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Background  Global concerns have been raised due to upward trend of Multi-drug Resistant (MDR)  Pseudomonas aeruginosa  reports in ocular infections. Our aim was to characterize the virulence determinants of MDR  P. aeruginosa  causing ocular infections.    Methods   P. aeruginosa  strains were isolated from 46 patients with conjunctivitis (2), endophthalmitis (11) and active keratitis (25) seen at our Institute, between 2016 and 2020. The isolates were identified by Vitek-2 and characterized based on growth kinetics, biofilm formation, motility, pyoverdine and pyocyanin production, phospholipase and catalase activity, urease production along with expression of exotoxins (exo-A, exo-U and exo-S) and correlated to its antibiotic profiles.    Results  Of the 46  P. aeruginosa  isolates, 23 were MDR and were significantly ( p  = 0.03) associated with older (> 65) patients, along with higher production of pyoverdine (58.3%), pyocyanin (30.4%), phospholipase (91.6%) and protease (62.5%) activity, formed strong biofilms and exo-A (30.4%). No significant relation between motility, urease and catalase production with antibiotic susceptibility was observed. Heatmap and PCoA analysis confirmed this unique virulence profile associated with  MDR-PA  strains.    Conclusion  Phenotypic characteristics of  P.aeruginosa  might be responsible for increased colonization and antibiotic resistance observed in vivo and understanding these differences may lead to development of clinical guidelines for the management of MDR infections.

journal of ophthalmic inflammation and infection

Virulence factors in multidrug (MDR) and Pan-drug resistant (XDR) Pseudomonas aeruginosa: a cross-sectional study of isolates recovered from ocular infections in a high-incidence setting in southern India