Chapter 22
Pseudomonas, Burkholderia,
and Similar Organisms
PREPARED BY SUZETTE B. DOCTOLERO
Objectives
Describe the normal sources (habitat) for Pseudomonas aeruginosa,
Burkholderia cepacia, B. pseudomallei, and B. mallei, including the routes
of transmission.
Identify the factors that contribute to the pathogenicity of P. aeruginosa,
and explain the physiologic mechanism for each.
List the various disease states associated with P. aeruginosa and
Burkholderia sp.
Compare and contrast the Gram-stain appearance of the gram-
negative bacilli discussed in this chapter.
List the appropriate identification scheme for identifying P. aeruginosa.
Describe the media and chemical principle of each media used,
including differential and selective agars that aid in the cultivation of
Pseudomonas, Brevundimonas, and Ralstonia.
Describe the potential therapies for B. cepacia and B. pseudomallei and
the concerns regarding optimal therapy.
Describe and identify the patterns of antibiotic resistance in P.
aeruginosa.
2
PREPARED BY SUZETTE B. DOCTOLERO
Pseudomonads
gram-_________ bacilli
strictly aerobic,
catalase-________
oxidase-______
Some are motile
3
PREPARED BY SUZETTE B. DOCTOLERO
Pseudomonas spp.
grow on MacConkey agar
oxidize glucose.
found in moist environments
4
PREPARED BY SUZETTE B. DOCTOLERO
Pseudomonas aeruginosa
UBIQUITOUS: env’t, domestic
env’t, hospital:
uncommon normal flora
MOT: ingestion or exposure to
contaminated food, water, or
medical devices.
opportunistic pathogen that can
cause CA or HA
5
PREPARED BY SUZETTE B. DOCTOLERO
Pseudomonas aeruginosa
Virulence factors include:
Exotoxin
A:_____________________________________
Endotoxins
Proteolytic enzymes:
_______________________________________
Pili
:_______________________________________
6
PREPARED BY SUZETTE B. DOCTOLERO
Pseudomonas aeruginosa
Virulence factors include:
Alginate:
__________________________________
__________________________________
Pyocyanin:
____________________________
Catalase:_________________________
Intrinsic resistance to many
antimicrobial agents
7
PREPARED BY SUZETTE B. DOCTOLERO
P. aeruginosa Infections
Community-Acquired
Folliculitis
Otitisexternal
Eye infections
Osteomyelitis
Endocarditis in intravenous (IV) drug users
Respiratory tract infections in patients with
cystic fibrosis
8
PREPARED BY SUZETTE B. DOCTOLERO
P. aeruginosa Infections
Hospital-Acquired
Respiratory
tract
Urinary tract
Wounds
Bacteremia
CNS
9
PREPARED BY SUZETTE B. DOCTOLERO
Pseudomonas aeruginosa Identification
Spreading, flat
colony with metallic
sheen
Beta-hemolytic
musty grape-like (or
corn tortilla) odor
May also be mucoid
10
PREPARED BY SUZETTE B. DOCTOLERO
Pseudomonas aeruginosa Identification
Denitrification of nitrates and
nitrites,
Arginine dihydrolase positive
Oxidizes glucose and xylose
__________: selective and
differential for P. aeruginosa
11
PREPARED BY SUZETTE B. DOCTOLERO
P. aeruginosa on MH
12
PREPARED BY SUZETTE B. DOCTOLERO
P. aeruginosa
NLF in MAC
Oxidase ________
Citrate __________
TSI:K/NC
Grows well at 42°C
13
PREPARED BY SUZETTE B. DOCTOLERO
Pseudomonas fluorescens and
Pseudomonas putida
low virulence, rarely causing clinical
disease.
Both species can grow at 4 °C but not
at 42 °C
Both produce pyoverdin, but not
pyocyanin
Differentiated by gelatin hydrolysis
14
PREPARED BY SUZETTE B. DOCTOLERO
Pseudomonas stutzeri
rareisolate
Colonies are wrinkled, leathery colonies
15
PREPARED BY SUZETTE B. DOCTOLERO
Burkholderia
These organisms are found in the
environment in water, in soil, and
on plants.
