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Role of chronic Pseudomonas aeruginosa infection in airway mucosal permeability.

The role of Pseudomonas aeruginosa infection in airway mucosal permeability was studied in 16 patients with chronic bronchitis by measuring the amounts of radiolabeled albumin in sputum. One group (A) consisted of six patients (two female, four male, 53 +/- 6 years, SEM) with chronic P aeruginosa infection for 5 +/- 0.9 years. Another group (B) consisted of ten patients (five female, five male, 67 +/- 4 years) without P aeruginosa infection for at least two years. No significant differences between groups A and B were found in the volume of sputum (63 +/- 21 ml/day in group A and 45 +/- 8 ml/day in group B, p = 0.44), the obstructive changes (FEV1 of 57 +/- 6 percent in group A and 51 +/- 4 percent in group B), or the duration of disease (19 +/- 4 years in group A and 14 +/- 4 years in group B). Saliva, sputum, and serum samples were collected at intervals of 2 h over an 8-h period, and at 24 h after intravenous administration of 131I-labeled human albumin. For counting, free 131I was removed by dialysis. Radiocounts (cpm) of saliva were significantly smaller than those of sputum or serum. The cpm from each sputum sample was divided by serum cpm at the time of each sampling. Group A showed significantly higher values in the ratio of sputum- to serum-cpm than did group B at all sampling times. Furthermore, the ratios at 2 and 4 h after 131I-albumin injection significantly correlated with sputum volume per day, whereas they did not correlate with any other factors (age, obstructive impairment, and duration of disease). These findings suggest that chronic P aeruginosa infection produces an increase in airway mucosal permeability to albumin.

Adult↗

Pseudomonas aeruginosa infection in an intrathecal baclofen pump: successful treatment with adjunct intra-reservoir gentamicin.

OBJECTIVE: To describe the use of intra-reservoir gentamicin for the treatment of a Pseudomonas aeruginosa infected baclofen pump. SETTING: Regional Spinal Injuries Centre, Hexham, Northumberland, England. SUBJECT: Male patient aged 32 years with progressive multiple sclerosis and severe bilateral spasticity. RESULTS: Intra-reservoir gentamicin proved successful in treating infection with Pseudomonas aeruginosa. CONCLUSION: Intra-reservoir gentamicin may be successful in treating pump infection with Pseudomonas aeruginosa without the need for pump removal.

Adult↗

Immunization with Pseudomonas aeruginosa high-molecular-weight polysaccharides prevents death from Pseudomonas burn infections in mice.

High-molecular-weight polysaccharides from the extracellular slime of Pseudomonas aeruginosa were evaluated as immunogens in Pseudomonas burn infections in mice. Immunization with immunotype 1 or 2 polysaccharides induced a strong immunotype-specific and weak cross-reactive antibody response but protected mice against burn infections caused by either immunotype. Passive protection was provided by rabbit antiserum to immunotype 1 polysaccharide against burn infection by the homologous organism. Pseudomonas high-molecular-weight polysaccharides are potentially effective vaccines in burn infections.

Animals↗

Use of ciprofloxacin in the treatment of Pseudomonas aeruginosa infections.

The therapeutic efficacy and safety of ciprofloxacin was studied in 30 patients with Pseudomonas aeruginosa infections. In 20 patients ciprofloxacin was given alone and in 10 patients (including 8 compromised hosts) in combination with an aminoglycoside (9) or azlocillin (1). Ciprofloxacin was given in doses of 500 mg orally or 200-300 mg i.v. every 12 h. In patients receiving only ciprofloxacin clinical cure with eradication of bacteria was obtained in 15 patients (75%) with infections of bone and joint (6), skin and soft tissue (4), lung (2), middle ear (2) and CSF (1). Two patients with lymphoma and Pseudomonas aeruginosa pneumonia died. In patients receiving combination therapy a definite therapeutic success was achieved in four (40%). Three patients with Pseudomonas aeruginosa septicemia died. In seven patients nine bacterial strains with decreasing susceptibility of ciprofloxacin (increase in MIC from less than or equal to 0.5 micrograms/ml to 2-16 micrograms/ml) were selected (6 Pseudomonas aeruginosa, 1 Enterobacter cloacae, 1 Serratia marcescens, 1 Staphylococcus aureus). Ciprofloxacin was well tolerated. This new quinolone seems to be suitable for single drug treatment of Pseudomonas aeruginosa infections in patients with normal host defense mechanisms, while its therapeutic potential in compromised hosts requires further evaluation.

