{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:14:14Z","timestamp":1791227654175,"version":"4.1.0"},"reference-count":64,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T00:00:00Z","timestamp":1727913600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Universidad Nacional Aut\u00f3noma de M\u00e9xico, Direcci\u00f3n General de Asuntos del Personal Acad\u00e9mico (DGAPA)","award":["IN203723"],"award-info":[{"award-number":["IN203723"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>The increase in the number of hospital strains of hypervirulent and multidrug resistant (MDR) Pseudomonas aeruginosa is a major health problem that reduces medical treatment options and increases mortality. The molecular profiles of virulence and multidrug resistance of P. aeruginosa-associated hospital and community infections in Mexico have been poorly studied. In this study, we analyzed the different molecular profiles associated with the virulence genotypes related to multidrug resistance and the genotypes of multidrug efflux pumps (mex) in P. aeruginosa causing clinically critical infections isolated from Mexican patients with community- and hospital-acquired infections. Susceptibility to 12 antibiotics was determined using the Kirby\u2013Bauer method. The identification of P. aeruginosa and the detection of virulence and efflux pump system genes were performed using conventional PCR. All strains isolated from patients with hospital-acquired (n = 67) and community-acquired infections (n = 57) were multidrug resistant, mainly to beta-lactams (ampicillin [96.7%], carbenicillin [98.3%], cefalotin [97.5%], and cefotaxime [87%]), quinolones (norfloxacin [78.2%]), phenicols (chloramphenicol [91.9%]), nitrofurans (nitrofurantoin [70.9%]), aminoglycosides (gentamicin [75%]), and sulfonamide\/trimethoprim (96.7%). Most strains (95.5%) isolated from patients with hospital- and community-acquired infections carried the adhesion (pilA) and biofilm formation (ndvB) genes. Outer membrane proteins (oprI and oprL) were present in 100% of cases, elastases (lasA and lasB) in 100% and 98.3%, respectively, alkaline protease (apr) and alginate (algD) in 99.1% and 97.5%, respectively, and chaperone (groEL) and epoxide hydrolase (cif) in 100% and 97.5%, respectively. Overall, 99.1% of the strains isolated from patients with hospital- and community-acquired infections carried the efflux pump system genes mexB and mexY, while 98.3% of the strains carried mexF and mexZ. These findings show a wide distribution of the virulome related to the genotypic and phenotypic profiles of antibiotic resistance and the origin of the strains isolated from patients with hospital- and community-acquired infections, demonstrating that these molecular mechanisms may play an important role in high-pathogenicity infections caused by P. aeruginosa.<\/jats:p>","DOI":"10.3390\/pathogens13100868","type":"journal-article","created":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T06:45:52Z","timestamp":1727937952000},"page":"868","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Molecular Properties of Virulence and Antibiotic Resistance of Pseudomonas aeruginosa Causing Clinically Critical Infections"],"prefix":"10.3390","volume":"13","author":[{"given":"Eric","family":"Monroy-P\u00e9rez","sequence":"first","affiliation":[{"name":"Facultad de Estudios Superiores Iztacala, Universidad Nacional Aut\u00f3noma de M\u00e9xico, Tlalnepantla 54090, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennefer Paloma","family":"Herrera-Gabriel","sequence":"additional","affiliation":[{"name":"Facultad de Estudios Superiores Iztacala, Universidad Nacional Aut\u00f3noma de M\u00e9xico, Tlalnepantla 54090, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Olvera-Navarro","sequence":"additional","affiliation":[{"name":"Facultad de Estudios Superiores Iztacala, Universidad Nacional Aut\u00f3noma de M\u00e9xico, Tlalnepantla 54090, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorena","family":"Ugalde-Tecillo","sequence":"additional","affiliation":[{"name":"Facultad de Estudios Superiores Iztacala, Universidad Nacional Aut\u00f3noma de M\u00e9xico, Tlalnepantla 54090, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3325-1458","authenticated-orcid":false,"given":"Luis