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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Microbiol.</journal-id>
<journal-title>Frontiers in Microbiology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Microbiol.</abbrev-journal-title>
<issn pub-type="epub">1664-302X</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fmicb.2020.544653</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Microbiology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Prevalence, Virulence, Antimicrobial Resistance, and Molecular Characterization of <italic>Pseudomonas aeruginosa</italic> Isolates From Drinking Water in China</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>Wei</surname> <given-names>Lei</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/760053/overview"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name><surname>Wu</surname> <given-names>Qingping</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="corresp" rid="c001"><sup>&#x002A;</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/254423/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Zhang</surname> <given-names>Jumei</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/276591/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Guo</surname> <given-names>Weipeng</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/276595/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Gu</surname> <given-names>Qihui</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/731313/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Wu</surname> <given-names>Huiqing</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/339141/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Wang</surname> <given-names>Juan</given-names></name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/386990/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Lei</surname> <given-names>Tao</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/645963/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Xue</surname> <given-names>Liang</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Zhang</surname> <given-names>Youxiong</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Wei</surname> <given-names>Xianhu</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Zeng</surname> <given-names>Xiaocong</given-names></name>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref>
</contrib>
</contrib-group>
<aff id="aff1"><sup>1</sup><institution>Guangdong Provincial Key Laboratory of Microbiology Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Guangdong Institute of Microbiology, Guangdong Academy of Sciences</institution>, <addr-line>Guangzhou</addr-line>, <country>China</country></aff>
<aff id="aff2"><sup>2</sup><institution>School of Bioscience and Bioengineering, South China University of Technology</institution>, <addr-line>Guangzhou</addr-line>, <country>China</country></aff>
<aff id="aff3"><sup>3</sup><institution>College of Food Science, South China Agricultural University</institution>, <addr-line>Guangzhou</addr-line>, <country>China</country></aff>
<aff id="aff4"><sup>4</sup><institution>Biological Testing and Analysis Department, Guangdong Provincial Institute of Food Inspection</institution>, <addr-line>Guangzhou</addr-line>, <country>China</country></aff>
<author-notes>
<fn fn-type="edited-by"><p>Edited by: Natalia V. Kirienko, Rice University, United States</p></fn>
<fn fn-type="edited-by"><p>Reviewed by: Yanhong Liu, United States Department of Agriculture (USDA), United States; Dingqiang Chen, Zhujiang Hospital, Southern Medical University, China; Yanmei Li, University of Maryland, Baltimore, United States; Guangchao Yu, Jinan University, China</p></fn>
<corresp id="c001">&#x002A;Correspondence: Qingping Wu, <email>wuqp203@163.com</email></corresp>
<fn fn-type="other" id="fn004"><p>This article was submitted to Antimicrobials, Resistance and Chemotherapy, a section of the journal Frontiers in Microbiology</p></fn>
</author-notes>
<pub-date pub-type="epub">
<day>03</day>
<month>12</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="collection">
<year>2020</year>
</pub-date>
<volume>11</volume>
<elocation-id>544653</elocation-id>
<history>
<date date-type="received">
<day>21</day>
<month>03</month>
<year>2020</year>
</date>
<date date-type="accepted">
<day>02</day>
<month>11</month>
<year>2020</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2020 Wei, Wu, Zhang, Guo, Gu, Wu, Wang, Lei, Xue, Zhang, Wei and Zeng.</copyright-statement>
<copyright-year>2020</copyright-year>
<copyright-holder>Wei, Wu, Zhang, Guo, Gu, Wu, Wang, Lei, Xue, Zhang, Wei and Zeng</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p></license>
</permissions>
<abstract>
<p><italic>Pseudomonas aeruginosa</italic> is an important opportunistic pathogen and remains a major threat to the microbial safety of drinking water. There is a lack of comprehensive data on <italic>P</italic>. <italic>aeruginosa</italic> contamination in drinking water in China. Therefore, this study aimed to determine the prevalence, genetic diversity, virulence genes, and antimicrobial resistance of <italic>P</italic>. <italic>aeruginosa</italic> isolated from mineral water and spring water in China. From January 2013 to January 2014, 314 drinking water samples were collected from 23 cities in China. Of the collected samples, 77 (24.5%) were contaminated with <italic>P. aeruginosa</italic>, and these comprised 34 raw water (30.4%), 39 activated carbon-filtered water (30.6%), and four final water product (3.9%). A total of 132 <italic>P. aeruginosa</italic> isolates were obtained, and all of them showed the presence of virulence genes, with the detection rates of <italic>ExoU</italic>, <italic>ExoS</italic>, <italic>phzM</italic>, <italic>toxA</italic>, and <italic>lasB</italic> genes being 7.6, 86.3, 95.5, 89.4, and 100%, respectively. All isolates were sensitive to the 14 antibiotics (ciprofloxacin, levofloxacin, ofloxacin, norfloxacin, gentamicin, tobramycin, amikacin, polymyxin B, imipenem, meropenem, aztreonam, ceftazidime, cefepime, and piperacillin/tazobactam) tested. The 132 isolates were categorized into 42 sequence types according to multilocus sequence typing, and ST235 accounted for 8.3% (11) of the total isolates. Thus, this study provides comprehensive data on the prevalence and characteristics of <italic>P. aeruginosa</italic> in drinking water in China and can aid in developing preventive measures against contamination during the drinking water treatment process.</p>
</abstract>
<kwd-group>
<kwd><italic>Pseudomonas aeruginosa</italic></kwd>
<kwd>mineral water</kwd>
<kwd>spring water</kwd>
<kwd>virulence genes</kwd>
<kwd>multilocus sequence typing</kwd>
</kwd-group>
<counts>
<fig-count count="3"/>
<table-count count="5"/>
<equation-count count="0"/>
<ref-count count="36"/>
<page-count count="9"/>
<word-count count="0"/>
</counts>
</article-meta>
</front>
<body>
<sec id="S1">
<title>Introduction</title>
<p>Microbial contamination of drinking water is a common problem that has a serious impact on public health (<xref ref-type="bibr" rid="B17">Li et al., 2017</xref>; <xref ref-type="bibr" rid="B32">Wang et al., 2018</xref>). <italic>Pseudomonas aeruginosa</italic> is an important opportunistic pathogen and is frequently detected in drinking water (<xref ref-type="bibr" rid="B31">Vaz-Moreira et al., 2012</xref>; <xref ref-type="bibr" rid="B18">Lu et al., 2016</xref>). <italic>P. aeruginosa</italic> widely inhabits diverse environments, including water and soil, and is one of the main pathogens of nosocomial infections, such as cystic fibrosis (<xref ref-type="bibr" rid="B1">Agarwal et al., 2005</xref>; <xref ref-type="bibr" rid="B8">Driscoll et al., 2007</xref>). <italic>P. aeruginosa</italic> has a disinfectant resistance gene and can form a biofilm, which makes it the most common contaminant in drinking water production (<xref ref-type="bibr" rid="B11">Guerin-Mechin et al., 2000</xref>; <xref ref-type="bibr" rid="B20">Mah et al., 2003</xref>). Previous studies have shown that <italic>P. aeruginosa</italic> is the most suitable indicator of the presence of pathogens in drinking water (<xref ref-type="bibr" rid="B22">Mena and Gerba, 2009</xref>). The recommended international code of hygienic practice for collecting, processing, and marketing of natural mineral waters (CAC/RCP 33-1985) and on the quality of water intended for human consumption (98/83/EC) short-listed <italic>P. aeruginosa</italic> as a bacterial indicator of drinking water quality.</p>
