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PseudomonasAcinetobacter    Dr Kamran Afzal Asst Prof Microbiology
30 years old femaleAccidentally got burnt in her houseTreated with wound dressingsI/V Vancomycin + Ceftriaxone
Gram stain from wound pus
Pseudomonas aeruginosa
Characteristics                     Gram negative rod                     NLF                     Oxidase and Catalase ...
   Two forms       Planktonic and Biofilm   Some strains produce    diffusible pigments       Pyocyanin (blue/green)  ...
Colony typesThree types of colonies      Small rough               Large smooth      colonies                  colonies   ...
Transmission in hospital   Ubiquitous to soil,          Respiratory and other    water, and vegetation         hospital ...
Virulence factors
Pathogenicity                   Endocarditis                   Respiratory infections                   Bacteremia and ...
Bacterial Endocarditis                        IV drug users                        Prosthetic heart valves              ...
Respiratory Infections   Pneumonia       Bacteremic pneumonia commonly occurs in        neutropenic cancer and CCF patie...
Bacteremia and Septicemia   Primarily in immunocompromised patients   Predisposing conditions       Hematologic maligna...
CNS Infections                    Meningitis                    Brain abscess                    Portal of Entry       ...
Ear infections                    Otitis externa                        "swimmers ear"
Eye infections                    Bacterial keratitis                    Neonatal ophthalmia                    Contami...
Bone and Joint Infections   Particular tropism for fibro-cartilagenous joints    of the axial skeleton       Direct inoc...
Urinary Tract Infections   Usually hospital-acquired       UT catheterization, instrumentation or surgery   3rd leading...
Gastrointestinal infections   The GI tract is also an important portal of entry    in Pseudomonas septicemia   Any part ...
Skin and Soft tissue infections   Wound infections, pyoderma and dermatitis   Localized and diffuse skin infections    ...
Treatment   Pseudomonas aeruginosa is frequently resistant    to many commonly used antibiotics   Many strains are susce...
Acinetobacter
   The name, Acinetobacter, comes from the Latin    word for "motionless," because they lack cilia or    flagella with wh...
INTRODUCTION   Gram-negative pleomorphic rods   Colonize aquatic environment   Associated with biofilms   Survives on ...
   Mostly isolated from hospital environment   Not part of normal human flora   A. baumannii is often a source of nosoc...
   Resistance to multiple drugs       - Over-expression of efflux pumps       - Expression of ß-lactamases          (In...
Genus: Acinetobacter                    CLASSIFICATION            Name              Genomic species No.A. calcoacetius    ...
EPIDEMIOLOGY    Habitat    Free living saprophyte in soil and water    Human colonization    25% healthy adults - cutaneou...
TRANSMISSIONAcinetobacter can be spread from person toperson (infected or colonized patients), contactwith contaminated su...
PATHOGENICITY    Virulence factors – Mostly unknown    n   LPS and Capsulen   Opportunistic infections - Immunocompromised...
Risk factors for nosocomial infections   Prolonged hospitalization   Catheterization - Urinary or IV   Broad spectrum anti...
CLINICAL MANIFESTATIONSNosocomial pneumoniaCatheter associated-UTIWound infectionsSepticemiaPeritonitisMeningitis - shunt ...
LABORATORY DIAGNOSISGram stainCultureBiochemical reactions
MORPHOLOGY Gram negative rods Pleomorphic [Coccobacilli] Gram variability Non-motile Capsulated
CULTURAL CHARACTERISTICSn Grows aerobically on routine culture median Grows at 44° Cn Colony morphology  BA: 1-2mm round, ...
BIOCHEMICAL REACTIONS  Catalase - Positive  Oxidase - Negative  Nitrate reduction – Negative  Indole negative  Do not ferm...
DIFFERENTIAL DIAGNOSIS     n   Gram stain: Neisseria species     n   Biochemical reactions: Enterobacteriaceae      Organi...
TREATMENTGeneral Principlesn Colonization vs. infection: Don’t treat colonization  with systemic antimicrobialsn Mild infe...
ANTIMICROBIALS    Carbapenems    [Ampicillin + Salbactam]    [Cefoperazone + Salbactam]n   4-fluoroquinolonesn   3rd and 4...