Rey","family":"Garc\u00eda-Cort\u00e9s","sequence":"additional","affiliation":[{"name":"Coordinaci\u00f3n de Investigaci\u00f3n del Estado de M\u00e9xico Oriente, Insitituto Mexicano del Seguro Social, Tlalnepantla de Baz 50090, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mois\u00e9s","family":"Moreno-Noguez","sequence":"additional","affiliation":[{"name":"Coordinaci\u00f3n Cl\u00ednica de Educaci\u00f3n e Investigaci\u00f3n en Salud, Unidad de Medicina Familiar No. 55, Insitituto Mexicano del Seguro Social Estado de M\u00e9xico Oriente, Zumpango 55600, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e9ctor","family":"Mart\u00ednez-Gregorio","sequence":"additional","affiliation":[{"name":"Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, Universidad Nacional Aut\u00f3noma de M\u00e9xico, Tlalnepantla 54090, Mexico"},{"name":"Laboratorio Nacional en Salud, Diagn\u00f3stico Molecular y Efecto Ambiental en Enfermedades Cr\u00f3nico-Degenerativas, Facultad de Estudios Superiores Iztacala, Universidad Nacional Aut\u00f3noma de M\u00e9xico, Tlalnepantla 54090, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe","family":"Vaca-Paniagua","sequence":"additional","affiliation":[{"name":"Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, Universidad Nacional Aut\u00f3noma de M\u00e9xico, Tlalnepantla 54090, Mexico"},{"name":"Laboratorio Nacional en Salud, Diagn\u00f3stico Molecular y Efecto Ambiental en Enfermedades Cr\u00f3nico-Degenerativas, Facultad de Estudios Superiores Iztacala, Universidad Nacional Aut\u00f3noma de M\u00e9xico, Tlalnepantla 54090, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria Luz","family":"Paniagua-Contreras","sequence":"additional","affiliation":[{"name":"Facultad de Estudios Superiores Iztacala, Universidad Nacional Aut\u00f3noma de M\u00e9xico, Tlalnepantla 54090, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.2147\/IDR.S299742","article-title":"Screening of Antimicrobial Resistance Genes and Epidemiological Features in Hospital and Community-Associated Carbapenem-Resistant Pseudomonas aeruginosa Infections","volume":"14","author":"Ejder","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1093\/jac\/dkab358","article-title":"Short versus prolonged courses of antimicrobial therapy for patients with uncomplicated Pseudomonas aeruginosa bloodstream infection: A retrospective study","volume":"77","author":"Bae","year":"2021","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.ijid.2016.06.014","article-title":"Prevalence of Pseudomonas aeruginosa and antimicrobial-resistant Pseudomonas aeruginosa in patients with pneumonia in mainland China: A systematic review and meta-analysis","volume":"49","author":"Ding","year":"2016","journal-title":"Int. J. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Newman, J.N., Floyd, R.V., and Fothergill, J.L. (2022). Invasion and diversity in Pseudomonas aeruginosa urinary tract infections. J. Med. Microbiol., 71.","DOI":"10.1099\/jmm.0.001458"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"El Husseini, N., Mekonnen, S.A., Hall, C.L., Cole, S.J., Carter, J.A., Belew, A.T., El-Sayed, N.M., and Lee, V.T. (2024). Characterization of the Entner-Doudoroff pathway in Pseudomonas aeruginosa catheter-associated urinary tract infections. J. Bacteriol., 206.","DOI":"10.1128\/jb.00361-23"},{"key":"ref_6","first-page":"403","article-title":"Study of Antibiotic Resistant Genes in Pseudomonas aeroginosa Isolated from Burns and Wounds","volume":"77","year":"2022","journal-title":"Arch. Razi Inst."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Markou, P., and Apidianakis, Y. (2014). Pathogenesis of intestinal Pseudomonas aeruginosa infection in patients with cancer. Front. Cells Infect. Microbiol., 3.","DOI":"10.3389\/fcimb.2013.00115"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Gomez-Olivas, J.D., Oscullo, G., and Martinez-Garcia, M.A. (2023). Isolation of Pseudomonas aeruginosa in Stable Chronic Obstructive Pulmonary Disease Patients-Should We Treat It?. J. Clin. Med., 12.","DOI":"10.3390\/jcm12155054"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Hall, C.W., Hinz, A.J., Gagnon, L.B., Zhang, L., Nadeau, J.P., Copeland, S., Saha, B., and Mah, T.F. (2018). Pseudomonas aeruginosa Biofilm Antibiotic Resistance Gene ndvB Expression Requires the RpoS Stationary-Phase Sigma