title: Clinical outcomes of type III Pseudomonas aeruginosa bacteremia.
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.
  
  
  OBJECTIVE
  To determine the association between the type 3 secretion system virulence factor in P. aeruginosa bloodstream infection and 30-day mortality.
  
  
  METHODS
  Retrospective analysis of 85 cases of P. aeruginosa bacteremia.
  
  
  METHODS
  Tertiary care hospital.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Veterans 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
authors.forename: Ali A
authors.initials: AA
authors.lastname: El-Solh
authors.forename: Angela
authors.initials: A
authors.lastname: Hattemer
authors.forename: Alan R
authors.initials: AR
authors.lastname: Hauser
authors.forename: Ahmad
authors.initials: A
authors.lastname: Alhajhusain
authors.forename: Hardik
authors.initials: H
authors.lastname: Vora
mesh_terms: D036002:ADP Ribose Transferases / Q000235:genetics; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D001426:Bacterial Proteins / Q000235:genetics; D001427:Bacterial Toxins / Q000235:genetics; D005098:Exotoxins; D005260:Female; D020690:GTPase-Activating Proteins / Q000235:genetics; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D011550:Pseudomonas aeruginosa / Q000235:genetics / Q000302:isolation & purification; D019105:Random Amplified Polymorphic DNA Technique; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; C477521:ExoT protein, Pseudomonas aeruginosa; D005098:Exotoxins; D020690:GTPase-Activating Proteins; C111749:pseudomonas exoprotein A protein, Pseudomonas aeruginosa; D036002:ADP Ribose Transferases; C444820:exoenzyme S
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