Pseudomonas aeruginosa

One-Sentence Definition

Pseudomonas aeruginosa is an oxidase-positive Gram-negative non-fermenter that thrives in moist environments and causes opportunistic infections with frequent MDR phenotypes and biofilm-associated disease.

Taxonomy & Morphology

  • Gram-negative rod; non-lactose fermenter
  • Grape-like odor; blue-green pigments (pyocyanin/pyoverdine) classic
  • Gram Stain: pink rods

Virulence Highlights

  • Biofilm (CF airways, devices)
  • Exotoxins (ExoS/ExoT/ExoU via T3SS), elastases, pigments
  • Intrinsic impermeability + efflux

Clinical Syndromes

  • VAP, burn wound infection, otitis externa (malignant in diabetics)
  • Bacteremia in neutropenic/hospitalized patients
  • Chronic CF lung infection

Diagnosis

  • Culture on standard media; oxidase-positive ID
  • AST mandatory for therapy
  • Molecular panels may include Pseudomonas targets

Treatment Notes (conceptual)

  • Antipseudomonal β-lactams / fluoroquinolones / aminoglycosides per AST and syndrome
  • Combination therapy sometimes used in severe disease — practice varies
  • Biofilm/device infections need source control

AMR

  • Intrinsic resistance high baseline
  • Acquired: carbapenemases, upregulated efflux, porin (OprD) loss
  • Difficult-to-treat resistance (DTR) category in modern stewardship language

Active Recall

  1. Why is Pseudomonas often multidrug-resistant even before treatment?
  2. Name two classic clinical niches.
  3. How do biofilms change expected antibiotic response?