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铜绿假单胞菌的生物学性状
Gram-negative non-fermenting, motile bacillus; known for blue-green pus (pyocyanin and pyoverdin pigments)
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铜绿假单胞菌常从何处被培养出？
Lab: culture of sputum, endotracheal aspirate, bronchoscopic specimens, urine, blood, abscess fluid, joint fluid, or CSF
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铜绿假单胞菌的生活环境
Nonfastidious organism, can inhabit a variety of environments including soil and water (hot tubs, sinks, water faucets, respirators, disinfectants and contact lens cleaning solutions). Produces biofilm.
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铜绿假单胞菌耐药机制：
Drug resistance mechanisms: includes active efflux pumps, chromosomal and inducible beta-lactamases, plasmid-mediated ESBLs (TEM, SHV, CTX-M), and altered permeability. Loss of protein porin OprD results in resistance to carbapenems, specifically imipenem.
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铜绿假单胞菌常致何种疾病？
Nosocomial, opportunistic pathogen, especially in setting of immunocompromised host or foreign body (central line or urinary catheter).
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铜绿假单胞菌常定植于何种疾病的肺部？
Chronic colonizer of cystic fibrosis lung
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铜绿假单胞菌是何种疾病的常见病原菌？
Cause of pneumonia (ventilator-associated), UTI, bacteremia (neutropenia), post-neurosurgical meningitis, post-surgical infections, and hot-tub folliculitis
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铜绿假单胞菌导致坏死性脓疮的机制：
Cause of ecthyma gangrenosum: infarcted skin lesions, due to vascular invasion with heavy organism burden; uncommon and seen mostly in immune suppressed or critically ill patients
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感染铜绿假单胞菌的常见危险因素
Risk factors include immunosuppression, DM, skin burns, cystic fibrosis and AIDS.
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铜绿假单胞菌耐药株常见于：
Multidrug resistance likely in those with recent abx therapy (past 90d),hospital stay > 4d, high rate of abx resistance in facility, residence in chronic care facility.
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与铜绿假单胞菌相关的既往史有：
Historically associated with high mortality in febrile neutropenia (bacteremia, pneumonia and skin and soft tissue infections) and infected burn wounds (heavy bacterial growth in burn eschar).
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铜绿假单胞菌常见感染部位
- Respiratory: pneumonia (nosocomial, CF, AIDS) & lung abscesses
- GU: UTI/pyelonephritis (complicated by obstruction, manipulation, or foreign body)
- CV: endocarditis (IDU); bacteremia, line sepsis
- Skin: ecthyma gangrenosum (neutropenia); cellulitis (DM, IDU, post-operative); folliculitis; abscesses; noma neonatorum (gangrenous stomatitis)
- ENT: otitis externa, malignant otitis externa (DM); chronic otitis media; sinusitis (AIDS)
- CNS: brain abscesses; meningitis (post-neurosurgical)
- Bone/joint: vertebral, sternoclavicular or pelvic bone infections (IDU); osteochondritis of foot (following penetrating injuries through tennis shoes)
- Eye: keratitis, endophthalmitis
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怎样防止铜绿假单胞菌的医源性感染
Prevention of nosocomial transmission with infection control: isolate infected pts, require hand-washing by staff & visitors.
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对有肺部疾病的患者的处理
In patients w/ chronic lung disease (e.g., CF), good pulmonary toilet (mucolytic agents, chest PT, postural drainage) are important adjunctive treatment measures.
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对怀疑铜绿假单胞菌的重症患者的治疗原则：
In seriously ill, empiric treatment with concern for P. aeruginosa should use two active agents from two different classes. Once susceptibilities known, narrow to one drug according to susceptibility report.
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治疗铜绿假单胞菌感染何种方案可能增强疗效？
Double coverage using high doses of synergistic antibiotic combinations (B-lactam + aminoglycoside) may improve outcomes of serious infections but remains controversial.
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对于多耐药铜绿假单胞菌可能有效的药物是：
Multi-drug resistant strains may be susceptible to colistin or polymyxin B.
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感染铜绿假单胞菌，何种病人需要提高氨基苷类抗生素的剂量？
Pts with CF, pregnancy, burns, and critical illnesses may require higher doses of aminoglycosides. Monitor serum drug levels.
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治疗铜绿假单胞菌感染的直接依据：
Use susceptibilities to guide final choices. Drugs that include activity against P. aeruginosa listed below but increasing resistance identified especially with ticarcillin, ciprofloxacin, levofloxacin.
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哌拉西林用于治疗铜绿假单胞菌时的剂量及注意事项：
Piperacillin 3g IV q4h or 4g IV q6h. Piperacillin/tazobactam offers no advantage for most isolated compared to piperacillin alone since most resistance is not beta-lactamase related.
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替卡西林用于铜绿假单胞菌时的治疗方案：
Ticarcillin 3 IV q4h (increasing resistance seen)
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头孢类用于铜绿假单胞菌治疗的方案
- Cefepime 1-2g IV q8h
- or ceftazidime 2g IV q8h
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碳青霉烯类用于铜绿假单胞菌的方案
- Imipenem 1g IV q6-8h;
- meropenem 1gm IV q8h;
- doripenem 500mg IV q8h
(carbapenemase-producing strains increasingly identified)
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环丙沙星用于铜绿假单胞菌的方案及注意事项：
Ciprofloxacin 400mg IV q8h or 750mg PO q12h, increasing risk of resistance; would not use as empiric monotherapy
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氨曲南用于铜绿假单胞菌的治疗方案
Aztreonam 2g IV q8h
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氨基苷类用于铜绿假单胞菌的治疗方案及注意事项：
- Gentamicin or tobramycin 3 mg/kg loading dose then 2 mg/kg IV q8h or 5-7 mg/kg IV every day or amikacin 8 mg/kg loading dose then 7.5mg/kg IV q12h. Monotherapy reserved for UTIs. Note: amikacin > tobramycin > gentamicin with respect to P. aeruginosa susceptibility percentages at most institutions. Irreversible
- vestibular and cochlear toxicity with greater cumulative dose and duration of tx.
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铜绿假单胞菌的治疗疗程：
Duration: uncomplicated UTI, 3-5d; urosepsis, 2 wks; pyelonephritis, 2-3 wks; pneumonia, >8-14d; bacteremia after removal of line, 7-10d; bacteremia with neutropenia, >14d or until neutrophil count recovered
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