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Crit Care Med. 2012 Apr;40(4):1157-63. doi: 10.1097/CCM.0b013e3182377906.

Clinical outcomes of type III Pseudomonas aeruginosa bacteremia.

Author information

  • 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

Abstract

BACKGROUND:

Pseudomonas aeruginosa bacteremia is a serious and life-threatening infection associated with high mortality. Among the multitude of virulence determinants possessed by P. aeruginosa, the type 3 secretion system has been implicated with more acute and invasive infection in respiratory diseases. However, the relationship between the type 3 secretion system and clinical outcomes in P. aeruginosa bacteremia has not been investigated.

OBJECTIVES:

To determine the association between the type 3 secretion system virulence factor in P. aeruginosa bloodstream infection and 30-day mortality.

DESIGN:

Retrospective analysis of 85 cases of P. aeruginosa bacteremia.

SETTING:

Tertiary care hospital.

INTERVENTIONS:

Bacterial isolates were assayed in vitro for secretion of type 3 exotoxins (ExoU, ExoT, and ExoS). Strain relatedness was analyzed using randomly amplified polymorphic DNA polymerase chain reaction genotyping. Antimicrobial susceptibilities were determined by means of the Kirby-Bauer disk-diffusion test.

MEASUREMENTS AND MAIN RESULTS:

At least one of the type 3 secretion system proteins was detected in 37 out of the 85 isolates (44%). Septic shock was identified in 43% of bacteremic patients with type 3 secretion system+ isolates compared to 23% of patients with type 3 secretion system- isolates (p = .12). A high frequency of resistance in the type 3 secretion system+ isolates was observed to ciprofloxacin (59%), cefepime (35%), and gentamicin (38%). There was a significant difference in the 30-day cumulative probability of death after bacteremia between secretors and nonsecretors (p = .02). None of the type 3 secretion system+ patients who survived the first 30 days had a P. aeruginosa isolate which exhibited ExoU phenotype.

CONCLUSIONS:

The expression of type 3 secretion system exotoxins in bacteremic isolates of P. aeruginosa confers poor clinical outcomes independent of antibiotic susceptibility profile.

PMID:
22080633
[PubMed - indexed for MEDLINE]
PMCID:
PMC3288436
Free PMC Article
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