<p>For epidemiological surveillance of <italic>P. aeruginosa</italic> in drinking water, molecular typing methods have the advantage of discriminatory ability and stability (<xref ref-type="bibr" rid="B22">Mena and Gerba, 2009</xref>). In recent studies, multilocus sequence typing (MLST), pulsed field gel electrophoresis (PFGE), enterobacterial repetitive intergenic consensus-polymerase chain reaction, and random-amplified polymorphic DNA have been conducted for tracing sources of <italic>P. aeruginosa</italic> (<xref ref-type="bibr" rid="B36">Wu et al., 2016</xref>; <xref ref-type="bibr" rid="B2">Bel Hadj Ahmed et al., 2019</xref>; <xref ref-type="bibr" rid="B28">Slekovec et al., 2019</xref>). Among these molecular typing methods, MLST and PFGE have the highest reproducibility and discriminatory ability for typing of <italic>P. aeruginosa</italic> isolates (<xref ref-type="bibr" rid="B7">De Cesare et al., 2016</xref>). <xref ref-type="bibr" rid="B14">Johnson et al. (2007)</xref> conducted molecular typing of 90 <italic>P. aeruginosa</italic> strains using PFGE and MLST, respectively, and the study proved that the resolution of PFGE and MLST was not significantly different. However, PFGE is labor time-consuming and requires sophisticated electrophoresis equipment. MLST typing is performed by comparing seven housekeeping gene sequences of bacteria. According to the result of MLST typing, the genetic diversity of bacteria is consistent in laboratories all over the world.</p>
<p>The pathogenicity of <italic>P</italic>. <italic>aeruginosa</italic> is mainly due to its expression of a dozen virulence factors, such as exotoxin A and pyocyanin (<xref ref-type="bibr" rid="B9">Feinbaum et al., 2012</xref>). The genes <italic>ExoS</italic> and <italic>ExoU</italic> encode the extracellular enzymes ExoS and ExoU, respectively. ExoS can destroy actin cytoskeleton to inhibit phagocytosis in host cells (<xref ref-type="bibr" rid="B12">Horna et al., 2019</xref>). ExoU is cytotoxic and has activity of phospholipid enzymes and adenopropionic acid cyclase (<xref ref-type="bibr" rid="B19">Luo et al., 2019</xref>). The gene <italic>toxA</italic> encodes exotoxin A, which can block the synthesis of cellular proteins, leading to host tissue necrosis (<xref ref-type="bibr" rid="B33">Wedekind et al., 2001</xref>). The gene <italic>phzM</italic> encodes a protein that converts phenazine-1-carboxylic acid to pyocyanin to inhibit cellular mitochondrial activity (<xref ref-type="bibr" rid="B24">Parsons et al., 2007</xref>). The gene <italic>lasB</italic> encodes elastase, which hydrolyzes host cell elastin. The synergistic effects of these various virulence factors contribute to the toxicity of <italic>P</italic>. <italic>aeruginosa</italic> (<xref ref-type="bibr" rid="B3">Bradbury et al., 2010</xref>).</p>
<p>Systematic data regarding the prevalence of <italic>P. aeruginosa</italic> in drinking water have not been obtained in China. In addition, information on virulent genes, antimicrobial resistance, and the genetic diversity of <italic>P. aeruginosa</italic> is also lacking. Therefore, in this study, we determined the prevalence, virulence genes, and antimicrobial resistance of <italic>P. aeruginosa</italic> in drinking water and further characterized the isolates using MLST.</p>
</sec>
<sec id="S2" sec-type="materials|methods">
<title>Materials and Methods</title>
<sec id="S2.SS1">
<title>Study Site and Sample Collection</title>
<p>From January 2013 to January 2014, according to the guideline of ISO-16266-2008, we collected water samples from 101drinking water factories (including 58 spring water and 43 mineral water factories) in 23 cities of China (Beijing, Shanghai, Chengdu, Wuhan, Xiamen, Guiyang, Kunming, Nanning, Haikou, Yangjiang, Yufu, Zhaoqing, Qingyuan, Shaoguan, Heyuan, Meizhou, Huizhou, Guangzhou, Dongguan, Foshan, Zhongshan, Zhuhai, and Jiangmen) (<xref ref-type="fig" rid="F1">Figure 1</xref>). As shown in <xref ref-type="fig" rid="F2">Figure 2</xref>, one part of raw water, one part of activated carbon-filtered water, and one part of final water product were collected in each drinking water factories. Since 11 drinking water factories (including seven spring water and four mineral water factories) have two raw water sources, a total of 314 water samples were collected, including 112 raw water samples, 101 activated carbon-filtered water samples, and 101 final water product samples. All samples were placed below 4&#x00B0;C during transportation and testing was performed immediately after receiving the samples.</p>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption><p>Sampling site of the drinking water in China.</p></caption>
<graphic xlink:href="fmicb-11-544653-g001.tif"/>
</fig>
<fig id="F2" position="float">
<label>FIGURE 2</label>
<caption><p>Production flow chart of mineral water and spring water in China.</p></caption>
<graphic xlink:href="fmicb-11-544653-g002.tif"/>
</fig>
</sec>
<sec id="S2.SS2">
<title>Isolation and Enumeration of <italic>P. aeruginosa</italic></title>
<p>The detection and the enumeration of <italic>P</italic>. <italic>aeruginosa</italic> were conducted as described in ISO-16266-2008 <xref ref-type="bibr" rid="B13">International Organization of Standardization [ISO] (2008)</xref>. Briefly, water sample (250 ml) was filtered through a 0.45-&#x03BC;m membrane (Millipore Co., Billerica, MA, United States) in a stainless steel multi-line filter system (Huankai Co., Guangzhou, China). The membrane was placed on CN agar medium (Huankai Co., Guangzhou, China), a selective medium for <italic>P</italic>. <italic>aeruginosa</italic>, and then cultured at 36&#x00B0;C for 48 h. <italic>P. aeruginosa</italic> colonies were identified based on any of the following: colonies with green color or producing fluorescence and ammonia in ethyl amide broth or forming red color and oxidase positive, producing ammonia in ethyl amide broth and fluorescence on King&#x2019;s B medium. All <italic>P. aeruginosa</italic> isolates were further identified by a species-specific <italic>ecfX</italic> gene. Genomic DNA was extracted using a Bacterial Genomic DNA Purification kit (Dongsheng Biotech, Guangzhou, China), according to the manufacturer&#x2019;s instruction. <italic>P. aeruginosa</italic> was identified by amplification of 200-bp fragments with primer pairs ecfX-F (5&#x2032; CCTTCCCTCCTTCCCCCCATGCCTATCAGGCGTTCCAT)/ ecfX-R (5&#x2032; CCTTCCCTCCTTCCCCCCGGCGATCTGGAAA AGAAATG) (<xref ref-type="bibr" rid="B26">Shi et al., 2012</xref>).</p>
</sec>
<sec id="S2.SS3">
<title>Detection of Virulence Genes</title>
<p>Five virulence genes, namely, <italic>ExoU</italic>, <italic>ExoS</italic>, <italic>phzM</italic>, <italic>toxA</italic>, and <italic>lasB</italic>, were detected with universal primer multiplex PCR described by <xref ref-type="bibr" rid="B26">Shi et al. (2012)</xref>. The PCR mixture (30 &#x03BC;l) contained 1 &#x03BC;l template (50 ng), 200 &#x03BC;mol/l dNTPs, 3 &#x03BC;l &#x00D7; 10 Buffer, 1.5 mmol/l Mg<sup>2+</sup>, primer mixture (0.045 &#x03BC;mol/l EXOU130-F/R, 0.06 &#x03BC;mol/l EXOS276-F/R, 0.09 &#x03BC;mol/l PYO366-F/R, 0.09 &#x03BC;mol/l ETA433-F/R, 0.045 &#x03BC;mol/l ELA556-F/R, and 2.0 &#x03BC;mol/l UP), and 5 U Taq enzyme. The amplification parameters were as follows: initial denaturation at 95&#x00B0;C for 5 min, 30 cycles of 30 s at 95&#x00B0;C, 30 s at 58&#x00B0;C, and 50 s at 72&#x00B0;C, and a final extension at 72&#x00B0;C for 10 min. All primers were synthesized by BGI instrument (Shenzhen, China) (<xref ref-type="supplementary-material" rid="DS1">Supplementary Table 1</xref>). <italic>P. aeruginosa</italic> CMCC10104 (Guangdong Culture Collection Centre) was used as the positive control, and distilled water was used as the negative control.</p>
</sec>
<sec id="S2.SS4">
<title>Antibiotic Resistance</title>
<p>Testing the antibiotic resistance of all <italic>P. aeruginosa</italic> isolates was performed by the Kirby&#x2013;Bauer disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) guidelines (<xref ref-type="bibr" rid="B5">Clinical and Laboratory Standards Institute [CLSI], 2010</xref>). <italic>P. aeruginosa</italic> CMCC 10104 (Guangdong Culture Collection Centre) was tested as positive control. A panel of antibiotics at a specific concentration per disk was tested: ciprofloxacin (5 &#x03BC;g), levofloxacin (5 &#x03BC;g), ofloxacin (5 &#x03BC;g), norfloxacin (10 &#x03BC;g), gentamicin (10 &#x03BC;g), tobramycin (10 &#x03BC;g), amikacin (30 &#x03BC;g), polymyxin B (300 U), imipenem (10 &#x03BC;g), meropenem (10 &#x03BC;g), aztreonam (30 &#x03BC;g), ceftazidime (30 &#x03BC;g), cefepime (30 &#x03BC;g), and piperacillin/tazobactam (110 &#x03BC;g) (Oxoid Co., Hampshire, United Kingdom). All <italic>P. aeruginosa</italic> isolates were classified as resistant, intermediate, or sensitive using the breakpoints specified by CLSI (<xref ref-type="supplementary-material" rid="DS1">Supplementary Table 2</xref>).</p>
</sec>
<sec id="S2.SS5">
<title>MLST Analysis</title>
<p>According to the protocols published on the <italic>P. aeruginos</italic>a pubMLST website,<sup><xref ref-type="fn" rid="footnote1">1</xref></sup> MLST analysis was performed using seven housekeeping genes, namely, <italic>acsA</italic>, <italic>aroE</italic>, <italic>guaA</italic>, <italic>mutL</italic>, <italic>nuoD</italic>, <italic>ppsA</italic>, and <italic>trpE</italic>, and all primers were synthesized by BGI instrument (Shenzhen, China) (<xref ref-type="table" rid="T1">Table 1</xref>). According to the experimental method described by <xref ref-type="bibr" rid="B6">Curran et al. (2004)</xref>, the housekeeping genes were amplified for all <italic>P. aeruginos</italic>a isolates, and PCR products were selected and sent to BGI Instrument (Shenzhen, China) for sequencing. The gene sequences were then compared to the existing sequences on <italic>P. aeruginos</italic>a pubMLST website<sup><xref ref-type="fn" rid="footnote2">2</xref></sup> to assign allele numbers and define sequence types (STs). Then, cluster analysis was conducted using BioNumerics 7.6 software (Applied Maths, Sint-Martens-Latem, Belgium), and a minimum spanning tree was generated from the allelic profiles of the isolates.</p>
