Correlation between virulence genotype and fluoroquinolone drugs resistance in Pseudomonas aeruginosa of lower respiratory tract infection / 中国人兽共患病学报

We investigated the correlation between toxin gene exoS,exoU and fluoroquinolone resistance in lower respiratory tract infection with P.aeruginosa so as to provide guidance for reasonable treatment of clinical infections.We collected P.aeruginosa of sputum samples in hospitalized patients from October 2015 to March 2016.The antimicrobial susceptibility was tested by liquid dilution method.The exoS and exoU genes were detected by PCR technique.Results showed that forty-six P.aeruginosa strains were identified from sputum.The exoS and exoU gene positive rate were 86.96 ％ (40/46) and 69.57 ％ (32/ 46) respectively,and the highest proportion of genotype was exoS+/exoU+ (60.87％,28/46).Among them,36.96％ (17/ 46) were multiple drug-resistant bacteria(MDR).Fluoroquinolone non-sensitive (FQ-NS) strain were 78.95％ (15/19) for MDR and 89.47 ％ (17/19) exoU gene were positive,which was significantly higher than the fluoroquinolone sensitive strains (FQ-S).Compared with the FQ-S strain,FQ-NS strains were serious drug resistance.The drug resistant rate of eefepime and aztreonam were more than 70％,and then meropenem and imipenem were more than 50％.The drugs of lower resistance rate in FQ-NS strain had polymyxin B(10.53％,2/19),amikacin(10.53％,2/19),ceftazidime (15.79％,3/19) and gentamicin (21.05％,4/19).P.aeruginosa of lower respiratory infection carried toxin genes exoS and exoU were higher,the main genetpy was exoS+/exoU+.FQ-NS strains were higher drug resistance rate and a higher proportion of exoU+ strains than FQ-S strains.We should strengthen virulence genes test and drug resistance monitoring in clinical practice.

Correlation Between Virulence Genotype and Fluoroquinolone Resistance in Carbapenem-Resistant Pseudomonas aeruginosa

BACKGROUND: Pseudomonas aeruginosa is a clinically important pathogen that causes opportunistic infections and nosocomial outbreaks. Recently, the type III secretion system (TTSS) has been shown to play an important role in the virulence of P. aeruginosa. ExoU, in particular, has the greatest impact on disease severity. We examined the relationship among the TTSS effector genotype (exoS and exoU), fluoroquinolone resistance, and target site mutations in 66 carbapenem-resistant P. aeruginosa strains. METHODS: Sixty-six carbapenem-resistant P. aeruginosa strains were collected from patients in a university hospital in Daejeon, Korea, from January 2008 to May 2012. Minimum inhibitory concentrations (MICs) of fluoroquinolones (ciprofloxacin and levofloxacin) were determined by using the agar dilution method. We used PCR and sequencing to determine the TTSS effector genotype and quinolone resistance-determining regions (QRDRs) of the respective target genes gyrA, gyrB, parC, and parE. RESULTS: A higher proportion of exoU+ strains were fluoroquinolone-resistant than exoS+ strains (93.2%, 41/44 vs. 45.0%, 9/20; P< or =0.0001). Additionally, exoU+ strains were more likely to carry combined mutations than exoS+ strains (97.6%, 40/41 vs. 70%, 7/10; P=0.021), and MIC increased as the number of active mutations increased. CONCLUSIONS: The recent overuse of fluoroquinolone has led to both increased resistance and enhanced virulence of carbapenem-resistant P. aeruginosa. These data indicate a specific relationship among exoU genotype, fluoroquinolone resistance, and resistance-conferring mutations.

Ativação do estresse oxidativo e da resposta antioxidante por ExoU de Pseudomonas aeruginosa / Activation of oxidative stress and antioxidant response by ExoU of Pseudomonas aeruginosa

ExoU, uma citotoxina produzida pelo patógeno oportunista Pseudomonas aeruginosa e translocada para o citosol de células hospedeiras via sistema de secreção do tipo III, é associada à gravidade de infecções agudas. No presente trabalho, o efeito de ExoU na ativação do estresse oxidativo e da resposta antioxidante foi avaliado em culturas de células epiteliais respiratórias humanas infectadas com a cepa PA103 de P. aeruginosa (produtora de ExoU), com a mutante deletada no gene exoU, PA103∆exoU, ou com a mutante complementada com exoU sem atividade tipo fosfolipase A2, PA103∆UT/S142A. Análises das dosagens de hidroperóxidos lipídicos e isoprostanos, considerados marcadores de estresse oxidativo, revelaram que ExoU promoveu um aumento em suas concentrações. Foi observado, também, que ExoU estimulou a produção de espécies reativas de oxigênio, óxido nítrico e peroxinitrito nas células infectadas, assim como a expressão de iNOS e eNOS, mas não de nNOS. Além disso, ExoU foi responsável pelo aumento da atividade de SOD1 e pela redução dos níveis de GSH, mas não afetou a atividade da catalase ou de NQO1. No modelo in vivo, a dosagem de malondialdeído, um subproduto da lipoperoxidação de membranas, evidenciou uma maior produção deste composto no pulmão de camundongos infectados pela cepa produtora de ExoU, em comparação ao pulmão de camundongos infectados pela cepa mutante. Em conjunto, estes resultados mostram que ExoU ativa a produção de espécies reativas de oxigênio e nitrogênio, levando à peroxidação lipídica e modulando o sistema de defesa antioxidante...

