title: Urinary tract infections caused by Pseudomonas aeruginosa among children in Southern Poland: Virulence factors and antibiotic resistance.
abstract: OBJECTIVE
  The aim of this study was to analyze antibiotic resistance and virulence patterns in Pseudomonas aeruginosa (PAR) isolates from urinary tract infections among children in Southern Poland.
  
  
  METHODS
  This study comprised consecutive, non-repetitive PAR isolates sent from two collaborative laboratories. The study group consisted of children aged up to 17 years from Southern Poland with culture-proven PAR UTIs. Relevant information about patients with UTIs, such as age, sex, and type of infection (polymicrobial or monomicrobial), was collected. Isolates were screened for major virulence factors found in uropathogenic PAR strains. Multidrug-resistant (MDR) strains were defined as strains not susceptible to one antimicrobial in at least three different antimicrobial classes. Extensively drug resistant (XDR) strains were defined as strains susceptible to no more than two antimicrobial classes.
  
  
  RESULTS
  The total prevalence of PAR UTIs was 2.1%, and in children <5 years of age it was 3.0%. A total of 26 isolates was tested: 21 from outpatients and five from inpatients. Most infections (80.8%) occurred in children ≤ 4 years of age. The most prevalent virulence gene was exoY (96.2%). The prevalence of other effector proteins was 88.5% for exoT, 92.3% for exoS, and 19.2% for exoU. The gene for LasB was present in 80.8% of isolates; the gene for AprA in 61.5%; the gene for PilA in 19.2%; and the gene for PilB was not detected. The PAR isolates were generally susceptible to beta-lactam and aminoglycoside antimicrobials. All isolates were also susceptible to colistin. A large proportion of isolates were resistant to carbapenems and fluoroquinolones (Fig. 1). No significant differences were found in antimicrobial resistance between males and females or inpatients and outpatients (p > 0.05 for all tested antimicrobials), or in antimicrobial resistance between younger (≤ 5 years old, n = 21) and older (> 5 years old, n = 5) children (p > 0.05 for all tested antimicrobials). Two isolates were classified as XDR and none as MDR. The EDTA test yielded one MBL-positive isolate (3.8%), from a 17-year-old patient in home care. No isolates with genes for the KPC, IMP, or VIM were identified.
  
  
  CONCLUSIONS
  As data on UTIs in children with Pseudomonas etiology are scarce, this paper provides useful information for clinicians and allows for comparison between Poland and other countries. Our findings have important implications for clinicians treating UTIs empirically, because the success of empiric treatment is based on knowledge of pathogen antimicrobial susceptibility patterns.
authors: Department of Microbiology, Jagiellonian University Medical College, Krakow, Poland. Electronic address: monika.pobiega@gmail.com.
authors: M
authors: M
authors: Pobiega
authors: Institute of Dentistry, Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Krakow, Poland.
authors: J
authors: J
authors: Maciag
authors: Department of Microbiology, Analytical and Microbiological Laboratory of Ruda Slaska KORLAB NZOZ, Ruda Slaska, Poland.
authors: M
authors: M
authors: Pomorska-Wesolowska
authors: Department of Microbiology, Jagiellonian University Medical College, Krakow, Poland.
authors: A
authors: A
authors: Chmielarczyk
authors: Department of Microbiology, Jagiellonian University Medical College, Krakow, Poland.
authors: D
authors: D
authors: Romaniszyn
authors: Higher School of Medicine in Sosnowiec, Poland.
authors: G
authors: G
authors: Ziolkowski
authors: Department of Microbiology, Jagiellonian University Medical College, Krakow, Poland.
authors: P B
authors: PB
authors: Heczko
authors: Department of Microbiology, Jagiellonian University Medical College, Krakow, Poland.
authors: J
authors: J
authors: Wojkowska-Mach
authors: Department of Microbiology, Jagiellonian University Medical College, Krakow, Poland.
authors: M
authors: M
authors: Bulanda
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011044:Poland / Q000453:epidemiology; D011550:Pseudomonas aeruginosa / Q000472:pathogenicity*; D012189:Retrospective Studies; D014551:Urinary Tract / Q000382:microbiology*; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D014774:Virulence
chemical_list: D000900:Anti-Bacterial Agents
keywords: Drug resistance; Pseudomonas aeruginosa; Urinary tract infections in children; Virulence