<table-wrap position="float" id="T1">
<label>TABLE 1</label>
<caption><p>PCR primers of housekeeping genes.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left"><bold>Primers</bold></td>
<td valign="top" align="left"><bold>Sequence (5&#x2032;&#x2192;3&#x2032;)</bold></td>
<td valign="top" align="center"><bold>Base pairs</bold></td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">acsA-F</td>
<td valign="top" align="left">ACCTGGTGTACGCCTCGCTGAC</td>
<td valign="top" align="center">842</td>
</tr>
<tr>
<td valign="top" align="left">acsA-R</td>
<td valign="top" align="left">GACATAGATGCCCTGCCCCTTGAT</td>
<td/>
</tr>
<tr>
<td valign="top" align="left">aroE-F</td>
<td valign="top" align="left">TGGGGCTATGACTGGAAACC</td>
<td valign="top" align="center">825</td>
</tr>
<tr>
<td valign="top" align="left">aroE-R</td>
<td valign="top" align="left">TAACCCGGTTTTGTGATTCCTACA</td>
<td/>
</tr>
<tr>
<td valign="top" align="left">guaA-F</td>
<td valign="top" align="left">CGGCCTCGACGTGTGGATGA</td>
<td valign="top" align="center">940</td>
</tr>
<tr>
<td valign="top" align="left">guaA-R</td>
<td valign="top" align="left">GAACGCCTGGCTGGTCTTGTGGTA</td>
<td/>
</tr>
<tr>
<td valign="top" align="left">mutL-F</td>
<td valign="top" align="left">CCAGATCGCCGCCGGTGAGGTG</td>
<td valign="top" align="center">940</td>
</tr>
<tr>
<td valign="top" align="left">mutL-R</td>
<td valign="top" align="left">CAGGGTGCCATAGAGGAAGTC</td>
<td/>
</tr>
<tr>
<td valign="top" align="left">nuoD-F</td>
<td valign="top" align="left">ACCGCCACCCGTACTG</td>
<td valign="top" align="center">1,042</td>
</tr>
<tr>
<td valign="top" align="left">nuoD-R</td>
<td valign="top" align="left">TCTCGCCCATCTTGACCA</td>
<td/>
</tr>
<tr>
<td valign="top" align="left">ppsA-F</td>
<td valign="top" align="left">GGTCGCTCGGTCAAGGTAGTGG</td>
<td valign="top" align="center">989</td>
</tr>
<tr>
<td valign="top" align="left">ppsA-R</td>
<td valign="top" align="left">GGGTTCTCTTCTTCCGGCTCGTAG</td>
<td/>
</tr>
<tr>
<td valign="top" align="left">trpE-F</td>
<td valign="top" align="left">GCGGCCCAGGGTCGTGAG</td>
<td valign="top" align="center">811</td>
</tr>
<tr>
<td valign="top" align="left">trpE-R</td>
<td valign="top" align="left">CCCGGCGCTTGTTGATGGTT</td>
<td/>
</tr>
</tbody>
</table></table-wrap>
</sec>
</sec>
<sec id="S3">
<title>Results</title>
<sec id="S3.SS1">
<title>Contamination of <italic>P. aeruginosa</italic> in Drinking Water</title>
<p>In this study, 50 (49.5%) drinking water factories were found to be positive for <italic>P. aeruginosa</italic> (<xref ref-type="supplementary-material" rid="DS1">Supplementary Table 3</xref>). Of all the water samples (314), 77 (24.5%) were contaminated with <italic>P. aeruginosa</italic>, including 34 (30.4%) raw water, 39 (38.6%) activated carbon-filtered water, and four (3.9%) final water products. A total of 132 <italic>P. aeruginosa</italic> isolates were obtained from the 77 positive samples for <italic>P. aeruginosa</italic> (<xref ref-type="supplementary-material" rid="DS1">Supplementary Table 4</xref>). The contamination rates of the different samples are shown in <xref ref-type="table" rid="T2">Table 2</xref>. Among the 133 mineral water samples, 18 (13.5%) were positive for <italic>P. aeruginosa</italic>, including eight (17%) raw water and 10 (23.3%) activated carbon-filtered water. The final water product was not found to be positive for <italic>P. aeruginosa</italic> among the mineral water samples. Among the 181 spring water samples, 59 (32.6%) were positive for <italic>P. aeruginosa</italic>, including 26 (40%) raw water, 29 (50%) activated carbon-filtered water, and four (6.9%) final water product. Among the 77 contaminated samples with <italic>P. aeruginosa</italic> (<xref ref-type="supplementary-material" rid="DS1">Supplementary Table 3</xref>), the contamination level of spring water samples of raw water, activated carbon-filtered water, and final water product was 22.2, 40.2, and 77.5 colony forming units (CFU)/250 ml, respectively, compared with 4.4, 11.8, and 0 CFU/250 ml, respectively, for mineral water samples. Among the 112 raw water samples, there were 98 groundwater and 14 surface raw water samples. As shown in <xref ref-type="table" rid="T3">Table 3</xref>, 23 (23.5%) underground and six (42.9%) surface raw water samples were contaminated with <italic>P. aeruginosa</italic>.</p>
<table-wrap position="float" id="T2">
<label>TABLE 2</label>
<caption><p>Prevalence of <italic>Pseudomonas aeruginosa</italic> from mineral water and spring water.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left"><bold>Samples</bold></td>
<td valign="top" align="center" colspan="2"><bold>Raw water</bold><hr/></td>
<td valign="top" align="center" colspan="2"><bold>Activated carbon filtered water</bold><hr/></td>
<td valign="top" align="center" colspan="2"><bold>Final water product</bold><hr/></td>
<td valign="top" align="center" colspan="2"><bold>Total</bold><hr/></td>
</tr>
<tr>
<td/>
<td valign="top" align="center"><bold>Positive amount/total</bold></td>
<td valign="top" align="center"><bold>Contamination rate (%)</bold></td>
<td valign="top" align="center"><bold>Positive amount/total</bold></td>
<td valign="top" align="center"><bold>Contamination rate (%)</bold></td>
<td valign="top" align="center"><bold>Positive amount/total</bold></td>
<td valign="top" align="center"><bold>Contamination rate (%)</bold></td>
<td valign="top" align="center"><bold>Positive amount/total</bold></td>
<td valign="top" align="center"><bold>Contamination rate (%)</bold></td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">M</td>
<td valign="top" align="center">8/47</td>
<td valign="top" align="center">17.0</td>
<td valign="top" align="center">10/43</td>
<td valign="top" align="center">23.3</td>
<td valign="top" align="center">0/43</td>
<td valign="top" align="center">0</td>
<td valign="top" align="center">18/133</td>
<td valign="top" align="center">13.5</td>
</tr>
<tr>
<td valign="top" align="left">S</td>
<td valign="top" align="center">26/65</td>
<td valign="top" align="center">40.0</td>
<td valign="top" align="center">29/58</td>
<td valign="top" align="center">50.0</td>
<td valign="top" align="center">4/58</td>
<td valign="top" align="center">6.9</td>
<td valign="top" align="center">59/181</td>
<td valign="top" align="center">32.6</td>
</tr>
<tr>
<td valign="top" align="left">Average</td>
<td valign="top" align="center">34/112</td>
<td valign="top" align="center">30.4</td>
<td valign="top" align="center">39/101</td>
<td valign="top" align="center">38.6</td>
<td valign="top" align="center">4/101</td>
<td valign="top" align="center">3.9</td>
<td valign="top" align="center">77/314</td>
<td valign="top" align="center">24.5</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<attrib><italic>M and S water represent mineral and spring water, respectively.</italic></attrib>
</table-wrap-foot>
</table-wrap>
<table-wrap position="float" id="T3">
<label>TABLE 3</label>
<caption><p>Prevalence of <italic>Pseudomonas aeruginosa</italic> in surface water and groundwater.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left"><bold>Samples</bold></td>
<td valign="top" align="center"><bold>Positive amounts</bold></td>
<td valign="top" align="center"><bold>Total amounts</bold></td>
<td valign="top" align="center"><bold>Contamination rates (%)</bold></td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">Surface water</td>
<td valign="top" align="center">6</td>
<td valign="top" align="center">14</td>
<td valign="top" align="center">42.9</td>
</tr>
<tr>
<td valign="top" align="left">Groundwater</td>
<td valign="top" align="center">23</td>
<td valign="top" align="center">98</td>
<td valign="top" align="center">23.5</td>
</tr>
</tbody>
</table></table-wrap>
</sec>
<sec id="S3.SS2">
<title>Detection of Virulence Genes</title>
<p>In this study, species-specific <italic>ecfX</italic> gene was found in all 132 <italic>P. aeruginosa</italic> isolates. The detection results for virulence genes (<italic>ExoU</italic>, <italic>ExoS</italic>, <italic>phzM</italic>, <italic>toxA</italic>, and <italic>lasB</italic>) in the 132 isolates are shown in <xref ref-type="table" rid="T4">Table 4</xref>. Among the isolates, 132 (100%), 126 (95.5%), 118 (89.4%), 10 (7.6%), and 114 (86.3%) were positive for <italic>lasB</italic>, <italic>phzM</italic>, <italic>toxA</italic>, <italic>ExoU</italic>, and <italic>ExoS</italic> genes, respectively. The virulence profiles of the isolates are shown in <xref ref-type="table" rid="T5">Table 5</xref>. Virulence profile B (<italic>ExoS</italic>, <italic>phzM</italic>, <italic>toxA</italic>, and <italic>lasB</italic>) accounted for 74.2% (<italic>n</italic> = 98) of all isolates, followed by virulence profile F (<italic>ExoS</italic>, <italic>phzM</italic>, and <italic>lasB</italic>) accounting for 7.6% (<italic>n</italic> = 10).</p>
<table-wrap position="float" id="T4">
<label>TABLE 4</label>
<caption><p>Virulence genes of 132 <italic>Pseudomonas aeruginosa</italic> isolates.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left"><bold>Virulence gene</bold></td>
