Pseudomonas aeruginosa as an Opportunistic Pathogen

Part of the series Infectious Agents and Pathogenesis pp 349-382

Immunochemical Prophylaxis against Pseudomonas aeruginosa

  • Michael S. CollinsAffiliated withMiles Pharmaceutical Division, Miles Inc.

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Healthy people are rarely infected by Pseudomonas aeruginosa. Consequently, serious P. aeruginosa infections are rarely community-acquired. However, in the hospital setting, P. aeruginosa causes about 7–15% of life-threatening bacterial infections such as bacteremia and pneumonia.1–5 In cystic fibrosis (CF), P. aeruginosa is the predominant pathogen.6,7 P. aeruginosa merits special attention as a common bacterial nosocomial pathogen, for the mortality rate is significantly higher than that seen in infections caused by other common gram-negative bacilli and staphylococci.8–10 Thus, in the host compromised by extreme youth or age, trauma, cancer, immunosuppressive therapy, or mechanical ventilation, P. aeruginosa can be a highly virulent pathogen.1,2,8–10 In the compromised patient P. aeruginosa has several attributes that contribute to its high virulence. P. aeruginosa is innately less sensitive than other common gram-negative bacilli to modern antimicrobials such as semisynthetic penicillins, third-generation cephalosporins, aminoglycosides, and fluorinated carboxyquinolones.11–15 Resistance can emerge during anti-microbial therapy, resulting in treatment failure.16–20 Also, it is insensitive to frequently used agents such as trimethoprim-sulfamethoxazole, tetracycline, ampicillin, and first-and second-generation cephalosporins. The use of theselatter oral antimicrobials for infection prophylaxis profoundly alters normal flora and can promote colonization of the host.21–23