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PubMed2002

Pseudomonas aeruginosa infections in a neonatal intensive care unit.

This report describes a cluster of nosocomial infections with Pseudomonas aeruginosa in a neonatal intensive care nursery. All 5 cases of P aeruginosa infection were clustered in September 1999. Aggressive infection control measures were instituted, including installation of a user-friendly handwashing soap and environmental cleaning. On the basis of the finding of persistent dirty equipment, a new full-time position was created that was dedicated to equipment cleaning. These measures were effective in eliminating the cluster. The nursery has remained free of P aeruginosa infection for more than 2 years, attesting to the success of our program.

Disease Outbreaks↗
PubMed1976

Serious infections due to Pseudomonas aeruginosa.

Infections due to Ps. aeruginosa are a problem in the tropics as in other parts of the world. Over a four year period, 15 patients attending University College Hospital, Ibadan, were proved to have septicaemia due to this organism and 13 patients died rapidly as a direct result of the infection. The two patients who survived the acute episode had received immediate treatment with at least one antibiotic active against Ps. aeruginosa: a third patient, who received immediate appropriate antibiotic therapy, was already suffering from aplastic anaemia and died rapidly despite treatment. The remaining patients received inappropriate antibiotic therapy because pseudomonas infection was not suspected at the time the diagnosis of septicaemia was made. Patients most at risk appear to be the very young and those with pre-existing malignant or other conditions affecting the defence mechanisms of the body: it is suggested that routine initial management of such patients should include a blood culture, followed by immediate treatment with an antibiotic combination that includes at least one agent likely to be active against Ps. aeruginosa. The development of medical services can lead to the introduction of ophthalmic or other operations on tissues that are highly susceptible to infection before facilities are provided for the maintenance of a pathogen-free environment. Following an outbreak of eye infection after cataract extractions, carried out in an old and unsatisfactory theatre, wide-spread room contamination was demonstrated with the same strains of Ps. aeruginosa that had been responsible for the clinical infections. Chemical disinfection of the theatre floor failed to eliminate the organisms, although other experiments suggested that the drying effect of air-conditioning would be successful in this respect. The wisdom of introducing such operations before the provision of adequate facilities is seriously questioned.

Adult↗
PubMed1984

Immunoserology of Pseudomonas aeruginosa infections in man. II. effect of natural and immune anti-LPS antibodies on pseudomonas colonization and infection.

In 39 acute patients of a respiratory unit a comparatively high Pseudomonas aeruginosa anti-lipopolysaccharide antibody level present on admission prevented colonization by the homologous pseudomonas serogroup. At lower natural antibody titres symptomless colonization occurred, and in patients with the lowest initial titres, later P. aeruginosa complications developed. A low antibody level also predisposed to pseudomonas infection in 9 chronic patients. When colonization occurred at high antibody titres, the presence of P. aeruginosa was only transient; however, the titre had no effect on the further duration of harbouring P. aeruginosa. Anti-LPS antibodies may play an important role not only in the outcome of pseudomonas infection, but also in other respects of pseudomonas-man interaction.

Adolescent↗
PubMed1999

Changing epidemiology of Pseudomonas aeruginosa infection in Danish cystic fibrosis patients (1974-1995).

