Abstract
Background: Pseudomonas.aeruginosa is among the most common opportunistic hospital pathogens, which exhibit an innate resistance and has developed increasing resistance to many useful antimicrobial agents over the last decades. This study investigated the occurrence of important types of ESBLs and MBLs in association with potential important virulence factors among P. aeruginosa isolates from feces of Jordanian infants. 
 Methods: A total of 302 feces samples were obtained randamely from neonates and infants admitted to Pediatric Clinic and the Neonate Intensive Care Unit (NICU)/Jordan University Hospital (JUH), over a 9-months period(2016- 2017). Fecal samples were cultured for P.aeruginosa and their growth was identified and tested using microbiological and antibiotic susceptibility methods. Additionly, virulence factors, antimicrobial resistance genes and genotypes were detected using Polymerase Chain Reaction (PCR).
 Results: A total of 16/302 (5.3%) of P. aeruginosa isolates were recovered from feces samples. Antimicrobial susceptibility of the isolates ranged between the lowest 18.75% to meropenem and highest of 87.5% to azetreonam among 9 tested drugs. The percentage of specific genes of ESBLs and MBLs in 16 P.aeruginosa isolates were the following: blaOXA-50, blaTEM, blaCTX-M , blaVIM ,blaKPC , blaSHV ,blaGES, and blaVEB were detected at the rate of 13(81.2%), 13(81.2%), 12(75%), 12(75%), 11(68.7%), 10(62.5%), 2(12.5),1(6.2%), respectively. The percentage of the potential virulence genes in the same isolates were detected as follow: lasB, algD , toxA, exo S and exo U at the rate of 100%, 87.5% , 81.2%, 81.2%,31.2, respectively. All P.aeruginosa isolates observed to develop beta-hemolysis on both human and sheep blood agar, and to produce either pyoverdin ((56.3%) or pyocyanin (43.7%). 
 Conclusions: The present study demonstrates high occurrence of multidrug resistant P.aeruginosa isolates in infant feces which carried high rates of important genes of ESBLs and MBLs and potential virulence factors.
Highlights
IntroductionPseudomonas aeruginosa is a major cause of nosocomial infections in children and adults, and its responsible for about 10% of all hospital-acquired infections worldwide [1, 2].P. aeruginosa causes severe infections especially in immune-compromised patients, and it continues to pose a therapeutic challenge resulting in high rate of morbidity and mortality due to development of drug resistance during antibiotic treatment of patients [3,4].P. aeruginosa infections are becoming more difficult to treat, and the number of multidrug drug resistant isolates from clinical and hospital environment sources is increasing worldwide including Arab Middle East countries [1, 5,6,7]
The present study demonstrates high occurrence of multidrug resistant P. aeruginosa isolates from only hospitalized infant feces which carried high rates of important genes of ESBLs and MBLs and potential virulence factors
This study aims to investigate the distribution of most important types of ESBLs, MBLs, and potential virulence genes in P. aeruginosa isolates from feces of examined infants in a tertiary care center in Amman, Jordan by using culture and molecular Polymerase Chain Reaction (PCR) methods
Summary
Pseudomonas aeruginosa is a major cause of nosocomial infections in children and adults, and its responsible for about 10% of all hospital-acquired infections worldwide [1, 2].P. aeruginosa causes severe infections especially in immune-compromised patients, and it continues to pose a therapeutic challenge resulting in high rate of morbidity and mortality due to development of drug resistance during antibiotic treatment of patients [3,4].P. aeruginosa infections are becoming more difficult to treat, and the number of multidrug drug resistant isolates from clinical and hospital environment sources is increasing worldwide including Arab Middle East countries [1, 5,6,7]. P. aeruginosa infections are especially difficult to prevent and to treat because of its common occurrence in hospital environment and water sources, and for both intrinsic resistance to many antibiotics as well as rapid development of antibiotic resistance [9,10,11]. These features facilitate P. aeruginosa infections to become a serious health care issue in hospitals worldwide [12]. This study investigated the occurrence of important types of ESBLs and MBLs in association with potential important virulence factors among P. aeruginosa isolates from feces of Jordanian infants
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