<p>Virulence Constitution of Multi-Drug-Resistant <em>Pseudomonas aeruginosa</em> in Upper Egypt</p>
Noha A. Hassuna, Sahar A. Mandour, Ebtisam S. Mohamed
Abstract
Purpose: 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 apr A, exo U, exo S, las B, alg D, tox A 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. exo U genotype was more predominant among the P. aeruginosa isolates with more than 48% of the isolates harboring this gene alone, 7% harboring both exo U and exo S and 43.5% harboring exo S 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 exo U 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. Keywords: P. aeruginosa , virulence, exo U, MDR