Recurrent and chronic lower airway infection with Pseudomonas aeruginosa (PA) is an important component of cystic fibrosis (CF) pulmonary disease. Different modes of treatment and control of CF patients have been introduced at the Copenhagen CF Centre over the past 20 years and have been associated with improved survival. Treatment consisted of: 1) elective antibiotics for 14 days every 3 months to patients with chronic PA infection (started in 1976), 2) cohort isolation to prevent cross-infection (patients with PA were separated from patients without PA, starting in 1981); and 3) early intensive treatment with inhaled colistin and oral ciprofloxacin from time of initial PA colonization (started in 1989). The aim of the present study was to evaluate the impact of each of these interventions on the changes in the epidemiology of PA. Based on monthly cultures of lower airway secretions in each CF patient seen during 1974-1995, significant changes in the incidence and prevalence of the PA infection were found. The monthly prevalence of chronic PA increased significantly (P < 0.0001) from below 40% before 1976 to above 60% in 1980, which was found to be due to cross-infection among the CF patients after introduction of elective antibiotic courses in 1976. To deal with this problem, cohort isolation was introduced in 1981, and since then the monthly point prevalence of chronic PA decreased slowly until 1989 (P < 0.0001), when early intensive treatment from initial PA colonization was introduced; this was associated with a further decrease in point prevalence to 45% in 1995 (P < 0.005). The annual incidence of chronic PA infection also decreased significantly (P < 0.01) from 16% to below 2% after introduction of cohort isolation and early intensive treatment from initial PA isolation. Furthermore, the time from acquisition of first PA to development of chronic PA infection increased significantly, from approximately 1 year to almost 4 years after introduction of cohort isolation (P < 0.0001). After introduction of early intensive treatment, the probability of still not having developed chronic PA infection 7 years after the first isolation of PA was above 80% (P < 0.0001). In conclusion, the introduction of cohort isolation and early intensive treatment following the initial isolation of PA resulted in a reduced incidence and prevalence of chronic PA infection. We are not aware of other studies showing a decreasing prevalence of chronic PA infection, as survival of CF patients has increased.

Adolescent↗
PubMed2001

Molecular epidemiology of Pseudomonas aeruginosa infections in a cystic fibrosis outpatient clinic.

Chronic respiratory infection by Pseudomonas aeruginosa is a significant determinant in the prognosis of cystic fibrosis patients. Cross-infection between cystic fibrosis patients and the prevalence of P. aeruginosa among them were investigated by microbiological surveillance and RAPD typing of the isolates. A total of 748 samples was cultured, including specimens from the respiratory tract (sputum or throat swabs) and hands of patients and medical staff, resulting in the collection of 86 isolates of P. aeruginosa from 65 samples. Prevalence of P. aeruginosa was 39.3% in respiratory samples, 0.2% on patients' hands and none in the medical staff's hand samples. RAPD typing characterised 51 genotypes and clonal persistence was observed in the majority of patients. These results suggest that cross-infection is not common in the outpatient clinic studied and a common source of acquisition is unlikely.

Adolescent↗
PubMed2002

Induction of neutrophil apoptosis by the Pseudomonas aeruginosa exotoxin pyocyanin: a potential mechanism of persistent infection.

Pseudomonas aeruginosa colonizes and infects human tissues, although the mechanisms by which the organism evades the normal, predominantly neutrophilic, host defenses are unclear. Phenazine products of P. aeruginosa can induce death in Caenorhabditis elegans. We hypothesized that phenazines induce death of human neutrophils, and thus impair neutrophil-mediated bacterial killing. We investigated the effects of two phenazines, pyocyanin and 1-hydroxyphenazine, upon apoptosis of neutrophils in vitro. Pyocyanin induced a concentration- and time-dependent acceleration of neutrophil apoptosis, with 50 microM pyocyanin causing a 10-fold induction of apoptosis at 5 h (p < 0.001), a concentration that has been documented in sputum from patients colonized with P. aeruginosa. 1-hydroxyphenazine was without effect. In contrast to its rapid induction of neutrophil apoptosis, pyocyanin did not induce significant apoptosis of monocyte-derived macrophages or airway epithelial cells at time points up to 24 h. Comparison of wild-type and phenazine-deleted strains of P. aeruginosa showed a highly significant reduction in neutrophil killing by the phenazine-deleted strain. In clinical isolates of P. aeruginosa pyocyanin production was associated with a proapoptotic effect upon neutrophils in culture. Pyocyanin-induced neutrophil apoptosis was not delayed either by treatment with LPS, a powerfully antiapoptotic bacterial product, or in neutrophils from cystic fibrosis patients. Pyocyanin-induced apoptosis was associated with rapid and sustained generation of reactive oxygen intermediates and subsequent reduction of intracellular cAMP. Treatment of neutrophils with either antioxidants or synthetic cAMP analogues significantly abrogated pyocyanin-induced apoptosis. We conclude that pyocyanin-induced neutrophil apoptosis may be a clinically important mechanism of persistence of P. aeruginosa in human tissue.

Apoptosis↗
PubMed1975

Combination therapy of anti-endotoxin antibody and gentamicin in the immunosuppressed mice with Pseudomonas aeruginosa infection.

