References
Pseudomonas otitis: what nurses need to know — frequently asked questions
Abstract
Ear disease is a common problem in primary care practice. A clear understanding of the underlying causes of disease, the need to recognise and treat infection effectively and reverse chronic change to the canal, are key to resolving disease and preventing recurrence. Although nurse's are not in a position to diagnose Pseudomonas infection in practice, it is important that they are aware of the aggressive, multiply resistant nature of the infection and the typical presenting signs of the disease. They can play an important role in the management of all otic disease but especially in Pseudomonas infection where owner compliance is often key to a successful outcome. Their input may be through a knowledge of taking and interpreting otic cytology or by giving advice to owners on the most effective way they can treat their pets through gentle cleaning and sympathetic choice of ear products.
The clinical management of otic infection with Pseudomonas spp. is challenging. The disease is painful and debilitating and the pathogen is commonly a multiple-resistant isolate. Infection often progresses to involve the middle ear, which makes selection of medication a difficult balance between the clinical benefits of the use of off-license drugs versus the potential damage caused by the use of ototoxic medication. This article on the management of Pseudomonas otitis has been written as a series of frequently asked questions, designed to help nurses understand and help in the management of this difficult disease.
Pseudomonas species are Gram-negative, rod-shaped bacteria. They are widespread in nature but are particularly found in aquatic habitats, soil and in decaying vegetation. Pseudomonas aeruginosa is the species most commonly implicated as a cause of otitis externa/media in the dog. It is recognised as an opportunistic pathogen (Paterson, 2012).
Pseudomonas is not a primary cause of otitis, but an infection that develops secondarily to the primary cause (Paterson and Matyskiewicz, 2018). Primary causes such as allergy, ectoparasites and endocrine disease are the inciting factors that lead to the development of otitis in both cats and dogs (Paterson and Matyskiewicz, 2018). They need to be addressed in all cases of otitis but especially in chronic disease where there is an increased risk of the development of multiple-resistant pathogens such as P. aeruginosa. Management of the underlying primary cause is essential to speed the resolution of the infection and prevent recurrence of infection, which is important to reduce antibiotic usage and reduce the risk of the development of more resistant forms of bacteria.
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