{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T18:21:48Z","timestamp":1790965308718,"version":"4.1.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"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. Microbiol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Bloodstream infections (BSI) in neutropenic cancer patients, particularly those caused by <jats:italic>Pseudomonas aeruginosa<\/jats:italic> (PA), are associated with high morbidity and mortality. The increasing prevalence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) PA strains complicates clinical management. This study aimed to characterise PA strains causing BSI in neutropenic cancer patients and assess the association between microbiological features and clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analysed PA strains from 94 BSI episodes in neutropenic cancer patients across five Spanish hospitals (2006\u20132018). Antimicrobial resistance, alginate and pigment production were assessed. Whole-genome sequencing was performed to identify resistance mutations and virulence genes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>PA strains exhibited high genetic diversity, with ST175 as the most prevalent clone (28.7%). MDR non-XDR and XDR strains accounted for 10.3% and 18.1% of cases, respectively. The highest resistance rates were for ciprofloxacin (42.6%) and imipenem (36.2%). Resistance was primarily driven by chromosomal mutations. ExoU was present in 24.4% of strains, associated with serotype O11 and ST253. Seven-day and 30-day mortality were 21.3% and 31.9%, respectively. Mortality was not significantly influenced by resistance phenotypes or the presence of ExoU. Polymicrobial infection (<jats:italic>p<\/jats:italic>\u202f=\u202f0.016), septic shock (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001), Intensive Care Unit admission (<jats:italic>p<\/jats:italic>\u202f=\u202f0.002), and inadequate empirical antibiotic therapy (<jats:italic>p<\/jats:italic>\u202f=\u202f0.002), were linked to increased 7-day mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ST175 was the dominant high-risk clone, associated with antimicrobial resistance, while virulence traits were more common in susceptible strains. Inadequate empirical antibiotic therapy and septic shock significantly impacted early 7-day mortality, underscoring the need for early diagnosis and optimised treatment strategies.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmicb.2025.1681506","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T05:28:43Z","timestamp":1759210123000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Molecular epidemiology and antimicrobial resistance profiles of Pseudomonas aeruginosa causing bloodstream infections in neutropenic cancer patients"],"prefix":"10.3389","volume":"16","author":[{"given":"Irene","family":"Cadenas-Jim\u00e9nez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Mar\u00eda","family":"Bad\u00eda-Tejero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"L\u00f3pez-Causap\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda-Isabel","family":"Morosini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u00e9s","family":"Portillo-Calder\u00f3n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Machado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nieves","family":"Larrosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piluca Mart\u00edn","family":"D\u00e1vila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaira","family":"Palacios-Baena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adaia","family":"Puig-Albasanz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fe","family":"Tubau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Oliver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enric","family":"Sastre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Mart\u00ed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlota","family":"Gudiol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1093\/jac\/dkaa396","article-title":"Molecular mechanisms driving the in vivo development of OXA-10-mediated resistance to ceftolozane\/tazobactam and ceftazidime\/avibactam during treatment of XDR Pseudomonas aeruginosa infections","volume":"76","author":"Arca-Su\u00e1rez","year":"2021","journal-title":"J. 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