Pseudomonas Infection

Pseudomonas infection is a condition caused by bacteria that are common in the environment but can become dangerous for people who are already ill or have weakened immune systems, potentially leading to life-threatening complications.

Table of contents

• What is Pseudomonas infection?
• Types of Pseudomonas infections
• How the infection is caused and spreads
• Who is at risk?
• Signs and symptoms
• How the infection is diagnosed
• Treatment options
• Possible complications
• How to prevent infection

What is Pseudomonas infection?

A Pseudomonas infection is an illness caused by a type of bacteria called Pseudomonas. These bacteria are found widely in the environment, including in soil, water, and plants^[1]. The most common type that causes infections in people is called Pseudomonas aeruginosa (P. aeruginosa)^[1].

Healthy people often carry these bacteria without knowing it and without having any problems. Sometimes these germs cause minor issues like swimmer’s ear and hot tub rash^[2]. However, for people who are weak or ill, these bacteria can cause very serious—even deadly—infections in any part of the body^[2].

The bacteria can appear in moist or wet areas, like bathtubs or sinks. You may also have it on your skin, but it may not cause an infection. Healthcare experts sometimes call this bacterial colonization^[1].

A Pseudomonas aeruginosa infection can be challenging to get rid of. The bacteria have evolved (changed in response to treatments), so certain antibiotics that would typically treat the condition no longer work. This is called antibiotic resistance^[1].

Types of Pseudomonas infections

Pseudomonas aeruginosa can cause many different types of infections in various parts of the body^[1]:

• Blood infection (septicemia or bacteremia)
• Ear infection
• Eye infection
• Lung infection (pneumonia)
• Skin infection (cellulitis)
• Urinary tract infections (UTIs)
• Bone, joint or muscle infections

It can also cause infections in your gastrointestinal (GI) tract, which includes your mouth, esophagus, stomach, small intestine, large intestine, and anus^[1].

Pseudomonas infections can affect all parts of the body and may also cause sepsis (blood poisoning) and endocarditis—a rare infection in the heart^[8].

How the infection is caused and spreads

Pseudomonas is a group of bacteria commonly found in the environment, like in soil and water^[4]. The bacteria are found widely in water, plants, soil, and produce^[1]. They favor moist environments and can thrive in damp places indoors^[5].

The infection can spread in several ways^[4]:

• Contact with contaminated surfaces or equipment
• Exposure in the soil or water
• Person-to-person contact, like from contaminated hands

You can get a pseudomonas infection from eating contaminated food, since the bacteria can grow on fruits and vegetables. It also thrives in wet areas such as lakes, pools, hot tubs, bathrooms, kitchens, and sinks^[10].

The most severe infections occur in health care settings, such as hospitals. Pseudomonas aeruginosa can easily grow in humidifiers and types of medical equipment (catheters, for instance) if they aren’t properly cleaned. If health care workers don’t wash their hands well, they can also transfer the bacteria from an infected patient to you^[10].

In hospitals, the bacteria can spread through medical equipment, cleaning solutions, and other equipment^[2]. The bacteria can also get into the body through intravenous (IV) needles or catheters^[2].

Who is at risk?

It’s rare for a Pseudomonas aeruginosa infection to develop in people with a healthy immune system. But it can be serious and potentially deadly if you have a weakened immune system (immunocompromised)^[1].

Patients in healthcare settings are at highest risk, especially those who^[4]:

• Are on breathing machines (ventilators)
• Have devices such as catheters
• Have open wounds from surgery or burns

Common causes of a weakened immune system include^[1]:

• Autoimmune conditions, such as lupus or rheumatoid arthritis
• Cancer
• Cystic fibrosis
• Diabetes
• HIV and AIDS
• Kidney disease
• Liver disease
• Organ transplants, such as a heart transplant or lung transplant
• Pregnancy
• Severe burns
• Surgery

You’re also at a higher risk if you have a lung condition, such as cystic fibrosis, bronchiectasis, or chronic obstructive pulmonary disease (COPD). These lung conditions can cause inflammation in your airways and make it harder to clear mucus. Pseudomonas can grow in this mucus and increase your risk of infection^[8].

People who can’t get out of bed because of another illness or those in the hospital are more likely to get this infection. This is more common when someone is in the intensive care unit (ICU)^[2].

Signs and symptoms

Symptoms vary according to where the Pseudomonas aeruginosa infection affects your body^[1]. If it’s in a wound, there may be green-blue pus in or around the area^[2].

Blood infections may cause^[1]:

• Chills
• Feeling very tired (fatigue)
• Fever
• Joint pain
• Low blood pressure (hypotension)
• Muscle pain

A blood infection can also cause very low blood pressure, known as hemodynamic shock, which can lead to failure of other organs including the heart, kidneys, and liver^[5].

