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Clin Microbiol Infect. 2019 Jul 6. pii: S1198-743X(19)30389-1. doi: 10.1016/j.cmi.2019.06.034. [Epub ahead of print]

Weighting the impact of virulence on the outcome of Pseudomonas aeruginosa bloodstream infections.

Author information

1
Servicio de Microbiología and Unidad de Investigación, Hospital Son Espases, Instituto de Investigación Sanitaria de les Illes Balears, Palma de Mallorca, Spain.
2
Servicio de Microbiología and Unidad de Investigación, Hospital Son Espases, Instituto de Investigación Sanitaria de les Illes Balears, Palma de Mallorca, Spain. Electronic address: laura.zamorano@ssib.es.
3
Servicio de Medicina Interna, Hospital Virgen de los Lirios, Alcoy, Spain.
4
Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
5
Hospital del Mar, Servicio de Enfermedades Infecciosas, Instituto Hospital del Mar de Investigaciones Médicas, Barcelona, Spain.
6
Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebrón, Barcelona, Spain.
7
Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
8
Sección de Enfermedades Infecciosas, Consorci Hospitalari Parc Taulí, Sabadell, Spain.
9
Sección de Enfermedades Infecciosas Hospital Mutua de Terrassa, Barcelona, Spain.
10
Unidad de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena and Departamento de Medicina, Universidad de Sevilla-IBiS, Sevilla, Spain.
11
Unidad de Gestión Clínica de Microbiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Departamento de Microbiología, Universidad de Córdoba, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain.
12
Hospital de Bellvitge, Bellvitge Biomedical Research Institute, Universidad de Barcelona L'Hospitalet de Llobregat, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
13
Departamento de Biodiversidad y Biología Evolutiva, Museo Nacional de Ciencias Naturales, Consejo Superior de Investigaciones Científicas, Madrid, Spain.
14
Servicio de Microbiología and Unidad de Investigación, Hospital Son Espases, Instituto de Investigación Sanitaria de les Illes Balears, Palma de Mallorca, Spain. Electronic address: antonio.oliver@ssib.es.

Abstract

OBJECTIVES:

We assessed the association between the lethality of Pseudomonas aeruginosa in a Caenorhabditis elegans model and outcomes of P. aeruginosa bloodstream infections.

METHODS:

A total of 593 P. aeruginosa bloodstream isolates recovered from a prospective Spanish multicentre study were analysed. Clinical variables, susceptibility profiles and Type III Secretion System (TTSS) genotypes (exoU/exoS genes) were available from previous studies. A C. elegans virulence score (CEVS) was used, classifying the isolates into high (CEVS 4-5), intermediate (CEVS 3) and low (CEVS 1-2) virulence. The main outcome analysed was 30-day mortality.

RESULTS:

Up to 75% (446/593) of the isolates showed a high-virulence phenotype, and 17% (101/593) a low-virulence one. No association between virulence phenotype and the main outcome variable (30-day mortality) was found (29/101 (28.7%) versus 127/446 (28.5%), p 1). However, an inverse association between C. elegans virulence and multidrug-resistant and extensively drug-resistant profiles was documented (OR 0.655 (95% CI 0.571-0.751) and OR 0.523 (95% CI 0.436-0.627), p <0.001, respectively), whereas the exoU genotype was significantly more frequent among isolates showing high virulence (10/101 (9.9%) versus 112/446 (25.1%), p <0.001). Moreover, although significance was not reached, strains showing a high-virulence phenotype tended to be associated with community-acquired infections (1/101 (1%) versus 25/446 (5.6%), p 0.065), whereas low-virulence phenotypes tended to be associated with a higher illness severity (such as higher median Pitt score: 2 (1-4) versus 1 (0-3), p 0.036, or initial multiorgan dysfunction: 17/101 (16.8%) versus 41/446 (9.2%), p 0.024), with some underlying conditions (such as chronic renal failure 24/101 (23.8%) versus 59/446 (13.2%), p 0.013), and with the respiratory source of infections (17/101 (16.8%) versus 45/446 (10.1%), p 0.058).

CONCLUSIONS:

Our results indicate that the P. aeruginosa virulence phenotype in a C. elegans model correlates with virulence genotype (TTSS) and resistance profile, but it is a poor prognostic marker of mortality in bloodstream infections.

KEYWORDS:

Bloodstream infections; Caenorhabditis elegans; Pseudomonas aeruginosa; Virulence

PMID:
31288102
DOI:
10.1016/j.cmi.2019.06.034

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