Administration, Oral↗

Clinical outcome after early Pseudomonas aeruginosa infection in cystic fibrosis.

OBJECTIVE: To determine the clinical consequences of acquiring Pseudomonas aeruginosa infection during early childhood in children with cystic fibrosis (CF). DESIGN: Prospective, observational cohort study of 56 children with CF identified by newborn screening during 1990-92. Each child underwent an annual bronchial lavage during the first 2 to 3 years of life. Clinical outcome was determined at 7 years of age. RESULTS: P aeruginosa infection was diagnosed in 24 (43%) cohort subjects. Four children died before 7 years of age, all of whom had been infected with a multi-resistant, mucoid strain of P aeruginosa (P =.04). In survivors, P aeruginosa infection was associated with significantly increased morbidity as measured by lower National Institutes of Health scores, greater variability in lung function, increased time in the hospital, and higher rates of recombinant human deoxyribonuclease therapy (P <.01). In this young CF cohort, best forced expiratory volume in 1 second was an insensitive measure of increased morbidity. CONCLUSIONS: Acquisition of P aeruginosa was common by 7 years of age in this CF birth cohort and was associated with increased morbidity and mortality. An improved disease severity score would improve the evaluation and study of early CF lung disease.

Age Factors↗

[Macrolides and Pseudomonas aeruginosa infection].

Several unique effects of subinhibitory concentrations of C14 and C15 macrolides on Pseudomonas aeruginosa infection are described in vitro: P. aeruginosa virulence factors inhibition, bacterial biofilm disruption, P. glycoprotein expression upregulation, anti-inflammatory and immunoregulatory effects. Clinical trials in vivo are warranted to assess the potential usefulness of macrolides for treatment of chronic infections caused by P. aeruginosa.

Anti-Bacterial Agents↗

Effect of clarithromycin on lymphocytes in chronic respiratory Pseudomonas aeruginosa infection.

In a newly established murine model of chronic Pseudomonas aeruginosa respiratory infection mimicking diffuse panbronchiolitis (DPB), we investigated the effect of oral administration of clarithromycin on lymphocyte accumulation in the lung. Infection was produced by placement of a plastic tube precoated with P. aeruginosa in the bronchus. The number of bacteria on the tube was 6.25 +/- 0.22 log10 colony-forming units (cfu)/ml. Viable bacteria were constantly isolated at 10(5) to 10(6) cfu/specimen from the lungs for more than 1 yr. The histopathologic features resembled those of DPB consisting of massive accumulation of lymphocytes in the lung. The total number of pulmonary lymphocytes started to increase on Day 7, reaching a peak level within 12 d of intratracheal challenge. The number remained steady at that level for up to 120 d. There was also a steady fall in the CD4+/CD8+ ratio in the lungs, commencing on Day 7 and persisting to Day 120. A 10-d course of oral clarithromycin (10 mg/kg/d) from Day 7 resulted in a reduction of lymphocyte numbers to baseline level, although the dose did not influence the number of bacteria in the lungs. Treatment also increased the CD4+/CD8+ ratio to the baseline level from Day 7 to 17. Our results were similar to those detected in bronchoalveolar lavage fluid of patients with DPB and suggest that the therapeutic benefits of clarithromycin are due to its anti-inflammatory properties rather than antimicrobial effect.

Animals↗