<td valign="top" align="center"><bold>Number of positive sample (%)</bold></td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left"><italic>ExoU</italic></td>
<td valign="top" align="center">10 (7.6)</td>
</tr>
<tr>
<td valign="top" align="left"><italic>ExoS</italic></td>
<td valign="top" align="center">114 (86.3)</td>
</tr>
<tr>
<td valign="top" align="left"><italic>phzM</italic></td>
<td valign="top" align="center">126 (95.5)</td>
</tr>
<tr>
<td valign="top" align="left"><italic>toxA</italic></td>
<td valign="top" align="center">118 (89.5)</td>
</tr>
<tr>
<td valign="top" align="left"><italic>lasB</italic></td>
<td valign="top" align="center">132 (100)</td>
</tr>
<tr>
<td valign="top" align="left"><italic>ecfX</italic></td>
<td valign="top" align="center">132 (100)</td>
</tr>
</tbody>
</table></table-wrap>
<table-wrap position="float" id="T5">
<label>TABLE 5</label>
<caption><p>Virulence profiles of 132 <italic>Pseudomonas aeruginosa</italic> isolates.</p></caption>
<table cellspacing="5" cellpadding="5" frame="hsides" rules="groups">
<thead>
<tr>
<td valign="top" align="left"><bold>Virulence profiles</bold></td>
<td valign="top" align="left"><bold>Virulence gene</bold></td>
<td valign="top" align="left"><bold>Isolate numbers</bold></td>
<td valign="top" align="left"><bold>Number of positive samples (%)</bold></td>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">A</td>
<td valign="top" align="left"><italic>ExoU</italic>, <italic>phzM</italic>, <italic>toxA</italic>, <italic>lasB</italic></td>
<td valign="top" align="left">1, 2, 31&#x2013;34</td>
<td valign="top" align="left">6 (4.5%)</td>
</tr>
<tr>
<td valign="top" align="left">B</td>
<td valign="top" align="left"><italic>ExoS</italic>, <italic>phzM</italic>, <italic>toxA</italic>, <italic>lasB</italic></td>
<td valign="top" align="left">3&#x2013;5, 8&#x2013;11, 14, 17, 18, 21&#x2013;30, 35&#x2013;42, 44&#x2013;63, 65&#x2013;73, 81&#x2013;105, 110&#x2013;112, 117&#x2013;124, 126, 129&#x2013;132</td>
<td valign="top" align="left">98 (74.2%)</td>
</tr>
<tr>
<td valign="top" align="left">C</td>
<td valign="top" align="left"><italic>phzM</italic>, <italic>toxA</italic>, <italic>lasB</italic></td>
<td valign="top" align="left">77&#x2013;80, 107&#x2013;108</td>
<td valign="top" align="left">8 (6.0%)</td>
</tr>
<tr>
<td valign="top" align="left">D</td>
<td valign="top" align="left"><italic>ExoS</italic>, <italic>toxA</italic>, <italic>lasB</italic></td>
<td valign="top" align="left">12, 13, 15, 16, 19, 20</td>
<td valign="top" align="left">6 (4.5%)</td>
</tr>
<tr>
<td valign="top" align="left">E</td>
<td valign="top" align="left"><italic>ExoU</italic>, <italic>phzM</italic>, <italic>lasB</italic></td>
<td valign="top" align="left">106, 125, 127, 128</td>
<td valign="top" align="left">4 (3.0%)</td>
</tr>
<tr>
<td valign="top" align="left">F</td>
<td valign="top" align="left"><italic>ExoS</italic>, <italic>phzM</italic>, <italic>lasB</italic></td>
<td valign="top" align="left">6, 7, 43, 64, 74&#x2013;76, 109, 113, 114</td>
<td valign="top" align="left">10 (7.6%)</td>
</tr>
</tbody>
</table></table-wrap>
</sec>
<sec id="S3.SS3">
<title>Antibiotic Resistance</title>
<p>All 132 isolates were classified as resistant, intermediate, or sensitive according to the diameter of the inhibition zone, as described by CLSI. As shown in <xref ref-type="supplementary-material" rid="DS1">Supplementary Figure 1</xref>, the result of antimicrobial susceptibilities showed that all 132 isolates were sensitive to 14 antibiotics (ciprofloxacin, levofloxacin, ofloxacin, norfloxacin, gentamicin, tobramycin, amikacin, polymyxin B, imipenem, meropenem, aztreonam, ceftazidime, cefepime, and piperacillin/tazobactam). No <italic>P. aeruginosa</italic> isolate was resistant to the antibiotics tested.</p>
</sec>
<sec id="S3.SS4">
<title>MLST</title>
<p>All the 132 <italic>P. aeruginosa</italic> isolates from the 23 cities and different sample types were characterized by MLST analysis, which showed that the isolates could be classified into 42 STs (<xref ref-type="supplementary-material" rid="DS1">Supplementary Table 3</xref>). ST235 accounted for 8.3% (11) of the total isolates, followed by ST111 at 6.1% (8) and ST277 at 6.1% (8). Additionally, 14 (33.3%) of the 42 STs included a single strain, and eight (19.0%) STs included two isolates. According to the allele numbers of the seven housekeeping genes, a minimum spanning tree was generated to reveal the relationships between the 132 isolates (<xref ref-type="fig" rid="F3">Figure 3</xref>). The STs of the isolates were then further analyzed relative to the sample type and virulence profiles (<xref ref-type="fig" rid="F3">Figure 3</xref> and <xref ref-type="supplementary-material" rid="DS1">Supplementary Figure 2</xref>). ST1420, ST1907, ST1974, ST2048, and ST2133 only existed in raw water samples. Five <italic>P. aeruginosa</italic> isolates from the final water product included five STs (ST175, ST267, ST298, ST324, and ST1182). Furthermore, 11 ST235 isolates included three virulence profiles (B, C, and F), eight ST277 isolates included three virulence profiles (A, B, and D), and eight ST111 isolates showed only one virulence profile (B).</p>
<fig id="F3" position="float">
<label>FIGURE 3</label>
<caption><p>Minimum spanning tree based on multilocus sequence typing data for the 132 <italic>P. aeruginosa</italic> isolates examined in this study. Each circle represents one sequence type (ST). The size of the circle is related to the number of strains within this ST. The colors in the circles represent the virulence profiles.</p></caption>
<graphic xlink:href="fmicb-11-544653-g003.tif"/>
</fig>
</sec>
</sec>
<sec id="S4">
<title>Discussion</title>
<p>According to the guidelines on the quality of water intended for human consumption (98/83/EC), drinking water should not test positive for <italic>P. aeruginosa</italic>. Although the prevalence of <italic>P. aeruginosa</italic> has been systematically studied in the final water product, the data on <italic>P. aeruginosa</italic> contamination are lacking for the whole treatment process. In our investigation, a large number of samples (112 raw water samples, 101 activated carbon-filtered water samples, and 101 final water product samples) were collected from 101 drinking water factories covering the whole treatment process, and these data can be used for risk assessment of <italic>P. aeruginosa</italic>. The results of this study showed that 77 (24.5%) samples were contaminated with <italic>P. aeruginosa</italic> among the 314 water samples. Consistent with previous investigations conducted by <xref ref-type="bibr" rid="B36">Wu et al. (2016)</xref>, the present result showed that <italic>P. aeruginosa</italic> contamination of raw water (30.4%) and activated carbon-filtered water (38.6%) was significantly higher than that of raw water (3.9%). Notably, the contamination rate of surface raw water was significantly higher than that of ground raw water. Thus, groundwater is better than surface water as raw water. The main reason for this is that surface raw water is generally drained from pipes to open cistern and is exposed to air for a long time without effective protection measures. In this study, the <italic>P. aeruginosa</italic> contamination rate of activated carbon-filtered water was the highest among the three kinds of water sample tested. Activated carbon filter system is one of the most important processes in drinking water treatment and is used to adsorb organic pollutants and microbes to purify water (<xref ref-type="bibr" rid="B10">Feng et al., 2013</xref>). The <italic>P. aeruginosa</italic> contamination rate of activated carbon-filtered water can be used to indicate the degree of production specification. Our previous studies have shown that activated carbon filter can get enriched with microorganisms and is the most serious microbial contamination problem in the whole treatment process of drinking water (<xref ref-type="bibr" rid="B34">Wei et al., 2017</xref>). Therefore, manufacturers of drinking water must clean, disinfect, and replace activated carbon filters regularly. <xref ref-type="bibr" rid="B29">Stoler et al. (2015)</xref> reported that 41% of 80 sachet water samples were positive for <italic>P. aeruginosa</italic>. In this study, no <italic>P. aeruginosa</italic> was detected in the final water product of mineral water. However, the contamination rate of the final water product was 6.9% in the case of spring water, which is harmful to the health of the costumers. The high contamination rate of <italic>P. aeruginosa</italic> in spring water may be caused by the irregular production process during the manufacturing process, including inadequate disinfection, the formation of biofilms of <italic>P. aeruginosa</italic> in the pipeline, and improper maintenance of activated carbon filter. Hence, manufacturers of drinking water should pay attention to the control and management of the production process to ensure the safety of drinking water.</p>
