Pseudomonas infection

A Pseudomonas infection is a disease caused by one of the species of the bacterial genus Pseudomonas, most commonly Pseudomonas aeruginosa, an opportunistic pathogen that primarily affects immunocompromised patients假单胞菌感染是由假单胞菌属细菌之一引起的疾病，最常见的是铜绿假单胞菌，一种主要影响免疫功能低下患者的机会性病原体。

Pseudomonas aeruginosa is a multidrug-resistant Gram-negative bacillus recognized for its ubiquity in the environment and its association with serious hospital-acquired infections such as ventilator-associated pneumonia and sepsis syndromes铜绿假单胞菌是一种多重耐药的革兰阴性杆菌，因其在环境中的普遍性以及与严重医院获得性感染（如呼吸机相关肺炎和败血症综合征）的关联而闻名。

Infection can affect many parts of the body, but typically targets the respiratory tract, the renal system, the gastrointestinal system and can cause bloodstream infections感染可影响身体多个部位，但通常针对呼吸道、泌尿系统、胃肠道系统，并可引起血流感染。

Terminology and classification

• Pseudomonas infections are classified by the site of infection, with Pseudomonas pneumonia, urinary tract infection, wound infection, bloodstream infection and ecthyma gangrenosum being the most clinically significant假单胞菌感染按感染部位分类，铜绿假单胞菌肺炎、泌尿道感染、伤口感染、血流感染和坏疽性脓疱病最具临床意义。^[1]
• In the ICD-10, Pseudomonas as the cause of diseases classified elsewhere is coded B96.5, while specific infections such as Pseudomonas pneumonia are coded under J15.1在 ICD-10 中，作为其他疾病病因的假单胞菌编码为 B96.5，而特定感染如铜绿假单胞菌肺炎编码在 J15.1 下。
• MONDO catalogues Pseudomonas infection as MONDO:0005141, with cross-references to EFO:0001076, ICD9:041.7, MedGen 10993, MeSH D011552, SNOMED CT 63398001 and UMLS C0033817MONDO 将假单胞菌感染编目为 MONDO:0005141，交叉引用包括 EFO:0001076、ICD9:041.7、MedGen 10993、MeSH D011552、SNOMED CT 63398001 和 UMLS C0033817。
• Wikidata maps the condition to Q7255052, with claims linking to MONDO:0005141, ICD-10 B96.5, MeSH D011552 and MedlinePlus Q788926Wikidata 将该病映射到 Q7255052，包含链接到 MONDO:0005141、ICD-10 B96.5、MeSH D011552 和 MedlinePlus Q788926 的声明。
• Ecthyma gangrenosum, a characteristic skin lesion of Pseudomonas sepsis, is coded 1B73.2 in the ICD-11 Mortality and Morbidity Statistics and mapped to UMLS C0276085坏疽性脓疱病作为铜绿假单胞菌败血症的特征性皮肤病变，在 ICD-11 死亡与发病统计中编码为 1B73.2，映射到 UMLS C0276085。
• Pseudomonas aeruginosa is classified under the Pseudomonadaceae family in the order Pseudomonadales, and is a type strain with multiple named strains including PA14 and PAO1 used in research铜绿假单胞菌在假单胞菌目假单胞菌科下分类，是一种具有多个命名菌株的模式菌，包括研究中使用的 PA14 和 PAO1。^[1]

