a review". Annals of Clinical Microbiology and Antimicrobials. 19 (1): 45. doi:10.1186/s12941-020-00389-5. ISSN 1476-0711.
  8. ↑ Proctor, Luke L.; Ward, Whitney L.; Roggy, Conner S.; Koontz, Alexandra G.; Clark, Katie M.; Quinn, Alyssa P.; Schroeder, Meredith; Brooks, Amanda E.; Small, James M.; Towne, Francina D.; Brooks, Benjamin D. (14 December 2021). "Potential Therapeutic Targets for Combination Antibody Therapy against Pseudomonas aeruginosa Infections". Antibiotics. 10 (12): 1530. doi:10.3390/antibiotics10121530.
  9. ↑ Pang, Zheng; Raudonis, Renee; Glick, Bernard R.; Lin, Tong-Jun; Cheng, Zhenyu (1 January 2019). "Antibiotic resistance in Pseudomonas aeruginosa: mechanisms and alternative therapeutic strategies". Biotechnology Advances. 37 (1): 177–192. doi:10.1016/j.biotechadv.2018.11.013. ISSN 0734-9750.
  10. ↑ "About Pseudomonas aeruginosa". Pseudomonas aeruginosa. 28 June 2024. Retrieved 19 October 2024.
  11. ↑ "Pseudomonas aeruginosa Infections Differential Diagnoses". emedicine.medscape.com. Retrieved 30 October 2024.
  12. ↑ Karruli, Arta; Catalini, Christian; D’Amore, Chiara; Foglia, Francesco; Mari, Fabio; Harxhi, Arjan; Galdiero, Massimiliano; Durante-Mangoni, Emanuele (16 February 2023). "Evidence-Based Treatment of Pseudomonas aeruginosa Infections: A Critical Reappraisal". Antibiotics. 12 (2): 399. doi:10.3390/antibiotics12020399.
  13. ↑ Nguyen, Lynn; Garcia, Joshua; Gruenberg, Katherine; MacDougall, Conan (6 June 2018). "Multidrug-Resistant Pseudomonas Infections: Hard to Treat, But Hope on the Horizon?". Current Infectious Disease Reports. 20 (8): 23. doi:10.1007/s11908-018-0629-6. ISSN 1534-3146.
  14. ↑ 14.0 14.1 Horcajada, Juan P.; Montero, Milagro; Oliver, Antonio; Sorlí, Luisa; Luque, Sònia; Gómez-Zorrilla, Silvia; Benito, Natividad; Grau, Santiago (18 September 2019). "Epidemiology and Treatment of Multidrug-Resistant and Extensively Drug-Resistant Pseudomonas aeruginosa Infections". Clinical Microbiology Reviews. 32 (4). doi:10.1128/CMR.00031-19. ISSN 0893-8512.
  15. ↑ Obritsch, Marilee D.; Fish, Douglas N.; MacLaren, Robert; Jung, Rose (October 2005). "Nosocomial Infections Due to Multidrug-Resistant Pseudomonas aeruginosa : Epidemiology and Treatment Options". Pharmacotherapy. 25 (10): 1353–1364. doi:10.1592/phco.2005.25.10.1353. ISSN 0277-0008.
  16. ↑ Matos, Eliseth Costa Oliveira de; Andriolo, Regis Bruni; Rodrigues, Yan Corrêa; Lima, Patrícia Danielle Lima de; Carneiro, Irna Carla do Rosário Souza; Lima, Karla Valéria Batista (2018). "Mortality in patients with multidrug-resistant Pseudomonas aeruginosa infections: a meta-analysis". Revista Da Sociedade Brasileira De Medicina Tropical. 51 (4): 415–420. doi:10.1590/0037-8682-0506-2017. ISSN 1678-9849.
  17. ↑ Al-Orphaly, Mahmood; Hadi, Hamad Abdel; Eltayeb, Faiha Kamaleldin; Al-Hail, Hissa; Samuel, Bincy Gladson; Sultan, Ali A.; Skariah, Sini (30 June 2021). "Epidemiology of Multidrug-Resistant Pseudomonas aeruginosa in the Middle East and North Africa Region". mSphere. 6 (3). doi:10.1128/msphere.00202-21. ISSN 2379-5042. Retrieved 9 November 2024.
  18. ↑ Soni, Vijay; Akhade, Ajay Suresh; Bhattacharya, Chandrima; Chawla, Yogesh; Bukhari, Zara; Gupta, Sneh Lata; Basu, Srijani; Jain, Sonia; Soni, Yogita (1 January 2023). "4 - Genomic surveillance of bacterial pathogens: expanding horizons". Genomic Surveillance and Pandemic Preparedness. Academic Press. pp. 71–117. ISBN 978-0-443-18769-8.
  19. ↑ Tacconelli, Evelina; Tumbarello, Mario; Bertagnolio, Silvia; Citton, Rita; Spanu, Teresa; Fadda, Giovanni; Cauda, Roberto (February 2002). "Multidrug-Resistant Pseudomonas Aeruginosa Bloodstream Infections: Analysis of Trends in Prevalence and Epidemiology". Emerging Infectious Diseases. 8 (2): 220–221. doi:10.3201/eid0802.010121. Retrieved 20 October 2024.
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