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Pseudomonas aeruginosa infections associated with transrectal ultrasound-guided prostate biopsies--Georgia, 2005.

Transrectal ultrasound (TRUS)-guided prostate biopsies are among the most common outpatient diagnostic procedures performed in urology clinics, with an estimated 624,000 performed annually in the United States (CDC, unpublished data, 2006). The procedures generally are performed in follow-up to elevated levels of prostate-specific antigen or abnormal digital rectal examinations. Septicemia has been reported as a rare complication of the procedure. This report summarizes an investigation of four cases of Pseudomonas aeruginosa infection after TRUS-guided prostate biopsies in which contamination of the equipment was the likely source. The findings underscore the need to adhere to recommendations for the cleaning and disinfection of TRUS-guided prostate biopsy equipment.

Aged↗

Long term effect of erythromycin therapy in patients with chronic Pseudomonas aeruginosa infection.

BACKGROUND: Diffuse panbronchiolitis is a chronic infection of the lower respiratory tract common among the Japanese people, with a persistent Pseudomonas aeruginosa infection in the late stage and sustained neutrophil retention in the airways. The long term effect of erythromycin was examined retrospectively in a group of patients with diffuse panbronchiolitis, with and without P aeruginosa infection, and the relationship between drug-induced bacterial clearance and clinical improvement was investigated. METHODS: The history, daily volume of sputum, type of organisms in sputum cultures, pulmonary function tests, arterial blood gas tensions, and chest radiographs were compared in 16 patients with diffuse panbronchiolitis with P aeruginosa infection and 12 without. The total and differential cell counts in the bronchoalveolar lavage (BAL) fluid were compared in 14 of the 28 patients (five of whom were infected with P aeruginosa) before and after 1-12 months of treatment with erythromycin (600 mg/day). The outcome of treatment in patients showing clearance of organisms on repeated sputum cultures was compared with that in those demonstrating persistence of bacteria in the sputum and patients with normal flora. RESULTS: Erythromycin improved respiratory function and arterial blood gas tensions irrespective of the presence or absence of P aeruginosa in the sputum. Treatment also resulted in a reduction in the BAL fluid total cell count and the percentage of neutrophils in both groups of patients. There were no differences between patients in whom the bacteria cleared and those with persistent bacteria or patients with a normal flora with regard to the degree of improvement of respiratory function, arterial blood gas tensions, and BAL fluid cell composition. CONCLUSION: The results suggest that the efficacy of erythromycin in diffuse pan-bronchiolitis may be due to anti-inflammatory effect, independent of P aeruginosa infection or bacterial clearance.

Adolescent↗

Heightened resistance of athymic, nude (nu/nu) mice to experimental Pseudomonas aeruginosa ocular infection.

BALB/c-derived athymic, nude (nu/nu) mice exhibited a heightened natural resistance to experimental corneal infection with Pseudomonas aeruginosa when compared with their heterozygote (nu/+) littermates. Stereomicroscopic examination of the eyes of nu/nu mice 24 h after corneal trauma and topical bacterial application revealed slightly cloudy corneas (iris visible), whereas nu/+ littermate corneas were opaque (iris not visible). Nu/+ mice failed to resolve the infection, and endophthalmitis and shrinkage of the infected eye occurred in these mice within 2 weeks after experimental Pseudomonas infection, as in the parent BALB/c strain. However, nu/nu mice, similarly infected, resolved the infection within 24 h and never exhibited full corneal opacity or eye shrinkage. Histological examination of the corneas of nu/nu mice 24 h after experimental wounding and bacterial application demonstrated subepithelial capillaries and a few polymorphonuclear neutrophils (with numerous intracellular bacteria) in the central cornea. In contrast, the equivalent corneal areas of infected nu/+ littermates, examined similarly, showed a more striking neutrophilic response (but with few intracellular bacteria) to similar bacterial infection, as well as a lack of blood vessels within the central cornea. The central corneas of uninfected and saline control nu/nu mice also were observed. This area in nu/nu mice exhibited an infrequent polymorphonuclear neutrophil (with no intracellular bacteria) and capillaries similar in size and location to those described for experimentally infected nu/nu mouse corneas. Untreated and saline control nu/+ mice, on the other hand, lacked both vessels and polymorphonuclear neutrophils in the central cornea.

