L40

Question 1

Pseudo

• GN or GP
• Air environment
• Ferment lactose?
• Oxidase +/-
• Plate characteristics

Answer 1

GN rod
Aerobic (blowing fire)
NO lactose fermentation (flow chart)
Oxidase + ring
Grows on MacConkey - grape smell!!

Question 2

Where/when are pseudo infections commonly seen?

Answer 2

NOSOCOMIAL

Question 3

Drugs to treat pseudo

Answer 3

3. Fluoro - cipro
4. Pip/tazo
5. 3rd & 4th cephalo (ceftaz & cefepime)
6. Meropenem = big guns

Question 4

Pseudo virulence factors

Answer 4

Pili & flagella = adherence
LPS = endotoxin –> massive septic shock
CAPSULE

Question 5

You just said LPS = endotoxin. Which endotoxin is this and what are its effects?

Answer 5

Exotoxin A
Mechanism = X protein synthesis
X phagocytes –> necrotizing tissue

Question 6

How does pseudo secrete its virulence toxins?

Answer 6

T3SS

Question 7

What are the clinical conditions caused by pseudo infection?

Answer 7

HA/VA-pneumonia
Bactermia --> endocarditis 
S/ST infection
Osteomyelitis 
UTI 
External ear otitis

Question 8

Is pseudomonas bacteremia a primary or secondary infection?

Answer 8

Secondary to pseudo pna, catheter/line infection, UTI, GI infection

Question 9

If there was a normal place to find pseudo in the body, where would you find it?

Answer 9

GI

Question 10

What kind would might you see resulting from pseudo bactermia?

Answer 10

Ecthyma gangrenosum

Question 11

Is pseudomonas endocarditis commonly seen? Which patients would you see this endocarditis in?

Answer 11

Rare, BUT if present - high mortality

IVDUs

Question 12

Describe ecthyma gangrenosum.

Answer 12

Not specific to pseudo
Ulcer - punched out lesion
Raised margins

Question 13

Which patients are most likely to get a lethal pseudo skin/ST infection?

Answer 13

BURN pts
Blue/green wounds
Grape odor

Question 14

What skin/ST infection is common and caused by pseudomonas? Treat?

Answer 14

Hot tub folliculitis

No antimicrobials needed

Question 15

Which oro-maxo-facial infections can be caused by pseudo?

Answer 15

Eye - contact lens solution

OTITIS EXTERNA - think dirty hot tubs

Question 16

How do you treat otitis externa?

Answer 16

Ciprofloxacin drops

Question 17

Acinetobacter baumanii

• GN/GP
• Shape
• Motile?
• O2 enviro
• Lactose fermentation?
• Oxidase +/-

Answer 17

GN 
Coccobacillus
Non-motile 
Aerobic
NO lactose fermentation
Oxidase NEG - differentiation from pseudo!!!

Question 18

Where is acinetobacter found?

Answer 18

Water & soil
- CAPSULE
Normal skin, RT, GI colonizer

Question 19

What types of infections does acinetobacter cause?

Answer 19

NOSOCOMIAL

Usually part of flora

Question 20

The infections you need to think of for acinetobacter

Answer 20

VAP
CAUTI
Line infections –> bactermia
Wound infections

Question 21

Treat acinetobacter

Answer 21

Broad GN coverage drugs: cephalo, carba, beta lactam + lactamase inhbitor, fluoro, aminoG, etx

Question 22

What other GN rods might you seen in the ICU? Aka nosocomial?

Answer 22

Strenotrophomaonas

Question 23

What is a GN bacteria that looks like pseudo and is most often seen in sickle cell pts?

Answer 23

Burkholderia