# Genotypic and phenotypic analyses of two distinct sets of Pseudomonas aeruginosa urinary tract isolates

## TL;DR

This study compares the genetic and physical traits of Pseudomonas aeruginosa from urinary tract infections in the UK and Kuwait, finding high antibiotic resistance in Kuwaiti isolates.

## Contribution

The study provides new insights into the genotypic and phenotypic diversity of P. aeruginosa UTI isolates from two distinct geographic regions.

## Key findings

- Kuwaiti isolates showed extreme antibiotic resistance, suggesting a potential hotspot for AMR.
- Multiple resistance genes were identified, linked to resistance against aminoglycosides, fluoroquinolones, and β-lactams.
- Phenotypic and genomic diversity was observed among the UTI isolates from both regions.

## Abstract

Introduction. Urinary tract infections (UTIs) are associated with a high burden of morbidity, mortality and cost. Pseudomonas aeruginosa employs a myriad of virulence factors, including biofilm formation and motility mechanisms, to cause infections including persistent UTIs. P. aeruginosa is highly resistant to antibiotics, and the World Health Organization has identified it as a pathogen for which novel antimicrobials are urgently required.

Gap statement. Genotypic and phenotypic characterization of P. aeruginosa from UTIs is underreported. In addition, the rise of antimicrobial resistance (AMR) is a cause for concern, particularly in many countries where surveillance is severely lacking.

Aim. To identify genotypic and phenotypic characteristics of P. aeruginosa UTI isolates sourced from the UK and the state of Kuwait, with an emphasis on genotypic diversity and AMR.

Methods. Twenty-three P. aeruginosa UTI isolates were sourced from the UK and Kuwait. To establish the phenotypes of UK isolates, growth analysis, biofilm formation assays, motility assays and antibiotic disc diffusion assays were performed. Whole-genome sequencing, antimicrobial susceptibility assays and in silico detection of AMR-associated genes were conducted on both sets of isolates.

Results. In terms of their phenotypic characteristics and genomic composition, the UTI isolates varied. Multiple resistance genes are associated with resistance to various classes of antibiotics, such as aminoglycosides, fluoroquinolones and β-lactams, particularly in isolates from Kuwait. Extreme antibiotic resistance was detected in the isolates obtained from Kuwait, indicating that the country may be an antibiotic resistance hotspot.

Conclusion. This study highlights that isolates from UTIs are diverse and can display extremely high resistance. Surveillance in countries such as Kuwait is currently limited, and this study suggests the need for greater surveillance.