History

• Pseudomonas aeruginosa was first isolated and described by the German botanist Friedrich Gustav Jacob Migula in 1900, who also established the genus Pseudomonas铜绿假单胞菌由德国植物学家 Friedrich Gustav Jacob Migula 于1900年首次分离并描述，他还建立了假单胞菌属。^[1]
• The species was originally named Bacillus pyocyaneus by Schroeter in 1872, reflecting the blue-green pigment (pyocyanin) it produces该物种最初由 Schroeter 于1872年命名为 Bacillus pyocyaneus，反映了其产生的蓝绿色色素（绿脓菌素）。^[1]
• Ecthyma gangrenosum, the characteristic skin lesion of Pseudomonas sepsis, was first described in association with Pseudomonas aeruginosa by L. Barker in 1897坏疽性脓疱病作为铜绿假单胞菌败血症的特征性皮肤病变，由 L. Barker 于1897年首次描述与铜绿假单胞菌的关联。
• The emergence of multidrug-resistant Pseudomonas aeruginosa as a major hospital pathogen was recognized in the 1980s and 1990s, driving the development of anti-pseudomonal antibiotic classes多重耐药铜绿假单胞菌作为主要医院病原体的出现在1980年代和1990年代被认识，推动了抗假单胞菌抗生素类别的发展。^[1]
• Hot tub folliculitis caused by Pseudomonas aeruginosa was first described in the 1970s, linked to contaminated recreational water sources由铜绿假单胞菌引起的热水浴缸毛囊炎在1970年代首次被描述，与受污染的休闲水源有关。
• The development of metallo-beta-lactamases and carbapenem resistance in Pseudomonas aeruginosa in the 2000s has created a significant public health challenge, limiting treatment options for severe infections2000年代铜绿假单胞菌中金属β-内酰胺酶和碳青霉烯耐药的发展造成了重大公共卫生挑战，限制了严重感染的治疗选择。^[1]

Epidemiology

• Pseudomonas aeruginosa is the most common species causing Pseudomonas infections in humans, and is a leading cause of hospital-acquired infections, particularly ventilator-associated pneumonia and catheter-related bloodstream infections铜绿假单胞菌是人类假单胞菌感染中最常见的物种，是医院获得性感染的主要病因，特别是呼吸机相关肺炎和导管相关血流感染。^[1]
• The organism is ubiquitous in the environment, found in soil, water, plants and animals, and can survive in moist environments including sinks, taps and respiratory equipment该微生物在环境中无处不在，存在于土壤、水、植物和动物中，可在潮湿环境中存活，包括水槽、水龙头和呼吸设备。^[1]
• The most commonly affected patient populations include those with cystic fibrosis, burn patients, immunocompromised individuals including cancer and AIDS patients, and those on mechanical ventilation最常受影响的患者群体包括囊性纤维化患者、烧伤患者、免疫功能低下个体（包括癌症和艾滋病患者）以及使用机械通气的患者。^[1]
• In cystic fibrosis patients, Pseudomonas aeruginosa is the most common chronic respiratory pathogen, acquired in approximately 60 to 80 per cent of adults with the disease在囊性纤维化患者中，铜绿假单胞菌是最常见的慢性呼吸道病原体，约60%至80%的成人患者会感染。^[1]
• Mortality from Pseudomonas bloodstream infections is significant, ranging from 20 to 40 per cent depending on the patient population and treatment铜绿假单胞菌血流感染的死亡率显著，根据患者群体和治疗情况从20%到40%不等。^[1]
• Risk factors include prolonged hospitalization, invasive devices such as endotracheal tubes and central venous catheters, broad-spectrum antibiotic use, and underlying immunocompromise危险因素包括长期住院、气管插管和中心静脉导管等侵入性装置、广谱抗生素使用以及基础免疫缺陷。^[1]

Pathophysiology

• Pseudomonas aeruginosa is a Gram-negative, aerobic, rod-shaped bacterium that produces multiple virulence factors including exotoxins, proteases, elastases and the pigment pyocyanin铜绿假单胞菌是一种革兰阴性、需氧、杆状细菌，产生多种毒力因子，包括外毒素、蛋白酶、弹性蛋白酶和色素绿脓菌素。^[1]
• The bacterium forms biofilms that adhere to surfaces including medical devices and airway epithelium, providing protection from antibiotics and the host immune system该细菌形成生物膜，附着在表面（包括医疗设备和气道上皮），提供对抗生素和宿主免疫系统的保护。^[1]
• Pyocyanin, the characteristic blue-green pigment, generates reactive oxygen species that damage host tissues and inhibit immune cell function绿脓菌素这一特征性蓝绿色色素产生活性氧，损害宿主组织并抑制免疫细胞功能。^[1]
• The type III secretion system of Pseudomonas aeruginosa injects effector proteins directly into host cells, disrupting cellular signalling and promoting bacterial invasion铜绿假单胞菌的III型分泌系统将效应蛋白直接注入宿主细胞，破坏细胞信号传导并促进细菌入侵。^[1]
• The organism is intrinsically resistant to many antibiotics due to low outer membrane permeability and the expression of efflux pumps, and acquired resistance further complicates treatment由于外膜通透性低和外排泵的表达，该微生物对许多抗生素具有固有耐药性，获得性耐药进一步使治疗复杂化。^[1]
• Ecthyma gangrenosum develops through bacterial invasion of blood vessels in the skin, causing thrombosis and necrosis of the surrounding tissue坏疽性脓疱病通过细菌侵入皮肤血管发展，引起血栓形成和周围组织坏死。