Factor. Appl. Environ. Microbiol., 84.","DOI":"10.1128\/AEM.02762-17"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.anl.2016.07.005","article-title":"Difference of Type 3 secretion system (T3SS) effector gene genotypes (exoU and exoS) and its implication to antibiotics resistances in isolates of P. aeruginosa from chronic otitis media","volume":"44","author":"Park","year":"2017","journal-title":"Auris Nasus Larynx"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.micpath.2016.07.013","article-title":"Molecular detection of virulence genes in Pseudomonas aeruginosa isolated from children with Cystic Fibrosis and burn wounds in Iran","volume":"99","author":"Faraji","year":"2016","journal-title":"Microb. Pathog."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"892","DOI":"10.3855\/jidc.10675","article-title":"Virulence genes and antibiotic resistance of Pseudomonas aeruginosa isolated from patients in the Northwestern of Morocco","volume":"13","author":"Elmouaden","year":"2019","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Sauvage, S., and Hardouin, J. (2020). Exoproteomics for Better Understanding Pseudomonas aeruginosa Virulence. Toxins, 12.","DOI":"10.3390\/toxins12090571"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"de Sousa, T., H\u00e9braud, M., Dapkevicius, M.L.N.E., Maltez, L., Pereira, J.E., Capita, R., Alonso-Calleja, C., Igrejas, G., and Poeta, P. (2021). Genomic and Metabolic Characteristics of the Pathogenicity in Pseudomonas aeruginosa. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms222312892"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3238","DOI":"10.1093\/gbe\/evx243","article-title":"Emergence and Spread of Epidemic Multidrug-Resistant Pseudomonas aeruginosa","volume":"9","author":"Tada","year":"2017","journal-title":"Genome Biol. Evol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Al-Orphaly, M., Hadi, H.A., Eltayeb, F.K., Al-Hail, H., Samuel, B.G., Sultan, A.A., and Skariah, S. (2021). Epidemiology of Multidrug-Resistant Pseudomonas aeruginosa in the Middle East and North Africa Region. mSphere, 6.","DOI":"10.1128\/mSphere.00202-21"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1590\/0037-8682-0506-2017","article-title":"Mortality in patients with multidrug-resistant Pseudomonas aeruginosa infections: A meta-analysis","volume":"51","author":"Matos","year":"2018","journal-title":"Rev Soc Bras Med. Trop."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/S1473-3099(17)30753-3","article-title":"Discovery, research, and development of new antibiotics: The WHO priority list of antibiotic-resistant bacteria and tuberculosis","volume":"18","author":"Tacconelli","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.biotechadv.2018.11.013","article-title":"Antibiotic resistance in Pseudomonas aeruginosa: Mechanisms and alternative therapeutic strategies","volume":"3","author":"Pang","year":"2019","journal-title":"Biotechnol. Adv."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Botelho, J., Grosso, F., and Peixe, L. (2019). Antibiotic resistance in Pseudomonas aeruginosa\u2014Mechanisms, epidemiology and evolution. Drug Resist. Update, 4.","DOI":"10.1016\/j.drup.2019.07.001"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Dreier, J., and Ruggerone, P. (2015). Interaction of antibacterial compounds with RND efflux pumps in Pseudomonas aeruginosa. Front. Microbiol., 6.","DOI":"10.3389\/fmicb.2015.00660"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Avakh, A., Grant, G.D., Cheesman, M.J., Kalkundri, T., and Hall, S. (2023). The Art of War with Pseudomonas aeruginosa: Targeting Mex Efflux Pumps Directly to Strategically Enhance Antipseudomonal Drug Efficacy. Antibiotics, 12.","DOI":"10.3390\/antibiotics12081304"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.ijmm.2017.07.004","article-title":"Relevance of multidrug-resistant Pseudomonas aeruginosa infections in cystic fibrosis","volume":"307","author":"Stefani","year":"2017","journal-title":"Int. J. Med. Microbiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1556\/030.2023.02029","article-title":"Association of carbapenem and multidrug resistance with the expression of efflux pump-encoding genes in Pseudomonas aeruginosa clinical isolates","volume":"70","author":"Yousefi","year":"2023","journal-title":"Acta Microbiol. Immunol. Hung."