<p>Virulence Constitution of Multi-Drug-Resistant <em>Pseudomonas aeruginosa</em> in Upper Egypt</p>

Abstract

Ventilator-associated pneumonia caused by Pseudomonas aeruginosa (P. aeruginosa) is a major health-care problem. In this study, we explored the epidemiology of virulence determinants among multi-drug-resistant (MDR) clinical P. aeruginosa isolates from hospitalized patients with ventilator-associated pneumonia in intensive care units in Upper Egypt. Patients and Methods: MDR P. aeruginosa isolates were screened for the presence of eight virulence factors and typed by ERIC-PCR. Results: A total of 39 clinical MDR isolates were selected out of 173 isolated P. aeruginosa showing a combination of adhesion and cytotoxicity virulence patterns, with the detection of aprA, exoU, exoS, lasB, algD, toxA in 74.3%, 58.9%, 46.1%, 41.2%, 30.7%, 20.5% of the isolates, respectively. The MDR isolates were grouped into 13 different virulence profiles according to the pattern of virulence gene distribution. exoU genotype was more predominant among the P. aeruginosa isolates with more than 48% of the isolates harboring this gene alone, 7% harboring both exoU and exoS and 43.5% harboring exoS gene. An intermediate degree of diversity was detected by ERIC-PCR typing where the isolates were clustered in 7 major groups, indicating possible cross-infection within the hospital. Conclusion: Our results highlight the increased frequency of virulent P. aeruginosa isolates with a shift to the more virulent cytotoxic exoU genotype. Further hospital infection-control measures are mandatory to control the hospital cross-transmission of these highly virulent isolates. This study could vastly be a help to develop efficient treatment policies against P. aeruginosa induced ventilator-associated pneumonia.

High prevalence of atypical virulotype and genetically diverse background among Pseudomonas aeruginosa isolates from a referral hospital in the Brazilian Amazon

“…The algD gene was detected in 98.1% of isolates, while absence of algU was noted in more than 53.0%. These findings differ from those reported by Hassuna et al (2020) [1] and Fazeli et al (2014) [57], who observed higher frequencies for algU and lower frequencies for algD, respectively. As both genes encode fundamental proteins for alginate biosynthesis, functioning as one of its main adhesins and mainly found in the respiratory tract of patients with acute infections and cystic fibrosis (CF), the low frequency of the algU may be associated to the high frequency of non-RTI isolates (57.4%) and also indicate deficient alginate production by most of tested isolates [10,58].…”

“…The high prevalence of the aprA gene is in line with other studies [1,13,56,59], highlighting the importance of zinc-metalloprotease secreted by T1SS, which has functions related to invasion, causing collagen and fibrinogen degradation in synergy with T2SS elastases, and…”

“…reports that indicates a high prevalence and conserved nature of the P. aeruginosa genome regarding the presence of virulence-related genes, variations in virulence patterns are observed in isolates from different geographic areas and settings, highlighting the need to investigate different markers among distinct P. aeruginosa populations [1,13,23,35,55,56]. The algD gene was detected in 98.1% of isolates, while absence of algU was noted in more than 53.0%.…”

“…Pseudomonas aeruginosa is an opportunistic pathogen, causing a wide spectrum of infections, including acute and chronic respiratory tract infections (RTIs) and bloodstream infections (BSIs) as the main infection sites [1][2][3][4]. It is estimated that P. aeruginosa is responsible to about 10% of all hospital-acquired-infections worldwide and associated to outbreaks in adult, pediatric and neonatal intensive care units (ICUs) due to the spread of multi-drug resistant (MDR) or extensively drug-resistant (XDR) and highly virulent P. aeruginosa strains, negatively impacting morbidity, mortality, length of stay and treatment costs of patients [5][6][7].…”

“…Pseudomonas aeruginosa is an opportunistic pathogen, causing a wide spectrum of infections, including acute and chronic respiratory tract infections (RTIs) and bloodstream infections (BSIs) as the main infection sites [ 1 – 4 ]. It is estimated that P .…”