Clinical features

• The clinical presentation depends on the site of infection, with pneumonia, urinary tract infection, wound infection, bloodstream infection and skin lesions being the most common临床表现取决于感染部位，肺炎、泌尿道感染、伤口感染、血流感染和皮肤病变最为常见。^[1]
• Pseudomonas pneumonia typically presents with fever, cough with greenish sputum, dyspnoea and chest pain, and is particularly dangerous in ventilated patients where it can cause necrotizing pneumonia铜绿假单胞菌肺炎通常表现为发热、绿色痰咳嗽、呼吸困难和胸痛，在通气患者中尤其危险，可引起坏死性肺炎。^[1]
• Ecthyma gangrenosum is the characteristic skin lesion of Pseudomonas sepsis, presenting as vesicles that rapidly evolve into pustules and necrotic ulcers with an erythematous border坏疽性脓疱病是铜绿假单胞菌败血症的特征性皮肤病变，表现为迅速演变为脓疱和坏死性溃疡的水疱，伴红斑边缘。
• Urinary tract infections caused by Pseudomonas are most common in patients with indwelling catheters and can cause fever, dysuria and flank pain铜绿假单胞菌引起的泌尿道感染在留置导管患者中最常见，可引起发热、排尿困难和侧腹痛。^[1]
• Complications include sepsis, septic shock, multi-organ failure, acute respiratory distress syndrome and death, particularly in immunocompromised patients并发症包括败血症、感染性休克、多器官衰竭、急性呼吸窘迫综合征和死亡，在免疫功能低下患者中尤为如此。^[1]
• Hot tub folliculitis presents as a pruritic rash approximately 24 to 72 hours after exposure to contaminated water, typically affecting the trunk and extremities热水浴缸毛囊炎表现为暴露于受污染水后约24至72小时的瘙痒性皮疹，通常影响躯干和四肢。

Diagnosis

• Diagnosis is made by culture and identification of Pseudomonas species from clinical specimens including blood, sputum, urine, wound swabs and other body fluids诊断通过对血液、痰液、尿液、伤口拭子和其他体液等临床标本的假单胞菌属培养和鉴定作出。^[1]
• In cystic fibrosis patients, respiratory cultures are routinely obtained to guide antibiotic therapy, and molecular methods such as PCR may be used for rapid identification在囊性纤维化患者中，常规获取呼吸道培养物以指导抗生素治疗，分子方法如 PCR 可用于快速鉴定。^[1]
• Antimicrobial susceptibility testing is essential for guiding treatment, given the high rates of resistance and the need for appropriate antibiotic selection鉴于高耐药率和适当抗生素选择的需要，抗菌药物敏感性测试对于指导治疗至关重要。^[1]
• The differential diagnosis for Pseudomonas pneumonia includes other causes of hospital-acquired pneumonia such as Klebsiella pneumoniae, Staphylococcus aureus and Acinetobacter baumannii铜绿假单胞菌肺炎的鉴别诊断包括其他医院获得性肺炎的原因，如肺炎克雷伯菌、金黄色葡萄球菌和鲍曼不动杆菌。^[1]
• The differential diagnosis for ecthyma gangrenosum includes other necrotic skin lesions such as pyoderma gangrenosum, anthrax and other gram-negative sepsis坏疽性脓疱病的鉴别诊断包括其他坏死性皮肤病变，如化脓性肉芽肿、炭疽和其他革兰阴性败血症。
• Rapid diagnostic techniques including matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF MS) can identify Pseudomonas species within minutes from cultured colonies包括基质辅助激光解吸电离飞行时间质谱（MALDI-TOF MS）在内的快速诊断技术可从培养菌落中在数分钟内鉴定假单胞菌属。^[1]

