Comparison of type III secretion system virulence among fluoroquinolone-susceptible and -resistant clinical isolates of Pseudomonas aeruginosa A. Wong-Beringer,

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Comparison of type III secretion system virulence among fluoroquinolone-susceptible and -resistant clinical isolates of Pseudomonas aeruginosa A. Wong-Beringer, J. Wiener-Kronish, S. Lynch, J. Flanagan Clinical Microbiology and Infection Volume 14, Issue 4, Pages 330-336 (April 2008) DOI: 10.1111/j.1469-0691.2007.01939.x Copyright © 2008 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 1 Distribution of exoU and exoS genes according to levofloxacin MIC. The proportion of isolates carrying exoU increases as the levofloxacin MIC increases, with a concomitant decrease in the proportion of isolates carrying exoS. Clinical Microbiology and Infection 2008 14, 330-336DOI: (10.1111/j.1469-0691.2007.01939.x) Copyright © 2008 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 2 Immunoblot analysis to determine ExoU secretion among 45 clinical isolates and control strains. O indicates the efflux pump over-expressed (EPO) phenotype, and N indicates no EPO phenotype. All isolates with the EPO phenotype also secreted ExoU, while two of three isolates without the EPO phenotype did not secrete the cytotoxin. Sample 17 was re-analysed with an increased amount of total protein. Clinical Microbiology and Infection 2008 14, 330-336DOI: (10.1111/j.1469-0691.2007.01939.x) Copyright © 2008 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 3 Cytotoxicity of clinical isolates according to type III secretion system, genotype and fluoroquinolone resistance. Isolates carrying exoU were more cytotoxic and more resistant than isolates carrying exoS. Clinical Microbiology and Infection 2008 14, 330-336DOI: (10.1111/j.1469-0691.2007.01939.x) Copyright © 2008 European Society of Clinical Infectious Diseases Terms and Conditions

Fig. 4 Correlation of ExoU secretion with cytotoxicity, fluoroquinolone resistance and the efflux pump over-expressed (EPO) phenotype (all shown on a logarithmic scale). The relative frequency of cytotoxicity (cyto), the EPO phenotype (as measured by at least a three-fold decrease in the levofloxacin MIC (L-Dec) in the presence of an efflux pump inhibitor) and fluoroquinolone resistance (levofloxacin MIC, LVX MIC) increase as ExoU secretion increases. Clinical Microbiology and Infection 2008 14, 330-336DOI: (10.1111/j.1469-0691.2007.01939.x) Copyright © 2008 European Society of Clinical Infectious Diseases Terms and Conditions