Animals↗

Protective effect of recombinant murine granulocyte-macrophage colony-stimulating factor against Pseudomonas aeruginosa infection in leukocytopenic mice.

The effects of recombinant murine granulocyte-macrophage colony-stimulating factor (rmGM-CSF) against Pseudomonas aeruginosa infection in ICR mice were investigated. Mice were treated with cyclophosphamide (CPA) and were then injected intraperitoneally with rmGM-CSF three times daily, beginning on the day after CPA treatment, for 7 days. The number of peripheral blood leukocytes in both CPA- and rmGM-CSF-treated mice and control CPA-treated mice reached a nadir on day 4, when P. aeruginosa was injected intraperitoneally. The administration of rmGM-CSF significantly increased the proportion of survivors among mice infected with a lethal dose of P. aeruginosa. This effect was further analyzed by monitoring sequential changes in leukocyte count and bacterial growth in various organs. The number of bacteria in the peritoneal cavities, peripheral blood samples, and livers of GM-CSF-treated mice decreased to an undetectable level after a transient increase, and the number was significantly lower than that in control mice. In GM-CSF-treated mice, the neutrophil levels in peripheral blood started to increase 5 days after CPA administration and were consistently higher than those in controls. Furthermore, the neutrophils in GM-CSF-treated mice were more mature morphologically. Thus, the prophylactic effect of rmGM-CSF against P. aeruginosa infection may result from a rapid recovery of myelopoiesis and a partial enhancement of mature neutrophil function.

Animals↗

Serial determination of complement and specific antibody titres in Pseudomonas aeruginosa infection.

Serial examination of the complement system and specific antibody titre of 12 surviving patients and 8 lethal cases suffering from Pseudomonas aeruginosa infection showed that except the onset of infection, until the development of septic shock, the level of the complement components corresponded to or exceeded the average normal value. In reversible septic shock the complement titre decreased significantly and in irreversible shock the values were even lower. Activation of the complement system occurred on 10 occasions via the classical and on 42 occasions via the alternative pathway. The number of activations grew parallel with the severity of the infection. Activation through the classical way was generally more intensive. During the whole infectious process not the individual characteristics of the P. aeruginosa present unbroken, but the pathological events and the specific antibody level determined the mode (alternative or classical pathway) of complement activation. The specific antibody level of the surviving patients significantly surpassed the titres of the lethal cases until the development of shock. Not an insufficiency of the complement system but the relative lack of specific antibodies was mainly responsible for the fatal outcome of P. aeruginosa infections.

Antibodies, Bacterial↗

Effect of salmeterol on Pseudomonas aeruginosa infection of respiratory mucosa.

We have studied the effect of salmeterol on both P. aeruginosa interactions with the mucosa of nasal turbinate organ cultures and on pyocyanin-induced (20 microg/ml) and elastase-induced (100 microg/ml) damage to nasal epithelial cells. Organ cultures were exposed to salmeterol either by preincubation with 4 x 10(-7) M salmeterol for 30 min or by pipetting 20 microl of 4 x 10(-7) M salmeterol onto the organ culture surface immediately prior to bacterial inoculation. Infected organ cultures (8 h) had significantly (p < or = 0.01) increased epithelial damage, and P. aeruginosa was predominantly associated with damaged epithelium and mucus. Salmeterol significantly (p < or = 0.02) reduced epithelial damage caused by infection and the total number of adherent bacteria (p < or = 0.05), but bacterial distribution on the mucosa was unchanged. Nasal epithelial cells incubated with pyocyanin (20 microg/ml) or elastase (100 microg/ml) for 3 h had significantly (p < or = 0.05) increased cytoplasmic blebbing and mitochondrial damage versus control values. Elastase also significantly (p < or = 0.05) increased cell projection and reduced the level of ciliation. Cells preincubated with salmeterol (2 x 10(-7) M) showed a significant reduction in some features of cell damage caused by both toxins, which was inhibited by the beta2-adrenoceptor antagonist propranolol. Our results indicate that salmeterol reduces P. aeruginosa-induced damage to both organ culture and nasal epithelium.