<p>The pathogenesis of <italic>P. aeruginosa</italic> is closely related to the virulence genes <italic>ExoU</italic>, <italic>ExoS</italic>, <italic>phzM</italic>, <italic>toxA</italic>, and <italic>lasB</italic> (<xref ref-type="bibr" rid="B21">Mavrodi et al., 2001</xref>; <xref ref-type="bibr" rid="B30">Strateva et al., 2010</xref>; <xref ref-type="bibr" rid="B26">Shi et al., 2012</xref>). In this study, all 132 isolates carried at least three virulence genes, a fact which was in contrast to a previous study (<xref ref-type="bibr" rid="B36">Wu et al., 2016</xref>). Notably, 132 (100%), 126 (95.5%), 118 (89.4%), 10 (7.6%), and 114 (86.3%) isolates were positive for <italic>lasB</italic>, <italic>phzM</italic>, <italic>toxA</italic>, <italic>ExoU</italic>, and <italic>ExoS</italic> genes, respectively, indicating that these virulence genes are widely distributed among <italic>P. aeruginosa</italic>. Consistent with previous investigations, the virulence genes <italic>ExoU</italic> and <italic>ExoS</italic> were not detected in the same isolates (<xref ref-type="bibr" rid="B35">Wolfgang et al., 2003</xref>; <xref ref-type="bibr" rid="B25">Shaver and Hauser, 2004</xref>). Furthermore, among the six virulent profiles of all isolates (<xref ref-type="table" rid="T5">Table 5</xref>), virulence profile B was predominant (<italic>ExoS</italic>, <italic>phzM</italic>, <italic>toxA</italic>, and <italic>lasB</italic>), accounting for 74.2% (<italic>n</italic> = 98) of the isolates. Importantly, the presence of the virulence genes indicates that <italic>P. aeruginosa</italic> is a potential pathogenic bacterium. The virulence gene expression in <italic>P. aeruginosa</italic> is mainly related to quorum sensing. Therefore, future studies should be conducted to study how these virulence genes are expressed in <italic>P. aeruginosa</italic>. In previous studies, clinical <italic>P. aeruginosa</italic> was generally resistant to antibiotics (<xref ref-type="bibr" rid="B16">Keating et al., 2013</xref>; <xref ref-type="bibr" rid="B23">Munita et al., 2017</xref>). However, no <italic>P. aeruginosa</italic> isolate was resistant to the 14 different antibiotics tested in our study. <xref ref-type="bibr" rid="B27">Silva et al. (2008)</xref> isolated 30 <italic>P. aeruginosa</italic> strains from drinking water that were resistant to one or more antibiotics. The difference in the results may be due to the different sources of the samples. In this study, the raw water mainly came from groundwater, and the small amount of surface raw water samples was also taken from sparsely populated remote areas, with less exposure to outside influences. These environments are rarely contaminated with antibiotics, so <italic>P. aeruginosa</italic> has not been induced to be antibiotic resistant.</p>
<p>Multilocus sequence typing is a crucial epidemiological typing method and is based on the sequences of seven different housekeeping genes. It has been used in studies on the evolution and population diversity of <italic>P. aeruginosa</italic> isolates and is advantageous, owing to its discriminatory value and rapid <italic>P. aeruginosa</italic> typing (<xref ref-type="bibr" rid="B4">Casta&#x00F1;eda-Montes et al., 2018</xref>; <xref ref-type="bibr" rid="B15">Kainuma et al., 2018</xref>). In this study, the MLST results provided a better overview of <italic>P. aeruginosa</italic> diversity. Of the 42 STs, 14 (33.3%) included a single strain and eight (19.0%) included two isolates, indicating the high genetic diversity of the isolates. As shown in <xref ref-type="fig" rid="F3">Figure 3</xref>, a good correlation among MLST and virulence profiles was found in some isolates. However, there was no significant correlation between ST type and sample type (<xref ref-type="supplementary-material" rid="DS1">Supplementary Figure 2</xref>). All isolates that belonged to ST111 (<italic>n</italic> = 8), ST298 (<italic>n</italic> = 6), ST244 (<italic>n</italic> = 5), ST316 (<italic>n</italic> = 6), ST1284 (<italic>n</italic> = 5), and ST357 (<italic>n</italic> = 5) showed the same virulence profile B (<italic>ExoS</italic>, <italic>phzM</italic>, <italic>toxA</italic>, and <italic>lasB</italic>). As no antibiotic-resistant isolate was found in this study, no correlation was observed between the MLST profiles and the antibiotic resistance profiles of the isolates.</p>
<p>In summary, this study investigated the prevalence, virulence, antimicrobial resistance, and molecular characteristics of <italic>P. aeruginosa</italic> isolates from drinking water samples across different cities of China. Of the water samples tested, 24.5% were contaminated, and the contamination rate of the final water product was 6.9% in the case of spring water, suggesting that drinking water products could be a potential vehicle for the transmission of <italic>P. aeruginosa</italic>. In addition, since activated carbon filters, the most serious potential contamination site in the whole production process, also showed a high degree of <italic>P. aeruginosa</italic> contamination, manufacturers of drinking water should regularly clean, disinfect, and replace activated carbon filters. Furthermore, our data indicated that all 132 isolates carried at least three virulence genes, indicating that they may have a potentially pathogenic effect on the health of consumers. The MLST data from this study can be used to trace the possible origins of <italic>P. aeruginosa</italic>, which would aid in developing effective and precise prevention and control measures against <italic>P. aeruginosa</italic> contamination of the whole drinking water production process.</p>
</sec>
<sec id="S5">
<title>Data Availability Statement</title>
<p>The original contributions presented in the study are included in the article/<xref ref-type="supplementary-material" rid="DS1">Supplementary Material</xref>, further inquiries can be directed to the corresponding author.</p>
</sec>
<sec id="S6">
<title>Author Contributions</title>
<p>QW, JZ, and LW conceived and designed the experiments. LW, XW, and WG performed the experiments. LW, QG, and JW analyzed the data. LX, YZ, and XZ contributed reagents, materials, and analysis tools. LW, HW, and TL contributed to the writing of the manuscript. All authors contributed to the article and approved the submitted version.</p>
</sec>
<sec sec-type="COI-statement" id="conf1">
<title>Conflict of Interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
</body>
<back>
<fn-group>
<fn fn-type="financial-disclosure">
<p><bold>Funding.</bold> We would like to acknowledge the financial support of the National Key R&#x0026;D Program of China (2018YFD0400901), the Local Innovative and Research Teams Project of Guangdong Pearl River Talents Program (2017BT01S174), the GDAS&#x2019; Project of Science and Technology Development (2018GDASCX-0910), and China Postdoctoral Science Foundation (2019M662829).</p>
</fn>
</fn-group>
<sec id="S8" sec-type="supplementary material"><title>Supplementary Material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fmicb.2020.544653/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fmicb.2020.544653/full#supplementary-material</ext-link></p>
<supplementary-material xlink:href="Data_Sheet_1.docx" id="DS1" mimetype="application/vnd.openxmlformats-officedocument.wordprocessingml.document" xmlns:xlink="http://www.w3.org/1999/xlink"/>
</sec>
<ref-list>
<title>References</title>
<ref id="B1"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Agarwal</surname> <given-names>G.</given-names></name> <name><surname>Kapil</surname> <given-names>A.</given-names></name> <name><surname>Kabra</surname> <given-names>S. K.</given-names></name> <name><surname>Das</surname> <given-names>B. K.</given-names></name> <name><surname>Dwivedi</surname> <given-names>S. N.</given-names></name></person-group> (<year>2005</year>). <article-title>Characterization of <italic>Pseudomonas aeruginosa</italic> isolated from chronically infected children with cystic fibrosis in India.</article-title> <source><italic>BMC Microbiol.</italic></source> <volume>5</volume>:<issue>43</issue>. <pub-id pub-id-type="doi">10.1186/1471-2180-5-43</pub-id> <pub-id pub-id-type="pmid">16033658</pub-id></citation></ref>
<ref id="B2"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Bel Hadj Ahmed</surname> <given-names>A.</given-names></name> <name><surname>Salah Abbassi</surname> <given-names>M.</given-names></name> <name><surname>Rojo-Bezares</surname> <given-names>B.</given-names></name> <name><surname>Ruiz-Rold&#x00E1;n</surname> <given-names>L.</given-names></name> <name><surname>Dhahri</surname> <given-names>R.</given-names></name> <name><surname>Mehri</surname> <given-names>I.</given-names></name><etal/></person-group> (<year>2019</year>). <article-title>Characterization of <italic>Pseudomonas aeruginosa</italic> isolated from various environmental niches: new STs and occurrence of antibiotic susceptible &#x201C;high-risk clones&#x201D;.</article-title> <source><italic>Intern. J. Environ. Health Res.</italic></source> <volume>30</volume> <fpage>643</fpage>&#x2013;<lpage>652</lpage>. <pub-id pub-id-type="doi">10.1080/09603123.2019.1616080</pub-id> <pub-id pub-id-type="pmid">31094221</pub-id></citation></ref>
