Evaluation of Efflux-Mediated Resistance and Biofilm formation in Virulent Pseudomonas aeruginosa Associated with Healthcare Infections

Abstract

Pseudomonas aeruginosa is a significant pathogen identified with healthcare-associated infections. The present study evaluates the role of biofilm and efflux pump activities in influencing high-level resistance in virulent P. aeruginosa strains in clinical infection. Phenotypic resistance in biotyped Pseudomonas aeruginosa (n = 147) from diagnosed disease conditions was classified based on multiple antibiotic resistance (MAR) indices and analysed with logistic regression for risk factors. Efflux pump activity, biofilm formation, and virulence factors were analysed for optimal association in Pseudomonas infection using receiver operation characteristics (ROC). Age-specificity (OR [CI] = 0.986 [0.946–1.027]), gender (OR [CI] = 1.44 [0.211–9.827]) and infection sources (OR [CI] = 0.860 [0.438–1.688]) were risk variables for multidrug resistance (MDR)-P. aeruginosa infection (p < 0.05). Biofilm formers caused 48.2% and 18.5% otorrhea and wound infections (95% CI = 0.820–1.032; p = 0.001) respectively and more than 30% multidrug resistance (MDR) strains demonstrated high-level efflux pump activity (95% CI = 0.762–1.016; p = 0.001), protease (95% CI = 0.112–0.480; p = 0.003), lipase (95% CI = 0.143–0.523; p = 0.001), and hemolysin (95% CI = 1.109–1.780; p = 0.001). Resistance relatedness of more than 80% and 60% to cell wall biosynthesis inhibitors (ceftazidime, ceffproxil, augumentin, ampicillin) and, DNA translational and transcriptional inhibitors (gentamicin, ciprofloxacin, ofloxacin, nitrofurantoin) were observed (p < 0.05). Strong efflux correlation (r = 0.85, p = 0.034) with MDR strains, with high predictive performances in efflux pump activity (ROC-AUC 0.78), biofilm formation (ROC-AUC 0.520), and virulence hierarchical-clustering. Combine activities of the expressed efflux pump and biofilm formation in MDR-P. aeruginosa pose risk to clinical management and infection control.

The Art of War with Pseudomonas aeruginosa: Targeting Mex Efflux Pumps Directly to Strategically Enhance Antipseudomonal Drug Efficacy

“…RND pumps not only drive the efflux of intrinsic toxic metabolites, safeguarding the bacterial milieu from their detrimental effects [ 65 , 66 ], but also play a role in modulating quorum sensing [ 67 , 68 ], influencing biofilm formation [ 69 ] and impacting bacterial virulence [ 70 , 71 ]. Thus, these versatile pumps contribute to fundamental cellular defense mechanisms [ 71 , 72 ].…”

Effluents from a university clinical analysis teaching laboratory: an inductive study on adhesion and cellular response of Pseudomonas aeruginosa

“…Edward et al, (2023) described 2.9% resistance to all antibiotics tested among 104 P. aeruginosa isolates. On the other hand, Akinduti et al (2023) reported almost 40% of multidrug resistant P. aeruginosa in a total of 147 isolates. Additionally, the literature reports studies where the highest rate of resistance in wild isolates of P. aeruginosa has been observed for antibiotics that act on cell wall synthesis, particularly cephalosporins.…”

Antimicrobial Resistance: Two-Component Regulatory Systems and Multidrug Efflux Pumps

“…P. aeruginosa has the ability to evade immune responses by producing numerous virulence factors, adhering to the host surfaces and assembling biofilms [ 151 , 152 , 153 ]. The ability to form biofilms, together with low membrane permeability and intrinsic mechanisms of resistance, makes P. aeruginosa less susceptible to antibiotics [ 151 , 154 , 155 ]. Particularly, the overexpression of multidrug efflux pumps in P. aeruginosa is associated with the ineffectiveness of anti-pseudomonal drugs.…”