Adrenergic beta-Agonists↗

Combination therapy using 9,3"-di-O-acetyl-midecamycin with beta-lactam antibiotics against Pseudomonas aeruginosa infection.

The combined effect of beta-lactam antibiotics and 9,3"-di-O-acetylmidecamycin were examined in 10 patients diagnosed as having chronic respiratory tract infections and complicated urinary tract infections. Patients were initially treated with 3 to 10 g/day of beta-lactams as intravenous infusions or by oral route for a certain period, after which period they were treated concurrently with 0.3 to 0.9 g/day of 9,3"-di-O-acetylmidecamycin by oral route. Through this combination therapy eradication of P. aeruginosa was obtained in 2 cases and remarkable decrease in another 2 cases out of the 10 cases. This combination therapy was judged to be effective in these 4 cases. Of the remaining cases, P. aeruginosa was eliminated before the start of the combination therapy in 3 cases, and no change in bacterial count was noted after the combination therapy in the other 3 cases.

Adult↗

[Bacteriological monitoring of the treatment of Pseudomonas aeruginosa infections with amikacin administrated at once-daily dosis in patients with cystic fibrosis].

The interest of the treatment with a single daily dose of amikacin (AMK) in cystic fibrosis (CF) patients with P. aeruginosa infections has been much debated. The aim of work was to study the efficiency of this treatment on (CF) patients with chronic bronchopulmonary P. aeruginosa infections previously treated for two weeks with the combination ceftazidime (CAZ 200 mg/day in 3 inj. IVD) and AMK (35 mg/day in one IV perf. of 30 minutes). The bacteriological supervision of this treatment was performed 1: by the determination of MICs before and after treatment, 2: by the decrease of P. aeruginosa colonization immediately after this treatment and during 11 months, 3: by the identification of P. aeruginosa strains with phenotypic methods (serotyping and antibiotyping) and with genotypic method (pulsed field gel electrophoresis). The use of AMK in a single daily dose in order to treat chronic lung infections colonized with P. aeruginosa susceptible to this antibiotic shows encouraging results as far as bacteriology is concerned: this treatment has given means to reduce colonization for a month in 15 of 18 patients. For 9 of the 18 patients, no P. aeruginosa strains were isolated for nine months. The serotyping and antibiotyping systems do not enable us to study the P. aeruginosa epidemiology. Genome macrorestriction fingerprinting of P. aeruginosa in pulsed field gel electrophoresis confirms that patient with CF were colonized with one or several clones. In our study no variation of these clones was noticed for the first eleven months. Genome macrorestriction fingerprinting appears to be one of the most effective methods for delineate strains of P. aeruginosa colonizing CF patients.

Adolescent↗

Protection against exotoxin A (ETA) and Pseudomonas aeruginosa infection in mice with ETA-specific antipeptide antibodies.

Pseudomonas aeruginosa is an opportunistic pathogen that causes serious and sometimes fatal infections in the compromised host, especially in patients with major trauma or thermal injuries. Exotoxin A (ETA) is the major and most lethal virulence factor produced by this ubiquitous microorganism. In a recent study (H. S. Elzaim, A. K. Chopra, J. W. Peterson, R. Goodheart, and J. P. Heggers, Infect. Immun. 66:2170-2179, 1998), we identified two major epitopes, one within the translocation domain (amino acid [aa] residues 289 to 333) of ETA and another within the enzymatic domain (aa 610 to 638), by using a panel of antipeptide antibodies. Synthetic peptides representing these two epitopes induced ETA-specific antibodies which were able to abrogate the cytotoxic activity of ETA, as measured by incorporation of [3H]leucine into 3T3 fibroblasts. In the present study, these antibodies were tested for the ability to provide protection against ETA and infection with a toxin-producing strain of P. aeruginosa in a mouse model. Antibodies to either of the synthetic peptides conferred protection against ETA. Also, when used for immunization, both peptides induced active immunity to ETA in mice. Antibodies to the peptide representing a region within the enzymatic domain of ETA, in combination with the antibiotic amikacin, enhanced the survival of mice infected with a toxin-producing strain of P. aeruginosa. Thus, antipeptide antibodies specific for ETA might be paired with antibiotic treatment for passive immunization of patients suffering from P. aeruginosa infection.