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"374","DOI":"10.3855\/jidc.10953","article-title":"Antibiotic resistance, virulence factors and genotyping of Pseudomonas aeruginosa in public hospitals of northeastern Mexico","volume":"13","year":"2019","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_26","first-page":"352","article-title":"Prevention Epicenters Program, US Centers for Disease Control and Prevention. Multidrug- and Carbapenem-Resistant Pseudomonas aeruginosa in Children, United States, 1999\u20132012","volume":"6","author":"Logan","year":"2017","journal-title":"J. Pediatric. Infect. Dis. Soc."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Zahedi-Bialvaei, A., Rahbar, M., Hamidi-Farahani, R., Asgari, A., Esmailkhani, A., Mardani-Dashti, Y., and Soleiman-Meigooni, S. (2021). Expression of RND efflux pumps mediated antibiotic resistance in Pseudomonas aeruginosa clinical strains. Microb. Pathog., 153.","DOI":"10.1016\/j.micpath.2021.104789"},{"key":"ref_28","unstructured":"Carpenter, D.E. (2013). Performance standards for antimicrobial susceptibility testing. CLSI, Twenty-Third Informational Supplement M100-S23, Clinical and Laboratory Standards Institute."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2888","DOI":"10.1128\/JCM.00792-09","article-title":"Development of a multiplex PCR-based rapid typing method for enterohemorrhagic Escherichia coli O157 strains","volume":"47","author":"Ooka","year":"2009","journal-title":"J. Clin. Microbiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1016\/j.biortech.2010.08.027","article-title":"Antibiotic resistance profiles and virulence markers of Pseudomonas aeruginosa strains isolated from composts","volume":"102","author":"Kaszab","year":"2011","journal-title":"Bioresour. Technol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.jcma.2016.08.011","article-title":"Beta-lactamase-producing Pseudomonas aeruginosa: Phenotypic characteristics and molecular identification of virulence genes","volume":"80","author":"Ullah","year":"2017","journal-title":"J. Chin. Med. Assoc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s10096-016-2792-8","article-title":"Determinants for persistence of Pseudomonas aeruginosa in hospitals: Interplay between resistance, virulence and biofilm formation","volume":"36","author":"Kaiser","year":"2017","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Kamel, N.A., Tohamy, S.T., Alshahrani, M.Y., and Aboshanab, K.M. (2024). Evaluation of fortimicin antibiotic combinations against MDR Pseudomonas aeruginosa and resistome analysis of a whole genome sequenced pandrug resistant isolate. BMC Microbiol., 24.","DOI":"10.1186\/s12866-024-03316-2"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Xu, C., Zeng, F., Huang, Y., Xu, Q., Yang, Y., Gong, W., Shi, C., and Zhang, Y. (2024). Clinical efficacy of ceftazidime\/avibactam combination therapy for severe hospital-acquired pulmonary infections caused by carbapenem-resistant and difficult-to-treat Pseudomonas aeruginosa. Int. J. Antimicrob. Agents, 63.","DOI":"10.1016\/j.ijantimicag.2023.107021"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Ali, A.S.B.E., Ozler, B., and Baddal, B. (2023). Characterization of Virulence Genes Associated with Type III Secretion System and Biofilm Formation in Pseudomonas aeruginosa Clinical Isolates. Curr. Microbiol., 80.","DOI":"10.1007\/s00284-023-03498-4"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Zhen, S., Zhao, Y., Chen, Z., Zhang, T., Wang, J., Jiang, E., Zhang, F., Mi, Y., Zhu, X., and Han, M. (2023). Assessment of mortality-related risk factors and effective antimicrobial regimens for treatment of bloodstream infections caused by carbapenem-resistant Pseudomonas aeruginosa in patients with hematological diseases. Front. Cells Infect. Microbiol., 13.","DOI":"10.3389\/fcimb.2023.1156651"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Wijit, K., Sonthisombat, P., and Diewsurin, J. (2023). A score to predict Pseudomonas aeruginosa infection in older patients with community-acquired pneumonia. BMC Infect. Dis., 23.","DOI":"10.1186\/s12879-023-08688-w"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.micpath.2016.10.027","article-title":"Passive immunization against Pseudomonas aeruginosa recombinant PilA in a murine burn wound model","volume":"101","author":"Mousavi","year":"2016","journal-title":"Microb. Pathog."