COMBINATION THERAPYImipenem +/- RifampicinUnasyn + aminoglycosideCarbenicillin + aminoglycosideQuinolone + amikacin
PREVENTIONIsolationContact precautionsVentilator careHouse keepingLocal antimicrobial prescribingpolicy
Pseudo+acineto
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Pseudo+acineto

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Pseudo+acineto

  1. 1. PseudomonasAcinetobacter Dr Kamran Afzal Asst Prof Microbiology
  2. 2. 30 years old femaleAccidentally got burnt in her houseTreated with wound dressingsI/V Vancomycin + Ceftriaxone
  3. 3. Gram stain from wound pus
  4. 4. Pseudomonas aeruginosa
  5. 5. Characteristics  Gram negative rod  NLF  Oxidase and Catalase +  Motile  Obligate aerobe  Non-fermentative  Non-Enterobacteriaceae  Optimum growth  37˚C, can grow at 42˚C  Minimal nutritional requirements
  6. 6.  Two forms  Planktonic and Biofilm Some strains produce diffusible pigments  Pyocyanin (blue/green)  Fluorescein (yellow)  Pyorubin (red) Grape-like odor Blue-green pus and colonies Broad antibiotic resistance
  7. 7. Colony typesThree types of colonies Small rough Large smooth colonies colonies Mucoid colonies
  8. 8. Transmission in hospital Ubiquitous to soil,  Respiratory and other water, and vegetation hospital equipment Introduced in hospitals  Contaminates soaps, on the soles of shoes, ointments, eye drops, on ornamental plants and flowers disinfectants Persist in dampness or  Resistant to weak standing water antiseptics and many Sinks, taps and mops commonly used antibiotics
  9. 9. Virulence factors
  10. 10. Pathogenicity  Endocarditis  Respiratory infections  Bacteremia and Septicemia  C N S infections  Ear infections- otitis externa  Eye infections  Bone and joint infections  Urinary tract infections  Gastrointestinal infections  Skin and soft tissue infections- wound infections, pyoderma and dermatitis
  11. 11. Bacterial Endocarditis  IV drug users  Prosthetic heart valves  Bacteremia
  12. 12. Respiratory Infections Pneumonia  Bacteremic pneumonia commonly occurs in neutropenic cancer and CCF patients Cystic fibrosis  Lower resp tract colonization of cystic fibrosis patients by mucoid strains of Pseudomonas aeruginosa Characteristics  Production of very viscid bronchial secretions  Tends to lead to stasis in the lungs  Predisposes to infection
  13. 13. Bacteremia and Septicemia Primarily in immunocompromised patients Predisposing conditions  Hematologic malignancies  Immunodeficiency relating to AIDS  Neutropenia  Diabetes mellitus  Severe burns Ecthyma gangrenosum
  14. 14. CNS Infections  Meningitis  Brain abscess  Portal of Entry  Inner ear or paranasal sinus  Inoculated directly  Surgery  Invasive diagnostic procedures  May spread from another site of infection like the urinary tract
  15. 15. Ear infections  Otitis externa  "swimmers ear"
  16. 16. Eye infections  Bacterial keratitis  Neonatal ophthalmia  Contaminated contact lenses
  17. 17. Bone and Joint Infections Particular tropism for fibro-cartilagenous joints of the axial skeleton  Direct inoculation of the bacteria  Hematogenous spread Osteo-chondritis  Puncture wounds of the foot
  18. 18. Urinary Tract Infections Usually hospital-acquired  UT catheterization, instrumentation or surgery 3rd leading cause of hospital-acquired UTIs Most adherent to the bladder uroepithelium Pseudomonas can invade the bloodstream from the urinary tract  Source of nearly 40 % of Pseudomonas bacteremias
  19. 19. Gastrointestinal infections The GI tract is also an important portal of entry in Pseudomonas septicemia Any part of the gastrointestinal tract  Perirectal infections  Pediatric diarrhea  Gastroenteritis  Necrotizing enterocolitis
  20. 20. Skin and Soft tissue infections Wound infections, pyoderma and dermatitis Localized and diffuse skin infections  ‘Jaccuzzi rash’ or ‘Whirlpool rash’ Common predisposing factors  Breakdown of the integument  Burns, trauma or dermatitis  AIDS and other IC states
  21. 21. Treatment Pseudomonas aeruginosa is frequently resistant to many commonly used antibiotics Many strains are susceptible to  3rd and 4th gen Cephalosporins, aminoglycosides, fluoroquinolones, carbapenems and colistin, but resistant forms have developed Aminoglycoside + ceftazidime is frequently used to treat severe Pseudomonas infections 4th gen Cephalosporin or Carbapenem as monotherapy
