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Determinants for persistence of Pseudomonas aeruginosa in hospitals: interplay between resistance, virulence and biofilm formation

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Abstract

Pseudomonas aeruginosa (Pa) is one of the major bacterial pathogens causing nosocomial infections. During the past few decades, multidrug-resistant (MDR) and extensively drug-resistant (XDR) lineages of Pa have emerged in hospital settings with increasing numbers. However, it remains unclear which determinants of Pa facilitated this spread. A total of 211 clinical XDR and 38 susceptible clinical Pa isolates (nonXDR), as well as 47 environmental isolates (EI), were collected at the Heidelberg University Hospital. We used RAPD PCR to identify genetic clusters. Carriage of carbapenamases (CPM) and virulence genes were analyzed by PCR, biofilm formation capacity was assessed, in vitro fitness was evaluated using competitive growth assays, and interaction with the host’s immune system was analyzed using serum killing and neutrophil killing assays. XDR isolates showed significantly elevated biofilm formation (p < 0.05) and higher competitive fitness compared to nonXDR and EI isolates. Thirty percent (62/205) of the XDR isolates carried a CPM. Similarities in distribution of virulence factors, as well as biofilm formation properties, between CPM+ Pa isolates and EI and between CPM- and nonXDR isolates were detected. Molecular typing revealed two distinct genetic clusters within the XDR population, which were characterized by even higher biofilm formation. In contrast, XDR isolates were more susceptible to the immune response than nonXDR isolates. Our study provides evidence that the ability to form biofilms is an outstanding determinant for persistence and endemic spread of Pa in the hospital setting.

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    Authors and Affiliations

    1. Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany

      S. J. Kaiser, N. T. Mutters, U. Frank & F. Günther

    2. Department of Infectious Diseases, Sapienza University of Rome, Rome, Italy

      A. DeRosa

    3. Institute of Hygiene and Infectious Diseases of Animals, Justus Liebig University Giessen, Giessen, Germany

      C. Ewers

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    Correspondence to F. Günther.

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    All authors report no financial or non-financial conflicts of interest. All used isolates were routinely collected in the microbiology laboratory of the Heidelberg University Hospital and stored at −70 °C. The present study thus is descriptive of a bacterial collection of those isolates and additional environmental isolates. Data collected from patients was anonymized and restricted to possible clinical symptoms of infection. Ethical approval and informed consent statements were therefore not required. The study was conducted without additional funding.

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    S. J. Kaiser and N. T. Mutters contributed equally to this work.

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    Heat map of the analyzed features for all isolates and groups used in this study. Yellow indicates values close to the median, while red indicates values associated with elevated feature characteristics and green low feature characteristics. (PDF 110 kb)

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    Kaiser, S.J., Mutters, N.T., DeRosa, A. et al. Determinants for persistence of Pseudomonas aeruginosa in hospitals: interplay between resistance, virulence and biofilm formation. Eur J Clin Microbiol Infect Dis 36, 243–253 (2017). https://doi.org/10.1007/s10096-016-2792-8

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