Not Normal flora
Two important human pathogens
Burkholderia __________
Burkholderia ___________
16
PREPARED BY SUZETTE B. DOCTOLERO
Burkholderia cepacia
May colonize respiratory tract
of patients with cystic fibrosis.
Assoc. with contaminated
equipment, medications, and
disinfectants,
MOT: _____________________
17
PREPARED BY SUZETTE B. DOCTOLERO
Burkholderia cepacia
Includes fulminant lung
infections and bacteremia.
Cystic fibrosis
Chronic granulomatous
disease
18
PREPARED BY SUZETTE B. DOCTOLERO
Burkholderia cepacia
May result from exposure to
contaminated medical
solutions or devices.
Septicemia
Urinarytract infections
Respiratory tract infections
19
PREPARED BY SUZETTE B. DOCTOLERO
B. pseudomallei
found in tropical and
subtropical areas.
MOT: inhalation or direct
inoculation through
mucosa.
20
PREPARED BY SUZETTE B. DOCTOLERO
B. pseudomallei
can survive within
phagocytes
Causes m______________
21
PREPARED BY SUZETTE B. DOCTOLERO
B. mallei
Is an agent of glanders in
horses.
Is associated with close
animal contact.
23
PREPARED BY SUZETTE B. DOCTOLERO
Gram-Stain Appearance
Medium-size
straight rods
Burkholderia mallei
Coccobacillus
Pseudomonas
pseudomallei
Small with bi-polar
staining
24
PREPARED BY SUZETTE B. DOCTOLERO
Burkholderia
gram-___________ BACILLI
aerobic,
non–spore-forming,
Allare motile except for
_________________
catalase positive
most are oxidase positive.
NLF on On MacConkey’s agar
25
PREPARED BY SUZETTE B. DOCTOLERO
Cultivation
5% sheep blood and
chocolate agars
MacConkey agar
Pseudomonas cepacia (PC)
agar
26
PREPARED BY SUZETTE B. DOCTOLERO
Cultivation
Oxidative-fermentative base-polymyxin
B-bacitracin-lactose (OFPBL) agar
B.
_________ ferments lactose and appears
___________
Ashdown medium
For the isolation of
_____________ w/c turns red
on this medium.
27
PREPARED BY SUZETTE B. DOCTOLERO
Therapy: DON’t copy
Antimicrobialtherapy for B. cepacia and
B. pseudomallei rarely eradicates B.
cepacia, and therapy for melioidosis
remains controversial.
Burkholderia cepacia
• Chloramphenicol
Piperacillin
• Trimethoprim-sulfamethoxazole
Ceftazidime
Ciprofloxacin
B. pseudomallei
• Amoxicillin-clavulanate
Ceftazidime
Piperacillin-tazobactam• Imipenem
Ticarcillin-clavulanate • Trimethoprim-
sulfamethoxazole
28
PREPARED BY SUZETTE B. DOCTOLERO
Pseudomonas aeruginosa
Therapy: DON’t copy
P.aeruginosa is intrinsically resistant to
various antimicrobial agents.
P. aeruginosa readily acquires resistance
to active agents.
Therapeutic options include:
• Imipenem
Antipseudomonal beta-lactam
• Meropenem
with or without an aminoglycoside
• Gentamicin
Quinolones
• Tobramycin
Piperacillin-tazobactam
• Amikacin-netilmicin
Ceftazidime
• Ciprofloxacin
Cefepime
• Levofloxacin
Aztreonam
29
PREPARED BY SUZETTE B. DOCTOLERO
References:
Henry, J. B. (2010). Henry’s Clinical Diagnosis
and Management by Laboratory Methods
21st ed. Philadelphia: W.B Saunders
Mahon, C., Lehman, D., & Manuselis,G.
(2015). Textbook of Diagnostic Microbiology.
Elsevier
Tille, P. (2014). Bailey and Scott’s Diagnostic
Microbiology. 13th ed. Elsevier Mosby.
31
PREPARED BY SUZETTE B. DOCTOLERO