Ear infections may cause^[1]:

• Earache
• Fluid that comes out of your ear (discharge)
• Itching
• Swelling
• Hearing loss

Gastrointestinal tract infections may cause^[1]:

• Headache
• Diarrhea
• Nausea and vomiting

Eye infections may cause^[1]:

• Inflammation
• Pain
• Pus
• Red eyes
• Swelling
• Sudden vision loss

Lung infections may cause^[1]:

• Chills
• Cough
• Difficulty breathing
• Fever

Skin infections may cause^[1]:

• Discolored (red, brown or purple) bumps
• Foul-smelling, clear or pink fluid that drains from a wound (draining wound)
• Itchiness
• White or yellow pus-filled bumps (abscess)

Urinary tract infections may cause^[1]:

• Having to pee suddenly or uncontrollably (urge incontinence)
• Leaking pee when you don’t mean to (urinary incontinence)
• Pain around your pelvic area
• Pain when you pee (dysuria)
• Peeing more than usual (frequent urination)

You can have pseudomonas in your lungs without any symptoms. But pseudomonas infections can be serious and often need treatment^[8]. When the infections are elsewhere in the body, you may have a fever and feel tired^[2].

How the infection is diagnosed

To determine if someone has a P. aeruginosa infection, healthcare providers will send a specimen to the laboratory for antimicrobial susceptibility testing^[4].

Your doctor may suspect a pseudomonas infection by hearing about your symptoms. To confirm the diagnosis, your doctor may take samples from the infected area. The samples may include blood, sputum (phlegm), urine, or tissue samples. These samples are then sent to a laboratory where they are tested to identify the bacteria^[10].

Treatment options

Antibiotics are the main treatment for a pseudomonas infection^[2]. Treatment generally includes antibiotics. Unfortunately, treatment options are limited for multidrug-resistant (MDR) P. aeruginosa^[4].

It can be hard to find the right antibiotic because the bacteria are resistant to many of these medicines. The infections are hard to treat because the bacteria can resist many types of antibiotics, the medicines normally used to kill bacteria^[2].

In some cases, surgery is used to remove infected tissue^[2]. Two agents from different classes should be used when the risk for antibiotic resistance is high (for example, in severe sepsis, septicemia, and inpatient neutropenia)^[12].

If your doctor prescribes antibiotics, be sure to take all the medicine even if you begin to feel better right away. If you don’t take all the medicine, you may not kill all the bacteria^[2].

No matter what your treatment, it’s important to call your doctor if your infection doesn’t get better as expected^[2].

Possible complications

Pseudomonas aeruginosa isn’t a form of sepsis. But a Pseudomonas aeruginosa infection can cause sepsis. Sepsis is a medical emergency in which your immune system stops fighting an infection and starts to attack your healthy tissues and organs. Studies show that P. aeruginosa is a common cause of sepsis in people with severe burns^[1].

All pseudomonas infections can make you very sick if they spread through the bloodstream (septicemia). A serious infection can cause symptoms of high fever, chills, confusion, and shock^[2].

Pseudomonas infections are common. In 2017, medical researchers estimated over 32,000 people had a P. aeruginosa infection^[1]. Some types are resistant to nearly all antibiotics, including carbapenems, known as multidrug-resistant (MDR) P. aeruginosa. In 2017, MDR P. aeruginosa caused an estimated 32,600 infections among hospitalized patients and 2,700 estimated deaths in the United States^[4].

How to prevent infection

As more antibiotic-resistant bacteria develop, hospitals are taking extra care to practice infection control. This includes frequent hand-washing and isolating patients who are infected^[2].

For patients and caregivers, important steps include^[4]:

• Keep their hands clean, particularly before and after caring for wounds or touching a medical device
• Remind people (including healthcare providers) to clean their hands before touching the patient or handling medical devices
• Allow healthcare staff to clean their room daily when in a healthcare setting

Practice good hygiene^[2]:

• Keep your hands clean by washing them often and well. Hand-washing is the best way to avoid spreading germs. You can use soap and clean, running water or an alcohol-based hand sanitizer
• Keep cuts and scrapes clean and covered with a bandage
• Avoid contact with other people’s wounds or bandages
• Don’t share personal items like towels or razors

Be smart about antibiotics^[2]:

• Know that antibiotics can help when an infection is caused by bacteria. But they can’t cure infections caused by a virus
• Always ask your doctor if antibiotics are the best treatment
• Always take all your antibiotic medicine as prescribed. Using only part of the medicine may cause antibiotic-resistant bacteria to develop
• Don’t save any antibiotics. And don’t use ones that were prescribed for someone else

If you are in the hospital, remind doctors and nurses to wash their hands before they touch you^[2].

If you have a pseudomonas infection, you can keep from spreading the bacteria^[2]:

• Cover your wound with clean, dry bandages
• Follow your doctor’s instructions on caring for your wound
• Keep your hands clean. You, your family, and other people with whom you are in close contact should wash their hands often, especially after changing a bandage or touching a wound
• Don’t share towels, washcloths, razors, clothing, or other items that may have had contact with your wound or a bandage
• Wash your sheets, towels, and clothes with warm water and detergent, and dry them in a hot dryer, if possible
• Keep your environment clean by using a disinfectant to wipe all the surfaces you touch often (such as countertops, doorknobs, and light switches)

Healthcare settings should always follow core infection control practices to reduce the risk of spreading these germs to patients and have water management plans in place^[4].