Therapeutic effect of anti-endotoxin antibody in combination with or without an antibiotic, gentamicin, was studied in DD-strain mice experimentally infected with Pseudomonas aeruginosa. Mice were treated by various immunosuppressive agents such as 60Co irradiation, cyclophosphamide, azathioprine or cortisone acetate prior to infection. Anti-endotoxin antibody was made in mice by immunization with original endotoxin protein (OEP). F(ab')2 fragment of IgG prepared from pooled immune sera was administered intravenously without side effects. Large dose of the antibody resulted in remarkable therapeutic effect even in absence of the antibiotic. Small dose of the antibody enhanced the therapeutic effect of gentamicin. Differential effect of the immunosuppressants for T and B lymphocyte populations was examined by anti-theta cytotoxicity test. Resistance of DD-strain mice to P. aeruginosa infection was not related to these lymphocyte population changes.

Animals↗
PubMed1983

Epidemiology of Pseudomonas aeruginosa infection and the role of contamination of the environment in a cystic fibrosis clinic.

In order to identify the possible reservoirs and routes of cross-infection with Pseudomonas aeruginosa, samples from patients, staff, and the environment of a cystic fibrosis centre and two control wards at an infectious disease clinic were collected during a two-week period in 1980. All the Ps. aeruginosa strains were phage and serotyped. Ps. aeruginosa was isolated from 90 (51%) of the cystic fibrosis patients and most belonged to the 0-3/9 complex, characteristic of strains from patients in the centre. Some of the patients were able to spread Ps. aeruginosa into the air and to their hands by coughing, and Ps. aeruginosa in dried sputum could survive for at least one week. Strains of the same epidemiological types as found in the cystic fibrosis patients were isolated from sinks, soap, baths, toys, tables, brushes, cloths, and air in the clinic. In contrast, Ps. aeruginosa of the same epidemiological types were only found in a few of the sinks in one of the control wards where a few cystic fibrosis patients were regularly treated in isolation cubicles. The precautions employed to prevent future cross-infection include segregation of Ps. aeruginosa-infected from non-infected patients in separate wards and arranging for visits on separate days in the out-patients clinic. The survival of cystic fibrosis patients treated in the centre is much longer than those treated outside the centre despite the problems of cross-infection.

Adolescent↗
PubMed1981

Protective effect of muramyl dipeptide analogs against infections of Pseudomonas aeruginosa or Candida albicans in mice.

Two analogs of N-acetylmuramyl-L-alanyl-D-isoglutamine (muramyl dipeptide) were found to give better protection than muramyl dipeptide against intraperitoneal Pseudomonas aeruginosa infection or intravenous Candida albicans infection in mice. The analogs tested were N-acetyl-nor-muramyl-L-alanyl-D-isoglutamine and N-acetylmuramyl-L-alpha-amino-butyryl-D-isoglutamine. The optimum treatment was 80 mg/kg per day given once daily for 4 consecutive days before infection by the intraperitoneal, intravenous, or subcutaneous route. Dose response was limited. The compounds were not orally active. Synergism was seen between N-acetyl-nor-muramyl-L-alanyl-D-isoglutamine and gentamicin. No postinfection protection was observed. A nonspecific stimulation of macrophage cells by muramyl dipeptide analogs may contribute to the protection because antiinfective activity against Listeria monocytogenes given intraperitoneally was achieved with CBA mice.

Acetylmuramyl-Alanyl-Isoglutamine↗
PubMed2006

Neonatal screening for cystic fibrosis does not affect time to first infection with Pseudomonas aeruginosa.