  22. 22. Acinetobacter
  23. 23.  The name, Acinetobacter, comes from the Latin word for "motionless," because they lack cilia or flagella with which to move
  24. 24. INTRODUCTION Gram-negative pleomorphic rods Colonize aquatic environment Associated with biofilms Survives on inanimate surfaces for weeks Infections and outbreaks  Intensive care unit and healthcare settings  Compromised immune systems at risk  Colonized and infected patients as point sources
  25. 25.  Mostly isolated from hospital environment Not part of normal human flora A. baumannii is often a source of nosocomial infections  Can reach a very high percentage of infections in ICU settings  Unfortunately it has the potential to often be multi-drug resistant
  26. 26.  Resistance to multiple drugs  - Over-expression of efflux pumps  - Expression of ß-lactamases (Including ESBLs and metallo-ß-lactamases which can cause carbapenem resistance) This can necessitate use of drugs with greater toxicity (such as polymyxins)
  27. 27. Genus: Acinetobacter CLASSIFICATION Name Genomic species No.A. calcoacetius 1A. baumanii 2A. haemolyticus 4A. junii 5A. johnsonii 7A. lwoffi 8A. radioresistens 12Unnamed (14)
  28. 28. EPIDEMIOLOGY Habitat Free living saprophyte in soil and water Human colonization 25% healthy adults - cutaneous 7% healthy adults and infants - pharyngeal Most common GNR - hospitalized patientsn Prevalence - Worldwide
  29. 29. TRANSMISSIONAcinetobacter can be spread from person toperson (infected or colonized patients), contactwith contaminated surfaces of exposure to theenvironment
  30. 30. PATHOGENICITY Virulence factors – Mostly unknown n LPS and Capsulen Opportunistic infections - Immunocompromisedn Growth at low pH and high and low temperaturesn Ability to survive for months on inanimate surfaces
  31. 31. Risk factors for nosocomial infections Prolonged hospitalization Catheterization - Urinary or IV Broad spectrum antimicrobials Endotracheal intubation Colonic colonization Burns
  32. 32. CLINICAL MANIFESTATIONSNosocomial pneumoniaCatheter associated-UTIWound infectionsSepticemiaPeritonitisMeningitis - shunt associatedInfective endocarditis
  33. 33. LABORATORY DIAGNOSISGram stainCultureBiochemical reactions
  34. 34. MORPHOLOGY Gram negative rods Pleomorphic [Coccobacilli] Gram variability Non-motile Capsulated
  35. 35. CULTURAL CHARACTERISTICSn Grows aerobically on routine culture median Grows at 44° Cn Colony morphology BA: 1-2mm round, smooth, opaque, mucoid, dome shaped, non-pigmented, hemolytic MA: NLF with purplish hue
  36. 36. BIOCHEMICAL REACTIONS Catalase - Positive Oxidase - Negative Nitrate reduction – Negative Indole negative Do not ferment glucose or most other sugars Saccharolytic [A. baumanii] Asaccharolytic [A. lwoffi] Urease production - Some strains Citrate utilization - Some strains
  37. 37. DIFFERENTIAL DIAGNOSIS n Gram stain: Neisseria species n Biochemical reactions: Enterobacteriaceae Organism Growth Oxidize Esculin L A Nit Litmus on MA Glucose D D C HStenotrophomonas + + ± + - ± +AcinetobacterSacchorylitic + + - - ± - -Asaccharolytic + - - - ± - -CDC Group NO-1 ± - - - - + ±
  38. 38. TREATMENTGeneral Principlesn Colonization vs. infection: Don’t treat colonization with systemic antimicrobialsn Mild infections: Removal of prosthetic devices/ foreign body, antimicrobials - not requiredn Superficial infections: Local managementn Moderately severe infections: Monotherapyn Severe/extensive deep infections: Combination therapy and debridement/drainagen Therapeutic failure to beta-lactams: 3rd or 4th generation Cephalosporins
  39. 39. ANTIMICROBIALS Carbapenems [Ampicillin + Salbactam] [Cefoperazone + Salbactam]n 4-fluoroquinolonesn 3rd and 4th generation cephalosporinsn Aminoglycosidesn Piperacillin/tazobactamn Doxycyclinen Co-trimoxazolen Polymyxin B/ Colistin
  40. 40. COMBINATION THERAPYImipenem +/- RifampicinUnasyn + aminoglycosideCarbenicillin + aminoglycosideQuinolone + amikacin
  41. 41. PREVENTIONIsolationContact precautionsVentilator careHouse keepingLocal antimicrobial prescribingpolicy

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