ExoU, a cytotoxin produced by the opportunistic pathogen Pseudomonas aeruginosa and translocated into the cytosol of host cells via a type III secretion system, is associated with severity of acute infections. In the present work, the effect of ExoU in the activation of oxidative stress and antioxidant response was evaluated in cultures of human respiratory epithelial cells infected with P. aeruginosa PA103 strain (producer of ExoU), or with its isogenic mutants, the ExoU-deficient PA103∆exoU or the exoU-depleted mutant complemented with an exoU gene with a site-specific mutation in the PLA2 catalytic site, PA103∆UT/S142A. Analysis of dosages of lipid hydroperoxides and isoprostanes, considered markers of oxidative stress, revealed that ExoU promoted an increase in their concentrations. It was also observed that ExoU stimulated the production of reactive oxygen species, nitric oxide and peroxynitrite in infected cells, as well as the expression of iNOS and eNOS, but not nNOS. Furthermore, ExoU was responsible for the increased activity of SOD1 and the reduced levels of GSH, but did not affect the activity of catalase or NQO1. In the in vivo model, the analysis of malondialdehyde, a byproduct of lipid peroxidation of membranes, showed increased production of this compound in the lungs of mice infected with the ExoU-producing strain compared to the lungs of mice infected with the mutant strain. Together, these results show that ExoU activates the production of reactive oxygen and nitrogen species, leading to lipid peroxidation and modulating the antioxidant defense system...

Atividade pró-trombótica da toxina ExoU de Pseudomonas aeruginosa detectada em modelos experimentais in vivo e in vitro / Prothrombotic activity of the Pseudomonas aeruginosa toxin ExoU detected in experimental models in vivo and in vitro

Pseudomonas aeruginosa é um importante agente de pneumonia, particularmente em pacientes submetidos à ventilação mecânica, que pode evoluir para sepse, com elevadas taxas de letalidade. Na sepse, o processo inflamatório sistêmico exacerbado favorece o desequilíbrio entre as vias de coagulação e fibrinólise e a instalação de um estado pró-coagulante, com o aparecimento de trombose microvascular, coagulação intravascular disseminada e falência de múltiplos órgãos. Conhecendo a potente atividade pró-inflamatória da toxina ExoU produzida por P. aeruginosa, decorrente de sua atividade fosfolipásica A2, o objetivo desta tese foi investigar seu potencial de indução de alterações hemostáticas relacionadas à patogênese da sepse. Utilizando modelo de sepse em camundongos inoculados, por via intratraqueal, com suspensões de P. aeruginosa produtora de ExoU (PA103) ou de cepa com deleção do gene exoU, não produtora da toxina, foi mostrado que ExoU determinou maior gravidade da infecção, maior taxa de letalidade, leucopenia, trombocitose, hiperpermeabilidade vascular e transudação plasmática, evidenciadas, respectivamente, pela maior concentração de proteínas nos lavados broncoalveolares (LBAs) e acúmulo do corante Azul de Evans, previamente inoculado nos animais, por via endovenosa, no parênquima renal. ExoU favoreceu, também, a ativação plaquetária, confirmada pela maior concentração de plaquetas expressando P-seletina em sua supefície, maior número de micropartículas derivadas de plaquetas e maior concentração plasmática de tromboxano A2. A histopatologia dos pulmões e rins dos animais infectados com PA103 confirmou a formação de microtrombos, que não foram detectados nos animais controles ou infectados com a cepa mutante. Nos pulmões, a produção de ExoU determinou intensa resposta inflamatória com maior concentração de leucócitos totais e polimorfonucleados, interleucina-6 e fator de necrose tumoral-alfa nos LBAs. A análise imunohistoquímica mostrou intensa deposição...