<ref id="B3"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Bradbury</surname> <given-names>R. S.</given-names></name> <name><surname>Roddam</surname> <given-names>L. F.</given-names></name> <name><surname>Merritt</surname> <given-names>A.</given-names></name> <name><surname>Reid</surname> <given-names>D. W.</given-names></name> <name><surname>Champion</surname> <given-names>A. C.</given-names></name></person-group> (<year>2010</year>). <article-title>Virulence gene distribution in clinical, nosocomial and environmental isolates of <italic>Pseudomonas aeruginosa</italic>.</article-title> <source><italic>J. Med. Microbiol.</italic></source> <volume>59</volume> <fpage>881</fpage>&#x2013;<lpage>890</lpage>. <pub-id pub-id-type="doi">10.1099/jmm.0.018283-0</pub-id> <pub-id pub-id-type="pmid">20430902</pub-id></citation></ref>
<ref id="B4"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Casta&#x00F1;eda-Montes</surname> <given-names>F. J.</given-names></name> <name><surname>Avitia</surname> <given-names>M.</given-names></name> <name><surname>Sep&#x00FA;lveda-Robles</surname> <given-names>O.</given-names></name> <name><surname>Cruz-S&#x00E1;nchez</surname> <given-names>V.</given-names></name> <name><surname>Kameyama</surname> <given-names>L.</given-names></name> <name><surname>Guarneros</surname> <given-names>G.</given-names></name><etal/></person-group> (<year>2018</year>). <article-title>Population structure of <italic>Pseudomonas aeruginosa</italic> through a MLST approach and antibiotic resistance profiling of a Mexican clinical collection.</article-title> <source><italic>Infect. Genet. Evol.</italic></source> <volume>65</volume> <fpage>43</fpage>&#x2013;<lpage>54</lpage>. <pub-id pub-id-type="doi">10.1016/j.meegid.2018.06.009</pub-id> <pub-id pub-id-type="pmid">30006046</pub-id></citation></ref>
<ref id="B5"><citation citation-type="journal"><collab>Clinical and Laboratory Standards Institute [CLSI]</collab> (<year>2010</year>). <source><italic>Performance Standards for Antimicrobial Disk Susceptibility Tests.</italic></source> <publisher-loc>Wayne, PA</publisher-loc>: <publisher-name>CLSI</publisher-name>.</citation></ref>
<ref id="B6"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Curran</surname> <given-names>B.</given-names></name> <name><surname>Jonas</surname> <given-names>D.</given-names></name> <name><surname>Grundmann</surname> <given-names>H.</given-names></name> <name><surname>Pitt</surname> <given-names>T.</given-names></name> <name><surname>Dowson</surname> <given-names>C. G.</given-names></name></person-group> (<year>2004</year>). <article-title>Development of a multilocus sequence typing scheme for the opportunistic pathogen <italic>Pseudomonas aeruginosa</italic>.</article-title> <source><italic>J. Clin. Microbiol.</italic></source> <volume>42</volume> <fpage>5644</fpage>&#x2013;<lpage>5649</lpage>. <pub-id pub-id-type="doi">10.1128/jcm.42.12.5644-5649.2004</pub-id> <pub-id pub-id-type="pmid">15583294</pub-id></citation></ref>
<ref id="B7"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>De Cesare</surname> <given-names>A.</given-names></name> <name><surname>Parisi</surname> <given-names>A.</given-names></name> <name><surname>Giacometti</surname> <given-names>F.</given-names></name> <name><surname>Serraino</surname> <given-names>A.</given-names></name> <name><surname>Piva</surname> <given-names>S.</given-names></name> <name><surname>Caruso</surname> <given-names>M.</given-names></name><etal/></person-group> (<year>2016</year>). <article-title>Multilocus sequence typing of <italic>Arcobacter butzleri</italic> isolates collected from dairy plants and their products, and comparison with their PFGE types.</article-title> <source><italic>J. Appl. Microbiol.</italic></source> <volume>120</volume> <fpage>165</fpage>&#x2013;<lpage>174</lpage>. <pub-id pub-id-type="doi">10.1111/jam.12977</pub-id> <pub-id pub-id-type="pmid">26481316</pub-id></citation></ref>
<ref id="B8"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Driscoll</surname> <given-names>J. A.</given-names></name> <name><surname>Brody</surname> <given-names>S. L.</given-names></name> <name><surname>Kollef</surname> <given-names>M. H.</given-names></name></person-group> (<year>2007</year>). <article-title>The epidemiology, pathogenesis and treatment of <italic>Pseudomonas aeruginosa</italic> infections.</article-title> <source><italic>Drugs</italic></source> <volume>67</volume> <fpage>351</fpage>&#x2013;<lpage>368</lpage>. <pub-id pub-id-type="doi">10.2165/00003495-200767030-00003</pub-id> <pub-id pub-id-type="pmid">17335295</pub-id></citation></ref>
<ref id="B9"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Feinbaum</surname> <given-names>R. L.</given-names></name> <name><surname>Urbach</surname> <given-names>J. M.</given-names></name> <name><surname>Liberati</surname> <given-names>N. T.</given-names></name> <name><surname>Djonovic</surname> <given-names>S.</given-names></name> <name><surname>Adonizio</surname> <given-names>A.</given-names></name> <name><surname>Carvunis</surname> <given-names>A.-R.</given-names></name><etal/></person-group> (<year>2012</year>). <article-title>Genome-wide identification of <italic>Pseudomonas aeruginosa</italic> virulence-related genes using a <italic>Caenorhabditis elegans</italic> infection model.</article-title> <source><italic>PLoS Pathog.</italic></source> <volume>8</volume>:<issue>e1002813</issue>. <pub-id pub-id-type="doi">10.1371/journal.ppat.1002813</pub-id> <pub-id pub-id-type="pmid">22911607</pub-id></citation></ref>
<ref id="B10"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Feng</surname> <given-names>S.</given-names></name> <name><surname>Chen</surname> <given-names>C.</given-names></name> <name><surname>Wang</surname> <given-names>Q. F.</given-names></name> <name><surname>Zhang</surname> <given-names>X. J.</given-names></name> <name><surname>Yang</surname> <given-names>Z. Y.</given-names></name> <name><surname>Xie</surname> <given-names>S. G.</given-names></name></person-group> (<year>2013</year>). <article-title>Characterization of microbial communities in a granular activated carbon-sand dual media filter for drinking water treatment.</article-title> <source><italic>Intern. J. Environ. Sci. Technol.</italic></source> <volume>10</volume> <fpage>917</fpage>&#x2013;<lpage>922</lpage>. <pub-id pub-id-type="doi">10.1007/s13762-013-0188-1</pub-id></citation></ref>
<ref id="B11"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Guerin-Mechin</surname> <given-names>L.</given-names></name> <name><surname>Dubois-Brissonnet</surname> <given-names>F.</given-names></name> <name><surname>Heyd</surname> <given-names>B.</given-names></name> <name><surname>Leveau</surname> <given-names>J.</given-names></name></person-group> (<year>2000</year>). <article-title>Quaternary ammonium compound stresses induce specific variations in fatty acid composition of <italic>Pseudomonas aeruginosa</italic>.</article-title> <source><italic>Intern. J. Food Microbiol.</italic></source> <volume>55</volume> <fpage>157</fpage>&#x2013;<lpage>159</lpage>. <pub-id pub-id-type="doi">10.1016/s0168-1605(00)00189-6</pub-id></citation></ref>
<ref id="B12"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Horna</surname> <given-names>G.</given-names></name> <name><surname>Amaro</surname> <given-names>C.</given-names></name> <name><surname>Palacios</surname> <given-names>A.</given-names></name> <name><surname>Guerra</surname> <given-names>H.</given-names></name> <name><surname>Ruiz</surname> <given-names>J.</given-names></name></person-group> (<year>2019</year>). <article-title>High frequency of the exoU+/exoS+ genotype associated with multidrug-resistant &#x201C;high-risk clones&#x201D; of <italic>Pseudomonas aeruginosa</italic> clinical isolates from Peruvian hospitals.</article-title> <source><italic>Sci. Rep.</italic></source> <volume>9</volume>:<issue>10874</issue>.</citation></ref>
<ref id="B13"><citation citation-type="journal"><collab>International Organization of Standardization [ISO]</collab> (<year>2008</year>). <source><italic>Water Quality-Detection and Enumeration of Pseudomon asaeruginosa-Method by Membrane Filtration.</italic></source> <publisher-loc>Geneva</publisher-loc>: <publisher-name>ISO</publisher-name>.</citation></ref>
<ref id="B14"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Johnson</surname> <given-names>J. K.</given-names></name> <name><surname>Arduino</surname> <given-names>S. M.</given-names></name> <name><surname>Stine</surname> <given-names>O. C.</given-names></name> <name><surname>Johnson</surname> <given-names>J. A.</given-names></name> <name><surname>Harris</surname> <given-names>A. D.</given-names></name></person-group> (<year>2007</year>). <article-title>Multilocus sequence typing compared to pulsed-field gel electrophoresis for molecular typing of <italic>Pseudomonas aeruginosa</italic>.</article-title> <source><italic>J. Clin. Microbiol.</italic></source> <volume>45</volume> <fpage>3707</fpage>&#x2013;<lpage>3712</lpage>. <pub-id pub-id-type="doi">10.1128/jcm.00560-07</pub-id> <pub-id pub-id-type="pmid">17881548</pub-id></citation></ref>
