Capsule Thickness, Not Biofilm Formation, Gives Rise to Mucoid Phenotypes That are More Prevalent in Long-Term Infections: A Study of Clinical Isolates from a Hospital in China.

Background: is a nosocomial pathogen of critical importance due to the increasing numbers of antibiotic-resistant isolates. Colonies can have a smooth or matt appearance, but also exhibit slimy, mucoid growth, with the latter being increasingly isolated in patients in recent years.

Methods: We isolated 60 strains from altogether 56 patients and found that all patients were infected by mucoid strains, with four patients having also matt phenotypes in addition to the mucoid ones. The morphology of the colonies and capsules was observed. The antibiotics susceptibilities were tested, and the biofilm formation ability was determined by crystal violet staining. The whole-genome sequencing (WGS) was performed on all the strains, and then the core genome multilocus sequence typing (cgMLST) and drug resistance gene analysis were performed. Finally, a part of isolates were selected to test virulence in a model.

Results: We observed much larger capsules in the mucoid strains compared to the matt isolates. But the mucoid phenotype did not correlate with the amount of biofilm produced by the strain. Almost all mucus-type were multi-drug resistant isolates, containing various antibiotic resistance genes. The main ST types of mucoid-type were ST191 and ST195, of which ST191 isolates were more virulence, while ST195 isolates were weaker.

Conclusion: The mucoid had resistance to most antibiotics and some strains had high virulence, which should be paid attention in clinical.