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Nonfermenters. Victor S. Flauta, M.D. Division of Medical Microbiology The University of Toledo April 2011. Pseudomonas. Pseudomonas aeruginosa. BAP. MAC. TSOY. TSOY. Pseudomonas aeruginosa. Spot tests are acceptable to identify this organism, although AST is necessary.

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Victor S. Flauta, M.D.

Division of Medical Microbiology

The University of Toledo

April 2011

pseudomonas aeruginosa4
Pseudomonas aeruginosa
  • Spot tests are acceptable to identify this organism, although AST is necessary.
  • Very mucoid strains have poor biochemical reactions.
  • Oxidase +, typical smell, & colony morphology (blue-green pigment) are 95% diagnostic.
  • Rare Aeromonas isolates can have similar colonies but no odor.
  • Pseudomonas is indole neg while Aeromonas is indole pos.
p aeruginosa
P. aeruginosa

Photo: Victor S. Flauta, M.D.

pseudomonas aeruginosa6
Pseudomonas aeruginosa
  • Prevalent in the following patients:
    • Burn wounds
    • Cystic fibrosis
    • Acute leukemia
    • Transplant
    • IV drug users
  • Occur at moist areas: tracheostomies, catheters, burns, ear, weeping wounds
  • Causes UTI, RTI, eye infections, otitis externa, dermatitis, endocarditis
p aeruginosa7
P. aeruginosa
  • Resistance to beta-lactams may arise during therapy.
  • Very rare to see gentamicin, tobramycin, & amikacin resistance concurrently.
p aeruginosa8
P. aeruginosa
  • 1st Rx: antipseudomonal penicillin, imipinem, tobramycin, ciprofloxacin, ticarcillin-clavulanate, piperacillin-tazobactam, or aztreonam.
  • 2nd Rx: for serious infections: (antipseudomonal penicillins or broad-spectrum cephalosporins, or aztreonam, or ticarcillin-clavulanate or piperacillin-tazobactam or imipinem) + (meropenem or tobramycin or ciprofloxacin)
p fluoresecens p putida p mendocina
P. fluoresecens, P. putida, & P. mendocina
  • None of these have blue-green pigment.
  • P. mendocina can be confused with nonpigmented P. aeruginosa.
  • P. fluorescens & P. putida are rare in clinical specimens
    • Both seen in bacteremia from transfused blood
    • P. putida – catheter-related sepsis
    • P. fluorescens - pseudobacteremia
  • Instrument will report as “fluorescens/putida group.”
p oryzihabitans
P. oryzihabitans
  • Formerly Flavimonas, Ve-2
  • The Flavimonas is replaced by Pseudomonas
  • Yellow pigmented but oxidase negative.
  • Wrinkled colony.
  • Similar to Chryseomonas luteola.
  • Associated with septicemia and prosthetic valve endocarditis.
  • Esculin negative.
p oryzihabitans12
P. oryzihabitans
  • MIC value or Etest value only.
  • Disk test unreliable.
p stutzeri
P. stutzeri

Photo: Victor S. Flauta, M.D.

p stutzeri14
P. stutzeri
  • Wrinkled colony (lactose negative) like B. pseudomallei (lactose positive).
  • Colonies are adherent on primary isolation but later become smooth.
  • Mainly comes from soil & water.
  • May have a slight yellow pigment.
p stutzeri15
P. stutzeri
  • Rare cause of infections (OM, pneumonia, endocarditis, meningitis, conjunctivits, osteomyelitis)
  • No CLSI interpretive criteria.
  • Refer or try Etest value.
  • Susceptible to most antibiotics.
burkholderia cepacia17
Burkholderia cepacia
  • Formerly, Pseudomonas cepacia or CDC EO-1
  • Can smell like P. aeruginosa
  • Lysine positive (rare in nonfermenters)
  • Oxidase positive (Stenotrophomonas maltophilia is

LYS + but oxidase neg)

  • May be yellow on TSI.
  • Dangerous nosocomial respiratory pathogen especially in cystic fibrosis
  • Often resistant to quaternary ammonium disinfectants.
burkholderia cepacia18
Burkholderia cepacia
  • New KB standards available for ceftazidime, meropenem, minocycline, & SXT
  • Natural resistance to ampicillin, amoxicillin, narrow-spectrum cephalosporin, colistin, & aminoglycosides
  • 1st Rx: SXT or meropenem or cipro
  • 2nd Rx: minocycline or chloramphenicol
glanders in wwi
Glanders in WWI

Allied cavalries, such as this Belgian convoy, may have been the target of glanders attacks in World War I.

glanders in wwii
Glanders in WWII

Hangzhou, capital of east China's Zhejiang Province.

  • Symptoms
    • nodular lesions in the lungs
    • ulceration of the mucous membranes in the upper respiratory tract
    • coughing, fever and the release of infectious nasal discharge
    • septicemia and death within days
  • Chronic form: nasal & subcutaneous nodules that eventually ulcerate.
  • Death can occur within months, while survivors act as carriers.
burkholderia mallei
Burkholderia mallei
  • Formerly Pseudomonas mallei
  • Causes glanders in horses but not in the U.S.
  • Can be transmitted to humans
  • Ensure testing for ceftazidime, tetracycline, & imipinem
b pseudomallei
B. pseudomallei