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Zhang, L., Fritsch, M., Hammond, L., Landreville, R., Slatculescu, C., Colavita, A., and Mah, T.F. (2013). Identification of genes involved in Pseudomonas aeruginosa biofilm-specific resistance to antibiotics. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0061625"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"6210","DOI":"10.1128\/AAC.01406-15","article-title":"Key residues of outer membrane protein OprI involved in hexamer formation and bacterial susceptibility to cationic antimicrobial peptides","volume":"59","author":"Chang","year":"2015","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"853","DOI":"10.2147\/IDR.S401473","article-title":"oprL Gene Sequencing, Resistance Patterns, Virulence Genes, Quorum Sensing and Antibiotic Resistance Genes of XDR Pseudomonas aeruginosa Isolated from Broiler Chickens","volume":"16","author":"Algammal","year":"2023","journal-title":"Infect. Drug Resist."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Jurado-Mart\u00edn, I., Sainz-Mej\u00edas, M., and McClean, S. (2021). Pseudomonas aeruginosa: An Audacious Pathogen with an Adaptable Arsenal of Virulence Factors. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22063128"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Shin, H., Jeon, J., Lee, J.H., Jin, S., and Ha, U.H. (2017). Pseudomonas aeruginosa GroEL Stimulates Production of PTX3 by Activating the NF-\u03baB Pathway and Simultaneously Downregulating MicroRNA-9. Infect. Immun., 85.","DOI":"10.1128\/IAI.00935-16"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Kuang, Z., Hao, Y., Walling, B.E., Jeffries, J.L., Ohman, D.E., and Lau, G.W. (2011). Pseudomonas aeruginosa elastase provides an escape from phagocytosis by degrading the pulmonary surfactant protein-A. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0027091"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1136\/thoraxjnl-2017-210298","article-title":"LasB protease impairs innate immunity in mice and humans by targeting a lung epithelial cystic fibrosis transmembrane regulator-IL-6-antimicrobial-repair pathway","volume":"73","author":"Villeret","year":"2018","journal-title":"Thorax"},{"key":"ref_46","first-page":"386","article-title":"Pseudomonas aeruginosa alkaline protease blocks complement activation via the classical and lectin pathways","volume":"188","author":"Laarman","year":"2012","journal-title":"J. Inmunol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"7512","DOI":"10.4049\/jimmunol.175.11.7512","article-title":"The exopolysaccharide alginate protects Pseudomonas aeruginosa biofilm bacteria from IFN-gamma-mediated macrophage killing","volume":"175","author":"Leid","year":"2005","journal-title":"J. Immunol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Goltermann, L., and Tolker-Nielsen, T. (2017). Importance of the Exopolysaccharide Matrix in Antimicrobial Tolerance of Pseudomonas aeruginosa Aggregates. Antimicrob. Agents Chemother., 61.","DOI":"10.1128\/AAC.02696-16"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"3902","DOI":"10.1128\/IAI.00338-07","article-title":"The Pseudomonas aeruginosa secreted protein PA2934 decreases apical membrane expression of the cystic fibrosis transmembrane conductance regulator","volume":"75","author":"MacEachran","year":"2007","journal-title":"Infect. Immun."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1111\/jam.12463","article-title":"Virulence factors and infection ability of Pseudomonas aeruginosa isolates from a hydropathic facility and respiratory infections","volume":"116","author":"Pereira","year":"2014","journal-title":"J. Appl. Microbiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1097\/ICO.0000000000001132","article-title":"The cif Virulence Factor Gene Is Present in Isolates from Patients with Pseudomonas aeruginosa Keratitis","volume":"36","author":"Bahl","year":"2017","journal-title":"Cornea"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Thacharodi, A., and Lamont, I.L. (2022). Aminoglycoside resistance in Pseudomonas aeruginosa: The contribution of the MexXY-OprM efflux pump varies between isolates. J. Med. Microbiol., 71.","DOI":"10.1099\/jmm.0.001551"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"16566","DOI":"10.1039\/D2CP00951J","article-title":"Recognition of quinolone antibiotics by the multidrug efflux transporter MexB of Pseudomonas aeruginosa","volume":"24","author":"Gervasoni","year":"2022","journal-title":"Phys. Chem. Chem. Phys."