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. This organism is frequently feared because it causes severe hospital-acquired infections, especially in immunocompromised hosts, and is often antibiotic resistant, complicating the choice of therapy.
The treatment of infections caused by P. aeruginosa in noncystic fibrosis patients will be reviewed here. The epidemiology, pathogenesis, clinical manifestations and diagnosis of the various pseudomonal infections are discussed separately. (See related topics).
PRINCIPLES OF TREATMENT
The following principles apply to the treatment of serious P. aeruginosa infections:
- Delayed therapy correlates with increased mortality.
- All infected catheters should be removed, and, whenever possible, abscesses or obstructions should be drained or removed.
- Combination therapy is indicated in certain high risk patients and in severe infections.
Combination versus monotherapy — One of the most controversial management questions involves the use of combination or monotherapy for serious infections due to P. aeruginosa.