Pseudomonas aeruginosa is an important agent of pneumonia, mainly in patients undergoing mechanical ventilation, which can progress to sepsis with high mortality rates. In sepsis, the systemic inflammatory process favors exacerbated imbalance between the coagulation and fibrinolysis pathways and the installation of a procoagulant state, leading to microvascular thrombosis, disseminated intravascular coagulation and multiple organ failure. Knowing the powerful proinflammatory activity of the P. aeruginosa toxin ExoU, secondary to its phospholipase A2 activity, the goal of this study was to investigate the ExoU potential to induce hemostatic changes related to sepsis pathogenesis. By using a murine model of pneumosepsis, obtained by the intratracheal injection of suspensions of the ExoU-producing PA103 P. aeruginosa strain or of its isogenic mutant PA103 exoU, defective in the toxin synthesis, ExoU was shown to enhance the severity of the infection and to induce higher mice mortality rate as well as leukopenia, thrombocytosis, vascular hyperpermeability and plasma transudation, evidenced, respectively, by the higher protein concentration in the bronchoalveolar lavage fluids (BALF) and accumulation of Evans blue dye, previously intravenous infectioned, in mice renal parenchyma. ExoU also favored platelet activation, evidenced by the higher concentration of platelets expressing P-selectin on their surface, greater number of platelet-derived microparticles and increased plasma concentration of thromboxane A2. Histopathology of the lungs and kidneys of PA103 - infected animals confirmed the formation of microthrombi, which were not detected in controls or in animals infected with the bacterial mutant. In lungs, ExoU induced an intense inflammatory response with high concentrations of total and polymorphonuclear leukocytes, interleukin-6 and tumor necrosis factor-alfa in mice BALF. Immunohistochemical analysis showed intense fibrin deposition in the alveoli...

ExoU contributes to late killing of Pseudomonas aeruginosa - infected endothelial cells

To ascertain the role of ExoU in late P. aeruginosa cytotoxicity, endothelial cells (EC) were exposed to wild type PA103, PA103deltaexoU and PA103::exsA for 1h and to gentamicin in culture medium. After 24h, the viability of PA103-infected cells (33.7 ± 14.3%) was significantly lower than the viability of PA103deltaexoU- (77.7 ± 6.3%) or PA103::exsA- (79.5 ± 23.3%) infected EC. P. aeruginosa cytotoxicity did not depend on the bacterial ability to interact with EC because the percentage of cells with associated PA103 (35.9 ± 15.8%) was similar to the percentage in PA103deltaexoU- (34.2 ± 16.0%) and lower than the percentage in PA103::exsA-infected cultures (82.9 ± 18.9%). Cell treatment with cytochalasin D reduced the PA103 internalization by EC but did not interfere with its ability to kill host cells.

Para determinar o papel de ExoU na citotoxicidade tardia de P. aeruginosa, células endoteliais (CE) foram expostas às cepas PA103, PA103deltaxoU e PA103::exsA por 1h e à gentamicina em meio de cultura. Após 24h, a viabilidade das CE infectadas com PA103 (33.7 ± 14.3%) foi inferior à de CE infectadas com PA103deltaexoU (77.7 ± 6.3%) e PA103::exsA (79.5 ± 23.3%). A citotoxicidade não dependeu da capacidade de interagir com as CE porque o percentual de células com bactérias associadas em culturas expostas a PA103 foi semelhante ao percentual em culturas expostas a PA103deltaexoU e inferior em culturas expostas a PA103::exsA. O tratamento das CE com citocalasina D reduziu a internalização de PA103, mas não interferiu em sua citotoxicidade.

ExoU contributes to late killing of Pseudomonas aeruginosa - infected endothelial cells

To ascertain the role of ExoU in late P. aeruginosa cytotoxicity, endothelial cells (EC) were exposed to wild type PA103, PA103deltaexoU and PA103::exsA for 1h and to gentamicin in culture medium. After 24h, the viability of PA103-infected cells (33.7 ± 14.3%) was significantly lower than the viability of PA103deltaexoU- (77.7 ± 6.3%) or PA103::exsA- (79.5 ± 23.3%) infected EC. P. aeruginosa cytotoxicity did not depend on the bacterial ability to interact with EC because the percentage of cells with associated PA103 (35.9 ± 15.8%) was similar to the percentage in PA103deltaexoU- (34.2 ± 16.0%) and lower than the percentage in PA103::exsA-infected cultures (82.9 ± 18.9%). Cell treatment with cytochalasin D reduced the PA103 internalization by EC but did not interfere with its ability to kill host cells.

Para determinar o papel de ExoU na citotoxicidade tardia de P. aeruginosa, células endoteliais (CE) foram expostas às cepas PA103, PA103deltaxoU e PA103::exsA por 1h e à gentamicina em meio de cultura. Após 24h, a viabilidade das CE infectadas com PA103 (33.7 ± 14.3%) foi inferior à de CE infectadas com PA103deltaexoU (77.7 ± 6.3%) e PA103::exsA (79.5 ± 23.3%). A citotoxicidade não dependeu da capacidade de interagir com as CE porque o percentual de células com bactérias associadas em culturas expostas a PA103 foi semelhante ao percentual em culturas expostas a PA103deltaexoU e inferior em culturas expostas a PA103::exsA. O tratamento das CE com citocalasina D reduziu a internalização de PA103, mas não interferiu em sua citotoxicidade.