3T3 Cells↗

Demonstration of neutrophil chemotactic activity in the sputum of cystic fibrosis patients with Pseudomonas aeruginosa infection.

The pathogenesis of tissue damage in the lungs of cystic fibrosis patients with chronic P. aeruginosa infection is quite complex and not well understood. Inflammatory cells, particularly neutrophils, are accumulated in the damaged tissues and in the sputum. This study demonstrates the presence of a heat-stable neutrophil chemotactic factor(s) in the sputum of CF patients. The chemotactic activity seems to be associated with the endotoxin present in the sputum. Chemotaxis of sol phase sputum was determined in a modified Boyden chamber assay. It was found that the sputum obtained from the patients showed strong chemotactic activity for peripheral blood neutrophils of normal individuals. The activity was greater than twice that of casein, a strong neutrophil chemo-attractant. Sputum at about dilution of 1:50 exhibited chemotactic activity equal to that of casein. Heat treatment of the sputum at 56 degrees C for 30 min, to inactivate complement, and at 100 degrees C for 15 min, to denature other proteins, somewhat reduced the chemotactic activity, but there was still strong chemotactic activity. The presence of endotoxin was demonstrated in both the non-heated and the heated samples by LAL and rocket immunoelectrophoresis. It is concluded that the sputum of CF patients contain chemotactic activity of heat-stable nature and most likely of bacterial origin endotoxin. These factors are involved in attraction of neutrophils to the lungs and sputum of these patients and contribute to the tissue damage of cystic fibrosis.

Chemotaxis, Leukocyte↗

[Clinical application of cefsulodin to Pseudomonas aeruginosa infections in the surgical field (author's transl)].

Cefsulodin (CFS), a new antipseudomonas cephalosporin, was clinically evaluated for treatment of the Pseudomonas aeruginosa infections in the surgical field to obtain the following results. 1. CFS was administered to total 11 cases of the surgical infections caused by P. aeruginosa, comprising of 5 cases with wound infections, 3 cases with infected burn and 1 case each with muscular abscess, decubitus and postoperative pneumonia in 0.5 approximately 1 g twice a day by intravenous bolus or drip infusion. Good clinical responses were obtained in 9 out of 11 cases (81.8%). 2. Bacteriological responses were observed in all cases. P. aeruginosa was eradicated in 9 cases and suppressed in 2 cases by CFS treatment. However, replacement of pathogens with the other organisms was observed in 6 out of 8 cases caused by P. aeruginosa only. 3. Neither objective and subjective side effects nor abnormalities of laboratory tests associated with CFS treatment were observed. 4. It can be, therefore, concluded that CFS is one of the useful drugs for treatment of the surgical infections caused by P. aeruginosa.

Adult↗

[Use of quinolones in the treatment of Pseudomonas aeruginosa infections in children with cystic fibrosis].

Quinolones, elective drugs for Pseudomonas aeruginosa (P. aeruginosa) pulmonary infections in Cystic Fibrosis (C.F.) patients, are controversially administered in prepuberal age for their arthropathic toxicity. We report the result of retrospective study on the use of quinolones in a group of 43 CF patients. The patients were divided into two groups: below 18 years (22 pts.) and over 18 (21 pts.). All patients were evaluated clinically with the scoring system Shwachman and Kulczyk. Ciprofloxacin and Ofloxacin (15/20 mg/kg/die) were administered. In 11.6% of the patients, all belonging to the second group, side effects, such as urticaria, tongue oedema, foreskin erythema, generalised erythema and itch, were described. No side effect has been reported in the patients below 18 years. Two patients complained knee arthralgias not related to the quinolones administration: in fact in the first case the demineralisation seemed to be responsible of the arthralgia, while in the second case an immunological disorder (ANA+, ICC+) should be involved in the pathogenesis of arthritis. Height velocity evaluation showed the same slowering of the CF untreated patients. In conclusion, our study confirms that quinolones use in indicated in severe and infective complications of CF on the basis of their efficacy, safety and their slight adverse effects similar to those of other potent antibiotic. Moreover our results confirm that no quinolone-induced cartilage toxicity is present in CF patients.

