Prevalence of Quorum Sensing and Virulence Factor Genes Among Pseudomonas aeruginosa Isolated from Patients Suffering from Different Infections and Their Association with Antimicrobial Resistance

Abstract

Purpose

Antimicrobial resistance and virulence genes play important roles in increasing the severity of Pseudomonas aeruginosa infections, especially in hospitalized patients with high antibiotic pressure. Most genes that encode Pseudomonas aeruginosa virulence factors are controlled and regulated by the quorum sensing (QS) system. The aim of this study was to investigate the frequency of some virulence genes (rhlR, rhlI, lasR, lasI, lasB, toxA, aprA, algD, ExoS, and plcH genes) and their association with antibiotic resistance.

Methods

Antimicrobial susceptibility was determined by Kirby–Bauer agar disk diffusion method. A total of 125 clinical isolates of P. aeruginosa were tested for some virulence genes using polymerase chain reaction (PCR).

Results

The highest resistance was observed against cefepime (92.8%). Multi-drug resistant (MDR) P. aeruginosa represented 63.2% of total isolates with high distribution among wound isolates (21/79, 26.3% of MDR isolates). LasB was the most prevalent virulence gene among the tested isolates (89.6%) followed by aprA (85.6%), exoS (84%), algD (80%), toxA (76.8%), and plcH (75.2). Furthermore, a significant association (P < 0.05) among most of the tested virulence genes and MDR isolates was found. The presence of more than 5 virulence genes was highly observed among wound infections, otitis media, and respiratory tract infection isolates.

Conclusion

The complex association of virulence genes including QS system regulating genes with antibiotic resistance indicates the importance of the tested factors in the progression of infections, which is considered a great challenge for the health-care team with the need for specific studies for each area having different antibiotic resistance profiles and the development of effective treatment strategies such as anti-virulent and quorum sensing inhibiting drugs against P. aeruginosa infections.

Keywords:

• Pseudomonas aeruginosa
• quorum sensing
• virulence genes
• antibiotic resistance

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, prior approval (No. HV16/2020) by the ethical committee of Faculty of Pharmacy, Minia University.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study. Written informed consent has been obtained from the patient(s) to publish this paper.

Acknowledgments

We are grateful to the medical staff of Minia University Hospital for collecting the specimens used in this study. The authors thank the Deanship of scientific research at Umm Al-Qura University for supporting this work by grant code (23UQU4290565DSR120).

Disclosure

The authors declare no conflicts of interest in this work.

Additional information

Funding

The authors thank the Deanship of scientific research at Umm Al-Qura University for supporting this work by grant code (23UQU4290565DSR120).