Resistance arises when the PBPs-and particularly the transpeptidases-are modified, or when they are protected by beta-lactamases or 'permeability barriers'.

Relevant β-lactams and aminoglycosides remain active against 70%–98% of P. aeruginosa isolates in the United States and the United Kingdom

Inhibition of protein synthesis. Once inside the bacterial cell, aminoglycosides bind to the 30s ribosomal sub-unit and cause a misreading of the genetic code.  This subsequently leads to the interruption of normal bacterial protein synthesis.

wo major adhesins have been identified in P. aeruginosa, flagella and type IV pili (Tfp) [10]–[12]. The single polar flagellum is a polymer composed of flagellin,

Local Cases/Outbreaks:             In 2006, University Hospital located in San Antonio, Texas saw an increase in P. aeruginosa infections in its neonatal intensive care unit, leading for a study to be conducted with data ranging from 2005 to 2007. [11] This unit generally has a low incidence of this pathogen and has seen fewer cases since revision of control measures. [11] The patients with this infection tended to be male and had received mechanical ventilation at one point. [11] During the study, 23 patients were confirmed with P. aeruginosa. Only 13% of patients were antibiotic resistance and 30% of the patients died. [11] In US hospitals, there are about 4 per 1000 discharges (0.4%) of P. aeruginosa infections. [3] Approximately 10.1% of nosocomial infections result due to this bacterium. [3] Also, this pathogen is responsible for about 16% of hospital acquired pneumonia, 12% of urinary tract nosocomial infections, 8% of surgical wound infections, and 10% of bacteremia infections. [2]   Global Cases/Outbreaks:             An outbreak in a Warsaw, Poland hospital saw 41 P. aeruginosa cases with PER-1 extended spectrum beta-lastamase. This clonal complex is normally seen in Turkey but has now been identified in the far eastern countries and Europe. In Greece, there was a hospital outbreak of multiple strains of this pathogen, which carried two metallo beta-lactamase gene variants. [13] Pseudomonas pneumonia is a common infection found in most hospitals throughout the world.

Tissue damage caused by proteases and toxins invade blood vessels causing a systemic inflammatory response, dissemination to other organs that may lead to multiple organ failure and possibly death. [2] The two hemolysins produced by this bacterium may act together in breaking down lipids and lecins along with tissue damage caused by the cytotoxins. The next stage after the acute infection is the chronic phase but  this stage can also happen directly after colonization. The chronic infection has selected alginate yielding mutants, protects from host immunity, has a low production of extracellular virulence factors, and the tissue damage is chiefly caused by the chronic inflammation process.  

RESULTS: Twelve patients with a culture positive for P. aeruginosa with the unique susceptibility pattern were identified in June-July 2007. No cases were documented from March 1 through May 31, 2007. Culture specimens obtained from B1 after high-level disinfection revealed P. aeruginosa, prompting removal of B1 from service on July 23, 2007. No cases occurred after that date. Eleven (55%) of 20 patients who were exposed to B1 during the cluster period had a culture positive for P. aeruginosa, compared with 1 (2%) of 53 patients who were exposed to other bronchoscopes (P < .001). PFGE patterns for P. aeruginosa isolates obtained from case patients and from B1 were identical. An engineering evaluation of B1 documented several internal damages. Two (10.5%) of 19 patients exposed to B1 during the cluster period may have developed P. aeruginosa infection following exposure to B1.

Many P. aeruginosa isolates are resistant to a large range of antibiotics and may demonstrate additional resistance after unsuccessful treatment

Identification[edit] Test Results Gram Stain - Oxidase + Indole Production - Methyl Red - Voges-Proskaeur - Citrate + Hydrogen Sulfide Production - Urea Hydrolysis + Phenylalanine Deaminase - Lysine Decarboxylase - Motility + Gelatin Hydrolysis + Acid from lactose - acid from glucose - acid from maltose - acid from mannitol + acid from sucrose - nitrate reduction + DNAse - Lipase + Pigment + (bluish green pigmentation) Catalase +

the blue-green color of laboratory cultures

citrate, catalase, and oxidase positive.