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Pseudomonas aeruginosa bacteremia and endocarditis

Souha S Kanj, MD
Daniel J Sexton, MD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Allyson Bloom, MD


Pseudomonas aeruginosa is one of the most commonly considered gram-negative aerobic bacilli in the differential diagnosis of a number of probable gram-negative infections. Consideration of this organism is important because it causes severe hospital-acquired infections, especially in immunocompromised hosts, is often antibiotic resistant, complicating the choice of therapy, and is associated with a high mortality rate.

The epidemiology, clinical manifestations, diagnosis, and treatment of P. aeruginosa bacteremia and endocarditis will be reviewed here.

The general principles of antimicrobial treatment of infections caused by P. aeruginosa, including antibiotic options and decisions on combination therapy, are discussed in detail elsewhere. (See "Principles of antimicrobial therapy of Pseudomonas aeruginosa infections".)

The clinical manifestations and management of other P. aeruginosa infections and the epidemiology and pathogenesis of infection with this organism are also discussed separately.

(See "Epidemiology, microbiology, and pathogenesis of Pseudomonas aeruginosa infection".)

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Literature review current through: Oct 2017. | This topic last updated: Apr 05, 2017.
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  1. Al-Hasan MN, Wilson JW, Lahr BD, et al. Incidence of Pseudomonas aeruginosa bacteremia: a population-based study. Am J Med 2008; 121:702.
  2. National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986-April 1996, issued May 1996. A report from the National Nosocomial Infections Surveillance (NNIS) System. Am J Infect Control 1996; 24:380.
  3. Vidal F, Mensa J, Almela M, et al. Epidemiology and outcome of Pseudomonas aeruginosa bacteremia, with special emphasis on the influence of antibiotic treatment. Analysis of 189 episodes. Arch Intern Med 1996; 156:2121.
  4. Sifuentes-Osornio J, Gonzalez R, Ponce-de-Leon A, Guerrero ML. Epidemiology and prognosis of Pseudomonas aeruginosa bacteremia in a tertiary care center. Rev Invest Clin 1998; 50:383.
  5. Wisplinghoff H, Bischoff T, Tallent SM, et al. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004; 39:309.
  6. Chatzinikolaou I, Abi-Said D, Bodey GP, et al. Recent experience with Pseudomonas aeruginosa bacteremia in patients with cancer: Retrospective analysis of 245 episodes. Arch Intern Med 2000; 160:501.
  7. Schechner V, Nobre V, Kaye KS, et al. Gram-negative bacteremia upon hospital admission: when should Pseudomonas aeruginosa be suspected? Clin Infect Dis 2009; 48:580.
  8. Mendelson MH, Gurtman A, Szabo S, et al. Pseudomonas aeruginosa bacteremia in patients with AIDS. Clin Infect Dis 1994; 18:886.
  9. Shepp DH, Tang IT, Ramundo MB, Kaplan MK. Serious Pseudomonas aeruginosa infection in AIDS. J Acquir Immune Defic Syndr 1994; 7:823.
  10. Leigh L, Stoll BJ, Rahman M, McGowan J Jr. Pseudomonas aeruginosa infection in very low birth weight infants: a case-control study. Pediatr Infect Dis J 1995; 14:367.
  11. Dropulic LK, Leslie JM, Eldred LJ, et al. Clinical manifestations and risk factors of Pseudomonas aeruginosa infection in patients with AIDS. J Infect Dis 1995; 171:930.
  12. Sorvillo F, Beall G, Turner PA, et al. Incidence and determinants of Pseudomonas aeruginosa infection among persons with HIV: association with hospital exposure. Am J Infect Control 2001; 29:79.
  13. Vuotto F, Berthon C, Lemaitre N, et al. Risk factors, clinical features, and outcome of Pseudomonas aeruginosa bacteremia in patients with hematologic malignancies: a case-control study. Am J Infect Control 2013; 41:527.
  14. Chen SC, Lawrence RH, Byth K, Sorrell TC. Pseudomonas aeruginosa bacteraemia. Is pancreatobiliary disease a risk factor? Med J Aust 1993; 159:592.
  15. Centers for Disease Control and Prevention (CDC). Pseudomonas aeruginosa infections associated with transrectal ultrasound-guided prostate biopsies--Georgia, 2005. MMWR Morb Mortal Wkly Rep 2006; 55:776.
  16. Classen DC, Jacobson JA, Burke JP, et al. Serious Pseudomonas infections associated with endoscopic retrograde cholangiopancreatography. Am J Med 1988; 84:590.
  17. Healey LA, Backes MB. Nitritoid reactions and angiotensin-converting-enzyme inhibitors. N Engl J Med 1989; 321:763.