<ref id="B15"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Kainuma</surname> <given-names>A.</given-names></name> <name><surname>Momiyama</surname> <given-names>K.</given-names></name> <name><surname>Kimura</surname> <given-names>T.</given-names></name> <name><surname>Akiyama</surname> <given-names>K.</given-names></name> <name><surname>Inoue</surname> <given-names>K.</given-names></name> <name><surname>Naito</surname> <given-names>Y.</given-names></name><etal/></person-group> (<year>2018</year>). <article-title>An outbreak of fluoroquinolone-resistant <italic>Pseudomonas aeruginosa</italic> ST357 harboring the exoU gene.</article-title> <source><italic>J. Infect. Chemother.</italic></source> <volume>24</volume> <fpage>615</fpage>&#x2013;<lpage>622</lpage>. <pub-id pub-id-type="doi">10.1016/j.jiac.2018.03.008</pub-id> <pub-id pub-id-type="pmid">29628388</pub-id></citation></ref>
<ref id="B16"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Keating</surname> <given-names>D.</given-names></name> <name><surname>Crowe</surname> <given-names>M. J.</given-names></name> <name><surname>Kennedy</surname> <given-names>B.</given-names></name> <name><surname>Salmon</surname> <given-names>A.</given-names></name> <name><surname>Britton</surname> <given-names>D.</given-names></name> <name><surname>Gallagher</surname> <given-names>C. G.</given-names></name><etal/></person-group> (<year>2013</year>). <article-title>Molecular detection of an atypical, highly resistant, clonal <italic>Pseudomonas aeruginosa</italic> isolate in cystic fibrosis patients.</article-title> <source><italic>J. Cystic Fibros.</italic></source> <volume>12</volume> <fpage>141</fpage>&#x2013;<lpage>146</lpage>. <pub-id pub-id-type="doi">10.1016/j.jcf.2012.07.007</pub-id> <pub-id pub-id-type="pmid">22902869</pub-id></citation></ref>
<ref id="B17"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Li</surname> <given-names>C.</given-names></name> <name><surname>Ling</surname> <given-names>F.</given-names></name> <name><surname>Zhang</surname> <given-names>M.</given-names></name> <name><surname>Liu</surname> <given-names>W.-T.</given-names></name> <name><surname>Li</surname> <given-names>Y.</given-names></name> <name><surname>Liu</surname> <given-names>W.</given-names></name></person-group> (<year>2017</year>). <article-title>Characterization of bacterial community dynamics in a full-scale drinking water treatment plant.</article-title> <source><italic>J. Environ. Sci.</italic></source> <volume>51</volume> <fpage>21</fpage>&#x2013;<lpage>30</lpage>. <pub-id pub-id-type="doi">10.1016/j.jes.2016.05.042</pub-id> <pub-id pub-id-type="pmid">28115132</pub-id></citation></ref>
<ref id="B18"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Lu</surname> <given-names>J.</given-names></name> <name><surname>Struewing</surname> <given-names>I.</given-names></name> <name><surname>Vereen</surname> <given-names>E.</given-names></name> <name><surname>Kirby</surname> <given-names>A. E.</given-names></name> <name><surname>Levy</surname> <given-names>K.</given-names></name> <name><surname>Moe</surname> <given-names>C.</given-names></name><etal/></person-group> (<year>2016</year>). <article-title>Molecular detection of <italic>Legionella</italic> spp. and their associations with <italic>Mycobacterium</italic> spp., <italic>Pseudomonas aeruginosa</italic> and amoeba hosts in a drinking water distribution system.</article-title> <source><italic>J. Appl. Microbiol.</italic></source> <volume>120</volume> <fpage>509</fpage>&#x2013;<lpage>521</lpage>.</citation></ref>
<ref id="B19"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Luo</surname> <given-names>R. G.</given-names></name> <name><surname>Miao</surname> <given-names>X. Y.</given-names></name> <name><surname>Luo</surname> <given-names>L. L.</given-names></name> <name><surname>Mao</surname> <given-names>B.</given-names></name> <name><surname>Yu</surname> <given-names>F. Y.</given-names></name> <name><surname>Xu</surname> <given-names>J. F.</given-names></name></person-group> (<year>2019</year>). <article-title>Presence of pldA and exoU in mucoid <italic>Pseudomonas aeruginosa</italic> is associated with high risk of exacerbations in non-cystic fibrosis bronchiectasis patients.</article-title> <source><italic>Clin. Microbiol. Infect.</italic></source> <volume>25</volume> <fpage>601</fpage>&#x2013;<lpage>606</lpage>. <pub-id pub-id-type="doi">10.1016/j.cmi.2018.07.008</pub-id> <pub-id pub-id-type="pmid">30036669</pub-id></citation></ref>
<ref id="B20"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Mah</surname> <given-names>T.-F.</given-names></name> <name><surname>Pitts</surname> <given-names>B.</given-names></name> <name><surname>Pellock</surname> <given-names>B.</given-names></name> <name><surname>Walker</surname> <given-names>G. C.</given-names></name> <name><surname>Stewart</surname> <given-names>P. S.</given-names></name> <name><surname>O&#x2019;toole</surname> <given-names>G. A.</given-names></name></person-group> (<year>2003</year>). <article-title>A genetic basis for <italic>Pseudomonas aeruginosa</italic> biofilm antibiotic resistance.</article-title> <source><italic>Nature</italic></source> <volume>426</volume> <fpage>306</fpage>&#x2013;<lpage>310</lpage>. <pub-id pub-id-type="doi">10.1038/nature02122</pub-id> <pub-id pub-id-type="pmid">14628055</pub-id></citation></ref>
<ref id="B21"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Mavrodi</surname> <given-names>D.</given-names></name> <name><surname>Bonsall</surname> <given-names>R.</given-names></name> <name><surname>Delaney</surname> <given-names>S.</given-names></name> <name><surname>Soule</surname> <given-names>M.</given-names></name> <name><surname>Phillips</surname> <given-names>G.</given-names></name> <name><surname>Thomashow</surname> <given-names>L.</given-names></name></person-group> (<year>2001</year>). <article-title>Functional analysis of genes for biosynthesis of pyocyanin and phenazine-1 carboxamide from <italic>Pseudomonas aeruginosa</italic> PAO1.</article-title> <source><italic>J. Bacteriol.</italic></source> <volume>183</volume> <fpage>6454</fpage>&#x2013;<lpage>6465</lpage>. <pub-id pub-id-type="doi">10.1128/jb.183.21.6454-6465.2001</pub-id> <pub-id pub-id-type="pmid">11591691</pub-id></citation></ref>
<ref id="B22"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Mena</surname> <given-names>K. D.</given-names></name> <name><surname>Gerba</surname> <given-names>C. P.</given-names></name></person-group> (<year>2009</year>). &#x201C;<article-title>Risk assessment of <italic>Pseudomonas aeruginosa</italic> in water</article-title>,&#x201D; in <source><italic>Reviews of Environmental Contamination and Toxicology</italic></source>, <volume>Vol. 201</volume> <role>ed.</role> <person-group person-group-type="editor"><name><surname>Whitacre</surname> <given-names>D. M.</given-names></name></person-group> (<publisher-loc>Boston, MA</publisher-loc>: <publisher-name>Springer</publisher-name>), <fpage>71</fpage>&#x2013;<lpage>115</lpage>. <pub-id pub-id-type="doi">10.1007/978-1-4419-0032-6_3</pub-id></citation></ref>
<ref id="B23"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Munita</surname> <given-names>J. M.</given-names></name> <name><surname>Aitken</surname> <given-names>S. L.</given-names></name> <name><surname>Miller</surname> <given-names>W. R.</given-names></name> <name><surname>Perez</surname> <given-names>F.</given-names></name> <name><surname>Rosa</surname> <given-names>R.</given-names></name> <name><surname>Shimose</surname> <given-names>L. A.</given-names></name><etal/></person-group> (<year>2017</year>). <article-title>Multicenter evaluation of Ceftolozane/Tazobactam for serious infections caused by carbapenem-resistant <italic>Pseudomonas aeruginosa</italic>.</article-title> <source><italic>Clin. Infect. Dis.</italic></source> <volume>65</volume> <fpage>158</fpage>&#x2013;<lpage>161</lpage>. <pub-id pub-id-type="doi">10.1093/cid/cix014</pub-id> <pub-id pub-id-type="pmid">28329350</pub-id></citation></ref>
<ref id="B24"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Parsons</surname> <given-names>J. F.</given-names></name> <name><surname>Greenhagen</surname> <given-names>B. T.</given-names></name> <name><surname>Shi</surname> <given-names>K.</given-names></name> <name><surname>Calabrese</surname> <given-names>K.</given-names></name> <name><surname>Robinson</surname> <given-names>H.</given-names></name> <name><surname>Ladner</surname> <given-names>J. E.</given-names></name></person-group> (<year>2007</year>). <article-title>Structural and functional analysis of the pyocyanin biosynthetic protein PhzM from <italic>Pseudomonas aeruginosa</italic>.</article-title> <source><italic>Biochemistry</italic></source> <volume>46</volume> <fpage>1821</fpage>&#x2013;<lpage>1828</lpage>. <pub-id pub-id-type="doi">10.1021/bi6024403</pub-id> <pub-id pub-id-type="pmid">17253782</pub-id></citation></ref>
<ref id="B25"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Shaver</surname> <given-names>C. M.</given-names></name> <name><surname>Hauser</surname> <given-names>A. R.</given-names></name></person-group> (<year>2004</year>). <article-title>Relative contributions of <italic>Pseudomonas aeruginosa</italic> ExoU, ExoS, and ExoT to virulence in the lung.</article-title> <source><italic>Infect. Immun.</italic></source> <volume>72</volume> <fpage>6969</fpage>&#x2013;<lpage>6977</lpage>. <pub-id pub-id-type="doi">10.1128/iai.72.12.6969-6977.2004</pub-id> <pub-id pub-id-type="pmid">15557619</pub-id></citation></ref>
