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Clinical outcomes of type III Pseudomonas aeruginosa bacteremia

Ali A El-Solh1, Angela Hattemer, Alan R Hauser

  • 1Veterans Affairs Western New York Healthcare System, Western New York Respiratory Research Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Buffalo, NY, USA. solh@buffalo.edu

Critical Care Medicine
|November 15, 2011
PubMed
Abstract

Insights

The type 3 secretion system in Pseudomonas aeruginosa bacteremia is linked to increased mortality. This virulence factor predicts poor outcomes, regardless of antibiotic resistance, highlighting its clinical significance.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Clinical Medicine

Background:

  • Pseudomonas aeruginosa bacteremia is a severe infection with high mortality.
  • The type 3 secretion system (T3SS) is a key virulence factor implicated in invasive infections.
  • The association between T3SS and clinical outcomes in P. aeruginosa bacteremia remains understudied.

Purpose of the Study:

  • To investigate the relationship between T3SS virulence factors in P. aeruginosa bloodstream infections and 30-day mortality.
  • To determine if T3SS expression impacts patient outcomes independently of antimicrobial susceptibility.

Main Methods:

  • Retrospective analysis of 85 P. aeruginosa bacteremia cases from a tertiary care hospital.
  • In vitro assays to detect type 3 exotoxins (ExoU, ExoT, ExoS) in bacterial isolates.
  • Randomly amplified polymorphic DNA genotyping for strain relatedness and Kirby-Bauer disk diffusion for antimicrobial susceptibility testing.

Main Results:

  • T3SS proteins were detected in 44% of P. aeruginosa isolates.
  • Patients with T3SS-positive isolates showed a trend towards higher rates of septic shock (43% vs. 23%).
  • A significant increase in 30-day mortality was observed in patients with T3SS-positive isolates (p = .02).
  • T3SS-positive isolates exhibited high resistance rates to ciprofloxacin, cefepime, and gentamicin.

Conclusions:

  • Expression of type 3 secretion system exotoxins in P. aeruginosa bacteremia is associated with poor clinical outcomes.
  • The T3SS appears to confer a worse prognosis independent of antibiotic susceptibility.
  • The absence of ExoU phenotype in survivors of T3SS-positive bacteremia warrants further investigation.

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