Management

• Treatment of Pseudomonas infections requires anti-pseudomonal antibiotics, including beta-lactams such as piperacillin-tazobactam, ceftazidime, cefepime and carbapenems such as meropenem and imipenem假单胞菌感染的治疗需要抗假单胞菌抗生素，包括β-内酰胺类如哌拉西林-他唑巴坦、头孢他啶、头孢吡肟和碳青霉烯类如美罗培南和亚胺培南。^[1]
• Aminoglycosides such as tobramycin and amikacin, and fluoroquinolones such as ciprofloxacin, are used in combination therapy or as alternatives depending on susceptibility results氨基糖苷类如妥布霉素和阿米卡星，以及氟喹诺酮类如环丙沙星，根据敏感性结果用于联合治疗或作为替代方案。^[1]
• In cystic fibrosis patients with chronic Pseudomonas infection, long-term nebulized tobramycin or aztreonam lysine is used for maintenance therapy to reduce bacterial load在患有慢性铜绿假单胞菌感染的囊性纤维化患者中，长期雾化妥布霉素或氨曲南赖氨酸用于维持治疗以减少细菌负荷。^[1]
• Source control measures such as removal of infected catheters, drainage of abscesses and debridement of necrotic tissue are essential components of management源头控制措施如移除感染导管、引流脓肿和清创坏死组织是管理的重要组成部分。^[1]
• Combination antibiotic therapy is often used for severe infections, particularly in immunocompromised patients or those with sepsis, to improve efficacy and reduce the risk of resistance development严重感染常使用联合抗生素治疗，特别是在免疫功能低下患者或败血症患者中，以提高疗效并降低耐药性发展的风险。^[1]
• Prevention measures include hand hygiene, sterilization of medical equipment, appropriate use of antibiotics and infection control protocols in hospital settings预防措施包括手卫生、医疗设备消毒、抗生素的合理使用和医院环境中的感染控制方案。^[1]
• The prognosis depends on the site and severity of infection, the patient's immune status and the promptness of appropriate antimicrobial therapy, with mortality remaining high in bloodstream infections预后取决于感染部位和严重程度、患者的免疫状态以及适当抗菌治疗的及时性，血流感染的死亡率仍然很高。^[1]

Research and controversies

• The emergence of carbapenem-resistant Pseudomonas aeruginosa, particularly strains producing metallo-beta-lactamases, is a major public health concern with limited treatment options耐碳青霉烯铜绿假单胞菌的出现，特别是产生金属β-内酰胺酶的菌株，是一个重大公共卫生问题，治疗选择有限。^[1]
• The role of biofilm formation in chronic Pseudomonas infections, particularly in cystic fibrosis patients, is an area of active research, with novel anti-biofilm strategies under investigation生物膜形成在慢性铜绿假单胞菌感染（特别是囊性纤维化患者）中的作用是活跃的研究领域，新型抗生物膜策略正在研究中。^[1]
• Phage therapy and monoclonal antibody approaches are being investigated as alternative or adjunctive treatments for multidrug-resistant Pseudomonas infections噬菌体疗法和单克隆抗体方法正在研究作为多重耐药铜绿假单胞菌感染的替代或辅助治疗。^[1]
• The optimal duration and combination of antibiotic therapy for Pseudomonas infections remain controversial, with different guidelines recommending different approaches假单胞菌感染的抗生素治疗最佳疗程和组合仍存在争议，不同指南推荐不同方法。^[1]
• Several clinical trials are registered on ClinicalTrials.gov for novel anti-pseudomonal agents and combination therapies, reflecting the ongoing challenge of drug resistanceClinicalTrials.gov 上注册了多项新型抗假单胞菌药物和联合疗法的临床试验，反映了耐药性的持续挑战。^[1]

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