b pseudomallei24
B. pseudomallei
  • Formerly Pseudomonas pseudomallei
  • Melioidosis in humans but not in the U.S.
  • Rough, convoluted colony in 3 days is diagnostic
active melioidosis
Active Melioidosis
  • Fever
  • Pain or other symptoms
  • Pneumonia
  • Bone or joint pain
  • Cellulitis
  • Intra-abdominal infection
  • B. pseudomallei abscesses have a characteristic honeycomb architecture (hypoechoic, multi-septate, multiloculate)
melioidosis vietnam war
Melioidosis : Vietnam War
  • Recognized in US servicemen involved in the Vietnam War, and was referred to as the "Vietnamese time-bomb.”
b pseudomallei27
B. pseudomallei
  • Ensure testing for amoxicillin-clavulanic acid, ceftazidime, tetracycline, imipinem, & SXT
  • 1st Rx: ceftazidime (IV)
  • 2nd Rx: SXT, imipinem
p mallei p pseudomallei
P. mallei, P. pseudomallei
  • Rx for P. mallei: sulfadiazine, SXT
  • Rx for P. pseudomallei: ceftazidime or amoxi-clavulanate, SXT
  • Resistance to SXT appearing in Southeast Asia.
sphingomonas paucimobilis
Sphingomonas paucimobilis
  • Formerly IIK-1, Ps. paucimobilis
  • Weakly motile
  • Bright yellow pigment.
  • Sometimes seen with respiratory equipment.
  • Isolated from various body sites & hospital environment
  • Bacteremia, peritonitis
sphingomonas paucimobilis30
Sphingomonas paucimobilis
  • Do not test for AST. If necessary try Etest. No CLSI criteria. Do MIC & report value only.
  • Most strains are susceptible to tetracycline, chloramphenicol, SXT, aminoglycosides
stenotrophomonas maltophilia32
Stenotrophomonas maltophilia
  • Probably the 2nd most common NF in the U.S.
  • Opportunistic infections
  • Emerging hospital-acquired pathogen
  • Ubiquitous
  • Now being reported in CF centers
  • Association between respiratory tract colonization & lung damage
  • Wide spectrum of disease
stenotrophomonas maltophilia33
Stenotrophomonas maltophilia
  • Risk factors associated with death:
    • ICU patient
    • Older than 40 years
    • Pulmonary source of the isolate
  • About 85% are susceptible to SXT
  • Lysine positive (rare in NF) & oxidase neg
stenotrophomonas maltophilia34
Stenotrophomonas maltophilia
  • Use new CLSI guidelines for disk testing of limited drugs
  • Naturally resistant to aminoglycosides and most beta-lactams except ticarcillin-clavulanate
  • Always resistant to carbapenem, imipinem, & ceftriaxone
  • 1st Rx: SXT
  • 2nd Rx: ticarcillin-clavulanate (+/- aztreonam)
acinetobacter baumanii complex37
Acinetobacter baumanii complex
  • Formerly A. calcoaceticus subsp anitratus or A. anitratus
  • Use the name currently on the database of the instrument
  • ~50% from UTI
  • Also ear, eye, nose, throat.
  • Normal on skin & feces
  • This organism is of nosocomial importance
  • Oxidase neg
a baumanii in iraq war
A. baumanii in Iraq War

acinetobacter baumanii
Acinetobacter baumanii
  • 5% resistant to imipinem
  • Often resistant to penicillin, ampicillin, chloramphenicol
  • Combination Rx with beta-lactam & aminoglycoside may be needed for serious cases
  • AST: interpret with Pseudomonas breakpoints
  • Always confirm if resistant to colistin.
acinteobacter lwoffi
Acinteobacter lwoffi
  • Oxidase negative
  • Sensitive to most other antimicrobials
ralstonia spp
Ralstonia spp.
  • R. pickettii (most common), R. paucula, R. gilardii
  • Rare in humans as etiologic agent
  • Probably a nonpathogen
  • Weak motility
  • Slow-growing, pinpoint colonies at 24 h on BAP
  • No CLSI interpretive criteria
  • Refer or try Etest value.
pandoraea spp
Pandoraea spp.
  • Biochemically similar to Burkholderia & Ralstonia
  • Differentiated by fatty acid profiles
  • Refer or report MIC value only.
brevundimonas spp
Brevundimonas spp.
  • B. diminuta, B. vesicularis (formerly Ps. diminuta & Ps. vesicularis)
  • Unusual in clinical specimens
  • B. diminuta is associated with few bacteremias
  • B. vesicularis in hemodialysis, sickle cell, & immunocompromised
  • Requires pantothenate, biotin, cyanocobalamin vitamins for growth (B. diminuta also requires cystine)
brevundimonas spp44
Brevundimonas spp.
  • Do not use the disk diffusion test with these organisms
  • Use MIC method and interpret with Ps. aeruginosa standards.
comamonas spp
Comamonas spp.
  • Formerly Pseudomonas spp
  • C. acidovorans, C. terrigena, C. testosteroni
  • Motile by flagellar tufts on polar stalks
  • Primarily a soil (environmental) organism
  • C. testosteroni is oxidase +, catalase +
  • GNR recovered from sputum, peritoneal fluid, urine, & stool
  • Uncertain pathogenicity
  • Orange indole reaction due to anthranilic acid from tryptone
  • MIC or Etest values only.
delftia spp
Delftia spp.
  • Phenotypically similar to Comamonas but oxidize fructose & mannitol
  • 25% have fluorescent pigment
  • 50% may be yellow or tan
  • Oxidase +
  • Grows on MAC
  • No CLSI criteria available for testing.
acidovorax spp
Acidovorax spp
  • Recently described genus
  • GNR; slightly curved
  • 3 species, all rare in humans
  • Questionably pathogenic
  • Aerobic & common environment (soil, water, plants)
  • No interpretive guidelines available
  • Do not do disk test
  • Use MIC only & use P. aeruginosa standards
  • Rx depends on susceptibility test