Pneumonia caused by Pseudomonas aeruginosa Pseudomonas are considered opportunistic microorganisms, the family Pseudomonadaceae, genus Pseudomonas. They are not able to ferment glucose, so they are non-fermenting gram-negative bacteria. Many species - free-living, are widespread everywhere.


Pseudomonas are capable of causing the development of diseases in the human body, animal or plant. A typical species is Pseudomonas aeruginosa( Pseudomonas aeruginosa).This is one of the most common pathogens of intrahospital pneumonia. Advantageously, such pneumonia occurs in patients with festering wounds, burns, infectious and inflammatory diseases of the urinary tract, taking antibiotics for a long time, are on mechanical ventilation in the postoperative period( especially susceptible to disease patients after surgery on the heart and lungs).This pathogen can often be identified on medical equipment, it is distributed to the medical staff and patients. A distinctive feature is the multiple resistance to antimicrobials.

Pseudomonas aeruginosa forms BAV: pigmentary, toxic substances and enzymes. A characteristic feature is its ability to produce slime and specific pigment - pyocyanin that stains discharge from the wound dressing and the culture medium in the blue-green color - fluorescein, which glows when irradiated with ultraviolet light.

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The pathogenic action of the rod is due to the release of exotoxin a, hemolysin, leukocidin, etc. This bacterium synthesizes enzymes such as elastase, metalloprotease, collagenase, lecithinase.

The structure of this pathogen is a combination of flagellar( H) and somatic( O) antigens. Specific production of bacteriocins( piotsins), which facilitate piotsinotipirovanie( intraspecific identification of crops).

Peculiarities of the clinical course of pneumonia caused by Pseudomonas aeruginosa

The clinic of pneumonia of pseudomonas etiology is similar to the picture of a severe course of pneumonia caused by other pathogens.

The onset of the disease is always acute. The general condition of the patient deteriorates extremely quickly, becomes heavy. Typical is fever( usually in the morning), severe intoxication, tachycardia, cyanosis, shortness of breath.

An objective study in the lungs of the patient are determined: focal-percussion sound blunting, auscultation, finely wheezing and crepitus. Characteristic of the early development of pleurisy( exudative or fibrinous), the rapid formation of new foci of inflammation, as well as abscessing.

on plain film thorax lung determine multiple focal dimming( inflammatory infiltrates determined predisposition to dissemination), with abscesses visualized cavity with liquid( horizontal level) in exudative pleurisy - intense homogeneous darkening( fluid in the pleural cavity) with verhnekosym level.

diagnostic criteria for pneumonia caused by Pseudomonas aeruginosa

diagnosis of pneumonia, which is a causative agent of Pseudomonas aeruginosa, confirmed:

  • analysis of clinical manifestations: severe course, abscessing and rapid development of pleurisy;
  • the patient has festering wounds, burns, especially extensive, urinary tract infections;
  • by detecting in the smear of gram-negative straight or slightly curved sticks having rounded ends( Gram staining).They are mobile, which is ensured by the presence of polar flagella;
  • by seeding Pseudomonas aeruginosa from sputum, separated from wounds, pleural cavity;The optimal medium for rod growth is conventional agar. When associations of Pseudomonas aeruginosa with microorganisms of the genus Proteus or other enterobacteria selective factors are used: cetrimide and nalidixic acid. For serotyping the pathogen, monospecific diagnostic sera are used;
  • detection of a high titer of antibodies to Pseudomonas aeruginosa( up to 1: 12800 - 1: 25000) in the patient's blood, indirect hemagglutination( RNGA) is used. In healthy carriers, titre sticks do not exceed 1:40 - 1: 160;
  • revealing in the patient's blood a high titer of antibodies to exotoxin A of Pseudomonas aeruginosa( titer 1:80 - 1: 2,500), the method used by AF is used. Moroz and I.A.Alexandrov with the help of a specific erythrocyte diagnosticum. The method is highly specific and highly sensitive. In healthy people, blood serum does not contain antibodies to exotoxin A.

Treatment of pneumonia of Pseudomonas aeruginosa

Because pneumonia of pseudomonas etiology may be resistant to beta-lactam antibiotics and aminoglycosides, the following are mainly used:

  1. Penicillins V and VI generations: azlocillin, ticarcillin, Pithracillin( in a daily dose of up to 24 g), amdinocillin( in a daily dose of 40-60 mg / kg).In some cases, carbenicillin( in a daily dose of 20-30 g) is quite effective.
  2. Cephalosporins: cefzulodin, cefopyrazone, ceftazidime( in a daily dosage of up to 6 g).These drugs are most effective when combined with aminoglycosides. They are also prescribed for a possible combination of a pseudomonasive pathogen with Staphylococcus aureus.
  3. Highly effective is the use of ciprofloxacin intravenously( in a daily dose of 0.4-0.6 g), aztreonama intramuscularly( in a daily dose of 8 g), the use of other quinolones orally. Aminoglycosides( gentamicin, netilmicin, amikacin) are also effective at the maximum permissible doses. It is also possible to combine preparations of the penicillin group with quinolones or aminoglycosides.

Bronchoscopy is often used to diagnose a concomitant disease( bronchogenic cancer).Exudative pleurisy is eliminated by pleural puncture, repeated if necessary. With pronounced empyema drainage is used( tube).

Prevention of pneumonia

To prevent the development of pneumonia, there are two areas: preventing contact with the pathogen and increasing the body's immune forces. Since the pseudomonas bacterium is transmitted by contact, care should be taken to ensure that those in contact with the weakened patient use gloves, masks, wash hands, etc. Important is also the early initiation of antibiotic therapy, treatment of conditions and diseases predisposing to aspiration, immunization of patients from risk groups.