Adolescent↗

Impaired function of polymorphonuclear leukocytes exuded into bronchoalveolar spaces infected with Pseudomonas aeruginosa in steroid-treated rabbits.

Steroid-treated and untreated rabbits were infected transbronchially with Pseudomonas aeruginosa. The polymorphonuclear leukocytes (PMN) exuded into the bronchoalveolar spaces were obtained by lavage 18 hr later, superoxide (O2-) production and chemotactic activity were studied. In the steroid-treated group, there was a heightened susceptibility to the infection, as compared to findings in the untreated group. The lung exudate PMN in the steroid-treated group showed a significant decrease (p less than 0.05) in O2- production, and somewhat depressed chemotactic activity. In the untreated group, both O2- production (p less than 0.01) and chemotactic activity (p less than 0.001) of lung exudate PMN doubled, compared with findings in blood PMN. There was, however, no significant difference between lung exudate PMN and blood PMN in the steroid-treated group. Impaired PMN function in the steroid-treated group was also observed in case of casein-induced lung exudate PMN. These results suggest that the antibacterial function of PMN exuded in the infected lung may be impaired in steroid-treated hosts, hence an enhanced susceptibility to lung infection.

Animals↗

Tobramycin and carbenicillin compared with gentamicin and carbenicillin in the treatment of infection with Pseudomonas aeruginosa in adult patients with cystic fibrosis.

Treatment with gentamicin or tobramycin given intravenously with carbenicillin is compared in the treatment of bronchopulmonary infection in older patients with cystic fibrosis. All patients improved on both regimens and there was no observed difference in the two treatments. Pseudomonas aeruginosa could still be isolated from the sputum 3 months after completion of treatment with both treatments. No toxic or allergic side-effects were noted.

Adolescent↗

Azithromycin blocks neutrophil recruitment in Pseudomonas endobronchial infection.

Macrolides exert their effects on the host by modulation of immune responses. In this study, we assessed the therapeutic efficacy of azithromycin in a murine model of mucoid Pseudomonas aeruginosa endobronchial infection. The clearance of Pseudomonas from the airway of mice treated with the macrolide azithromycin was not different than untreated mice challenged with Pseudomonas beads. However, the azithromycin-treated mice showed a remarkable reduction in lung cellular infiltrate in response to Pseudomonas beads, as compared with untreated mice. This effect was associated with significant decreases in lung levels of tumor necrosis factor-alpha and keratinocyte-derived chemokine in azithromycin-treated mice compared with untreated mice. Furthermore, there was a significant reduction in the response of both mouse and human neutrophils to chemokine-dependent and -independent chemoattractants when studied in vitro. Inhibition of chemotaxis correlated with azithromycin-mediated inhibition of extracellular signal-regulated kinase-1 and -2 activation. This study indicates that the azithromycin treatment in vivo results in significant reduction in airway-specific inflammation, which occurs in part by inhibition of neutrophil recruitment to the lung through reduction in proinflammatory cytokine expression and inhibition of neutrophil migration via the extracellular signal-regulated kinase-1 and -2 signal transduction pathway.

Animals↗

[The effect of stimulants of immunity on anti-infective resistance and on the activity of the liver monooxygenase system].

The effect of some immunostimulants (bacterial lipopolysaccharide prodigiosan, active thymic peptide T-activin, synthetic compound levamisole) on the anti-infection resistance and metabolic function of the liver (hexobarbital sleeping-time) was studied on noninbred male mice. It was found that when administered in doses and under schedules that protected mice against lethal infection (Pseudomonas pyocyanea, i.p.) prodigiosan and levamisole inhibited metabolism of hexobarbital. T-activin was inactive in both tests. The possible mechanism of correlation is discussed.

Adjuvants, Immunologic↗