<ref id="B26"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Shi</surname> <given-names>H.</given-names></name> <name><surname>Trinh</surname> <given-names>Q.</given-names></name> <name><surname>Xu</surname> <given-names>W.</given-names></name> <name><surname>Zhai</surname> <given-names>B.</given-names></name> <name><surname>Luo</surname> <given-names>Y.</given-names></name> <name><surname>Huang</surname> <given-names>K.</given-names></name></person-group> (<year>2012</year>). <article-title>A universal primer multiplex PCR method for typing of toxinogenic <italic>Pseudomonas aeruginosa</italic>.</article-title> <source><italic>Appl. Microbiol. Biotechnol.</italic></source> <volume>95</volume> <fpage>1579</fpage>&#x2013;<lpage>1587</lpage>. <pub-id pub-id-type="doi">10.1007/s00253-012-4277-8</pub-id> <pub-id pub-id-type="pmid">22923133</pub-id></citation></ref>
<ref id="B27"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Silva</surname> <given-names>M. E. Z. D.</given-names></name> <name><surname>Filho</surname> <given-names>I. C.</given-names></name> <name><surname>Endo</surname> <given-names>E. H.</given-names></name> <name><surname>Nakamura</surname> <given-names>C. V.</given-names></name> <name><surname>Ueda-Nakamura</surname> <given-names>T.</given-names></name> <name><surname>Filho</surname> <given-names>B. P. D.</given-names></name></person-group> (<year>2008</year>). <article-title>Characterisation of potential virulence markers in <italic>Pseudomonas aeruginosa</italic> isolated from drinking water.</article-title> <source><italic>Antonie Leeuwenhoek</italic></source> <volume>93</volume> <fpage>323</fpage>&#x2013;<lpage>334</lpage>. <pub-id pub-id-type="doi">10.1007/s10482-007-9209-8</pub-id> <pub-id pub-id-type="pmid">18038252</pub-id></citation></ref>
<ref id="B28"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Slekovec</surname> <given-names>C.</given-names></name> <name><surname>Robert</surname> <given-names>J.</given-names></name> <name><surname>Van Der Mee-Marquet</surname> <given-names>N.</given-names></name> <name><surname>Berthelot</surname> <given-names>P.</given-names></name> <name><surname>Rogues</surname> <given-names>A.-M.</given-names></name> <name><surname>Derouin</surname> <given-names>V.</given-names></name><etal/></person-group> (<year>2019</year>). <article-title>Molecular epidemiology of <italic>Pseudomonas aeruginosa</italic> isolated from infected ICU patients: a French multicenter 2012-2013 study.</article-title> <source><italic>Eur. J. Clin. Microbiol. Infect. Dis.</italic></source> <volume>38</volume> <fpage>921</fpage>&#x2013;<lpage>926</lpage>. <pub-id pub-id-type="doi">10.1007/s10096-019-03519-w</pub-id> <pub-id pub-id-type="pmid">30826996</pub-id></citation></ref>
<ref id="B29"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Stoler</surname> <given-names>J.</given-names></name> <name><surname>Ahmed</surname> <given-names>H.</given-names></name> <name><surname>Asantewa Frimpong</surname> <given-names>L.</given-names></name> <name><surname>Bello</surname> <given-names>M.</given-names></name></person-group> (<year>2015</year>). <article-title>Presence of <italic>Pseudomonas aeruginosa</italic> in coliform-free sachet drinking water in Ghana.</article-title> <source><italic>Food Control</italic></source> <volume>55</volume> <fpage>242</fpage>&#x2013;<lpage>247</lpage>. <pub-id pub-id-type="doi">10.1016/j.foodcont.2015.02.038</pub-id></citation></ref>
<ref id="B30"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Strateva</surname> <given-names>T.</given-names></name> <name><surname>Markova</surname> <given-names>B.</given-names></name> <name><surname>Ivanova</surname> <given-names>D.</given-names></name> <name><surname>Mitov</surname> <given-names>I.</given-names></name></person-group> (<year>2010</year>). <article-title>Distribution of the type III effector proteins-encoding genes among nosocomial <italic>Pseudomonas aeruginosa</italic> isolates from Bulgaria.</article-title> <source><italic>Ann. Microbiol.</italic></source> <volume>60</volume> <fpage>503</fpage>&#x2013;<lpage>509</lpage>. <pub-id pub-id-type="doi">10.1007/s13213-010-0079-3</pub-id></citation></ref>
<ref id="B31"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Vaz-Moreira</surname> <given-names>I.</given-names></name> <name><surname>Nunes</surname> <given-names>O. C.</given-names></name> <name><surname>Manaia</surname> <given-names>C. M.</given-names></name></person-group> (<year>2012</year>). <article-title>Diversity and antibiotic resistance in <italic>Pseudomonas</italic> spp. from drinking water.</article-title> <source><italic>Sci. Total Environ.</italic></source> <volume>426</volume> <fpage>366</fpage>&#x2013;<lpage>374</lpage>. <pub-id pub-id-type="doi">10.1016/j.scitotenv.2012.03.046</pub-id> <pub-id pub-id-type="pmid">22521167</pub-id></citation></ref>
<ref id="B32"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname> <given-names>F.</given-names></name> <name><surname>Li</surname> <given-names>W.</given-names></name> <name><surname>Li</surname> <given-names>Y.</given-names></name> <name><surname>Zhang</surname> <given-names>J.</given-names></name> <name><surname>Chen</surname> <given-names>J.</given-names></name> <name><surname>Zhang</surname> <given-names>W.</given-names></name><etal/></person-group> (<year>2018</year>). <article-title>Molecular analysis of bacterial community in the tap water with different water ages of a drinking water distribution system.</article-title> <source><italic>Front. Environ. Sci. Eng.</italic></source> <volume>12</volume>:<issue>6</issue>. <pub-id pub-id-type="doi">10.1007/s11783-018-1020-4</pub-id></citation></ref>
<ref id="B33"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Wedekind</surname> <given-names>J. E.</given-names></name> <name><surname>Trame</surname> <given-names>C. B.</given-names></name> <name><surname>Dorywalska</surname> <given-names>M.</given-names></name> <name><surname>Koehl</surname> <given-names>P.</given-names></name> <name><surname>Raschke</surname> <given-names>T. M.</given-names></name> <name><surname>Mckee</surname> <given-names>M.</given-names></name><etal/></person-group> (<year>2001</year>). <article-title>Refined crystallographic structure of <italic>Pseudomonas aeruginosa</italic> exotoxin A and its implications for the molecular mechanism of toxicity.</article-title> <source><italic>J. Mol. Biol.</italic></source> <volume>314</volume> <fpage>823</fpage>&#x2013;<lpage>837</lpage>. <pub-id pub-id-type="doi">10.1006/jmbi.2001.5195</pub-id> <pub-id pub-id-type="pmid">11734000</pub-id></citation></ref>
<ref id="B34"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Wei</surname> <given-names>L.</given-names></name> <name><surname>Wu</surname> <given-names>Q.</given-names></name> <name><surname>Zhang</surname> <given-names>J.</given-names></name> <name><surname>Guo</surname> <given-names>W.</given-names></name> <name><surname>Chen</surname> <given-names>M.</given-names></name> <name><surname>Xue</surname> <given-names>L.</given-names></name><etal/></person-group> (<year>2017</year>). <article-title>Prevalence and genetic diversity of <italic>Enterococcus faecalis</italic> isolates from mineral water and spring water in China.</article-title> <source><italic>Front. Microbiol.</italic></source> <volume>8</volume>:<issue>1109</issue>. <pub-id pub-id-type="doi">10.3389/fmicb.2017.01109</pub-id> <pub-id pub-id-type="pmid">28670302</pub-id></citation></ref>
<ref id="B35"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Wolfgang</surname> <given-names>M.</given-names></name> <name><surname>Kulasekara</surname> <given-names>B.</given-names></name> <name><surname>Liang</surname> <given-names>X.</given-names></name> <name><surname>Boyd</surname> <given-names>D.</given-names></name> <name><surname>Wu</surname> <given-names>K.</given-names></name> <name><surname>Yang</surname> <given-names>Q.</given-names></name><etal/></person-group> (<year>2003</year>). <article-title>Conservation of genome content and virulence determinants among clinical and environmental isolates of <italic>Pseudomonas aeruginosa</italic>.</article-title> <source><italic>Proc. Natl. Acad. Sci. U.S.A.</italic></source> <volume>100</volume> <fpage>8484</fpage>&#x2013;<lpage>8489</lpage>. <pub-id pub-id-type="doi">10.1073/pnas.0832438100</pub-id> <pub-id pub-id-type="pmid">12815109</pub-id></citation></ref>
<ref id="B36"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Wu</surname> <given-names>Q.</given-names></name> <name><surname>Ye</surname> <given-names>Y.</given-names></name> <name><surname>Li</surname> <given-names>F.</given-names></name> <name><surname>Zhang</surname> <given-names>J.</given-names></name> <name><surname>Guo</surname> <given-names>W.</given-names></name></person-group> (<year>2016</year>). <article-title>Prevalence and genetic characterization of <italic>Pseudomonas aeruginosa</italic> in drinking water in Guangdong province of China.</article-title> <source><italic>LWT Food Sci. Technol.</italic></source> <volume>69</volume> <fpage>24</fpage>&#x2013;<lpage>31</lpage>. <pub-id pub-id-type="doi">10.1016/j.lwt.2016.01.014</pub-id></citation></ref>
</ref-list>
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<label>2</label>
<p><ext-link ext-link-type="uri" xlink:href="http://www.pubmlst.org/paeruginosa">www.pubmlst.org/paeruginosa</ext-link></p></fn>
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