  18. Roberts R, Tarpay MM, Marks MI, Nitschke R. Erysipelaslike lesions and hyperesthesia as manifestations of Pseudomonas aeruginosa sepsis. JAMA 1982; 248:2156.
  19. FORKNER CE Jr, FREI E 3rd, EDGCOMB JH, UTZ JP. Pseudomonas septicemia; observations on twenty-three cases. Am J Med 1958; 25:877.
  20. Kuikka A, Valtonen VV. Factors associated with improved outcome of Pseudomonas aeruginosa bacteremia in a Finnish university hospital. Eur J Clin Microbiol Infect Dis 1998; 17:701.
  21. Osmon S, Ward S, Fraser VJ, Kollef MH. Hospital mortality for patients with bacteremia due to Staphylococcus aureus or Pseudomonas aeruginosa. Chest 2004; 125:607.
  22. Kang CI, Kim SH, Kim HB, et al. Pseudomonas aeruginosa bacteremia: risk factors for mortality and influence of delayed receipt of effective antimicrobial therapy on clinical outcome. Clin Infect Dis 2003; 37:745.
  23. Bisbe J, Gatell JM, Puig J, et al. Pseudomonas aeruginosa bacteremia: univariate and multivariate analyses of factors influencing the prognosis in 133 episodes. Rev Infect Dis 1988; 10:629.
  24. Baltch AL, Hammer M, Smith RP, Sutphen N. Pseudomonas aeruginosa bacteremia: susceptibility of 100 blood culture isolates to seven antimicrobial agents and its clinical significance. J Lab Clin Med 1979; 94:201.
  25. Hilf M, Yu VL, Sharp J, et al. Antibiotic therapy for Pseudomonas aeruginosa bacteremia: outcome correlations in a prospective study of 200 patients. Am J Med 1989; 87:540.
  26. Marra AR, Pereira CA, Gales AC, et al. Bloodstream infections with metallo-beta-lactamase-producing Pseudomonas aeruginosa: epidemiology, microbiology, and clinical outcomes. Antimicrob Agents Chemother 2006; 50:388.
  27. Endimiani A, Luzzaro F, Pini B, et al. Pseudomonas aeruginosa bloodstream infections: risk factors and treatment outcome related to expression of the PER-1 extended-spectrum beta-lactamase. BMC Infect Dis 2006; 6:52.
  28. Peña C, Suarez C, Gozalo M, et al. Prospective multicenter study of the impact of carbapenem resistance on mortality in Pseudomonas aeruginosa bloodstream infections. Antimicrob Agents Chemother 2012; 56:1265.
  29. Aliaga L, Mediavilla JD, Llosá J, et al. Clinical significance of polymicrobial versus monomicrobial bacteremia involving Pseudomonas aeruginosa. Eur J Clin Microbiol Infect Dis 2000; 19:871.
  30. Scheetz MH, Hoffman M, Bolon MK, et al. Morbidity associated with Pseudomonas aeruginosa bloodstream infections. Diagn Microbiol Infect Dis 2009; 64:311.
  31. Jeddi R, Ghédira H, Ben Amor R, et al. Risk factors of septic shock in patients with hematologic malignancies and Pseudomonas infections. Hematology 2011; 16:160.
  32. Bodey GP, Jadeja L, Elting L. Pseudomonas bacteremia. Retrospective analysis of 410 episodes. Arch Intern Med 1985; 145:1621.
  33. Ibrahim EH, Sherman G, Ward S, et al. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 2000; 118:146.
  34. Todeschini G, Franchini M, Tecchio C, et al. Improved prognosis of Pseudomonas aeruginosa bacteremia in 127 consecutive neutropenic patients with hematologic malignancies. Int J Infect Dis 1998-1999; 3:99.
  35. Reyes MP, Palutke WA, Wylin RF. Pseudomonas endocarditis in the Detroit Medical Center. 1969-1972. Medicine (Baltimore) 1973; 52:173.
  36. Wieland M, Lederman MM, Kline-King C, et al. Left-sided endocarditis due to Pseudomonas aeruginosa. A report of 10 cases and review of the literature. Medicine (Baltimore) 1986; 65:180.
  37. Reyes MP, Ali A, Mendes RE, Biedenbach DJ. Resurgence of Pseudomonas endocarditis in Detroit, 2006-2008. Medicine (Baltimore) 2009; 88:294.
  38. Gouëllo JP, Asfar P, Brenet O, et al. Nosocomial endocarditis in the intensive care unit: an analysis of 22 cases. Crit Care Med 2000; 28:377.
  39. Komshian SV, Tablan OC, Palutke W, Reyes MP. Characteristics of left-sided endocarditis due to Pseudomonas aeruginosa in the Detroit Medical Center. Rev Infect Dis 1990; 12:693.
  40. Reyes MP, Lerner AM. Current problems in the treatment of infective endocarditis due to Pseudomonas aeruginosa. Rev Infect Dis 1983; 5:314.
  41. Dawson NL, Brumble LM, Pritt BS, et al. Left-sided Pseudomonas aeruginosa endocarditis in patients without injection drug use. Medicine (Baltimore) 2011; 90:250.
  42. Arbulu A, Holmes RJ, Asfaw I. Tricuspid valvulectomy without replacement. Twenty years' experience. J Thorac Cardiovasc Surg 1991; 102:917.
  43. Robin E, Belamaric J, Thoms NW, et al. Consequences of total tricuspid valvulectomy without prosthetic replacement in treatment of Pseudomonas endocarditis. J Thorac Cardiovasc Surg 1976; 68:461.