OBJECTIVE: Newborn screening for cystic fibrosis was introduced in the Piedmont region of Italy in the year 2000. Our aim with this study was to estimate the effect of newborn screening on the risk of Pseudomonas aeruginosa infection at the regional cystic fibrosis pediatric reference center. METHODS: The time to first infection with P aeruginosa within the historical cohort of cystic fibrosis children diagnosed between January 1, 1997, and June 30, 2004, was investigated, comparing survival functions and the adjusted hazard ratio of children diagnosed before and after newborn screening introduction. The role of pancreatic insufficiency was also concurrently investigated. RESULTS: Overall, 71 children diagnosed with cystic fibrosis were identified, 27 cases were clinically diagnosed before newborn screening introduction, and 5 of them presented with meconium ileus, whereas 44 were identified by newborn screening. Among them 35 needed pancreatic enzyme supplementation, whereas 34 children were infected with P aeruginosa. Both the nonparametric and semiparametric survival estimates failed to show any significant increase in the risk of P aeruginosa infection among screened children compared with historical controls. However, the median time from cystic fibrosis diagnosis to P aeruginosa infection among screened children was significantly shorter (183 vs 448 days). Children with impaired pancreatic function were at high risk of P aeruginosa infection. CONCLUSIONS: The results of the study suggest that health authorities should regard newborn screening for cystic fibrosis as an opportunity to improve care and outcomes among affected children and shift the focus from whether it is appropriate to screen to how to optimize biomedical and psychosocial outcomes of screening.

Case-Control Studies↗
PubMed1996

[Pseudomonas spp. infections in patients with HIV infections].

BACKGROUND: The aim of this study was to describe the characteristics of the infections by Pseudomonas spp. observed in patients with HIV infection in Spain. METHODS: A retrospective study was performed of the isolations of Pseudomonas spp. in microbiologic samples of patients with HIV infection in three hospitals from Mallorca, Spain, since 1986. RESULTS: Twenty-nine patients with some positive culture for Pseudomonas were reviewed. In 20 cases the infection presented in advanced stages of the disease when the patient fulfilled AIDS criteria. The most frequent foci in both community acquired and nosocomial infection was respiratory (16 and 3 cases, respectively). Fifty percent of the cases presented bacteremia. The classically described predisposing factors for infection by this germ were presented in 19 patients. Pseudomonas aeruginosa was the most frequently isolated type (22 cases). Only 5 patients received the appropriate treatment on admission. Clinical cure was achieved in 23 patients, with recurrence being observed in 10. Five patients died in relation to the infection. CONCLUSIONS: Infections by Pseudomonas spp. in Spain appear to have increased in frequency in patients with HIV infection in the last decade. These infections appear in advanced phases of the disease and mainly involve the lung, with high rates of bacteremia and a high number of recurrence. Empiric treatment of patients with advanced HIV infection with suspicion of bacterial infection should include antipseudomonic drugs.

Adult↗
PubMed1993

The host inflammatory response prior to death in patients with cystic fibrosis and chronic Pseudomonas aeruginosa infection.

The intensity of the host inflammatory response to pulmonary infection with Pseudomonas aeruginosa immediately prior to death was determined in six patients with cystic fibrosis (CF). Plasma concentrations of neutrophil elastase alpha 1-antiproteinase, tumour necrosis factor-alpha (TNF alpha) and serum C-reactive protein (CRP) were increased in the 7 days prior to death (P < 0.05) when compared with a period of clinical stability during the preceding 6 months. An increased inflammatory response was sustained for many weeks prior to death and was associated with poor symptom and lung function responses to apparently appropriate antibiotic treatment.

Adolescent↗
PubMed1976

Therapy of neutropenic rats infected with Pseudomonas aeruginosa.

Rats made profoundly neutropenic with cyclophosphamide were injected with 100 or 1,000 50% lethal doses of a strain of Pseudomonas aeruginosa suspended in mucin. Rats were treated for 24, 48, or 72 hr with thrice daily intramuscular administration of carbenicillin (400 mg/kg), gentamicin (10 mg/kg), both of these agents at the same doses, or saline. One hour after injection of antibiotics, the mean bactericidal titers in serum were 1:4.7, 1:21., and 1:8.6 for rats receiving carbenicillin, gentamicin, and a combination of the two agents, respectively. Combination chemotherapy produced a greater reduction in mortality rate than did either agent alone for both inoculum sizes and for all three durations of therapy. Gentamicin was at least as effective as carbenicillin regardless of inoculum size or duration of therapy. Fourfold or greater increases in minimal inhibitory concentrations of P. aeruginosa were seen in 54% of postmortem blood culture isolates from animals treated with carbenicillin, in 15% from rats treated with gentamicin, and in none from animals receiving both agents.

Agranulocytosis↗