{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:11:40Z","timestamp":1787026300386,"version":"build-2736575974"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"\n Objective<\/jats:title>\n \n Objective: This study investigated the antimicrobial resistance profile of carbapenem-resistant\n Pseudomonas aeruginosa<\/jats:italic>\n (CRPA) and its association with the T3SS, aiming to provide evidence for managing highly resistant and virulent CRPA and to guide the optimization of infection control strategies.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Retrospective cohort study was performed with CRPA lower respiratory tract infection from a tertiary hospital (July, 2021, and May, 2025). All strains underwent whole-genome sequencing (WGS), antimicrobial susceptibility testing(AST); selected isolates\u2019 virulence were further evaluated using galleria mellonella infection assays.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 106 patients caused by CRPA infections, the majority were male (73.6%), with a median age of 69.5 years and median hospital stay of 26.5 days. Prior antibiotic exposure included piperacillin\/tazobactam (57.5%) and carbapenems (49.1%). AST revealed high resistance to piperacillin\/tazobactam, but favorable susceptibility to ceftazidime\/avibactam and tobramycin, with no polymyxin B resistance. Multidrug resistance occurred in 49.1% of isolates, and 28.3% were difficult-to-treat\n Pseudomonas aeruginosa<\/jats:italic>\n (DTR-PA). The\n exoU<\/jats:italic>\n and\n exoS<\/jats:italic>\n genes were detected in 28.3% and 64.2% of strains, respectively, with 7.5% co-detection.\n ExoU<\/jats:italic>\n +\/\n exoS<\/jats:italic>\n - strains showed significantly higher resistance to ceftazidime, cefepime, and piperacillin\/tazobactam. All isolates had\n oprD<\/jats:italic>\n mutations. Carbapenemase genes were found in 21.7%, primarily\n bla<\/jats:italic>\n KPC-3.<\/jats:sub>\n ExoU+\/exoS-<\/jats:italic>\n strains were linked to\n \n bla\n KPC-3<\/jats:sub>\n <\/jats:italic>\n and\n bla<\/jats:italic>\n OXA-50<\/jats:sub>\n subtypes(OXA-488,OXA-1032), while\n exoU-\/exoS+<\/jats:italic>\n strains associated with\n \n bla\n OXA-486<\/jats:sub>\n <\/jats:italic>\n and\n \n bla\n OXA-904<\/jats:sub>\n <\/jats:italic>\n . Among 59 sequence types, ST1076 (13.2%) and ST491 (10.4%) dominated, with serotypes O11 (38.7%) and O6 (25.5%) prevalent. Six international high-risk clones\u00a0included ST233, ST244, and ST357. Phylogenetically, phylogroup A (\n exoU<\/jats:italic>\n -\/\n exoS<\/jats:italic>\n +, e.g., PAO1) was larger, and phylogroup B (\n exoU<\/jats:italic>\n +\/\n exoS<\/jats:italic>\n -, e.g., PA14) included highly virulent strains.\n ExoU<\/jats:italic>\n +\/\n exoS<\/jats:italic>\n - strains grouped in ST1076 and ST357, and\n exoU<\/jats:italic>\n +\/\n exoS<\/jats:italic>\n + in ST463. The survival of\n galleria mellonella<\/jats:italic>\n further indicated that carrying the\n exoU<\/jats:italic>\n may cause a higher lethality rate.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n ExoU<\/jats:italic>\n +\/\n exoS<\/jats:italic>\n - strains were strongly associated with resistance genes like\n bla<\/jats:italic>\n KPC-3<\/jats:sub>\n ,\n bla<\/jats:italic>\n OXA-488<\/jats:sub>\n ,\n bla<\/jats:italic>\n OXA-1032<\/jats:sub>\n , ICU admission and exhibited a more pronounced drug-resistant phenotype. Potential high-risk clones such as ST1076-O11 and ST463-O4 display both extensive resistance and high virulence, underscoring the clinical and public health importance of enhanced surveillance and effective containment.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1757868","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T06:33:49Z","timestamp":1771310029000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Molecular epidemiological association between antimicrobial resistance characteristics and type III secretion system in carbapenem-resistant Pseudomonas aeruginosa from lower respiratory tract infections"],"prefix":"10.3389","volume":"16","author":[{"given":"Yun","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory, The Affiliated Lihuili Hospital of Ningbo University","place":["Ningbo, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanzi","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Scientific Research, The Affiliated Lihuili Hospital of Ningbo University","place":["Ningbo, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, The Affiliated Lihuili Hospital of Ningbo University","place":["Ningbo, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ximing","family":"Wang","sequence":"additional","affiliation":[{"name":"Basic Medical Sciences and Forensic Medicine, Hangzhou Medical College","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, The Affiliated Lihuili Hospital of Ningbo University","place":["Ningbo, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Lihuili Hospital of Ningbo University","place":["Ningbo, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1093\/femsre\/fuad011","article-title":"Galleria mellonella-intracellular bacteria pathogen infection models: the ins and outs","volume":"47","author":"Asai","year":"2023","journal-title":"FEMS Microbiol. 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