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Background  To determine the relationship between type three secretion genotype and fluoroquinolone resistance for  P. aeruginosa  strains isolated from microbial keratitis during the Steroids for Corneal Ulcers Trial (SCUT) and for two laboratory strains, PA103 and PAO1.    Methods  Confirmed  P. aeruginosa  isolates from the SCUT were divided into  exoU (+) or  exoU (−). The  exoU (+) strains contained the gene encoding ExoU, a powerful phospholipase toxin delivered into host cells by the type three secretion system. Isolates were then assessed for susceptibility to fluoroquinolone, cephalosporin, and aminoglycoside antibiotics using disk diffusion assays. Etest was used to determine the MIC of moxifloxacin and other fluoroquinolones. Laboratory isolates in which the  exoU  gene was added or deleted were also tested.    Results  A significantly higher proportion of  exoU (+) strains were resistant to ciprofloxacin (p = 0.001), gatifloxacin (p = 0.003), and ofloxacin (p = 0.002) compared to  exoU (−) isolates. There was no significant difference between  exoU (+) or  exoU (−) negative isolates with respect to susceptibility to other antibiotics except gentamicin. Infections involving resistant  exoU (+) strains trended towards worse clinical outcome. Deletion or acquisition of  exoU  in laboratory isolates did not affect fluoroquinolone susceptibility.    Conclusions  Fluoroquinolone susceptibility of  P. aeruginosa  isolated from the SCUT is consistent with previous studies showing elevated resistance involving  exoU  encoding (cytotoxic) strains, and suggest worse clinical outcome from infections involving resistant isolates. Determination of  exoU  expression in clinical isolates of  P. aeruginosa  may be helpful in directing clinical management of patients with microbial keratitis.

bmc ophthalmology

Cytotoxic clinical isolates of Pseudomonas aeruginosaidentified during the Steroids for Corneal Ulcers Trial show elevated resistance to fluoroquinolones