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The current study aimed to determine the presence of the <jats:italic>exoU<\/jats:italic>+\/<jats:italic>exoS<\/jats:italic>+ genotype in <jats:italic>P<\/jats:italic>. <jats:italic>aeruginosa<\/jats:italic> clinical isolates. The presence of <jats:italic>exoS<\/jats:italic>, <jats:italic>exoT<\/jats:italic>, <jats:italic>exoU<\/jats:italic> and <jats:italic>exoY<\/jats:italic> was determined in 189 <jats:italic>P<\/jats:italic>. <jats:italic>aeruginosa<\/jats:italic> by PCR, and the presence\/absence of <jats:italic>exoU<\/jats:italic> was analysed according to source infection, clonal relationships, biofilm formation, motility and antimicrobial susceptibility. The <jats:italic>gyrA<\/jats:italic>, <jats:italic>parC<\/jats:italic>, <jats:italic>oprD<\/jats:italic>, efflux pump regulators and \u03b2-lactamases genes were also analysed by PCR\/sequencing. The <jats:italic>exoS<\/jats:italic>, <jats:italic>exoT<\/jats:italic> and <jats:italic>exoY<\/jats:italic> genes were found in 100% of the isolates. Meanwhile, <jats:italic>exoU<\/jats:italic> was present in 43\/189 (22.8%) of the isolates, being significantly associated with multidrug resistance, extensively drug resistance as well as with higher level quinolone resistance. However, the presence of \u03b2-lactamases, mutations in <jats:italic>gyrA<\/jats:italic> and <jats:italic>parC<\/jats:italic>, and relevant modifications in efflux pumps and OprD were not significantly associated with <jats:italic>exoU<\/jats:italic>+ isolates. MLST analysis of a subset of 25 isolates showed 8 different STs displaying the <jats:italic>exoU<\/jats:italic>+\/<jats:italic>exoS<\/jats:italic>+ genotype. The MDR basis of the <jats:italic>exoU<\/jats:italic>+ isolates remain to be elucidated. Furthermore, the clinical implications and spread of <jats:italic>exoU<\/jats:italic>+\/<jats:italic>exoS<\/jats:italic>+\u00a0<jats:italic>P<\/jats:italic>. <jats:italic>aeruginosa<\/jats:italic> isolates need to be established.<\/jats:p>","DOI":"10.1038\/s41598-019-47303-4","type":"journal-article","created":{"date-parts":[[2019,7,26]],"date-time":"2019-07-26T10:03:04Z","timestamp":1564135384000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":91,"title":["High frequency of the exoU+\/exoS+ genotype associated with multidrug-resistant \u201chigh-risk clones\u201d of Pseudomonas aeruginosa clinical isolates from Peruvian hospitals"],"prefix":"10.1038","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8974-7044","authenticated-orcid":false,"given":"Gertrudis","family":"Horna","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Amaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aida","family":"Palacios","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2617-053X","authenticated-orcid":false,"given":"Humberto","family":"Guerra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4431-2036","authenticated-orcid":false,"given":"Joaquim","family":"Ruiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,7,26]]},"reference":[{"key":"47303_CR1","doi-asserted-by":"publisher","first-page":"e42973","DOI":"10.1371\/journal.pone.0042973","volume":"7","author":"M Agnello","year":"2012","unstructured":"Agnello, M. & Wong-Beringer, A. 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