Disease Description (Causes and Symptoms)
- Cause: Pseudomonas spp. (mainly Pseudomonas aeruginosa, known in Korean as noknonggyun) are widely present in soil, water, and the environment and cause opportunistic infections in immunocompromised people or patients with medical devices. They commonly occur in wounds, burns, around artificial devices (tubes, catheters), and at procedure sites during hospitalization.
- Pathophysiology: The bacteria infiltrate through mucous membranes, skin, or mechanically damaged areas, causing local tissue necrosis and pus formation. Toxins and endotoxins amplify inflammation, and spread through the bloodstream can cause sepsis. Some strains show multidrug resistance.
- Main symptoms: Redness, pain, warmth, and pus discharge at the site of infection; skin rashes (for example, folliculitis after exposure to hot tubs or bathtubs); cough, difficulty breathing, and fever in respiratory infections (hospital-acquired pneumonia); and otitis media, sinusitis, urinary symptoms, prostatitis, and others. Chills, high fever, and shock may occur with bloodstream infections.
Treatment Methods
- Diagnostic principles: Culture and antibiotic susceptibility testing are performed using samples from the suspected site of infection (wound, blood, sputum, urine, etc.). Imaging tests (chest X-ray/CT, etc.) may be needed.
- Medication treatment (general standard): Antibiotics are selected based on the strain’s susceptibility.
- Combination therapy is recommended for severe infections, bloodstream infections, or a risk of resistance (for example, a beta-lactam + an aminoglycoside or fluoroquinolone).
- Examples of available antipseudomonal drugs: piperacillin-tazobactam, ceftazidime, cefepime, carbapenems (meropenem, imipenem; some resistance is possible), aztreonam, aminoglycosides (gentamicin, tobramycin), fluoroquinolones (ciprofloxacin), polymyxins (colistin, polymyxin B)—last-line drugs may be needed in multidrug-resistant cases.
- Local infections: Mild skin infections and folliculitis often improve with local treatment (disinfection and antibiotic ointment). For the external ear canal (swimmer’s ear), topical antibiotic and steroid drops (for example, ciprofloxacin otic) are used.
- Inhalation treatment: In chronic airway infections (for example, in patients with cystic fibrosis), inhaled aminoglycosides (inhaled tobramycin) and others may be used.
- Procedures/surgery: Drainage of infected tissue and removal of necrotic tissue (surgical drainage/debridement), or removal of contaminated medical devices (such as a central venous catheter). Surgical treatment may be necessary for worsening bone or joint infections, endocarditis, and others.
- Precautions during treatment and lifestyle management: Follow the prescribed antibiotic dosage and treatment duration, maintain hydration and nutrition, and visit a medical institution immediately if fever occurs or a wound worsens. Avoid contact with hot tubs, bathtubs, hot springs, and frequently contaminated bodies of water (heated pools, jacuzzis). To prevent healthcare-associated infections, practice thorough hand hygiene and catheter care.
- Risk of complications: Sepsis, worsening pneumonia, osteomyelitis, endocarditis, corneal ulcer, necrotizing skin infection (for example, ecthyma gangrenosum), and others. The prognosis is poor in immunocompromised people and those with severe underlying diseases.
Checklist Before an Outpatient Visit (Including Items to Prepare and Example Questions)
- Items and information to prepare:
- A list of all medications currently being taken (prescription drugs, over-the-counter drugs, and supplements) and a history of allergies (especially drug allergies)
- A record of recent fever, the date symptoms began, and changes in symptoms (if available, photos of the wound or rash)
- Recent test results (cultures, blood tests, and imaging) or a history of previous antibiotic use
- History of hospitalization, medical devices currently in use (central venous catheter, urinary catheter, etc.), and whether immunosuppressive treatment is being received (steroids, anticancer drugs, etc.)
- Underlying diseases (diabetes, kidney failure, liver disease, etc.)
- Information to tell the healthcare provider first during the outpatient visit (examples):
- “What antibiotics have I used recently, and for how long?”
- “The wound or fever has suddenly worsened (or improved)—I would like to show you these photos.”
Examples of General Questions to Ask the Doctor
- Which antibiotics is this strain susceptible to? (Request an explanation of the culture and susceptibility results.)
- Do I need hospitalization or intravenous antibiotic treatment? How long will the treatment last?
- What are the main side effects of the antibiotics, and which tests should be monitored (such as kidney function)?
- What is the prognosis after the infection? What should I watch out for to prevent complications?
- Which activities should I avoid in daily life (such as hot tubs and swimming pools), and how should I care for the wound?
Examples of Condition-Specific Questions
- The culture showed multidrug-resistant Pseudomonas. Which antibiotic combination do you recommend, and is additional susceptibility testing needed?
- This is an infection of the skin (or external ear canal or cornea). How do you determine whether local treatment is sufficient or systemic antibiotics are needed?