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Kumar, A., and Schweizer, H.P. (2011). Evidence of MexT-independent overexpression of MexEF-OprN multidrug efflux pump of Pseudomonas aeruginosa in presence of metabolic stress. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0026520"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Laborda, P., Lolle, S., Hernando-Amado, S., Alcalde-Rico, M., Aan\u00e6s, K., Mart\u00ednez, J.L., Molin, S., and Johansen, H.K. (2024). Mutations in the efflux pump regulator MexZ shift tissue colonization by Pseudomonas aeruginosa to a state of antibiotic tolerance. Nat. Commun., 15.","DOI":"10.1038\/s41467-024-46938-w"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1906","DOI":"10.1128\/AAC.01645-10","article-title":"Spanish Network for Research in Infectious Diseases (REIPI). Overexpression of AmpC and efflux pumps in Pseudomonas aeruginosa isolates from bloodstream infections: Prevalence and impact on resistance in a Spanish multicenter study","volume":"55","author":"Cabot","year":"2011","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2681","DOI":"10.1007\/s11274-014-1692-2","article-title":"The effects of active efflux pumps on antibiotic resistance in Pseudomonas aeruginosa","volume":"30","author":"Terzi","year":"2014","journal-title":"World J. Microbiol. Biotechnol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1556\/030.2022.01882","article-title":"Characteristics of multiresistant Pseudomonas aeruginosa isolates from burn patients in Iran","volume":"70","author":"Abednezhad","year":"2023","journal-title":"Acta Microbiol. Immunol. Hung."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Ugwuanyi, F.C., Ajayi, A., Ojo, D.A., Adeleye, A.I., and Smith, S.I. (2021). Evaluation of efux pump activity and bioflm formation in multidrug resistant clinical isolates of Pseudomonas aeruginosa isolated from a Federal Medical Center in Nigeria. Ann. Clin. Microbiol. Antimicrob., 2.","DOI":"10.1186\/s12941-021-00417-y"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.jgar.2020.01.011","article-title":"Prevalence of \u03b2-lactamase and antibiotic-resistant Pseudomonas aeruginosa in the Arab region","volume":"22","author":"Nasser","year":"2020","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e159","DOI":"10.1016\/S2666-5247(22)00329-9","article-title":"Global epidemiology and clinical outcomes of carbapenem-resistant Pseudomonas aeruginosa and associated carbapenemases (POP): A prospective cohort study","volume":"4","author":"Reyes","year":"2023","journal-title":"Lancet Microbe"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.micpath.2017.12.052","article-title":"Diversity of virulence genes in multidrug resistant Pseudomonas aeruginosa isolated from burn wound infections","volume":"115","author":"Haghi","year":"2018","journal-title":"Microb. Pathog."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1093\/cid\/ciu866","article-title":"Spanish Network for Research in Infectious Diseases (REIPI). Influence of virulence genotype and resistance profile in the mortality of Pseudomonas aeruginosa bloodstream infections","volume":"60","author":"Cabot","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Bosaeed, M., Ahmad, A., Alali, A., Mahmoud, E., Alswidan, L., Alsaedy, A., Aljuhani, S., Alalwan, B., Alshamrani, M., and Alothman, A. (2020). Experience with Ceftolozane-Tazobactam for the Treatment of Serious Pseudomonas aeruginosa Infections in Saudi Tertiary Care Center. Infect. Dis., 13.","DOI":"10.1177\/1178633720905977"}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/13\/10\/868\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:09:52Z","timestamp":1760112592000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/13\/10\/868"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,3]]},"references-count":64,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["pathogens13100868"],"URL":"https:\/\/doi.org\/10.3390\/pathogens13100868","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,3]]}}}